Denied

I found out today I was denied by Accordia. I didnt have enough documented information in my file, no thanks to the Med Surg Group of Oak Hill. Needless to say I am extremely disappointed and dont know what my next step will be yet. Folks, just a reminder here. Make sure your PCP is documenting. Force them to make notes, no matter what. Best wishes to all. I will keep in touch. Jen

Its not about the 7 months; its the financial and emotional strain for me. The psych evaluation is only good for 6 months. I had to pay $400 for it before I got my consult w/ Dr Shin. It would have been paid by Accordia AFTER I was approved. Since I was denied, Accordia wont pay for it. Now, I have to go another 7 months/visits, which will bring me past the 6 month expiration date for the first Psych Eval, so I will need another costing me an additonal $400 and then I have to pray I get approved so Accordia will pay for it. Not to mention the additional expense of seeing my PCP on a monthly basis, another consult w/ Dr Shin, ect.. We're a one income family here. Its bringing additional stress on us. And, I feel helpless when it comes to my medical records. I cant believe I had this past years worth of visits with Med Surg group that werent documented properly. All they ever said to me was "Lose weight" "walk" "Do this, do that..." But, never documented it. Why? They mentioned my co-morbidities, but never the fact that they were monitoring me. When I ask them why, they refuse to answer. I was with this group for over 10 yrs. Its not like I had access to my medical records so I could monitor them. It just angers me that they can get away with this. I told myself when I began this process that if I were denied, I would take it as a sign that this was not meant to be. Im just so frusterated. I dont know what I should do next.

sweetie, we understand your frustration and anger... you have a right to feel all of those emotions but someone bigger than the insurance company is saying "now is not the right time". I am a firm believer that God puts obstacles in our way to keep us safe. How many people lived on 9/11 because they missed their train that morning? There is a reason for all of this and you may never know the true reason... just have faith that it will happen when the time IS right. Now for that office!!! After each visit, give them a few days but let them know you want a copy of your visit notes. Give them a few days to get things documented (alot of docs will dictate notes at the end of the day... transcriptionist may take another day or two to get things typed and then another day to get it filed into your chart). Have them mail your copies to you or if its convenient go pick them up in person... call them the day before so the records will be ready and you don't have to deal with a huffy receptionist. Get a binder and keep impecable records yourself. STay on that doc and that office... you really don't want another delay after jumping thru hoops for an additional year. Call your ins. company and find out exactly what they want to base their decision. Going to the office and discussing weight and comorbidities isn't enough. They are going to want to see that you followed an 1800 cal (or less) or another type of dr. advised diet with monthly followup. During this time keep a log of your exercise... what you did on what day and for how long... this is not necessary for approval but include it with your diet info to the ins company... it will show them that you are serious about wanting this surgery and that you are ready to do what you need to do to get it. Good luck and keep the faith! Wanda

I believe the same thing... GOD feels the time isnt right. Last week was the hardest part for me. Today, a week later, Im thinking more clearly and working on moving forward. 7 Months isnt that long, I guess. I was just really excited about 'being there' in 7 months instead of 'starting there' in 7 months. I do know it was a test of my temptation. I am an emotional eater and when my emotions were tested by my denial, I was extremely tempted to binge. I didnt and Im proud of that. If there is one thing this has shown me is that this IS a modification of lifestyles.. not just a quick fix. I have talked to Katie @ Dr Shin's and she told me what I needed. I also talked to Vida @ Accordia to see exactly what I need. Hopefully, Accordia will not make too many changes when they rewrite their policy in July. But, I will deal with that when the time comes. Until then, Im going to be as specific as possible with my PCP. Thanks for writing. I appreciate the feedback. Jen

Jen, Sounds like your head and heart have come together and now time will fly... Stay focused and stay aware... I am VERY proud of you for not giving into that binge desire... thats a tuff one to combat and it sounds like you fought it with a vengence... keep up the good work... This 7 mos is going to fly by... you've the 4th to focus on and then summer with the kids.. then school starts back up then Halloween, and before you know it Thanksgiving and Christmas will be right here... then time to breath a sigh of relief.. you made it thru the holidays... and then you are right at your 7 mos mark... be here before you know it... fortunately you will lots to occupy your mind between now and then. Keep up the spirit, keep up the desire... you will get there, your dream will come to you! Hugs Wanda