Question:
I have

They requested I go to a psychologist and a nutritionist, which I did. The psychologist, whom I talked to for approximately 15 minutes, make the comment in her report that I admitted to "over-eating!" Now this insurance has denied me because they "fear" I will not be able to conform to the diet postop! Amazing. How many others on here admitted to over-eating??? Gee, I wonder why I am fat? Not because I eat like a bird!! Maybe the psychologist was mad at me because in the MMPI I found 2 instances where the "word" "oftener" was used!! I said, "this is not even a word, has anyone ever commented on that before?" She assured me it was a word and I asked her to prove it (not necessarily in those words). She got a dictionary and could not find that "word" at all!! Because it is not a word! Anyway...I am extremely upset about all the crap they are putting me through. I have been on EVERYTHING....Medifast, Pondimin, Xenical....as well as every diet know to manking and a few I made up! I think they approve people who are on state assistance and have Medicaide, but if you are just getting Medicaide for "medically needy" and only temporary they do not want to approve surgery! Anyone else have this problem? I am really wanting to discuss this with an attorney. Please help! Thanks so much....Julie    — jtyler (posted on February 24, 2004)

February 24, 2004
Just got back from my PCP and she said that she would write a letter stating that I have been on medically supervised diets and have had temporary success and have failed in the end. She said that she would have been more concerned if I had said that I do not over-eat! Anyway, I just wondered if anyone had been denied by Medicaid (Iowa) under the "medically needy" program and, if so, what they did to attempt and gain approval. Can they legally say that I need to go to yet another nutritionist or another doctor and give it one more go with another doctor-supervised diet and then approve someone else without the same criteria?? I was on Jenny Craig for months and conformed quite nicely and was successful and kept the weight off for about 1 year. I have gained it all back plus approximately 100 more. I am rambling, I know, but I am just hoping that someone else has shared this experience and can point me in the right direction as to how to fight this. I will be getting the letter from my PCP and I plan on using some of Sharon Brittain's information and penning another letter to insurance......is there anything else I can do?? Thanks in advance to anyone who can help!! Julie
   — jtyler

February 24, 2004
Hi Julie, Here is a phone number to the Iowa Foundation 1-800-338-7909 or 383-1173 ask for Marilyn Walsh. She's a nice lady & she will explain why you were turned down. I was turned down as she mis-read mine! She read my highest weight (over 30 yrs ago when I was a teen) & had seen how I had lost the weight. I kept my letter simple, I explained I wanted to be able to take walks, ride a bike again & go to the amusement parks & be able to ride! I also told them that without surgery I would probably die (co-morbids) & in fact I got my approval only to turn around & have a mild heart attack! Your doc needs to keep the letter simple, tell your co-morbids & your risks & that this is in your best interest. Write your own & do the same. Don't go overboard but tell of your deepest feelings, the pain you've been thru etc. Email me anytime if I can be of any help. Carolyn
   — Carolyn

February 24, 2004
My psych said that over-eating caused by depression is almost like a co-moribidity. If we weren't depressed we wouldn't overeat, if we didn't overeat we wouldn't be overweight, if we weren't overweight we could physically do more, if we could physically do more, we wouldn't be overweight. It's a viscous circle. I would ask if that particular psych was experienced in assessing people for weight loss surgery. I don't know what option you have, but hopefully they will offer you the opportunity to get a second opinion. Just as a side note, the word "oftener" is in my 2001 Merriam Webster dictionary. It's an adverb, an alteration of the Middle-English word "oft" which is more commonly used in modern language as the word "often."
   — Shayna T.

February 24, 2004
The guy I went to put in my report,"patient admits to drinking 3 glasses of sweet tea daily". So what? I have to have something to drink with my meals and that was my choice. Now he will not file my insurance and he is a preferred provider for Blue Cross. They told him what code to use to file and he said no. That was not what he did and it would be insurance fraud. How can something the insurance company tells you to do be insurance fraud? Needless to say, the insurance company is investigating. Good Luck to you.
   — CAMFR

February 25, 2004
Julie email me([email protected]) your phone number, I can help you obtain a lawyer or help you get advice from a top attorney.
   — Trudy S.