DENIED!!!!!!!

Well.... I called my insurance today again... to the run around again.. finaly got over to certs and they tell me I was denied this morning. Not a medical necesity. Here I sit on 2 different bp pills, triglicoride pill, and an anti inflamitory for the tissues around my heart. I can barely walk because my feet and ankles keep swelling to all ends and they tell me its not a medical necesity.. I have been in tears for the past 2 hours now. Calling new start and dr. Richardson only to be told the people I need to talk to are not in the office. My insurance said I could have dr. Richardson call and request a peer to peer and that might help. If not I will have to file and apeal.. I am so scared.. i had my hopes so high for a new life with my children and now I feel like its been ripped right out from under me. Its not fair.. and it hurts so damn much! My mother didnt use her vacation time because she wanted to be up here for my surgery so i screwed her out of that.. so many things going through my head.. I thought i would be able to have this tool to make me healither.. To get rid of my heart problems or atleast help with them.. that i would be able to finaly lose some weight so I could start exercising and playing out side with my children.. so i could feel more intamite with my husband...instead of being so damn self concious all the time. It just feels like all that i have hoped about all that i have started to think about.. running and playing with my children.. being able to take them to six flags and actually sit in the seats.. being able to go to the mall with my daughter and not get so damn tired walking around it. and now... to know that I cant get that extra help.. all i wanted was this tool to help me.. to help me make a better me.. a stronger healthier me... and now im told im denied.. Im sorry for venting... I really am.. I just needed to talk to someone.... Jai

okay.. i guess I should really just calm down before i go posting away. im sorry.. I have to remember now.. The lord never gives us anything we cant handle.. okay.. so now I have to find the loop holes.. I just have to work harder at getting this.. I called Dr. Richardsons office again and she is goign to have one of the heads call me back.. And if any of you know anyone who can write up a really good appeal letter or atleast help me write one up... please let me know. I just have to start looking at this in a different view I guess.. One more stepping stone.. one more hill to get over.. i just hope i can make it over this hill with out being emotionaly drained. Again i am sorry about the earlier post.. i really need to stop and think before i just go typing away.. Thanks for listening.. Jai

Jai I am so very sorry you are going thru this. On the main message board somewhere is a lawyer that does just that with insurance companies. I forgot his name. Craig knows who it is. Email him if you cant find the name and ask him for it. Dont worry about venting on here that is what it is for . We are here to help each other out when we can. I know it is a disappointment but you have to keep trying. Love you and will pray for the insurance company to change their mind. Jan

Don't give up!! Remember that your PCP can be an advocate for you!! If you have a good repore with your doctor and they have treated you for your conditions...have them write a LONG and DETAILED letter recommending WLS...and tell them point blank that your surgery has to be medically necessary. Ask them to outline how losing weight could benefit each condition you're being treated for. Please don't give up and, find a way to make WLS happen for you. The peer to peer with Dr. Richardson sounds great...I've heard of that but, if it includes your WLS surgeon...then it's all good. He's a great, well respected surgeon in this field. Take care and God bless, Kelli

Jai, What ever you do...Do NOT give up.....You should have seen all the fighting and rough roads Jan and I had to go through to get surgery...I use to come on to post, I would type and cry and cry.....I got up and said this is not going to beat me down......We all prayed and finally got approved.....Jai this is my fourth Doc. for gastric bypass....You're not the only one who ever had trouble......Ask for an appeal and do a peer to peer so they can see in person your condition.....I will pray for you and we will thank Jesus for his help and for furture blessings ..........God Bless....Craig Lee

I have to agree with the others, don't give up. I had to try with two different insurance compnaies beofre I was approved. Good luck.. If it is meant to be, it will happen...

Thank you all for your prayers and warm thoughts.. I am in no way giving up. I just have to go about it in a new direction I guess. Dr. Richardson head person told me she will talk to him and have him call to set up a peer to peer. She said normaly after the surgeon does this the ins. company normaly overturns their descision... So fingers crossed. If not I am getting ready to file an appeal. My insurance does cover this surgery if it is medical necesity.. The woman from Dr. R's office said that with everything going on it should have been a hands down but sometimes they have to go in after them. I just want to get this done while I am still young and my children are still young so i can enjoy my future with them instead of being upset and not being able to do certain things with them. Again thank you so much! Jai

The lawyer is Walter Lindstrom and his website address is http://www.obesitylaw.com/ Dr. Hornbostle said that he is so good that many insurance companies just have to see his letterhead and they approve you because if he sues them he usually wins. I can't remember what he charges but I'm wanting to say it was around 4 or 5 hundred dollars. You could appeal also, have you noticed when looking at the insurance information thing how many many many people get denied the first time and approved the second time? I wonder if they do that to weed out the people that really aren't that serious about it, so they don't have to pay as much. Good luck!!!