I was DENIED!

I guess I knew I would be. Now I have to start the appeal process. Im not sure as of yet the basis for my denial, but I suspect it will be the 12 month supervised diet requirement, despite the fact that Ive been on a 1500 cal ADA for the last 2.5 years (likely PCP never charted this info). Damn insurance companies. Anyone with a good appeal letter that would help address the diet issue? I really can't afford to spend money for 12 months on WW or the like to satisfy this requirement, especially when I have done so in the past with little result to show for it and always gain it back. Its not fair that I should have to do it again. What good does it do to say it has to be medically supervised, when you've clearly been seeing your doctor regularly and your doctor put you on an ADA diet to begin with? How is that any different?

Don't give up Colleen!! Call your doc and ask him/her to write a letter for you saying he has had you on a supervised diet and anything else he can say to help you. Then write your own appeal and put everything you can into it. Tell all your comorbidities, how your weight is hurting your life, and put as many statistics on obesity in it that you can. Send it together with your docs letter and see what happens. Call your insurance and ask who to send it to and fax it, don't mail it . I went through all this crap for a year with blue care network, and i know how disappointed you are. Don't worry, in the end it will work out. Good luck. Hugs Linda

Colleen, Did you get to read your doctors letter to HAP. I don't care how supportive the doctor is, they don't get it that they have to be very specific to Hap with their information. Just asking and stating your BMI and co-morbidities is not enough. There is a sample letter in the "getting accepted by insurance section" that tells you what all the doctor needs to cover. Your doctor can also request a peer to peer appeal, it they are willing to do so. This is where they talk to someone (I think this can be done on the phone, not sure, but they can check) and the information is taken. Hopefully they can't screw that up. Just remember that if you send in an appeal letter at the same time they will not look at the doctors letter at all, your letter cancels out theirs. If you decide that you are going to do an appeal letter, have your doctor write a letter and you can attach it to yours, this way it will be read. That way you can make sure his letter says what it should. And make sure he knows what you want it to say. He should be telling about the diets he put you on and your results. I have been trying for about a year to get approved, these are mistakes I have made. Please don't make the same ones. Sorry so long but I can't stress enough, HAP is the "pits" and does not want to cover this surgery and they will do any and everything to get out of it. I don't know what the magic words are but I know that I am dying a little each day I don't get it. But I will not give up until I absolutely have to. Good Luck and Hugs, Cheryl

Sorry, still learning the lingo here,, what is HAP pls?

HAP is the acronym for Health Alliance Plan

Well, I thought she would know exactly what she needed to do seeing as she does all the medical clearance exams for HFH and understands how the program works. But, who knows. She is a new PCP for me. My former PCP was not at all supportive and I knew it would be pointless trying to get her to help me. I will call the doctor on Monday and ask her what she recommends now. I will ask if I can pick up the appeal letter she dictates so that I can attach my own with it so they both get read. Where is the "getting accepted by insurance" section located?

Colleen, Go to top of page and click on Home. Then look in left top section and click on weight loss journey. Then click on Getting authorization and on the left hand side of page are lists of example letters to different doctors. You can copy them off of there and use them for your own, just change to your info. Take a look and see what you think. Hugs, Cheryl

I am so sorry you were denied. I read about your friend the other day. I loathe HAP. I am currently job hunting and my fear is that I will find the job I want, but they will only offer HAP. I think I would have to turn the job down. We may have to switch over my insurance so my DH can look for a better job at a later date. If we ever had complications from WLS or my TT, I am afraid they would not cover us. I have had HAP before and would not wish them on my worst enemy. Once you have a PPO, going to an HMO is a horror show. I know there are some here who were approved through them though. I might ask on the main board too. Good luck and please keep us updated.

DOH!!!! Well, if they want a fight, lets give them a fight. If (when) I get my denial, I am going to appeal and tell HAP in no uncertain terms that I will continue to do so over and over and over.... Don't get discouraged...I'll be going through this too and let's just keep encouraging each other. THIS WILL HAPPEN! Get your jumpin shoes on...the hoops are coming out and it looks like we got some work to do!!!

You betcha, Kim. Im ready. Ultimately, I just want approval. Bring it on, cuz this ol' girls ready to kick someone's ass, may as well be HAPs.