Scared it's not worth it..sorry long

Well, I was denied, again, for surgery. My six months of  visits don't count since some of the times I went to the doctors for more than one thing. So even though we discussed my weight and diet, since that wasn't the "primary" reason for the visit, they don't count and they want me to start over -- again.  This puts me into next year and ANOTHER $2000 out of pocket cap.  I don't think so. So, I called a lawyer and have sent them all the paperwork. A friend is lending me the $1100 (includes a fee for expediting the process) and as soon as the check clears, I'll be paying the lawyer.  I know CA has stated that insurance can not deny surgery due to the six month diet...I wish NJ did the same. I'm scared, I am still paying off the bills from last year -- all the tests including the sleep study and Cpap...now there are more from a procedure I had to have this year.  At this point I have made my out of pocket cap again --- I need to have surgery this year -- or it's another 2 grand next year.  Further in debt with nothing to show. I'm so scared that I'll be spending another $1100 and the lawyer won't get the denial overturned.  I feel like I am shelling out this money and will never get what I need.   This is crazy. 

What type of insurance do you have?

You need to continue the appeal process and your doc's office should be helping you. Depending on your insurance, you might have to do as much as 3 appeals and then you can request a peer to peer review. That is where their medical director and your surgeon get on the phone and work it out. In my experience, they will approve before a peer to peer. Personally I think it's because the medical director looks at it and realizes he doesn't have a leg to stand on, so he has his staff call us and cancel the peer to peer because he approves it. Do not give up, you can begin another supervised diet "just in case" while the appeals are happening, but do not just give up, exhaust the appeals process, the patient usually wins! Bonnie

AWW! DAG! DONT GET TO PISSED OFF. GOD HAS THE FINAL ANSWER IN ALL THAT WE DO!  RESEARCH, RESEARCH, AND RESEARCH! CALL THOSE INSURANCE COMPANY AND ASK WHAT U NEED PRECISELY! I WISH YOU THE BEST! THE BIRTH OF A NEW YOU IS WORTH ALL THE THE HASSLE! BELIEVE ME IT IS. CAUSE I KNOW YOU WANT THIS SO BAD!