Insurance denied again
gspea
Posts: 412 Member
Well I officially got the FEDX package yesterday from the Insurance company. they upheld the original denial. Arrrgggghhhh - now going to go thru a 6 month medically monitored weight loss program. I think the ins company just wants to delay it hoping I will give up!!! Not gonna happen.
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That is exactly why they denied it. A certain percentage will give up. But don't quit trying. Jump through their hoops and eventually they will approve it. It's a game but you can win it. Best of luck!0
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Part of the game they play is to see if you will stick to it. They do not want to pay for the surgery and have the person not make the life long changes that go with it. So no quitters. You can do it and they will approve you. Just keep at it. I will be praying for you.0
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I log my food here and print it, and keep it in a binder, all of which my coordinator faxes to the ins company so they can see that I am serious. try it.0
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i was denied initially, did the 6 month thing too... but honestly it was the best thing i could have done! i saw my dr regularly and i saw a therapist. i love my therapist and give her credit for my success! I was also denied 3 additional times after my 6 month monitored period... I gave up after the last denial. The woman at the surgeon's office said that I would have to re-appeal myself.. i had given up but received a phone call from her a week later. She had reapplied on my behalf because she said the surgeon and his staff really believed that it was in my best interest and I had all the right pieces to the puzzle to become a success... after my last appeal they approved my surgery and voila! i am where i am today! 91 pounds lighter!
moral of the story.... DON'T GIVE UP! DON'T EVER GIVE UP!!!!0 -
i was denied 4 times and then they tried to pull this "reapply" bull**** when the new year rolled around, but we got our employers associates working on that. we would've sued them but they gave in. stick with it. lots of tears but worth it.0
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Wow I hadn't thought they might deny more than once. But I will keep my journal and keep at this. I know I can lose the weight but i really could use this tool in my toolchest to keep it off. I so want to be at a healthier weight. Thanks for the motivation.0
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Don't give up. I had to make sure that this time they had put all the medically necessary reasons on the form and I had to jump through a lot of hoops, but it was worth it in the end. It is worth the 6 month period, because I actually am seeing a great therapist who doesn't make me feel like it's all my fault for my weight issues. It also has given me enough time to become mentally and emotionally ready for this journey. Keep the faith.0
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I understand that comment about getting ready mentally and physically. I am trying to follow some of the guidelines that I will be following after surgery. And I have found out that I do need this time to mentally prepare myself! I will keep everyone updated on this journey.... Thanks for the words of support! I really needed that.0
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It's not easy, but you can do it. While I was preparing for this, they put me on a 1200 calorie diet, but as I got closer I started to do protein shakes twice a day and one meal, that really helped me to see what it was going to be like after surgery.0
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what were all of the reasons that they gave for the denys? I am having a hard time waiting the six months, how long does it take once you get denied? This is making me a little nervous0
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In Canada where we have Universal Health care (thank god by the way) I had to pay for mine..it is not gov funded. and so 16000 for my surgery. I still have no regrets I would jump through a few hoops for 6 months if I could have had it paid for..but in my case that would have taken 5 years. if at all so no thanks I'll pay and no regrets0
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They told me that it was denied because of no Medically Supervised Weight Loss proof. I have been on some form of diet since forever - and even lost 90 pounds one year - but since it was not supervised by my doc every month - it did not count. So I am going thru six months of visiting the doc every month for the dietician to ask if I have any questions, comment on my understanding what I need to do, the PA listening to my heart, asking me if I have any questions. July will be six months - and then we will re-apply. I meet all the requirements other than have this one thing.
I am nervous that they will deny again. Not sure what we will decide to do then. I have a friend who paid for it herself by taking a second mortgage out on their house. My hubby and I have discussed and I will not go to that extreme - my friend ended up losing her house...
I will keep you all appraised of the results. So far I have lost 16 pounds and the docs office is happy with me on that.0 -
Hopefully the 6 months will be good for you. It will help your mindset get ready for lifelong changes, it will make your healthier to get into surgery. Just keep going.
I had the good news/bad news scenario. Bad news, bariatric surgery was specifically excluded from my policy. The good news, no hoops to jump through. I paid a pre-negotiated cash price with the Dr., anesthesia, and hosp. 17K. Fortunately we had the money. It is an investment in MY health. I will spend less money on food, less money treating future health problems and more money on new clothes :-)
My Doctor told me the average WLS patient breaks even in 2-3 years.0 -
I am also going to use this 6 months to prepare and try and lose as much as possible before surgery so that will be less after. I was afraid to lose too much because I don't want them to deny me for losing it on my own. I don't have trouble losing, its keeping it off. I am also using this time to get all the appointments in with the therapist, nutrtionist, and hopefully all the paperwork ready. My six months will be up in the middle of August, but I'm going to keep trying to lose on my own till then. Keep us posted0
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It will fly by fast. The therapist has been the biggest help for me, and she has even given me different relaxation techniques to help out. The nutritionist will be able to give you plenty of insight on the best way to lose, but in a safe way. I didn't have to do their products until two weeks before surgery, so basically it was learning how to eat more of the right foods and less of the junk.
Make sure that you have a great support system at home with your family and friends. That work great for me this time. You can do this, your definitely not alone.0
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