Why I was denied

Do you know they never asked me to write a letter stating why I wanted wls and why I thought I needed it. I thought that was strange. I wrote a letter to give to my doctor that explains exactly what I need so maybe they will write it right. Again thank you for responding to my post and giving me advice all of the people who has typed me back has helped me so much.

I don't want to criticize your surgeon but it sounds kind of like they dropped the ball on telling you the requirements. All my information came from my surgeon. I could get nothing useful about requirements out of the people I spoke to at TennCare. My surgeon's office gave me a list on my first visit describing exactly what it would take to get approved through TennCare. My pcp had to write two letters. A letter of referral and a letter describing my health and and detailed information about my daily activities and all the limits I had because of obesity.  I send my pcp a letter explaining what a typical day was like for me. I listed each limitation, each personal activity that I needed help with, like getting in and out of the tub and taking care of my personal hygiene. It was a little easier for me to get approved because I've been using a wheelchair fairly regularly for about 8 years. Constantly for the last 4 or 5. My pcp was great about writing exactly what I needed in the letter. It was actually a nurse practitioner who saw me monthly for my 6 month diet that handled all the paper work. I give her a lot of credit for me getting approved so quickly.
I also had to write a letter explaining why I wanted weight loss surgery and that I understood the changes that would be required after surgery and that I would be compliant with follow-up with my surgeon for the rest of my life. This letter was required according to the insurance lady at my surgeon's office. I'm really surprised that you werent told to do this. In your place, I would write it and send it anyway. It is harder for them to deny if they read something from the real you and not just a clinical assesment in your doctor's letter.
I hope things turn out well.
Blessings,
Karen

I'm not sure just yet if she should send a letter stating why she wants the surgery.  They might think its her appeal letter... ?  What do you think?  

 Sonya, you need to rest on this for just a few days.  Get your thoughts together, start writing an appeal letter...  but call Tncare first and find out if you send that, will they consider it your written appeal.  If so, then you will surely want to make it as extensive as possible...  very detailed, including copies of pertinent notes stating, "on such and such date, I was diagnosed with ..." and "on this date, I weighed ? lbs"...  I dont' remember how many you are able to have, but some insurance companies only allow you 1 appeal.  And, that's after a peer to peer.  Did they do that yet, peer to peer with Dr. Olsen?

I wasn't suggesting she send just the letter, but just that she include it in the information she sends for her appeal. Everything will need to be sent at the same time. They need to have all the information together to make a decision. I am just suggesting that she make every effort to influence them in her favor.
Karen

I gotchya....  that is a good idea...  so then they can't come back and say "hey, we still need x, y, z".   I would surely put as much in there as possible...  then they can't say that you didn't provide any info! lol

Sonya,

So sorry to read about your problems with the insurance!!  I have faith you will come through this and have your surgery. 

Sounds like the others on the board who have responded, have given you good advice.

Keeping trucking on, I have faith you will beat this too.

Love and good luck to you,

Nancy

Yes they always give me good advice and I am so greatful to have all of you there for me. It means a lot to me.

Hey Sonya, I don't post much , but read your message. I have been trying for over 2 years for wls. Tenncare (americhoice) turned me down last year for the same reason. They said my 6 month supervisied diet was not documented enough (said it wasn't a full 6 months)  and I was not using a cane or walker. Well, if we used a cane or walker we would  be concered "disabled" and be able to get the surgery. I just finished  another 6 months of dieting with my doctor and he is writing ANOTHER  letter but this time he is stating how "my weight affects my everyday life". We were told by my case worker that this is how is has to be worded to get around the wheelchair/cane thing. I too have bad back (buldging disc)  and bad knees along with bad sleep apena , high blood pressure , sugar.........and still was denied. This letter he is writing now is how my weight effects my everyday life such as work, I can't exercise, how many hours I am in the bed because I can't stand for long periods of time , all the pain meds  I am on to deal with my legs and back etc.....And how in a few years if I continue I WILL be bed ridden. If you have it documented where your dr. suggested a cane, I think that would do it for you to get the surgery.  Have them at his office pull up your chart and make copies of the visit you think he suggested it and if it is in there, fax it on to Tenncare.
I have heard that Tenncare is really hard to get approved for WLS, but I do know of one person that was approved so that helps me to keep on trying. If I get turned down again, I don't know what I am going to do. I am going for RNY even though my  name says Shell4banding...I changed my mind about banding. 
Keep on trying....~shell

Yea I guess my 6 month diet paperwork was ok, they told me I had all the requirements.I just needed to be incapacitated.  I am very limited to what I can do. The worse thing is when I turn over at night in bed  I get out of breath and my heart races Is that not terrible. When I am laying down my heart rate is way to high the doctor said it was like I was running. This all goes on while I am asleep. So he put me on Atenolol to slow my heart down. That is because I am so fat when I lay down my heart has so much pressure on it that it speeds up. It is very dangerous and every night I worry I am gonna have a heart attack. Who cares if I have to use a cane if I walk a lot. The other is much more dangerous. And my back surgeon said my back trouble was weight related and if I didn't lose the weight I should expect to have a lot of surgeries on my back. So they could pay for one surgery to help get the weight off or a bunch of back surgeries. What makes more sense. But I guess you cant argue with them you do have to comply with what ever they want. And I am gonna have to do that. Thanks for sharing your story with me Shell it sounds bad but its good to hear I am not alone, I am so happy everyone is so help full to me it is great to know people care.

Sonya,
If you decide to write a letter about why you want weight loss surgery let me know. I still have a copy of mine saved on my computer. I would be happy to email it to you if it would help.
Karen