Insurance denial imminent :(

Apparently my pre-cert is going to be denied because MWM was supposed to be six consecutive visits. I had 8 or more visits, counting my Primary Care, but they weren't all consecutive. I'm at a loss. I'm on the pre-op diet, preparing for surgery that was supposed to be next week, and now it looks like it will be in four months.

That is the frustrating part, I know they want to make sure we are ready, but some of the rules are silly.

I had to have at least 1 month in between each NUT visit, but I also had to have one each calendar month.  So I started on Sept 10th and had to then go Oct 10th or later and then Nov 10th or later.

I also had to have 3 yrs of weight history, but I had not gone to any Dr. in 2011.  So I had 2012 and 2013, and got pictures showing I had been this large in 2011 (like I was a 60 BMI in 2010 (when I did have weight history), but lost it all after the last Dr vist and then regained).  Then because I could not have surgery until hte beginning of 2014, that would have counted.  Seriously, how does me getting weighted in Dec 2013 and then again in Jan 2014, count as 2 yrs weight history, but going from 2010 - 2013 with a consistent BMI over 55, not count?  It is not like I was barely over the line, I was way over.

But the good news is, you can keep doing what you need to, follow the crazy rules and have surgery.  Sure it is later than you wanted, but you can do this.

I went through all of the pre op requirements then had to have leg surgery and wasn't allowed to have surgery because I couldn't walk.

starting over, from the beginning was so annoying but, the worst was after five CONSECUTIVE months, my PCP got sick and cancelled my sixth appointment and rescheduled two days into the next month.  My insurance wanted me to start over again!! 

Both my PCP and my surgeon went to bat for me and the insurance company gave in.  It's so frustrating! See if any of your doctors will make calls for you so you don't have to reschedule.

Good luck!

marty

Thank you for sharing your experiences! My pre-cert was indeed denied. My plan today is to call my PCP and have her submit additional visits I've had with her. Then, I have a service called Health Advocates. My representative from that service is going to call my surgeon with me on the line to find out what is possible. We've already talked to my insurance company to find out about the appeal process, although the rep frustratingly wouldn't tell us anything about the details of the denial.

I've lost so much weight, sometimes I wonder about going it alone. I do think that if I lose my date and have to do four more months of MWM, I will find another surgical practice. I am so frustrated by their lack of organization. Every time I went in for MWM, I got a different story from EVERYONE I talked to about how many more visits I needed to do, and at one point was even told that they didn't have to be consecutive.

My #1 reason for having this surgery was to lose weight for having kids. Every delay just slays me.

I was APPROVED. I cannot believe it. I don't know how it happened and I'm not sure I want to, but I am overwhelmed with relief. 

Congratulation on your approval, just goes to show you to take it one day at time!! You never know what will happen!! Now it begins!!