HELP!!!!

Wanda A.
on 10/1/07 8:24 am - Clover, SC
Hello everyone,  I am in desperate need of your help.  My doctors office finally submitted my paperwork Thursday.  I found out today I was denied because my bmi is over 55 .  Currently, my bmi is 64-65.  I don't even want to, or need to express my disgust, disappointment, or rage .  I have not rec'd my denial letter yet however, I am preparing for my appeal.  While cruising the forums I came across an appeal letter of a member or her friend (I don't recall), it was so thorough, with quotes and references.  I'd love to use it as a guideline for my own.  If anyone has an appeal letter I can reference I'd greatly appreciate it.  I will also xpost this to see if I can get some help.

Our deepest fear is not that we are inadequate.
Our deepest fear is that we are powerful beyond measure.
It is our Light, not our darkness that most frightens us. 
We ask ourselves -- Who am I to be brilliant, gorgeous, talented, fabulous?Actually, who are we not to be?
You are a child of God. Your playing small does not serve the world. There is nothing enlightened about shrinking so that other people do not feel insecure around you. We were born to manifest the Glory of God that is within us. It is not just in some of us, it is in everyone.
And as we let our light shine, we unconsciously give other people permission to do the same. As we are liberated from our own fears, our presence automatically liberates others.
M Williamson

Cinderellen
on 10/1/07 8:39 am - Winterville, NC
I don't have an appeal letter, but I wanted to say I'm sorry Wanda.  Keep fighting, some of the members have had to appeal multiple times to get approved.  You can do it!  Take care. Ellen

Own it all, it's yours!

425/350/185/150  Highest/Surgery/Current/Goal


Anniep59
on 10/1/07 9:36 am - Pittsboro, NC
Hi wanda, Dont give up this fight. Sometimes it feels like the insurance companies make it seem almost impossible to obtain this surgery which in the long run saves them tons of money because after wls any co morbiditys you may have will go away or lessen to a great degree. My BMI when I started looking into wls was 62. I was denied twice for very simple reasons which I was able to stay on top of and give them what they wanted. I did write an appeal letter and hand delivered it myself and with in two weeks got approved. I will never understand why this carrot is dangled out there for the morbid obese making it seem so easy to get. This is not an easy choice to make but for me it was a life saving choice. I too had many co morbiditys from being super morbid obese and I am happy to say many of them are gone because of wls. I thought I saved my appeal letter but I cant find it on my computer. All I can say is speak from your heart and you will be heard. I wish you luck on your quest to help your future health. You have to take a very active role in getting wls and you have to stay with it even when you feel you have no desire to keep fighting.                                Love & Light,                                           Annie

It is never too late to be what you might have been.?


www.youravon.com/annieadams 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

Wanda A.
on 10/1/07 10:19 am - Clover, SC
Thank you ladies for the words of encouragement. Wanda
Reenie07
on 10/1/07 10:24 am - Fort Mill, SC
Keep up the spirit. That is what motivates all of us going.


"The difficult is that which is done immediately; the impossible is that which takes a little longer." - George Santayana
dolphindreams
on 10/1/07 10:54 am - Bakersville, NC
i dunno which procedure you are planning to have.....but i was told by Dr B. that insurance simply wouldn't cover lapband unless my BMI was under 50.  sorry you are having to go thru this and i hope you get it all worked out.
Wanda A.
on 10/1/07 11:03 am - Clover, SC
I plan on having the RNY.
dolphindreams
on 10/1/07 11:10 am - Bakersville, NC
aww then that really sucks. no idea why they would turn you down for that when it would obviously help you. i hate insurance companies. second to that, i hate dr offices...
gordonfamily3
on 10/1/07 11:32 am - Concord, NC

The only insurance that I have personally worked w/ that has that 55 limit is Medcost for CHS employees. I know it stinks but I will tell you from my experience I haven't heard anyone win this becuase it's insurnace policy. I really wish that I could give you so good advice or even a good letter. If you have co-morbid conditions use those, if you have family history of obesity and co-morbid conditions write about those, also if your doctors back you on this get them to write letters of support. If you are denied Dr B can do a peer to peer a lot of people don't know that so as for a peer to peer. It helps sometimes but not always but it's worth a try w/o using an appeal. :) Good Luck and if I can find an letter or anything to help you I will get it posted here.

Wanda A.
on 10/1/07 11:47 am - Clover, SC
What exactly is a peer to peer review and how does it work?
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