Question:
Can they deny me because of past depression?

I have done everything to get approved. I provided all information and went to all appointments. After the third denial they are saying that I have had a history of depression and they do not feel like I have proved that I would be able to follow the postop way of life. I would think that being on Jenny Craig for 33 weeks and attending weekly meetings, and getting down to a weight of 134 pounds would suggest otherwise. What can I do?? Please email me any suggestions [email protected]    — jtyler (posted on April 22, 2004)

April 22, 2004
Hmmmm. Are they denying you because you've sought and received treatment for depression in the past? If so, shame on them ... obesity and depression go hand-in-hand for many of us. If they're suggesting you are suffering from untreated depression, and further suggesting that it might interfere with your ability to succeed with WLS, they may have a point. (I doubt it, because it's generally all about saving money by denying the operation by any means necessary, but we can play along with them here. ;-p). If you're not sure, and if it's the latter, I would try to enlist the help of a WLS-friendly psychiatrist or psychologist (or social worker/counselor), to demonstrate that you are getting treatment for depression (IF you are, in fact, depressed). That would seem to plug *that* particular loophole. This is a crummy reason to be denied, though. Hang in there, and keep on trying!
   — Suzy C.

April 22, 2004
I would fight this. I was treated for anxiety. Big deal. They can only follow the law and the policy and it does not say gee will she follow the new way of life? Well if you dont you'll get sick. However, if there is a history of serious depression with suicide ideations they are more concerned that you will forget your vitamis, meds etc. Fight them hard. Gary Viscio www.obesitylawyers.com
   — gary viscio

April 22, 2004
Depression is NORMAL for MOs. Cant get around and live life like others, poor self image. and other causes/ We REALLY need to get a law passed requiring WLS coverage, just like mental health care. Insurance companies are just trying to save money.
   — bob-haller

April 22, 2004
Thankyou all for the responses. I have been treated in the past for depression. I have had depression probably most of my life. I am not, however, psychotic nor do I have suicidal ideation. I definitely feel like I am being jerked around. I don't know what to do to fight this. I feel like this surgery was my last hope of living a normal life. I have, like most of you all, tried everything. I have been successful and lost weight and then gained it back. They say that they are not convinced that I will adhere to the way of life...how can they say that about anyone??? Any suggestions on ways of fighting this would be much appreciated! Thanks!
   — jtyler

April 22, 2004
In my opinion they are walking a very fine line of discrimination. I'm assuming you had a psych eval that determined you were good to go for surgery. If so they have a lot of guts saying the doctor doesn't know what he or she is doing. <p>Based on their answer I sure would have never gotten approved as I have been treated for depression, at times quite severe, since 1995. It has been very well controlled for the past 4 years but I must continue to take my meds. That is one reason I wanted my treating psychiatrist to do the psych eval than a total stranger that didn't know me from adam. If you have not had a psych eval that would be the first thing I would get done. If you did, ask them to send you to another psych for a 2nd opinion. <p>What was the reason for the first two denials? It sounds like each time they are changing the tune. This may well be a case where a lawyer will be successful, especially if it looks like discrimination. Basically they are not saying they won't cover the surgery but coming up with bogus crap to avoid it. Good luck! You do not deserve to be treated this way. Depression is a disease and nothing to be ashamed of. Treated properly someone with depression can live a very normal life.
   — zoedogcbr

April 22, 2004
This sounds really fishy. What jerks! Normally depression is considered another justification FOR surgery, not against it. Remind them that you are aware that this is the norm according to the medical establishment. "Following the postop way of life" can only be proven through doing it, and tell them you're more than happy to see a nutritionist and counselor (which they should pay for anyway!) to ensure you're on the right track. Fight this tooth and nail! Good luck hon! Christie, 7 mo post, -170
   — christied

April 22, 2004
Does you policy refuse to cover treatment for alcoholism because someone was treated for depression in the past? I doubt it. I would appeal this as far as I could go. Sounds to me like they are grasping at straws in order to deny your surgery.
   — koogy

April 22, 2004
I assume this is your insurance saying no, not your doctor, right? Have you seen a psych doc? If so, and they felt favorable toward you having surgery, they should be able to write you a letter stating that you are a good candidate and your depression is under control and may improve w/surgery, etc, etc. Have you done this? BTW- it DOES sound like insurance grasping at straws. You should push them.
   — LMCLILLY