Self Imposed Exile

Well...it has been a long road with still no end in sight.

I went to a dark place after my initial denial in late December. That was denied by review of a OBGYN then the appeal was reviewed by a surgical oncologist and also denied. I didn't care about much of anything. I have finally crawled out of the hole I was in.

Luckily I did not gain any weight BUT my a1c went up. I just saw my surgeon this last week and he is resubmitting and confident an approval with it. It seems everyone...the cardiologist, PCP and surgeon were shocked I was denied. It seems I got the short straw that day. Mind you the reasons for denial is that I had to good of numbers...never mind that I weigh 330 give or take pounds.

Also a new development I had to start pills for my thyroid. So far it hasn't done much in way of weight loss or energy.

Sorry your road to approval has been filled with bumps, twists and turns. Interesting that an obgyn reviewed the claim. Doesn't seem like their area of expertise. Good luck this time around.

Was your thyroid overactive or underactive?

Insurance companies use medical directors from all specialties.

I didn't know that. Interesting. I guess Bariatric docs would always leans towards approvals.

There is no choice in which doctor reviews a case. Some companies have the requesting doctor call to talk with a medical director, and it is whichever one is available. Some companies schedule times for a discussion and will supply the medical director's name and specialty prior to the discussion.

Thank you! It is less active I'm on the beginning dose and haven't had any weight loss as of yet. My doctor seemed to be surprised about the reviewing doctors.

Denials are always surprising in this day and age. Did you ever call the insurance company and ask for a copy of their criteria?

Has to be so hard. Good Luck

I researched before I even asked my doctor. They required a certain BMI over 40 with only two comorbidities. I have more than two...I think I just got the short straw that day. All of my doctors and health care professionals were shocked I was denied. My PCP's first thought was that I changed my mind.

Thank you!

Hope it works out. It is life changing. Submit an appeal.

I work at a Drs office and the people that do the authorizations even on simple meds at insurance companies..and deny them simply amaze me. Half of our day is spent on the phone fighting insurance companies to get daily meds covered for patients.