So depressed that I'm about to give up......denied for the 2nd time!!!

I've been denied yet again by Accordia and their reason this time is insane!!!! The first time I was denied because of lack of documentation back in August of 2004. This time their reason was "no recent participation in a medically supervised weight loss program" I don't understand where they get that from, when included with all 27 pages of medical documentation it included notes from the dietician I have been seeing, not to mention that in an attempt to start losing I joined Curves and TOPS, although I had to quit Curves after only a couple of sessions because I had an open ulcer on my leg that became inflammed. I am 34 years old and i'm about 330 pounds right now. I am diabetic and on insulin, I have hypertension, asthma, sleep apnea, GERD, severe edema in my legs and feet, and an ulcer on my leg that has not fully healed since 2001! Yet even with all of this documentation they STILL denied me yet again!! I'm so angry and depressed at the same time that I can barely function right now. I"m also scared because over the past several months my health has taken a sharp decline. I'm afraid that if I don't get approved for this surgery soon that I could wind up having a heart attack or stroke. I get out of breath just walking from one room to another. My feet ache so badly and are so swollen that I can barely get shoes on my feet. After this most recent denial I'm getting ready to write a letter of appeal and request them to review my case again, and going to submit yet more medical records but by now I am so discouraged that I wonder what the point is and that they're just going to find some other insane reason to deny me. I had heard that Accordia was supposed to be one of the easiest insurance companies to deal with and that most people got a quick approval.........not the case at all!!!!!!

I'm sorry you have been denied again, it sounds like they are just not looking at what you gave them...I would definatley take it to the next level of appeals. As for you legs, it sounds very similar to lymphedema, have you ever heard of it? Do they get hard from the swelling? If you google it a couple of sites with information will come up. You can also look on Amy William's site she had some good information. http://www.obesityhelp.com/morbidobesity/profile.phtml?N=W1029266563

You are where I fear that I am going to be next month.....I have wanted and waited so long to have this surgery and I finally decided to see the doctor and get this going and I know they are going to give me a hard time. I have suffered through years of the aches and PAINS of being overweight. I am in your boat with pain just moving from one room to another! I never used to go to the doctor for any of it because all I would hear was, lose weight...Now I wish I had gone to the doctor for everything just so I would have it in my paperwork. The only papers I have are for sleep apnea. All the regular doctor visits were not tagged with diet attempt, which makes me very enrgy now, because that's why I started going in january just to get the supervised weight loss taken care of before I see the surgeon and now I see my records are worded so it looks like it was for other things and not just for weight loss. So here I am 5 months behind. They also told me since I was on medicaid that after they submit the papers to medicaid it can take up to a year to have them reviewed....then if I'm denied it starts all over again...So I know the feeling you are having..It's such a beat down everytime you hear the denials.......

Hi Debbie, Sorry to hear about your denial, but DO NOT give up. I used this form below to document all my visits to the doctor for the "physician supervised diet, and although I did not have your insurance, it did help. Finally after 1-1/2 yrs, I had my surgery on 04/04/05. I know it is hard, but just keep plugging away. The insurance companies want you to give up.....so be bull-headed and keep going after them. Good Luck ===== BC PHYSICIAN PERSONALLY SUPERVISED DIET PLAN PATIENT NAME: ____________ DATE OF BIRTH: __________________ INSURANCE ID#:______________ SS#: ________________________ Date: __________ Weight:__________________Height____________BMI_______ Type of Diet:___________________________________________________ Expected Calorie Intake: __________ Recommended Exercise Regimen:__________________________________ _____________________________________________________________ Diet Medication: ________________________________________________ Dr.'s Assessment:_______________________________________________ ______________________________________________________________ Co-Morbid Conditions related to obesity: __________________________________________ _____________________________________________________________ Follow-up visit:______________________ Physician Signature:______________________________ PHYSICIAN: __________________ ADDRESS: ________________________ PHYSICIAN PHONE: _____________________ PHYSICIAN FAX: _____________________

Julie, I understand EXACTLY how you feel. I was denied by my insurance 3 times. Each time they had a different kakmamie excuse. I hired a lawyer who "scared" them by requesting a copy of my policy and copies of ALL paperwork regarding my case. I also copied my lawyer when ever I communicated with customer service (using the term VERY loosley) via email. When I received the copies of office memos etc. about my case, it gave me a little more to "go on". I requested an external review and sent x-rays of my problem joints along with a NEW appeal letter. As it turned out "some one" overturned my denials BEFORE it went to external review. I sincerely believe that many insurance companies WANT you to become so dejected and broken that you just give up...that way no one has to take the responsibility of approving a 30,000.00 plus procedure. EVEN THOUGH this expense WILL save them money in the long run, they still don't want to do it. Have a good cry, lay in bed for a week end, then get on the internet and search "appeal letters"...find something to pattern your next attack after and please, please, don't give up. It took me 18 months to get my surgery and now I am almost a month out. It also doesn't hurt to have an "irritated" letter from your Dr. Your Dr. could even call them. I will keep you in my prayers. Liz Hillsboro

They figure if they say no, a few will stop trying and if they say no again, one more might quit fighting. If they can stop just two thats about 100,000 give or take a few. They don't lose anything by stalling. My doctors all got together and wrote a letter with a formal complaint to the state. DOn';t give up the fight. If I am not mistaken, in the state of ohio it can't be denied if it is considered medically neccessary as long as there is not an exclusion. Richard

Dont give up,. your aLMOST THERE. I HAD TO GIVE MY INSURANCE A 6 MONTH SUPERVISED DIET FROM MY DOCTOR. i HAD TO GO IN 1 TIME A MONTH FOR A WEIGH IN. (FOR 6 MONTHS)AND TALK ABOUT MY DIET. THE 6 MONTHS WENT REALLY FAST . I JUST KEEP BUSY. THEY ARE RUNNING OUT OF EXCUSES. GET A APPOINTMENT AND GET THAT STARTED. AND EVEN SEND THEM IN ONE AT 3 MONTHS THAT MIGHT WORK. nEVER GIVE UP THAT IS WHAT THET ARE PUSHING FOR. FIGHT FOR YOUR SURGERY. BUG THEM AND MAKE IT MISIABLE FOR THEM. TAKE CARE BARBARA

Julie, I'm on my third level appeal with Aetna. They are just trying to scare you. With this last appeal I sent a copy of the client complait from the Ohio Insurance Commission which I downloaded and filled out. It's a one page form. No insurance wants the Ohio Insurance Commission in their business. Keep on appealing to the next level and don't let them win. They are counting on you giving up. Good Luck. Luann

Hi Julie, Do you have a copy of your policy? My insurance approved mine on the first try. Then after the surgery, I started getting the bills. Talk about being scared!! When I called them, they said it was not covered under my plan...I had my plan in front of me...I told them what page I was looking at. Then, she said...Well, you were not preapproved...I had my letter right in front of me...then she said, Oh...well, I will get this all taken care of right now. Haven't had one bit of trouble after that. If I was one that would be intimidated...I would have been up the creek without a paddle...but, I had everything right in front of me...and came back with an answer each time she came up with something!! So be prepared with all your paper work, and don't take no for an answer!! Who knows what these insurance companies are thinking...it's like we are trying to get by with something wrong! Maybe a lot of people do that. Good Luck!! Jeannie