*******s denied me!!!

Frankie
on 7/23/11 8:04 am - NY

Ok OH family, I need your assistance. My insurance company has denied my request for revision: this is what was said in my letter:

"after consideration of all available information, our medical director has determined that the requested procedure will not be covered for the following reason(s): based on your health plan criteria this request for weigh reduction surgery cannot be approved at this time. Your bmi of 38.2, there is no history of Type 2 Diabetes Mellitus or heart disease. No high blood pressure, no cardiopulmonary problems. Medical criteria not met".

So i went back and read my policy for bariatric surgery, so I guess I should eat myself to a bmi of 40 in order to get approved. This is some BS! SMDH! I gotta figure out what to do next.

Frankie

airbender
on 7/23/11 8:11 am

oh I am sorry for your denial. but it sounds like they are following NIH criteria if you don't have any co-morbidities then you need a bmi of 40 (i don't agree with that but it is pretty standard) the sad thing is with a bmi of 38.2 depending on your height etc it could be a difference of 10 lbs or so, and for me i know in time i would just continue to gain without wls.... but I guess they have to make a cut off somewhere. sorry for your denial

Frankie
on 7/23/11 8:20 am - NY

DS on 09/26/11

It sucks! I will try and talk to my doctor's office to see what we can do next. I will also call the insurance company on Monday to speak with them as well. I swear its a shame to jump through hoops to get healthy.

ALSGIRL02
on 7/23/11 9:06 am

RNY on 08/30/11

I AM SO SORRY ABOUT YOUR DENIAL HOPEFULLY YOU AND YOUR DR. CAN COME UP WITH SOMETHING OTHER THAN GAIN MORE WEIGHT. BUT I DO HAVE A QUESTION IF YOU HAD RNY IN 2004 WHAT ARE YOU TRYING TO GET APPROVED FOR NOW? I HAD THE LAPBAND AND IM SWITCHING TO RNY.

Frankie
on 7/23/11 11:56 am - NY

DS on 09/26/11

I am seeking a revision from RNY to DS.

Shavonne P.
on 7/23/11 11:37 pm

I am so sorry to hear this Frankie. Please keep us posted on any updates you get.

Nothing feels better than being able to go into ANY store and fit their clothes!

Band to DS
on 7/23/11 11:54 pm, edited 2/3/12 10:09 pm

Unfortunately, I had to delete this post due to privacy concerns.

Got a lap band in 2008. Tried hard, but didn't lose much weight & developed swallowing problems. Fought my insurance company for almost a year & finally had a band to DS revision on 5/11/12. Have now lost 125 pounds. Yay!

smileyjamie72
on 7/25/11 6:06 am - Palmer, AK

DS on 12/29/11

Frankie,

You have gotten good replies on your thread, especially from Airbender. The standard guideline is a BMI of 40..... or....... BMI of 35 with co-morbidities, like what your denial letter said.

Prayers & hugs.... This WILL work out!!!!! Keep TRYING!!!!!
-Jamie

RNY 2/26/2002                           DS 12/29/2011
HW 317                                     SW 263 BMI 45.1
SW 298                                     CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003

Normal BMI 24.8 is my GOAL!!!

GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**

Frankie
on 7/25/11 6:17 am - NY

DS on 09/26/11

I am going to see Dr. Roslin and my PCP and have them measure and weigh me again to see if my bmi will be >40.

I re-read my policy and unless I have co-morb's I won't get approved, so back to the drawing board.

Thanks for the love, I hope you get your approval soon!

smileyjamie72
on 7/25/11 6:30 am - Palmer, AK

DS on 12/29/11

Frankie,

Insurance companies SUCK.... so basically, what you ploicy is saying is THEY WANT YOU SICKER.

What??!!?? I will never understand them!!!!

Good LUCK, dear!!!!
-Jamie

RNY 2/26/2002                           DS 12/29/2011
HW 317                                     SW 263 BMI 45.1
SW 298                                     CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003

Normal BMI 24.8 is my GOAL!!!

GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**

*******s denied me!!!

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*******s denied me!!!