Need some direction Re: denial

HAven't got the official denial letter but a phone call to teh PCP confirmed It was on the way. It was sent in adn denied by the insurance company. this was completely expected sincxe the PCP is a non believer. What the BEST next step, should I hire a WLS atty and fight the appeal. Should I change PCP and start over, is that even possible? Not sure what the next step is.  ALSO, I was denied for the actual surgery BUT rather for the referral to the surgeon. Based on the psyche eval.

My .02, get a PCP who supports your decisions. Then find another quack. You want all the advocates you can get in your corner when you start knocking on the insurance door. I was denied once before finally being accepted. I have a BMI of 48. No other co-morbides to speak of other than elevated blood pressure, but I'm not on medication for it. I owe it all to my surgeon and doc working the system that they know much better than I did. If your advocates aren't able to get it done for you, then you can look into an attorney or self pay if that's an option. It took what I thought was going to be a 2 month process and turned it into 7. Have patence, but don't give up...   Jim

The psyche eval said I was a high risk for failure BECAUSE of my past eating habits.  She is of the opinion that I need to go through a diet program for 6 monthes before I should get the surgery. This is required for the medical group she works for. It is NOT required by my insurance or medical group. I have ordered a copy of all my notes tests and labs and referrals from PCP so I have them when I make the switch. It take 2 weeks for them to get it all together.

I was very unfortunate in that my insurance provider turned me down. Two days later my bariatric surgeon called them and I was approved on the spot. I just couldn't thank him enought for going to bat for me....he's a great guy. Get a team that will work for you. Good luck..... Dave

Who is your insurance provider?

i'm so sorry for you. i hate it when the janitor has all the power over your operation. i would suggest getting a pcp who is all for the surgery. then, that surgeon's staff will be expert in fighting for your pay off. that's all they do is argue with the insurance companies and they usually win. so i would start over from square one. also, if you come across any psych or other doctor along the way is not for the surgery, just excuse yourself and get out before anything is even on paper. i would ask before the appointment if they are anit-wls. i'm serious, otherwise it's a waist of time and money and one more item on the list you'll have to explain away. screw the 6 month diet, get a doctor that will shove you in the pipeline like yesterday. they're out there, believe me. good luck.....carbonblob

Ronnie  Blue Cross CA. thanx guys

Huh... Just one question. What's a PCP?

I'm sorry to hear about your denial.  You should definately appeal. It would be a good idea to ask your surgeon to recommend a new PCP and a psychologist that you could use. Keep trying.