So now what?

I have now been turned down for surgery a total of 4 times. Twice with two different insurance companies. Each time I am turned down I find myself so depressed I cannot leave my home. I loose all hope and I gain weight. So now what?

Hi, I am sorry to hear you have been in a rough spot since denial. I guess I'm not sure how I can answer your question without being given more information... Have you gone through the program at EMMC? What's your insuarance? Why have you been denied? I looked on your profile but there's no info there either. Let us know what we can do to help you through this time. Casey

What program and what is EMMC? My previous insurance was Prudential. My current insurance is United Health Care. I changed insurance companies because I learned that it's easier to get accepted through UHC. They denied me because it's not medically necessary. Meanwhile I am on 3 meds because of my weight and I have a long list of problems due to my weight.

Hi, I was refering to the Surgical Weight Loss Program at EMMC (Eastern Maine Medical Center in Bangor). Since I saw you are from Caribou, and most northern Mainer's go to Bangor for surgery I thought you may have. The program is through Dr Donald Clough's surical practice, he has 3 other surgeons working with him. They do RNY and the Band. If you are 100lbs overweight you are a possible candidate. I would suggest you get a referall from your PCP to go to Bangor. And before you say, it's a long distance, remember this is your life...and Dr Clough has board certification. Lynn Bolduc at the Diabetes and Endocrine Center in Bangor is the coordinator. She can get the ball rolling if you make the first steps with your PCP. You need a program working for you to get the nessacary paperwork and proof to be sent to your insurance for approval...EMMC works wonders... I had surgery last June on the 12th. Started at a height of 5'2" and my weight was 240lbs...I have lost 120lbs since...and am below goal weight. It takes between 4 and 6 months to complete the classes, meetings and appointments through Bangor but it's MUCH better than just having some surgeon give you the surgery and not have educated you and have a follow up protocol. Goodluck, Casey

Hmmm yeah. Well that was my first Doctor. He referred me to Dr. Clough. But my insurance wouldn't cover it. Now my new doctor referred me to Dr. Jimenez and my new insurance won't cover me either. I've seen Dr. Jimenez twice. I can continue to see him but at $230.00 for each appt with my insurance not helping I won't. Diet and exercise doesn't work. I don't know what to do. I can starve myself or give up. Today I've only had 20oz of water. Looks like it's the starve method. I'm took the day off work. I didn't think I could work through my tears.

Hi, Well I'm sorry to hear you have had trouble with insurances, but there must be something you haven't done yet? Are you saying you did all the appointments and what not with Dr Clough? Or that your insurance doesn't work with him at all? I think you may want to make an appointment with a nutritionist and someone who can help you with the emotional aspect of this battle. Casey

I never saw Dr. Clough at all. And he's not in my "network" anymore. Three months ago I saw Dr. Jimenez for the first time. I saw a dietitian shortly thereafter. I increased my exercise and I modified my diet. In three months I lost 3 pounds. Well it's better than gaining 3 pounds. Anyway my insurance won't pay for Dr. Jimenez or the dietitian. I've done this all my own. I'm totally broke now. For the past three months I've spent my mortgage money for medical purposes. I really cannot do it any longer. Now I owe 3 months for my mortgage along with the added interest. I'm totally depressed. I've done nothing but sleep and cry since I returned from my appt this morning.

HI, I am a little surprised you might have appointments without knowing if it was covered or not. Is there an appeal process through your insurance? Casey