Well Nothing Is Fair

I have never been more depressed than I am right now at this moment. I called my Pre-Cert. department and they told me that they do not require a psych. eval. In fact, they don't require anything EXCEPT one year's worth of documented supervised weight loss. I don't have that. My doctor gave me xenical last year and it didn't work and I discuss my weight each time I go to see them each year but that is not sufficient. I have lost over 100 lbs twice on my own in 1997 and in 2004 and gained all of it plus some back. So now I have to wait another damn year. This is NOT fair. The NIH does not say you need a year's worth to be considered morbidly obese so why is my insurance requiring this? I can barely work for trying to hold back the tears.

What about LA Weight loss? Didn't you do that? Surely you have enough in your med. charts to document a year!! FIND IT! If not, begin the race now. HI-Energy is there in Jackson and is a great place for supervised weight loss. I did lose with it but as always, it came back. I am so sorry, Sue. I will be praying for you. Kitsy

Sue, I tried to email you privately but it wont let me thru obesity help. Can you email me so I can get your email address?

Sue, Hon, I know exactly how you feel, honestly. I don't want to bother you with it all but feel free to read my profile and you'll see why. Except in my case it was the physician that was unrealistic and not my insurance. At any rate, just take a deep breath and see if you can find one year's worth of documented attempt. If not, get an appointment tomorrow with your physician and get on the ball, if that's the only way your insurance will pay for it. Think about your options. Self Pay isn't an option in most of our cases, and one year may be a long time to wait if you 're just starting, but it will go by and you'll reach your goal and get surgery if you just fulfil their requirements. I even had documented proof of losing over 70 lbs on a diet < diabetic diet while being pregnant! > and was rejected, the jerk said that is not a recognized diet... IMAGINE!! Dont give up. Keep up your chin and you'll get it all done {{{{{{{{{hugs}}}}}}}}}}}} ~Andie~

I'm so sorry!!! This is tragic. glenda

I found out today my insurance is self-funded, and am not quite sure what that means. But I am going to attack this from the aspect that they had my paperwork there for a month before this "sudden policy change". They sent me a letter saying I fell within the guidelines of the "Criteria requirements" and then all of a sudden the very next day their policy changed. Who should I go to with this, my HR people, the ins. company? Sue

Hey Sue, I am so sorry to hear about this but keep your head up. I would send my records anyway. I really didn't have a whole years worth either but my ins. approved my surgery. I guess because I had been on diet pills on and off. If you haven't tried it I would try it anyway and if you can get your dr to write a really good letter. Maybe stating that you had done other programs that didn't needs his assistance therefore he didn't have the documentation(msp) I wish you the best. Becky