DENIED!

I am so sad and depressed. My insurance company has denied my application for WLS. I went through Dr. Patterson's office and was frustrated with the responsiveness. When I spoke with them about the denial they just stated that the company has an exclusion and that was that. Period. I thought you could appeal and that there is hope. I guess not. I don't know what to do next. Self-pay is out of the question. Should I speak with someone at my employment? It feels weird to speak about something so private with people I that I'm not on a personal basis with. What would I say? Vena

Vena - I was denied also, so I know how you feel. You can indeed appeal over and over and some people find a glimmer of hope with that, but I know with my ins BCBS Regence State of Oregon it is iron clad and no one has ever worked their way around it. The surgeons wouldn't even touch it at all. So I had to go self pay. Thankfully we sold a house last year and made enough extra so I could afford to go to Mexico ($8500 +travel) and have it done. Best money I ever spent. I don't know how your employment structure is set up, but unless it's a private and profitable company, I don't know if I would be too optimistic about it. But it certainly can't hurt....Good luck! Dina

Hi Dina, Thank you for your reply. I am with OEA Choice Trust and just got off the phone with a rep who was very kind and helpful. He said that my request hadn't gone before the medical review team, so that was the next step. I am happy to have a bit of hope. How was your surgery? How long ago did you have it? I was thinking of self-pay also...it would take me a couple of years to come up with the money. This process can be so discouraging. Vena

Vena - Sorry I didn't get back to you right away. I haven't been getting email notifications of my post responses again. ::sigh:: Anyway, I hope you are able to appeal and get approval through your insurance. As far as me, I had mine on March 10th of this year. It went really really well and I am surprised at how wonderful I feel. Dr. Aguirre is really fantastic! As for self-pay, I know it's hard to come up with the money, but I have to say knowing what I know now, I should have sold my car or something a long time ago to afford this. I should have put it on a card or gotten a loan. It's THAT good. The way I look at it, to go to Mexico is like the cost of a good used car. This is way more worth it to me than that. In fact, the money I used for my surgery was dogeared for some remodeling we were going to do in the house. DH put it to me like this: Would you be happier staying fat and having a brand new master suite, or would you be happier having lost your weight and in our small bedroom? Well, honestly it didn't take me long to answer that question. Brilliant question - really put it in perspective for me! I hope I don't come off as too overzealous, but that is how strong I feel now. I certainly won't wait as long to get the plastic surgery I will need later!!! Dina

How about another response from another Dina?! LOL! Vena (isn't that wierd - all of our names have that same sound!) You can also look into possibly hiring an attorney to assist you with the appeal process. There are two that specialize in this sort of thing. www.obesitylawyer.com www.obesitylaw.com Self-paying, btw, is typically way more affordable than most people realize. People use retirement money (it can be used pre-tax for medical purposes, too!), take out second mortgages, lines of credit, have friends and family loan the money - I even know one guy who sold his antique cars to pay for his wife's surgery. It's amazing the ways that people get creative when their very life is in the balance! And I can totally relate, I'm trying to come up with the money so my husband can have surgery, too. Feel free to let me know if I can be of any assistance, okay? Blessings, dina BPD/DS July 2, 2002 Dr. Aniceto Baltasar in Alcoy, Spain SW: 365 lbs, BMI 64 CW: 160 lbs, BMI 25.8 GW: 130 lbs, BMI 23 Read my story at: http://www.duodenalswitch.com/Patients/Dina/dina.html See my photos in the Photo Gallery at http://www.bodybybaltasar.com/