How to pass this sentence???

Again, I'd like to thank everyone who sent up a prayer for my approval, but I guess it is not to be at this time. My insurance company, in their infinite wisdom, says that I haven't tried hard enough or long enough (20 years?), so I MUST go to the doctor once a month, every month until the end of the year before submitting again. My doctor does not agree, but I guess that is besides the point. So, I am now asking for your support and suggestions on how to get through the next 8 months as painlessly and positively as possible. Please--no negative comments and don't tell me to just "suck it up", I know I have to do that. I am asking for POSITIVE suggestions to help me through this difficult time without losing my good humor and sanity. I have been fighting for this since January of 2005, and I am SO tired and heart broken right now. Not to mention dealing with my failing health. I am trying to hold it together while facing the coming months--year. So....if you have any constructive ideas on how to deal with this setback, please let me know. Thank you all so much, I DO appreciate your support. Dawn

Hi Dawn, so sorry to hear that you were turned down. It happens to so many people *****ally need WLS. Don't despair, fight back girl. Go to your Dr. and have the supervised diet program for the next year. Then you will already be on your way to becoming healthy when you are approved. Best of luck, Pattie

Hi Dawn- I don't have any constructive ideas, but do want to tell you I will pray for you. I can only hope that you will find the next months just flying by until you are ready with new ammunition to fight again. I haven't been approved yet and may have a long haul ahead of me, but I do believe if and when it is meant to be, it will happen. Hang in there! Hugs, Wendi

Thank you Wendy for your kind words. I have gotten over the depression that I was feeling the other day, mostly with the kind words and encouragement from you and all the others that responded to my plea. I just read your profile, and (for what it's worth) everything that I have read about United Health insurance is that they give quick approvals if you qualify. I will wish that for you. At my doctor's visit last night, she put me on Adepix-P, another diet drug. Oh well, maybe I will lose 20 pounds and feel a tiny bit better. It certainly won't disqualify me for surgery, my BMI is 47. Thank you again, and make sure to let us know how things go, Dawn

My insurance company required a medically supervised diet plan sometime in the 2 years before applying for approval. I met all the criteria of medical necessity when I first applied, except for the supervised diet. I had given up structured diet programs as I'd learned that I'd be throwing my money away. I didn't ask my insurance ahead of time like I should have so I would have been prepared. I studied the surgery for 2 years before contemplating asking for approval, but I didn't bother to call my insurance to get the nitty gritty of the requirements. Dumb. I first applied for authorization in February '04 and didn't have surgery until December '04, went through 2 appeals before finally getting the OK. When I went through it was a 3-6 month diet; now I hear it is 6 months minimum. Some insurances I've heard require a year. The 40 years of information from every diet club/plan I'd followed didn't matter. I went to the dietitian at my surgeon's clinic for 5 months before resubmitting, and was approved. Luckily, my health insurance covered the dietitian's services since I had the diagnosis of morbid obesity. The insurance company holds all the cards since they have the checkbook. Find out what your insurance will consider as medical supervision for this diet and do it. After surgery you will have to follow a strict diet, too, so this is good practice for you and shows the insurance company that you are really serious about this. The insurance company wants to make sure that you can't lose weight by following what is generally accepted as a safe way to lose weight. You and I were well aware that we weren't going to lose weight with this diet, but the insurance company doesn't want people to make surgery their first option. (I know people who got aproved with little other advance dieting attempts in their lives, and most of them were pretty shocked at what the surgery changes in your life.****pt a detailed food and exercise journal (which you are going to need to do after the surgery, too), which I submitted to the dietitian and was submitted to the insurance company. I actually gained weight the first month following the dietitian's recommendations. Failure to lose weight following this type of program is more indication that you are indeed a candidate for surgery. I was very frustrated at having to do this supervised diet. My health was bad in many ways, too, and the prospect of going through more months without surgery was traumatic. My emotions were like a rollercoaster. I was depressed and weepy. I was angry. I couldn't contemplate going to a support group meeting, couldn't stand to see others getting approved and losing after surgery. However, in retrospect, I see that it was a valuable time to learn to look at my behavior, to gain greater understanding of myself and how I respond to situations in my life. It also increased my patience, which is very valuable after surgery when you hit those dreaded plateaus. The time of supervised dieting also gave me time to contemplate what life would be like after surgery. This makes a huge change in life, at least it did for me. I can eat anything, but not very much at one time. My whole relationship with food and my life has changed. I really had time to think about it, did I recognize the changes that were coming, was I willing to make those changes. What if I had side effects, which luckily I do not but some people do. Was I really willing to go the distance? I really thought through all of this while I was fighting the insurance company, and from the time when I got the approval letter in the mail I was peaceful and calm, sure that I'd made the right decision. Don't let the insurance company win! They want you to give up! Be tough and fight all the way to your approval. A couple of more months isn't much compared to what will happen if you give up. Sue O.

Thank you Sue. As I told Wendy (and Patty too)....the worst of the depression has lifted. I was just SO frustrated. If I had known about the requirement, I could have had it done before submitting the first time. Oh well, I have taken my new diet drug ("speed") in to be filled, and will do what is required. I really doubt that this one will work any better than any of the others, but I can play their game, and if I do lose a few pounds, I will be closer to my ultimate goal. I just hate to take drugs, and we all know that as soon as you stop taking the drugs, (or for me....after a month when they stop working) we will gain everything lost and then some. I have been working on this SO long, and I have already incorporated many of the changes that will be required later, but.....practice makes perfect, I guess. I will continue to lurk around this site, and post encouragment when I can. Thank you again for sharing, and I am glad that things are working for you. Dawn

Hi Dawn, Sorry to hear about the denial. I had a problem before having surgery of even finding a doctor that would recommend the surgery to my insurance. My own primary care doctor told me to "go on a diet". (like that never occured before?!) I found a second one and he said maybe I need to just do some push up's - pushing myself up and away from the table sooner! How profound! And he went to medical school for how many years to make that recommendation?! I finally contacted the surgeon (Dr. Chua in Milwaukee, WI) who I wanted to perform the surgery and asked their recommendation for a primary care doctor who has had success with insurance referrals. Thank God I did because after seeing the new doctor, getting his blessing, having him write the letter to insurance and getting my approval, it only took 2 weeks! Granted, some of the things in the letter from him were stretching the truth a bit (I sounded like I was near death) but it made results happen! Long story short, contact the surgeon and ask for a recommendation for someone they have had success with. Never give up!!!!!! Good Luck! - Lois