DENIED

DENIED DUE TO THE FACT THAT THE PROPER PAPERWORK WASN'T SENT INTO THE INSURANCE COMPANY. WHY THE HELL ARE WE REQUIRED TO JUMP THROUGH SO MANY HOOPS AND DO SO MANY TESTS IF THE DR'S OFFICES THAT SEND IN THE REQUESTS FOR SURGERY DO NOT PROPERLY SEND IT IN CORRECTLY? I HAVE BEEN WAITING FOR OVER A MONTH NOW TO GET APPROVAL OR DENIAL, AND NOW I JUST RECEIEVED IT IN THE MAIL, ONLY TO HAVE TO GO THROUGH THIS ALL OVER AGAIN... THERE IS NO DOCUMENTATION OF THE FOLLOWING: HISTORY AND PHYSCIAL PREFORMED BY THE BARIATRIC SURGEON (INCLUDING HEIGHT AND WEIGHT) CONDITION OF MORBID OBESITY FOR AT LEAST THREE YEARS PARTICIPATION IN A MEDICALLY SUPERVISED WEIGHT LOSS PROGRAM WITH AT LEAST ONE ATTEMPT IN THE PAST YEAR AND PARTICIPATION IN THE PROGRAM FOR AT LEAST 6 MONTHS. I JUST WENT THROUGH THIS, I AM SO UPSET... GUESSING I AM GOING TO HAVE TO START ALL OVER AND IF I DO, I AM GOING TO USE A DIFFERENT SURGEON! THIS IS BEGINNING TO BE A BUNCH OF CRUD! DISAPPOINTED IN LA, LORI

Hi Lori, I am so sorry to hear this, But you have the right attitude. Fight for what you want and I too would change surgeons. That makes no darn sense. It is their job to make sure the paper work is in order and filed the right way. Keep holding your head high and fight for what you want!!! I'll keep you in my thoughts and prayers, Dee

OK SO I JUMPED THE GUN.... ONCE AGAIN IT IS THE DANG QUACK OF A PCP THAT I FIRED LAST WED THAT CAUSED THIS. I WAS REASSURED BY DANIELLE AT SURGEONS OFFICE THAT THE PROPER PAPERWORK WAS SENT IN. BUT IT APPEARS THAT I AM NOT THE ONLY ONE WHO WAS DENIED THROUGH THE SAME INSURANCE COMPANY AND FOR THE SAME EXACT REASONS, SO SHE IS SUBMITTING AN APPEAL LETTER ON MY BEHALF, TO GET THIS REVERSED. SO I AM HOPING ONCE AGAIN THAT WE CAN GET THIS BALL ROLLING, BUT AM STILL GOING TO GO AHEAD AND GET A NEW PCP GOING TO GET THIS SHOW ON THE ROAD! GOD BLESS LORI

hi lori, sounds like the surgeon's office failed to send the right documention. H&P from baratric surgeon, the surgeons office should be the one to know all the above. I hope everything goes your way. I'm waiting with the same surgeon's office also. I was in the process of getting approved before the hurricane, since then havn't been able to reach the surgeon's office due to phone lines. I'm going in person today. Keep on , don't give up.... you'll get there. I'm striving to have the surgery also. what a long journey!!!!!!!but we can do it!!!!!

WAY TO GO GIRL!!! FIGHT FOR WHAT YOU WANT AND DON'T GIVE UP. THIS IS YOUR DREAM AND A DREAM YOU WILL SUCCEED IN. KNOW WE ARE ALL HERE FOR YOU AND WE'LL BACK YOU UP WITH PRAYER!!! KEEP US INFORMED DEE

Don't give up on your dreams!!! That's the first rule of a WLS seeker. Second, if you've already done all the missing documentation maybe it's just a matter of getting hold of the paperwork and resubmitting??? It should only be a matter of your surgeon's office faxing over the missing information. Then you should be approved. Peggy B.

Lori,girl don't you even think about giving up.Get in there with you gloves on and duke it out with them.Tie a knot in the end of the rope and hang on,dig in your heels.Grit your teeth,back your ears,,,uuuhhhmmm let's see what else can I say.Girl I'm praying and believing for your approval.(((((HUGS)))))

Lori, Sorry the insurance company is being that way. I hope the letter will get it through for you. I will keep my fingers crossed. Tina

Hey Lori, I am sorry for your troubles. I would not be so sure it was not the insurance company that misplaced the documentation. I filed insurance for several dentists and for a local hospital. I know the games they play. They somehow lose everything. I have even faxed copies of documentation and had someone stand by to recieve it. The correct paperwork was recieved but somehow got lost. I hated having to always resend work, (made a lot more work for me) so I always sent the correct stuff in the first place. So many times I would fight fight fight, until I threatened to go to the insurance commisioner. Somehow they got their act together and found the documentation. Good luck with your appeal. JC

Lori I am so so sorry. It will be ok though, I feel it somehow it will come together just the way it is suppose to in your corner. If you need to talk anytime let me know neighbor. I just got back from a cruise to Alaska and so I am home awaiting my dream also now. take care Denise