ALL I DID WAS CRY! NOT IN A GOOD WAY...

I guess I don't have enough depression in my life. Blue Cross just DENIED my surgery!! I got the call on friday afternoon as I was driving home. I had to pull of f on the side of 70 and have a major melt down. Crap, I'm crying now as I write this.  If someone has any words of wisdom for an "Apeal" letter, please let me know. I even have a PPO. I truely don't think they even looked at my history or letters I sent. I think they made their decision on the sole fact that I didn't have 6 months of managed weight loss. I don't think the name "CareFirst"  means a thing! BMI 41, Severe Obstructive Sleep Apnea, Uncontrolled Blood Pressere averaging 180/118, Borderline Diabetic, Severe Depression, and an attempt to take my life.  I have spent the past 2 months taking every test required by my Suregon (Dr. Green), and paid him a fee of $500.00 upfront. I even enclosed a copy of the Maryland Mandate on Bariatric Surgery coverage with my packet. I don't think I can wait another 6 months. Please share any "Appeal" tips you have. Do you only get 1 appeal? Thanks to all for listening, Kristy

Kristy: I totally understand:   when someone says six months you think OMG:  that is so long. But it sounds like you already have 2 months covered so it really is only four more months. Yes that sucks  but they will pass quickly I swear.  My surgury is set for July 5 and I started this back in November. Take a deep breath calm down and pray.  God will take care of you.

Kristy first here are some BIG HUGS coming to you. Now, I assume you have had a psych consult and your PCP is 100% behind this. If so, I think you should get them to write a letter with the implication that another 6 months may create a situatuation that is life threatening from the uncontolled BP and suicide attempt that could potentially be repeated. This will wake them up incase they did not read your history all the way through. Take care and let us know how you do. Jo

Kristy, I am so sorry to hear that your insurance denied you.  One thing I would like to suggest is to contact the insurance and find out exactly why the denied the claim if a 6 month supervised weight loss visit was not required before why is it required now.  Somethimes it is something simple that was missed and it has to be sent in.  I know this has got to be so frustrating. But please do not let it keep you down. You fight until you get it over turned.   I have read of so many others here on OH that has gotten denied and they never gave up. I will keep you in ym thoughts and prayers. ((((((hugs)))))))

I had to do 6 months also.  It really went fast. Once they sent that it in to bc/bs. It took one week for approval. They needed something documented for 6 months straight and done in the last 2 years. Keep your chin up and be persistant. It will happen! Best wishes. Keep us updated.

Kristy, I am so sorry for this terrible turn of events after you did all your testing and paid the $500 fee. I, too, have BC/BS PPO and I was told by the staff that works for DVR that they required a 6 month supervised diet. They started me right away. I was so happy that his staff took care of all the insurance for me. I hope you can file an appeal especially if you were unaware of this 6 mos. diet. Take care...Gail

Kristy, I hear you honey.....  Been down that awful road.... I knew i had to do the 6 month too... My dr sent my packet after my visit at 5th visit (which was the 4th month) and i got my approval within a week...

Since you are going to Dr Greene..I'm going to assume you live in Mont Co.  I'm not far from you and come down to G-burg twice a week in the evenings...

If you need just an understanding shoulder to cry on...Let me know... Sometimes it helps to have someone who's been there. I can remember many a night and morning crying my way down 270. (i worked down there with an employer who had a complete exclusion).  I am just guessing you may already be on some type of anti-depressives but there is no shame in asking your PCP for them to get you through the next 6 months if that's what the plan has to be.  Remember, God does have a plan for you.... (of course he has a sense of humor too..although dark and twisted at times) Your surgery will come... just not maybe right now... Did you check with your insurance on their requirements prior to doing all that testing? If they never told you about the 6 months upfront then that would be a case to apeal now...  

 

 

Thank you for being so kind.... I did know, but they suggested I send in the paperwork I had along with a letter from my therapist.. I believe all they did was open the packet and when they didn't see the 6 months of managed weight loss, they didn't bother to look any further.  I actually don't live in Montgomery County, I live in Mt. Airy! Much closer to you! Do you have Dr. Green as well??  What route did you take for your documented weight loss? The thought of 6 more months of this upsets me to no end.  Anyway, Thank you for talking me off the ledge! My email is:   [email protected] Hugs received, More Hugs given Kristy

Kristy I am so sorry you are going threw this. I'm not sure what to do for an appeal letter. I would talk to your surgeon, I am sure they will know what to do. Keep us posted on what goes on and best wishes. We are all here for you

Kristy -- Something I found out, that they didn't tell me is -- if you have done any program -- weigh****chers, jenny craig, etc.. and have receipts or bank statements, and you can prove you have done 6 months -- or 2 3 month stints with them, they will approve you.  I have Carefirst also -- and I got mine approved by proving I had done weigh****chers. Kelly