Too Healthy-DENIED!!!!!!!!!

Well with my surgery scheduled for Oct 4th, 2 weeks away, I am now officially denied my Medicaid. I am apparently too healthy to have this surgery by their standards. I don't have any serious co-morbidities and therefore will not be approved. I am so bummed. I have researched, gone to support group meetings, doc appts, psychiatric evals and nutritionist consults. I waited 11 months to get my consult!! I've seen my PCP, Neurologist and Endocrinologist to make sure that all was okay with me before surgery and now this!!!! When I read that others have been approved because their BMI is high with no-comorbs I think why not me? It doesn't always happen folks. My BMI is 48 or 49 depending on the day and I still don't qualify. What can I do now? Any advice would be welcomed after the day I have had. Now what's instore for me? Wait till I have diabetes and then undergo a risky complicated surgery!!??? I quess it's fsfmd day. Feel sorry for myself day. God I hate insurance companies!Thanks all. -Tiffany

I am so sorry! I really wouldn't know how to comfort someone in your position. I have just started the journey and I am clueless when it comes to insurance companies. All I have to give is my prayers and support. I know....definitely...dearly I would want someone there for a shoulder to cry on! I hope for the best for you. And keep positive, as hard as it may be. INSURANCE COMPANIES ~Ashley

sooo sorry this has happened to you but just fight it ok ive heard of many cases where it was denied at first but they kept fighting it and got it at the end im not sure of what u can do to fight it but u can write a letter to the insurance to reconsider and listing every single problem u have due to your weight post on the main board for a sample letter cuz there is some reall good ones out there good luck

Wow.. I would fight that one. Most insurance will approve you if your BMI is above 40 OR 35 w/co morbids. I was at 49 when i had surgery but other than being OBESE, there was nothing wrong with me. Perfectly healthy. FIGHT IT!!! Find out thier exact requirements for the surgery. If you meet them, then they have to pay.

You can try for an appeal, but with Medicaid they have strict standards and it is almost impossible to get them to pay when they say no. The best thing to do is look for a job that you know there insurance will cover it. HTH Tina

Hi Tiffany, I am so sorry! This really does suck because you were so prepared, but don't let it get you down. I was denied at first by the surgeon I went to. He said I was too young at 23. So I took time and tried to lose on my own. I lost 50# and gained back 65 then got high blood pressure and then went to a better surgeon and he was the best! My only thought here is that everything happens for a reason. But keep fighting if u really want this. Try to appeal. Write letters...have your doc write letters. Keep bugging them...they might think you will just give up because you are young and you can show them how wrong they are Best of luck to you and keep us posted! Keep your head up! Big Hugs, Sara

Hi Tiffany Sorry to hear about your day, but there is hope . You can always make an appeal to the insurance companies to over turn there dicission. I did! Have your PCP and all your other doc's that you have seen to write another letter to your insurance company stressing the issue of future health risk,and have them to also break down furture cost of vs. WLS now. My PCP wrote a letter to my insurance compnay telling them that I didn't have any co-morbidities now, but with my family history they were do to come, and in the long run it will cost the insurance more. Also, you should write a very descriptive letter explaining your struggle's with your weight. I wrote a 17page letter that had all my family history and my struggle. I hope this helps you, after you make your appeal call them everyother day, sooner or later, they will rule in your favor.

I tell ya hun, what my surgon did, is he told them that i had back pain. And I got approved right away. No problems. Maybe if your surgon will send another letter to them telling them that your back hurts (or something) maybe they will approve it. either way.. FIGHT IT!!!

I can't believe they did that to you!?!?!?!? That is crazy. I would appeal it and fight! You went through all that in 11 months, I would not leave them alone. Constantly call them, write them, have your PCP and surgeon and family write them. You can beat this. I believe there is a section on appeals or insurance denials here at ob.com. Look around and maybe look around on the message boards. Keep us posted on what happens. I'm praying for you! I too was healthy except for my weight, but was still able to have the surgery. Make sure you include on your letters that if you do not have the surgery, the chances of you losing weight are very slim (your doc can back you up on this) and if you continue to gain weight, you will begin to have co- morbilities and be on many different medications which will cost the insurance company. I hope this helps. Keep in touch! -Lynn 8-16-05 297/267/150

I didn't have any co-morbitities either. We are all young, so chances are we haven't developed them yet. Do you have diabetes in the family? I did which was a big factor in my approval. Try that along with joint and back pain. Good luck. Liz