Insurance Frustration

Ugh... I feel so crappy about this. I guess I just need to vent in a place where people understand. I started this whole procedure the end of February/ beginning of March. I've already gone to my seminar and the psychologist and everything, and they were supposed to have started my insurance stuff last Monday. They said everything looked great, and that they didn't see where anything would be a problem. Well, I got a call on Friday saying that because my BMI was less than 40 (37.8) that they had to have proof of my other comorbidities, being either sleep apnea, diabeties or hypertension. Well, I have hypertension, I'm just not taking medicine for it, I'm prediabetic (once again, not taking medication...yet), I have high insolin levels, which I'm taking metformin for and I have really mild sleep apnea, which is getting progressively worse. So... they are JUST now wanting records for this. It's not like they're just now finding out my BMI is less than 40... so, I don't understand why they're just now presenting this as a problem. Had they said something to begin with, I could've already had the records...but now, I have to just start the process to drudge up all my records, and I don't know how long it's going to take. So... hopefully I'll get these records within a week, and then it's going to take 30-60 days from then to get my insurance approved. I feel like it's never going to happen. Maybe I should take this as a sign. *sigh*. This whole BMI thing is ******g me off anyways, because I'm 115 lbs over weight, but because I'm 5'10, it makes my BMI a couple digits less than 40...UGH!!! Anyways... I don't know if there's anyone out there that can relate to me, or has any advice for me to help me get past this. Any input at all would be appreciated.

Hang in there and give them what they want, all the documents in the world if that's what they want. What is another 30 or 60 days if it means they'll approve you. I had to hang in there another 6 months and it was well worth it. Don't give up. Donna 338/238 -100

Donna is right, and she was very patient. These things take time. In the past it used to take 30-60 days. Now because of the increase in requests it can take as long as 4-6 months to overturn a denial. It will happen. You sound like you meet the criteria. Don't forget to remind them that the NIH criteria is 40 without co morbs and 35 with co morbs. Seems like you meet it in my book. Best of luck Gary Viscio obesitylawyers.com

I can't really help in any way, except to say that I understand completely. I started with my PCP in January, and my information did not get submitted to insurance until the middle of March, then 3 weeks later, they still say they have no record of my request. The surgeon's office has faxed twice and mailed once. I have almost 70 pages, so it seems a little hard to believe that it got lost.....Now my insurance representative is getting in on it and she has submitted the 70 pages and I'm still waiting. I will not be surprised if they ask for more stuff. I feel like Dorothy in the Wizard of OZ......... Keep your chin up and try to hang in there....I have heard from most people that you can usually win in the end, it just takes a lot more of a fight for some.

I don't have any helpful suggestions, but I CAN sympathize. I have been working on this since my PCP told me in January that I needed this surgery. I had my surgical consult at the end of February and my information was submitted in the middle of March. The surgeon's office has faxed it twice and mailed the whole thing (almost 70 pages) once. Three weeks later, the insurance company says that they have no record of any request for re-cert for me. Now my insurance representative has gotten all 70 pages and has submitted them to her contact, and I am still waiting. I expect them to ask for more stuff..... I feel like Dorothy in The Wizard of OZ. Hang in there and just keep giving them what they ask for. I have heard that eventually, most people win through persistence.

Sorry.....I thought the first reply was lost, so I did it again....

It's the most frustrating thing that I've ever been through. I started with Doctor visits in November. Insurance first posted in January and now I'm waiting for the results of the second appeal. We'll just hang in there together. Cathy P

Hang in there. I'm sorry you have to go through this. But, it will be worth the wait. I had to wait about 6 months for my surgery and it had nothing to do with insurance. So, I don't have to tell you how it feels. Someone has a key to good health and they're holding it back. Just a life test. Be strong and best of luck Gary