Request Denied

I have been gone all weekend, which BTW I had a great time at the Grand Canyon.  As I would get winded walking some of the long walks or steps, all I could think about was how when I do this again, I hope it will be after my lab-band and I will be able to walk the trails for that would be ejoyable.  I guess I don't need to tell ya'll what was in my mailbox when I got home.  My request to my ins has been denied.  It says I can appeal, I just need to find out how to do that and based on what.  Based on the letter, it says I dont meet the criteria.  My Dr says I do, I don't know how I don't.  I hope this is something I can discuss with my Dr and us together, we can figure it out. I don't know what to say or do from here, to be honest.  I want to cry, no I want to scream!!!  I am so sad but yet I am not crying.  I have this huge lump from within. 

I guess I will call my Dr's office and see what they say. People get denied.... I know this happens.  I will shove on from here......

Whatever you decide to do appeal, appeal, appeal to the end.  If you have to hire a lawyer do it.  I used Walter Lindstrom and they got me approved.  First talk it over with your Dr. have him write an appeal letter and then get the rest of your ducks together before you submit again.

Keep your chin up and hang in there.

Don't fret.  They ALWAYS say that with a denial!  You can win this.  A lot of times insurance companies just deny the first time because they know they can save money because many people will just let the denial be.  Email me your email address and I will send you my appeal letters.  I have more than one.  You can tweak them to fit your needs.  I won my appeal and with one of the hardest insurance companies to boot!  

Seriously, don't worry about this.  You can definitely win this if you get your ducks in a row and be proactive. Don't just let your dr's office handle everything. 

I don't know how to use email here, so I hope it's ok that I put my email address in here.  Sorry in advance if this is against policy.  [email protected]

Thank you for offering to send me your copies of your appeal letters.  I had no idea what to even think about saying.

BTW, I have Tricare, your ins harde than them?

Make sure you  know what their criteria is and what they have based the denial on ...  An appeal may be a lot easier than you think ..

Hi there, you are NOT alone!  I am right along with you in this ship of DENIAL!  I got denied my first time around for my revision also. (and...I got denied three times for my panniculectomy as well!) .......but, WE CANNOT GIVE up!!  We need to follow the advise of our friends HERE and fight and APPEAL!

I have learned to (try) and be DETERMINED from Deanne who JUST had her surgery  today and is doing Great!!  She was denied once too!  So see, it is POSSIBLE!  We just have to 'get our ducks in a row'......all the letters from docs and medical files.....and someone offered you her letters to use as samples...which is totally cool!! 

Don't be discouraged, I KNOW how devastating it is to get those denial letters in the mail (me, FOUR!).....and they DID make me cry, every one of them, but then I'm a big cry baby!! 

My insurance is Great West.  ...I've said it before, and I'll say it again......ain't NUTHIN' 'great' about it, so far!!

Good luck!!  Good luck for both of us!! (ninja power!!)

Gwynn

If you need and want help appealing this just send me a PM and we can get a game plan together to appeal the denial

Hello,

I haven't posted in a long while and yes, my picture needs to be updated but I decided I needed to post as my insurance company was Tricare also.  When I was doing my research I found that Tricare does not approve lapband, only RNY (unless they have changed in the last couple of years and I doubt it).  Also, I believe you have to have at least 2 co-morbidities, which in my case, I had about 5 so they approved me right away.  Take a look at Tricare's website to see what their criteria is.  I did my search on gastric bypass and found the information I needed.  Good luck to you.

Virginia