*sigh* I got denied

I spoke with CIGNA today and was told my precert was denied as I did not do a physician supervised weight loss program (which I most certainly did) or that I had not had a nutritional evaluation (yet the insurance won't pay for me to go to a dietician). I wanna scream and cry and throw myself on the floor and kick and yell some but a 358lb grownup looks silly throwing a temper tantrum. I know getting denied first time out is common, but I am just sick about it. I don't even know what the next step is. I guess they will tell me in my denial letter. I swear if I had not needed to work, I would have told them to shove their job up their ass and walked out. Bottom line is with the obesity, I am no longer in any shape to go back to working the floors as a nurse. On the other side, Dr. Wright's office did resubmit my paperwork to BC/BS of IL. The girl stated she didn't code it wrong the first time but the code she gave it is considered investigational. Well, duh, you won't find an insurance company anywhere that will precert something not approved by the FDA. I am so bummed by all this I had a cigarette and I hadn't smoked since April in anticpation of this surgery, but I'm beginiing to feel like it'll never happen now. Worse thing is I have heard the rumor that on October 1st, 2004 lots of insurance companies are gonna write WLS as an exclusion to their policys. Well, I'm going to drown my sorrows in a bowl of ice cream and maybe have a good cry. Love to you all and congrats to those who got a surgery date today, Kelly

Kelly, I'm sitting here feeling so sad for you. I wish there was some kind of magic dust that I could spread for you, I surely would. I hope that the insurance company will approve it next time round. Know that we are out here in cyberland rooting and praying for you. Hugs, Carol

*Hugs* Sorry to hear this, Kelly! If the October 1st thing is true - You still have 2 months to get whatever paperwork they need/want! Don't give up, especially when your THIS close! Good luck, be patient, and best wishes~ -Katie

Thanks Carol and Katie for commiserating with me. I'm still pretty bummed out this morning. I am unsure if I have to start the whole 6 month diet process again since the doctor didn't send me to a nutritionist, or if I can see the nutritionist now. Well I am off to work; I'm gonna call the surgeon's office today and see what they say.

Oh Kelly, I'm so sorry! Keep away from the ice cream...unless it's sugar free I know with my first denial, it was because my BMI wasn't quite there (38 as opposed to 40), but my doc wrote a letter and I did as well. Sent those in and I was approved. Email me if you need to chat. Hugs! Jen

Kelly I'm sorry you got denied I did too the first time over a psyh eval. Do not give up!! I would go on to the nutritionist and have your visits set-up every three months or something... At least they didn't say Not Med needed !! Keep plugging away at it , look at far you have come and a short way to go now !!! Best wishes Linda

Kelly - I am so very sorry that you got denied. I got denied the first time too, but the second attempt was successful and I just had surgery last week. Stay the course - good luck!! Jules

Ok wait a minute, you got denied for not having 6 months of a physician weight loss program, but you actually did?? If you have actually done it all you have to do is submit this as proof & that should take care of that. As far as a nutritional eval, can't your doctor do that? If not how much could it really cost to have one done? Call tomorrow & make you an appt, ASAP & then get the records proving your 6 months of medically supervised diet. Get off your butt, stop whining & get it in gear, you can do this!!!!!!! ( A little tuff love never hurt anyone). No one can do this for you, so JUST DO IT (to steal the slogan from Nike). TTYS Candi

Ok, today I am over being depressed and I AM JUST PISSED! How dare some ********itting states away decide what is good for me when I proved I needed this surgery to live. APPEALS, HERE I COME!

I know it is hard not to get down but I was denied 4 or 5 times!!!!! (I lost count!) Just be persistent...as the ins person at my docs office told me "It all depends on *****views it" and just keep at it until they either figure out that a) you are not going to give up and b)the right person reviews it. I had to go to a nutritional consult just to make sure I undertood the nutritional implications of the surgery, what I would have to do afterwards, etc. (I have BC/BS of TN) Even if you have to pay out of pocket, its worth it to get approved. But most of all - KEEP AT IT! Write your own letter, get your own doctors notes proving your medically supervised attempts to lose weight, etc. Lisa