denied because of age almost 16

My daughter will be sixteen March 1 which is just around the corner. Pacific Care HMO sent a denial  because of her age. Can anyone help out. Dr Higa her surgeon call and talked to the insurace Dr that denied Sabrina, the nurse said Higa got very angry about the call. We are now putting together letters to send. Higa is writing, I am writing, Sabrina Chiroprator is writing and i have a call into Sabrina's PCP. Maybe someone has a winning letter that I could use to help with my letter. It is so disappointing. My DH got his authorization and is scheduled for Jan 11. They were going to have wls hopefully on the same day so it has just made it that much harder for Sabrina to see her Dad getting his surgery without her. He needs it bad so we couldn't wait to see how long it will take for Sabrina to get approved. 

Sorry to hear that. I had the same problem. My insurance would not approve it until I was 18. I tried appeal letters twice but no luck. So, I dont have any help. I had to wait. Hope something will work out for her.

I hope we willl be able to cut through all this red tap. what insurance did you have did they just say you were to young?

I have medcost. They never came out and said it was my age, but we knew it was. They told me that I didnt have enough medical diet history, which I had more then enough....Insurance can be so stupid!

Hi Cathy, If you have already filed your appeals with your HMO and they continue to deny, you do have an option at that point to file a grievance with the Department of Managed Health Care. They will look into it to see if your HMO has grounds for the denial, if they handled it properly, etc. They do have the power to push your HMO should they favor in your daughters medical needs. I don't know if they will or not, but it is worth a try if you have not done so already. Many Blessings Merry Christmas Joie

Hi Joie, We are sending in the first set of letters of appeal. So maybe they will do the trick. Thanks for the advice I will do everything and then some to get this for my daughter. I just picture some skinny old Dr that has never been fat putting the denial stamp on her file. They don't know who they are messing with lol. It is very stressful I can hardly get my daughter to go to school she is depressed as I would be.

Dear Kathy, My daughter is 14, beautiful, bright, but she feels ugly, worthless and I had to keep her back a year in 7th grade because I couldn't get her to go to school. I ended up pulling her out of public school and she re-did her 7th grade year in a Charter program, she did attend 3 core classes in a classroom setting, the other courses were taught at home. This year, in her 8th grade session, I could barely get her to go because of the 3 core classes so I ended up pulling her out to be home schooled completely. I am not a teacher and I struggle like crazy to get her to even do assignments, she has no care anymore, feeling no self pride at all now. I am a single Mom working too, it is often more than I can bare. I feel so frightened for her because I know she is so smart and the world is at her finger tips if she could just find that confidence. I know she needs to be in a support group of her peers, to lose weight. Are there any? No! I am going to see if I can get something going on my own after the 1st of the year, however I feel I am running low on my stretching abilities now! But who knows, it may all work out in the end, if she begins to lose some weight, becomes competitive with other kids also going through the same things and also trying to lose weight, she may gain some of that much needed self acceptance and acceptance from others like her, she may start caring more about life in general. Let's hope, Let's pray! The Department of Managed Health Care will not touch a case unless you have filed a 30 day written grievance with you HMO. So I am glad to hear you are doing that, it will get the ball rolling or ... in your case, the heads flying!! Thank you for getting back with me and please keep me posted! Joie

This is really sad to here, I hope that after sending those other letters they do final Approve her. I am 15 (wont be 16 till sept.) and also have Pacific Care HMO, I already have done the 6 month Healthy Roads Program and am now taking the next steps in my Journey to WLS. I talk to Sabrina Every once in a while over myspace to get an update on how things are going but havnt' in a while. So not only am i sad for her but it definetly gives me a heads up for what i might have to deal with now. Well i hope the best for you all!  -Moddy

Thanks Moddy, Sabrina is really devistated by this turn of events. She has been depressed and sad. Give her a shout on My Space she could use some teen support.

I tried when I was 16 and was 440lbs...got denied and had to wait until I was 19...when I was 600lbs. Just tell your daughter not to get depressed about it. Thats what I did and I felt like it was over and I gave up for awhile - and thats how I gained that extra weight...keep trying don't give up! And have her do whatever she can before she gets approved to try and stay focused on her goals and to just think of this as a small obstacle on her road to a new life.