You are denied...arghhh...

So I received the letter of DOOM today --- denied because "member's BMI is less than 40 and existing co-morbid conditions are treatable by more conservative measure."... Huh?  When I was in the office I was just over 40 at 40.18 or something miniscule like that but it read 40+.

Just went to the psych eval last Thurs - felt really great about the decision to pursue VSG.  Dr. gave me info on lapband failure to give to my PCP.  I am going to get on the phone with the center first and then the insurance company.  I want to do this in an un-emotional manner...could not have done it yesterday so I'm glad the letter came on the weekend. 

They didn't even have the letter from my PCP yet so they could not have seen my historical weight for the past 10 years or so...

Sorry I'm rambling -- just needed to get this off my chest.  Is there anything specific I need to know about this process -- I'm appealing for sure -- I got nothing to lose -- except about 100 pounds of ugly fat!!!!!!  Thanks for listening...

Meg

So you appeal the denial with the reading from the doctors office. It will also help if your 5 year history is also over 40. But if you can get your doctor to write that you have tried and failed to lose weight, it goes a long way.

Keep trying, at some point, squeaky wheels do get greased. Liz

Thanks, Liz --- they're going to hear me squeak for sure.  I am going to ask for a specific letter from my PCP...

You've got the right attitude - appeal, appeal appeal!  We have several members of this board that had to jump through some major hoops to get insurance to approve. 

I can't help you with the process... but I think you're going along the right path.  I'm sure someone who had a struggle will pipe in and give some advice.

Meg, I would also think a letter from your PCP, describing how the "conservative" treatments have not imporved your co-morbids, would be helpful.  Good luck with the appeals process.

So here's the update after leaving 2 voice mail messages --- ins co calls back and leaves a huge message on the process for appeal... then surgeon's office calls back and they submitted incorrect info on my BMI - so they are sending it over via email today and some man named Joe will be in touch with a final determination...

I'm scheduled for the 6 month class beginning 8/26 so I'm not cancelling that and we'll see how it rolls!

Breathing easier this afternoon...  Thanks for your thoughts!

I didn't have to play the insurance game, but many people on here have. Some memebers on the VSG board have the actual letters they used for their appeals posted on their pages. Do a search for insurance denial or appeal or something and you should be able to find plentey of threads about what worked for others. I'll keep my fingers crossed and say some prayers for you!

Meg, good luck.  I hope you get everything worked out with the insurance company.
Linda

Good idea, Shannon -- I'll do some searching today.  Thanks for the kind message and prayers!!!!  Had a good dream about this process last night!  I'm hopeful!!!!  I'll let you know what I find out!

Meg

I got denied the first time too.
Hang in there and appeal.
Maria