Please I need help with my Insurance

Here is my problem, I was turned down for the following reasons: No documentation of: obesity status for 5 years, diabetes status for last 5 years, blood pressure readings for the last 5 years etc, my problem is that I have only been seeing my PCP for about 1.5 years and really didnt have a PCP before that I seen my OBGYN and a back doctor beforeb but I have been pretty healthy untill about 1.5 years ago that is why I found the PCP then and have been seeing her sence. My BMI is 44 I am border line diabetes, my mother died at a young age of diabetes. I am having shortness of breath and joint pain, I have a bulgging disk in my lower back I have been taking throyde meds for 10 years and prozac for 15 years and I also take High calostrol med for about 1 year. My Insurance is MedBen / Sagamore This was turned down by a review organization for MedBen named Nationwide Management Systems, Inc. Please Help e-mail [email protected] Call 765-342-9480 Fax 765-349-4189 Thanks a Million Sheila

Sheila, Just a thought...if you work outside of the home, does your employer keep physical records? I included their records of my weight, etc with my package. Sherri

Who has been giving you your thyroid meds??? I have to get mine from a Dr who runs blood tests on me every 6 weeks if needs adjusting and every 3 months if I am leveling out... Your GYN should have weight chars on you and back Dr should have weight chart and some documentation how your weight affects your back problems... do some more checking.. We all thought we were pretty healthy... HA!! That high of BMI was killing us!!! Linda

One thing I will offer is get a letter from every Dr you have seen, especially your back Dr. Get him to state that your pain is increased due to your weight. Then get your PCP to send the insurance a copy of your medical records. Then just keep appealing until they get tired of hearing from you. Your life is worth all the time you have to spend appealing their decissions. I was first turned down 2 years ago and got mad at the insurance company and did not appeal. All I did was to get worse and bigger. I finally ended up in a wheel chair and decided enough is enough. I started the process over again and they denied me again, do I ended up appealing their decissions twice and finally the gave the go ahead. Had my surgery Nov 2005. So I am speaking from experience. Insurance company tries to come up with a reason not to approve and you have to give them every possible reason in the world as to why you should be approved. It is a game they like to play so play hard ball with them. Good luck in your endevors. It is worth it. Dan

thank you very much I am in the process of talking to all of the doctors. I will appeal untill I get approved! Thank you for your help. Sheila