I WAS DENIED!!!!

MY SURGERY WAS FOR 11/30....I WAS TOLD EVERYTHING WAS OK AND IT WAS/ WOULD BE APPROVED...DONT WORRY I WAS TOLD...WELL I WAS DENIED ...NOW I HAVE TO WAIT FOR THE APPEAL TO GO THRU...I STARTED MY 2WK DIET AND EVERYTHING....I'AM SO UPSET...MY FAMILY IS TELLING ME NOT TO WORRY..GOD WORKS IN MYSTEROUS WAYS...ITS JUST NOT UR TIME YET...I GUESS THEY THOUGHT THAT WOULD MAKE ME FEEL BETTER...WELL GUESS WHAT..IT DIDNT...BUT ANYWAY..I'M JUST LOOKING FORWARD TO GETTING A APPROVAL..THAT'S IT...I'LL KEEP EVERYONE UPDATD ON MY PROFILE...PEACE YA'LL...

Oh my gosh Dawn! I am SOOOOOOOO sorry!!!!!!! This happend to me too!!!!! I know how it feels!!!! The coordinator called me like, 2 days before surgery and said, "Now the insurance is saying they dont know if their going to approve you." EVEN though they ALREADY approved me, AND gave me the confirmation number!!!!!! I WAS PIIIIIIIIIISSED!!! But then they fought for me and the next day she called me back and said that now they approve it "again". So my advice, keep your head up!!!! You STILL have time to be approved!!!!!!!! Ill be praying for you!!!!!! ~Amy post-op DS 11-5-04

THANKS AMY.... I REALLY HOPE YOUR RIGHT.......I'AM REALLY PISSED..THANKS FOR KEEPING ME IN YOUR THOUGHTS.....DAWN

{{{{{{{{{{{{{Dawn}}}}}}}}}}} I can only imagine what you must be going through. What is the reason why they denied you. I would definately appeal it!!! Janet

I WAS TOLD THAT MY PCP DIDNT WRITE ENOUGH DETAILED DR'S NOTES....THEY REALLY WANT DETAILED NOTES....IT WOULDNT BE A PROBLEM FOR ME TO REQUEST FOR MY DR TO RE-WRITE THE NOTES...THE THING IS SHE IS ON VACATION UNTIL DECEMBER 6TH....IN THE MEANTIME THE SURGEONS OFFICE SAID THAT THEY WILL APPEAL IT FOR ME....SO I WILL WAIT TO SEE WHAT HAPPENS WITH THAT...I'M CROSSING MY FINGERS....KEEP ME IN YOUR THOUGHTS AND PRAYERS....THANKS JANET.....DAWN

Dawn- Keep us updated on the appeal process!!!!!! Janet

There has to be a reason you were denied! I was denied too... they did not have documentation that I was on a 12 week Dr. assisted diet. So I appealed it and did the diet and I was approved 1 week later! You just have to stay with them and let them know that you mean business! Lots of times the Insurance companies play games to see if you are really serious about the surgery! It's crazy what they will do! Stay determined to have this done and keep appealing until they approve you! I am scheduled for 11/29! Determination works! You just have to stay on top of things! Jennifer Wright

Dawn, I hope you have better luck then I did with the appeal. I was denied my appeal. It seems that my insurance company requires that you are on a diet by a physician for one year. It doesn't matter that I went to WW and did other diets all of my life. The bottom line is that the insurance company makes this rule because they don't want to pay. I have been through all of the pre admission testing for the lap-band procedure and all set to go. I have tried several times to contact the attorney from the obesity lawyer website, but he never returns my calls or emails. Best of luck to you!!!!

Dawn, I was also put through similar crap by Aetna US HealthCare HMO Standard Policy. I have six drs that have been treating me for several co-morbidities for approx 10yrs all under this same insurance yet when my PC sent my original papers his notes were also inadequate. He immediately appealed on my behalf but did not use their procedure. Aetna allowed me only 2 appeals on my denial - and my properly done appeal was also denied. My options were to go legal or jump through their hoops all over again. I couldn't afford the lawyer so I jumped hoops. You can't give up. Even after hooping for 7months I was denied again on this new application. I was livid. This is what worked for me and maybe it will help you too. I went personally to every one of my Drs and secured letters from each one stating the benefit this surgery would have for that co-morbidity. I did this even though my PC's notes this time were very thorough and listed these co-morbidities. Let me tell you - the support available to you from your Drs. is stronger than the HMO. I never once threatened legal action but the tone of many of the letters suggested the worst possible developments I would have to endure if the surgery wasn't approved. I think this was as effective. Two days after faxing these to the company I called to confirm their receipt. They denied any receipt so I immediately sent them again. This time I called right back to prevent anymore games. They got them and two hours later I WAS APPROVED!!!! Don't give up. They want you to be discouraged. I hate hearing when anyone suffers more than necessary when it isn't necessary to begin with. Be well and best of luck! Bruce PS - total time of my fighting was just over a year