Denied! grrrrr... peer to peer???

OMG I think I'm gonna burst! I don't post much but lurk a lot... Just hope someone has had to deal with this before... I have had a bunch of problems that have slowed down the processing of my paperwork. Hard time getting appointment with nut added 3 weeks then the insurance specialist was on vacation for 2 weeks... Has been very discouraging I had lost 10 + pounds and have gained it all back while waiting and have been suffering from last supper syndrome.... I hate food! I just want this over with! I know I need to spend some time with my psych. just need to find a new one the guy they gave me is a total nut. I'm looking for someone new... I had my last required appointment on march 17th... The insurance specialist came back from her vacation on the 31st and I was on the phone with her 10 min after I got out of bed... She sent my paperwork in on the 2nd.... I have been calling the insurance company everyday! I called today and was told I was denied... ok that was where I stopped listening till she gave me a number for the pre auth line or something. I called the number and was told something about not having 2 years of dieting or something in my file (which is totally crazy cause I have more then that submitted) she also said something about my dr doing some peer to peer thing... that is what I'm questioning. I have no idea what it is... I'm going crazy. I was not really listening to the person from the insurance company because she said that I should call my dr. I called the insurance specialist and of course she was out of the office for the rest of the day and no one else would beable to help me.... I suppose i could wait till tomorrow and just call her... I'm not going to sleep tonight....  sorry I just needed to vent... thanks for reading!

It's always a slow  process. I am sorry you got denied... but hopefully you'll have another chance. We're all very eager to get the surgery but I always remind myself that it took years of bad habits/bad hormones/etc to put on the weight, and  it will take several years to take it off.

I hope all goes well for you. Give them a call, clear things up, and do what is required this time around. And hopefully all will go well! Good luck!!

Hey Dear!  Sorry you were denied.  Now, here comes the advice.  As far as a therapist seek out Lana Boutacoff (PM me if you are interested and I will PM you her digits) as she specializes in Obesity and WLS.  She will see you and evaluate you a few times and then refer you to a therapist that she works with.   NOW, a denial (as hard as it may be right now) is not the end.  There are people here that have had them overturned.  This takes LOTS of work and is a hard fight.  You have only 10 days to appeal once you get the denial letter.  And yes, get a peer to peer.  Find out the EXACT reason for denial, get your proof to disprove that.  Get as many letters of recommendations from you PCP or any other doctor who knows you and your battle with obesity.  Gather together ALL evidence related with your weight loss attempts.  Once you have all that, make copies and send it to your insurance for appeal. Then, remain calm.  You may have to appeal 2 times and then take it to the external appeal with the state.   I may not know what it is like to be denied for WLS but I have been denied twice for medical procedures that are much needed and am at the state appeal level........hang in there!  GET BACK to losing the 10 pounds so that THAT won't be a roadblock for surgery!!!  Be empowered! YOU CAN DO IT!! Hugs!

Just keep fighting and it will happen for you. And once you talk with the insurance specialist, maybe you can find out what happened to your papework. I wish you luck! Lori

Okay take a deep breath. Now fight that insurance it will happen.

I'm sorry you got a denial, that has to really suck!  I know it is all very stressful right now, but you do need to take a few deep, calming breaths, and get your focus.  Take it step by step, tackle each piece seperately because looking at the whole pic can be overwhelming.  Remember that this is not the end of the road.  It is a long, sometimes rather slow process.  We all get frustrated and anxious.  You need to keep working on learning your program, and get back on the weight loss horse.  You don't want to get auth next week and not be able to have surgery because you didn't lose enough pre-op.  You need to find alternatives to handling stress, cause we can not turn to food after surgery.  Follow your instincts and get yourself a counselor, they can be very helpful. Good luck

2 things YOU need to do...find out exactly what your insurance policy says about weight loss surgery coverage and find out why you were denied.  then and only then can you fight your denial. 

noone cares more about getting this approved than you, so you have to be proactive and do some of the leg work.  The person at your surgeons office is a good resource, but you really should be involved.  Call back the number you were given, talk to someone and take some notes on what they tell you. Remember this is for the rest of your life.  Waiting a little bit to get your insurance sorted out won't hurt in the long run. And remember all of those extra meals you are eating - you will be able to eat those foods after surgery, just in much smaller amounts.  Now is the time to establish really good habits in preparation for surgery...you can do this. i was denied 2 times with 2 different insurance companies before i had my first surgery and it was rough, but worth it.  i was worth it.  Good Luck!!  

My first question is what insurance do you have? Second question is which procedure are you submitting for? Peer to peer can be a good thing. It gives the your surgeon and the insurance company a chance to sort out what has been submitted and if all the t's have been crossed and i's dotted from my understanding. I agree fully with Reese. YOU need to be informed and be proactive. Follow her suggestions above. Also, I agree with Sandie. Go to Lana! I cannot say enough wonderful things about her. She gets you to see the big picture and brings everything full circle for people. She is VERY good at bariatrics, nutrition, emotions, etc. I highly recommend her! Answer the insurance question though because we may have members able to give you more insight if that piece of it is uncovered. Keep your chin up!

Thank you everyone for the comments! Everyone here is so awesome! It's been a long day.... Lots of phone calls. I have aetna and I'm going for RNY. I did get a chance to talk to the insurance spec at my clinic today she said that the insurance company needs more info on my weight loss history and my weight history. I'm not sure how that stuff didn't get included in the first place. I know I provided my clinic with all of the info from my diets when I first started. The insurance spec said that the surgeons rarely do a peer to peer they try to do everything by paper work. I'm not sure I like that from what I have read I need to do what the insurance company says. I still have not received the letter from the insurance company. I called my pcp and had her nurse fax my history over to the clinic. Guess I'm gonna let the clinic do what they normally do for now and see what happens. I have settled down. I could not tell anyone what was going on... I would have heard all about how I don't need the surgery and all that crap... not what I wanted to hear... I am looking in to another therapist. Can't really afford to go now but in the next few weeks I'll have to find someone. Thanks again!!!