INSURANCE HELP!

Hi everyone, I have John Deere Select (State of TN) health insurance, and they have turned me DOWN for my WLS. Needless to say, I am totally devasted. I am an "older" divorced professional female, who is 175 pounds overweight!!! I have several medical conditions that are directly caused by my morbid obesity. I have tried every single diet out there for the last 10+ years. This is my LAST hope! I am totally devasted..I cannot believe my insurance turned me down.. Can any of you help me?? !!! What do I need to do for the appeal process, etc.?? Dr. Boyce's office suggested that I try this forum. You can also reply to [email protected] instead of here...Thank you so much for ANY advice/help anyone can give me! Kathy W.

Hi Kathy, the best advice I can give you is appeal. Look on your medical card and call customer service ask for a case manager. This person will work with you and for you to help you get approved. I would say about 85% are denied the first time around. Your Dr.'s surgical nurse will be filing an appeal on your behalf. Write a letter to go with your appeal paperwork, send copies of pictures, get a letter from each of your Dr.'s referring you to have the surgery, and it must state in the letters "medically necessary", why surgery is the last option for you. Don't give up, just follow these ideas, and trust that God will see you thru all this. I have been denied by 8 surgerons, before I even get to the insurance part. I am having to go out of state for my surgery. I haven't given up and don't you dare. Basically they want to know whether you can lose it on your own before they will agree. Best of luck and keep us posted about your journey to becoming a loser. Kathy

Hi Kathy..Thank you sooo much for writing to me! You really cheered me up and I'm defintely not going to give this up! My gosh..sounds as though you have really been through a mess! Isn't it just absurd/crazy that we have to be put in this position by insurance companies and Doctors!!?... I will be thinking of you..Please keep me posted on your efforts. Again..thank you so much for the helpful reply! Kathy W.

Hi Kathy, I too have John Deere Select insurance. I was denied for surgery as well. even though my doctor submitted 27 pages of medical history. Their reason for denial was my primary care physician had not documented my last six month diet history as well as they wanted him too. So my surgeon suggested that I join the Weight Loss Management Center here in Greeneville. I go every Monday and weigh, get a B12 shot and vitiamins. They do excellent documentation every week on my weight loss attempt and they have a physician that signs off on the notes. I also called John Deere and requested an appeal form. They will mail this to you and you then provide as much documentation as possible to support your reason for the appeal. My primary care physician wrote a great letter of appeal for me and I submitted that letter along with some more documentation for my co-morbidities. They told me I would have an answer by the 25th of this month. So if they approve me, then I can go ahead and have my surgery. If not, I will complete six months at the weight loss center and then try again for approval. Just don't give up. But call now and request your appeal form.

They say DR. Ray in Swee****er always gets his people appoved. I don't know with the way Tenncare is now if anyone is going to be approved. Has anyone heard of anyone being approved in the past week or so?

sorry this has taken so long to get to you but I have been away fromt he boards for awhile. I hope that by now you have appealed the decision of your ins company. I have worked with several wls potential patients and know the struggle your going through, not to mention I have been there myself. the best advice I can give you is to appeal and perservere and dont take no for an answer, my experince tells me that perserverance, persistance andpatience are the keys to success here. read through my profile and feel free to use any letters posted there, and if you really feel the need for legal help dont hesitate to contact me directly. I dont have much time these days but am always willing to help when I can.