Did you get denied...then appealed

What did you get denied for? Did your appeal get overturned?

 Yes I was denied by my medical group for a referral to a bariatric surgeon. My medical group said I didn't do a 6 month medically supervised diet  (btw you don't need to do that in the state of CA). Appealed to my insurance, the denial was overturned. My surgeon put in for RNY and was approved the first time out. I do not want the RNY so I asked my PCP to refer me for DS (duodenal switch). Referral was thrown out by my medical group, denied by my insurance twice, and now in IMR (independent medical review) with the DMHC. I too live in CA and we are very lucky to have the DMHC (dept of managed health care) who are very pro WLS and oversee HMOs.
Insurance companies will deny you for any reason they want: you didn't do the supervised diet, you didn't lose weight before surgery, you're not fat enough, blah blah blah blah. If you want WLS make sure you know if your insurance covers WLS, what their specific criteria are, all the different surgery types available to you, your right to appeal and get WLS if you meet NIH criteria. Best of luck to you

Wow! I am sorry to hear your WLS experience has not gone smooth. My insurance provider is Kaiser. They "require" you to attend a 6 month "Option Program" and lose 10% of your weight.

I am in my 2nd month of the program. So far the classes have been helpful, but I am struggling with the weight loss. 10%...ouch! It's very challenging.

My BMI is 39.9 I don't have any co-morbities. I am anticipating the insurance denying me to have WLS surgery. I guess you can say I am a healthy obese person.

Any advice?

 Are you sure you don't have any comorbidities? High cholesterol? High blood pressure? Joint pain/ swelling? Missed or irregular periods (PCOS)? Do you snore, if so you could have sleep apnea. There really isn't such a thing as a healthy obese person. And even if you are healthy now, your body will start having adverse effects from being MO soon enough. With your BMI being borderline I think you'd be better off proving you have at least one comorbidity.

To qualify for WLS you need to meet NIH criteria: BMI >40 w/o cormobids or BMI >35 with comorbs.

You don't have to do the 6 month supervised diet or lose 10% of your weight. Read my thread in my signature. That being said you need to be careful because Kaiser could deny you since you don't officially meet NIH criteria since your BMI isn't 40 or over. 

SURPRISE!!!  I am also in the Options program through Kaiser.  Today was class 18.  The case manager came in to have us fill out the decision survey to let them know what type of surgery we want.  Then she proceeded to tell us that Kaiser has changed their requirements for WLS.  As of now If your BMI was not 50 or above at the date of orientation you do not qualify without any co-morbidities.  If your BMI was between 40 and 49.9 your case will be reviewed and you need co-morbidities in order to qualify for surgery.  I KNOW WHAT I AM TALKING ABOUT.  MY CLASS WAS TODAY, JANUARY 23, 2009 AT 1:45PM.  They do not care what class you are on or what sacrifices you have made to make the classes.  They have decided this is the way it is and they dont' care.  I have been really impressed with Kaiser and their proactive attitude to preventative medicine until today.  I cannot believe they are doing this to people who are only 6 classes from graduating and moving on to surgery.  IT IS UNFAIR AND CRUEL!!!!!!!  Good luck to all who have to deal with this "situation."  KAISER DOESN'T CARE ABOUT US THEY ONLY CARE ABOUT THE MONEY.  SO WE HAVE TO BECOME SICK FIRST BEFORE THEY WILL HELP.  But keep cashing my monthly premiums i pay, no problem.  THANKS KAISER, YOU GUYS ROCK!!!