Denied!!

OK my hopes were up and then today I find out I am denied by my insurance (Sagamore-American Community) they said it wasn't medically necessary. What is that supposed to mean? I have type II Diabetes (taking 1 oral and 2 injectable medications), and High Blood Pressure (taking 2 medications). They said they would send me a letter explaining why....... After the rollercoaser ride the past 2 months I though for sure I wouldn't have any problem getting approved. I sent in all kinds of documentation..... I'm trying to be strong and positive that maybe it is just something simple that didn't get sent in with everything. But I'm getting my appeal letter ready tonight. Any suggestions on where I could start? Regina

Hi Regina - Sorry to hear this. Some insurance companies routinely deny on the first go around. Don't be discouraged. Wait for their letter of explanation. Go to your surgeon and do an appeal, but address the factors on which they are denying you. I looked at your profile and based on your BMI and the fact that you have diabetes, most insurance companies wouldn't have denied you. Good luck! Dianne

Regina, I know this isn't any comfort belive me I have been there, I fought my insurance over 18 months, call them and find out just what made them come to the concluson(sp) on not medically necessary, most of the time it is one or two things, they will tell you what they are wanting, like a monitored diet with deitan and doctor, proof of activity, more medical records, ect, find out just what they are baseing it on. Don't give up I can't tell you how many times I cried and wanted to just say, then it wasn't to be and then I would get pissed again and start to fight and want to know what I need to do..... When everyone told me this "Don't give up and appeal " I would get so mad........ But that is what I am telling you. If your insurance company has the wls written in there policy, I would not give up. Lisa B

I am so sorry. That is my biggest fear right now. I would get on that appeal as soon as possible. Hopefully your dr will be very helpful getting that going for you. Mariah

Good girl, go gettem. lisa b

Thanks for the encouragement! I'm starting my letter right now. I'm going to fight them until they approve. Weight loss is covered in cases of morbid obesity, is what my policy states. Bring it on!!! This is a good time to practice what we talked about in the pysche eval. I will not eat things that are bad for me, I will not eat things that are bad for me................ Regina

You go girl, Dont eat crap, just give'em hell Mariah

Regina~ I cant lend any advice on the appeal process, but don't give up! I think some of these insurance companies deny us hoping we'll give up and drop it. Stay positive and keep your chin up!! Jaimee

Thanks Jaimee, I'm going to keep fighting them. And keeping my chin up!! Regina

DO NOT GIVE UP!!! I have Sagamore, but not American Community. I was approved after the first letter, I do not have any problems. What I'm saying is I am morbidly obese & that is all. I do not take any medications for any problems. Appeal & call them every week. I'm praying for you. If you have any questions please call me. Check out my profile - - I was denied 2 times by my first insurance & then I went to Sagamore & was approved. I started this process last June & my surgery date is August 1st. I thought this was an overnight thing, but now I know that it takes time. Kristi