My denial letter

Well Crystal at Surg Assoc FINALLY got the letter of why I was denied.  Hopefully I'll get mine within the next few days. She said that I'm going to have to have 6 mo. physician supervised diet, more documentation on my "treatment" of cholesterol and HBP (I'm not being treated for HBP, but I am taking fish oil for my cholesterol), AND THIS is the WEIRD part...  They say I have indications of BINGE eating!!  WTH?????  What in my medical records would give them that indication?  Hopefully, I can do my physician supervised diet, note everything I eat (and that I'm NOT binging) and go to Curves regularly (and get print-outs of my attendance) and be approved by the end of the year... So, here goes the tough fight... Dot

Hang in there I am right with you.  I started my 6 month physician supervised diet in March.  I was on one 2 1/2 years ago (which they want you to be on one in the last 2 years) and I am still waiting on the insurance to make a decision.  But in the meantime I have got a jump start on the supervised diet.  Good Luck. 

I wish you luck in getting a quick approval!

I was going to start a 6 mo supervised diet last October, but I skipped my Jan or Feb appt and didn't ever pick back up on it after that... I wasn't sure my doc was documenting properly anyway.  I still need to get that cleared up what all I need the doc to document.

I'm so sorry you're having to deal with this. Your insurance company sure isn't making anything easy. What does binge eating have to do with being an exclusion? And, where would they get that kind of information? That's kinda strange and makes me wonder if their trying to read between the lines and doing their self-interpretation of your medical records, rather than basing everything on actual facts. I hope you get the diet done and everything sails through for insurance coverage soon.

Binge eating? Sounds fishy unless they are using history of your past weigh-ins at the doc's office,maybe?? I just hope that they will approve you after the supervised diet, etc. which bites. ((hugs)) to you. I know you can do it. Be stubborn!

Past weigh-ins is all I can think of...  But, obviously, if I'm dieting my weight goes down.  When I'm not, my weight goes up!  Also, whose to say where I was at on my cycle at those appointments and if I had water retention??  I think it sounds like a load of $ # ! ^  if you ask me..... I turned in two different attempts of  WW notes.  I don't think I did any binging on those..... They just suck.  That's all I can say~

Dot, I am so sorry about the letter.  At least you know what you are facing.  I used the appeal letter I found on this site.  You know we are all in this with you!  Let me know if there is anything I can do!  Oh, and where were you for the support group meeting?  I missed ya.  Looking forward to seeing you and everyone else on the 30th at Olive Garden, right? Michelle

Dot, I am going through the same thing as you are except I am having to go to my PCP every month for 12 months.  I told them I have been going to the same doctor for 5 years and they said I have to go every month not every two months.  So...here I am waiting.  I have to document discussions of exercise, nutrition, and monitored dieting.  My final appointment is in July!  I know you feel like this is going to take forever...but it won't.  They are just trying to discourage you so they don't have to pay for your surgery.  That's insurance for ya...They think you won't stick it out.  Six months is a short time to get a surgery that can add years on to your life.  So keep at it and good luck! 

Have you lost any weight in your 12 months??  I'm afraid if I lose much weight, they'll just deny me because "I can lose weight"!!!!!!  UGH!!  Or because that will bring me under a 40 BMI!!!!! I'm going to try to have the doc document nutrition consultations, exercise discussions, and my caloric intake.  I plan to start back at Curves and print out my attendance record there. I should go tonight.....