Okay now I am just really angry

After shedding a few tears, I got mad.  So I called back the insurance.  It does not state anywhere in my policy that you have to have BMI greater than 40 for 3 years.  The claims dept said it is general guideline for gastric bypass.  How can they deny me for wording that is not in my policy.  And how come Dr. Loggins office never said it would be an issue?????  I wish I could talk to Crystal!!  I have done everything asked of me. I know I can appeal but I have no idea what to do or say.

there is a lawyer on the insurance forum, (i can't remember his name greg or gary???) and he will tell you exactly what to do.... I really suggest you go see what he can say to help you... "DON'T GIVE UP'  GIRL!!!   I've read some people have been denied 3 times.... You go girl.....

I would definitely appeal. I had to come up with 5 years of weight records and I know a few years back my bmi was not 40 or above. What is your insurance? I would ask them to show you where is states the bmi thing.

http://www.obesityhelp.com/member/gviscio/ Send him a message as ask for help.... good luck sweetie

I am waiting for Crystal to call me back.  I hope she has a solution for this

You would think that if it really is standard procedure for gastric that it would be in the policy then!  I would appeal for sure.  I am sure Crystal will work with you every step of the way and this will just be a bump in the road.  Keep your chin up. 

Crystal will help, she is a genious with insurance stuff.  If it really is a no, there is a lawyer  that files a letter. It costs 500$ but it would so www.obesitylaw.com  be worth the 20-25K surgery! The is a woman on the Main board that is very eloquent about insurance deniels, as is HOW DARE they KEEP YOU FROM HEALTH!! Her web site is great...Sophiegrace, check her out...also the thread with JoeGA from 3/24/08 its a few pages in but worth the read from what they all say... Good luck with this!! We are all praying an honking!!

Ok, don't give up......you need to get the insurance company to send your case to the appeals committee.  They probably won't do this without prompting.  Get your PCP to write a letter as to why he/she feels that this surgery will help you.  Hubby and I both were denied three times but much of it had to do with paperwork not getting to the right place at the right time.  Keep copies of everything....I admit I haven't read all of your story but believe me when I say that just because they say "no" right now does not mean you can't fight and get them to pay.  There are examples of appeals letters here also.  But call the insurance company and ask if it can be sent to appeals.  Make sure they have all the paperwork.