denied but going forward

Well insurance denial a second time but I will continue on my journey with self pay.  We are talking my life here.  My next step is psych eval and then from  what i understand my next step is the surgery date.  I am still very excited.  I enjoy this is a wonderful sitge and I have learned so much already.

I'm so sorry to hear your insurance is being a pain....what ins. do you have???  What has been the reason they've denied?

Edie

 so sorry about your denial. I'm glad you have the means to move forward with self-pay. I hope all goes smoothly from here on out.

I'm really sorry to hear about your second denial.  Did your doctor write an appeal letter for you?  I wrote an appeal letter and my pcp did one for me also listing my co-morbidities and the reason he felt gbs was the best for me health wise.  If your pcp didn't write an appeal letter for you, I'd try again with his letter.  Don't give up.  Sounds like you're going to go forward no matter what.  Good for you, you won't be sorry.
Jan

I was denied twice by my insurance.  I am in the union at work.  The president of our local union called the insurance company, basically said, they needed to make sure they had all their ducks in a row because when she got back from the memorial day weekend, she was going to review my file and go from there.  This was late the Thursday before memorial day.  Amazingly enough, by 10:00am Tuesday morning, the insurance company called my surgeon and had the surgery approved.  Verification letter was faxed to them by noon, and I was scheduled by the next day.

What insurance company do you have?
What is the reason for the denial?
Is your company a fully insured or self funded? 
Is the reason they are giving "justifiable"?

This information would be really helpful to determine if a third appeal would be beneficial.

Priority Health is the insurance and it is fully funded. Denial is did not meet medical criteria of losing 10% weight loss and no comorbidities.  BMI is 49 though.  It will be hard to fund myself but it is a sacrifice im willing to make,.

I had Priority Health, and they paid 100% of my surgery (after my out-of-pocket, of course), but I know even the same insurance company offers many different plans and what they cover, so we are likely not talking apples to apples.  I don't know your situation, but my employer (at the time) wanted me to work for them so badly that they changed their coverage, and thus made certain that I could not only have WLS but that I could have the one I wanted -- the DS.  If you haven't spoken with your employer about this, it is really worth the effort to do so.

Also, find out what their cut off is for co-morbs.  The weight loss thing can be fought & often won (if you have your weight history documented, usually for 5 years), they can require you to go on a supervised diet for a period of time (usually no longer than 6 months), but cannot require actual weight loss.  They also lose if your situation goes to an outside review board if, during that 6 months, your BMI falls below what they had as their cut-off for WLS, they more often than not have to use the weight you started with when requesting WLS.

For a lot of insurance companies, the magic cut-off with no co-morbs is a 50 BMI.  Seems worth gaining some weight to me, if you find that is the case with your insurance!

If you do go the self-pay route, I hope that you realize that you have MANY less expensive options than just the local surgeons.  I am not familiar with many self-pay rates for your surgery choice of RnY, but find the difference in self-pay rates that people can get for the more complex DS surgery to be astonishing considering what my insurance paid for mine ($70,000).