It's been denied

so amerigroup Texas denied the surgery 8 days until the surgery date. The reason? I am well managed with my health issues..aka diabetes and such. They approved all the previous crap and then denied it.

Im basically being punished for trying. The doctor is going to call them but I doubt they'll budge. Heck they denied my flu shot.

I'm really upset and feel defeated.

Oh dear! Try to stay positive. A lot of people get denied at first and then with a peer to peer review (your doctor talking to a doctor at the insurance co) get approved. I'll keep my fingers crossed for you.

There is always an appeal process. Don't give up, and stay on top of your doctor.

I'm sorry, that really sucks. Keep fighting!

I'm so sorry. I can only imagine the hurt and upset that you must be feeling.

Don't give up! Please don't give up! Your doctor may be able to sway them. If not, I had two friends (married couple, BMIs of 38 with diabetes and 44 with no co-mordities) that were denied that had the surgery by saving up the money over several months and having it in Mexico. They had an excellent doctor there, in Tijauana. You may not be able to have it now if they don't change their minds, but that doesn't mean that you cannot have it someday. Do your research and stay on top of it. Try to keep from becoming stagnant and eating your feelings, because I know that's so, so easy to do.

You are worth it.

You probably met a deductible.. sometimes they put up a fight to see if you are stubborn enough. Plus they want you to pay your deductible next year.

don't give up.

I just feel so deflated. Like my soul got a good/bad jolt to it. I will appeal.

I am in a dark place but should find out tomorrow for sure if they say yes or no to my doctor. If it's a no then time for the official appeal. Another long wait period then i'll have to start over.

Thanks everyone.

Usually, the first decision is made by a civilian. In the appeal, your doc can ask that a bariatric surgeon review the decision (or at least a medical doctor). Generally, the appeal works. Try to stay positive. Virtual Hugs.

Ditto what Knitter said. I had to fight 8 months to get a knee surgery done that I desperately needed, and filed FIVE appeals. (That was just because the insurance company sent me down the wrong appeals path so I had to start over, normal is three.)

The first rejection is basically a rubber stamp by a claims adjuster. Not even a nurse, usually. The doctors can request a peer to peer evaluation where the doc talks to another doc, and I've heard that most of the WLS rejections are overcome there.

It sucks that they did this to you so close to your surgery date, that causes a lot of anxiety. But check with your surgeon's office... they deal with this stuff all the time and will have the best clue whether they'll get it overturned or not.

Hugs, and hang in there!

Melsbells,

Remember this decision is not about you. It's about the insurance companys bottom line. This surgery works to relieve/reverse diabetes and many of the complications of it. They want you sick and on many medications. It is what makes them money.

FIGHT THEM! until there is no other appeal then if still not approved go another route.esearch things for natural control of blood sugar issues.

My surgeons group was involved in a study( my Mom and I were both in the study) that genetically linked obesity to the genome..thru the genes that are reflected in digestion process/liver/gall bladder /pancreas/and fat storage systems. This is not your fault! It IS a struggle to overcome.

. Hang in there and let us know how you come thru it all.