back from vacation and update on denial!

Hi everyone!!!!  I am back from Disney and we had a great time!!!  Maddie had the time of her life!!   Well, the approval process is not going to well for me!  Maggie called the insurance last week to tell them that I have met all the requirements and to have them review my case.  I AM being DENIED because my 5 year medical history did not show morbid obesity all 5 years!  Then for the 6 month supervised diet, I gained 3 pounds.  Even if I lost 4 lbs one month and 1 the next, when it was all said and done , I gained 3 pounds.  Sooooo thats why they are denieing me!!  Maggie said that I could turn my case over to an atterney and he gets 90% of the patients approved.  I feel like a total failure!!!  I want and need this soo bad! Maggie also said something about maybe having to do the 6 month supervised diet over again.  Screw that!!  I don't know what I should do???  I guess I could always just pay for it out of pocket.  I would have to finance it, because I don't have $14,000 just laying around!  As I was typing this, Maggie called to talk and she said that my BMI was not over 40 during the 5 years and over 35 w/ 2 corbids.  So with that said, it looks like I could either start the diet over and loose weight, or just pay?????  I am soooo upset!!!  Oh, and today is my birthday..not how I wanted my birthday to end!!

Big Hugs to you Kim........  I'm really sorry to hear about the news that was thrown your way.  Don't give up the fight.

Try to have a decent birthday, I know it's going to be hard considering the blow you just took.  I can't wait to hear about your trip and maybe see some pictures on Sunday.  You are not a failure...  Get that skinkin thinkin out of your head!

Christina

Kim, was that in their criteria that you could not gain any weight and is it in writing? I would discuss this with your DH as to consulting an attorney or if it is feasable to finance the procedure. I am at a loss as to giving some type of verbal comfort to you. I am not versed in any of this. I will put my thinking cap on for you. One thing - have you posted this on the insurance board asking what others have gone though in your situation? Christine

First off Kim Happy Birthday!!! I'm so sorry that you were denied.  I'm sure that something will fall into place one way or another for you!  I will keep you in my thoughts!! hugs

Thanks Monica!  You are sooo sweet!  Remember I faith in you and this time next month, you will be posting that you got approved!!!  Hang in there and work it girl!!!

Thanks Kim, it won't be next month though I am only going through month 2 of my 6 month diet.  oh well.  Sometime after the new year hopefully!

I do remember how trying dealing with insurance was. Now to be clear.  You weren't denied cause you gained 3 pounds.  You were denied cause you don't have a 5 year record of morbid obesity.  That's the clincher here. How much more time do you need to get that 5 years of info.  That's what they are looking for. Heck if you could lose weight on the supervised diet you wouldn't need the WLS would you? Anyway, find out how much more you need on the history.  That's the key!  Then make them re-submit your paperwork. In the meantime, keep going with the supervised diet. It just shows more time that you are obese and will help once you do have the surgery (getting used to eating healthier) Hang in there.  It will happen for you too.

Happy belated birthday Kim......I am sooo sorry to hear of that denial!    This such an emotional ride, people have no idea!     Just don't get discouraged.....got to get another game plan going!   This is what you want and some way you will get it!    I'm always available for you if you want to talk!   I will make the time.....just say when!      Hugs     Pam

Hi Ronna,   Thanks for the suggestions!  Before this year I was never morbid obese.  I gave them all five years of medical history like they said.....the lowest I droped was 169...hubby and I were having problems and that weight did not last very long!  I think I will start w/ the supervised diet again!  My doctor will get sick of seeing me!  Thanks for all your info and support!

Well...I had a talk w/ DH last night and he seems to think I can lose all the weight on my own.  I am soooo frustrated!  He also said that paying out of pocket is not an option!  I have all five years of medical history, but I am not morbidly obese ALL five years.  I was obese all five, but not morbidly obese.  What I am going to do is look on my insurance website and get the criteria for wls....I swear they said to just do a 6 month supervised diet and did not say anything about having to lose a certain amount.  Any suggestions would be appreciated.  Does anyone know how much monthly you would have to pay if you finance it.  The lapband is $16,000.  I don't know if financing through the medical surgery program is the best bet.  Maggie said that if I was a self pay, I could have surgery within 30 days.  What should I do??????