I've been denied the procedure

[Guest guest]

Hello everyone,

I haven't been around for a long while,just waiting for my insurance

to approve my surgery.

I got a call from my to be surgeons office,Monday,saying my

insurance,Gateway Health plan,denied my surgery.

They claim it is not medically necessary for me.

They said I didn't do a required documented monitored diet by a

dietician for 6 months,(I did 4 w/dietician & 2 on my own with my

pcp).They also said my thyroid levels are high & nothing is being

done to control it (I am on synthroid for 6 1/2 years now) and they

said I didn't have a psych evaluation or clearance to do the

surgery.This too was completed & All this info was faxed to them.My

DR appealed their decision & The insurance company uphealed the

appeal.My DR said there is nothing I can do,they just don't want to

pay for it.

I REFUSE to give up because I KNOW I need this surgery!I called my

insurance & said I want to file a complaint.I am supposed to get a

call Monday morning from someone to tell me what will happen then.

Has anyone else gone through a denial?

If so I would be really apprecative to hear about what you did.

I really need help.I have to get this done!

Thanks for listening everyone!

Kim - raoulbabu@... or wickedcarver@...

[Guest guest]

>

> Kim,

>

> Did you do the dietician during the first 4 months or the last 4

months?

> What would the insurance company say if you did another six

months (or 2 if the

> dietician was the last 4 months) of dietician monitored diet?

What kind of

> documentation do they require for the thyroid? I have been told

by my

> doctor that if there is any deviation from the prerequisites

established by the

> school district that I work for, the surgery will be denied.

This includes

> monitoring by physician, dietician and a documented exercise

program for six

> months. I hate the idea of waiting six months, but I can't

afford to pay for

> the surgery out-of-pocket. I wish you luck in filing your

complaint.

>

> Joan

>

>

>

[Guest guest]

Don't give up hope! I have been fighting the process for 2 years

now and I am set for surgery on May 22nd! It's been a long, hard

road, but I'm getting there! My insurance also said it was not

medically necessary and I'd have to go through a 12 month DR

supervised diet. 12 months sounds like a really long time, and I

did not have the patience for that, so I gave up... then last fall I

decided to try again... My biggest supporter was my family DR. He

was willing to do whatever to help me be accepted! He agreed to see

me monthly and monitor my diet/wt/exercise. A friend of a friend

was accepted after she " failed " the sleep apnea test, so I figured

I'd ask for that test... I failed it too! I was moving and pulled a

muscle in my back and my dr gave me muscle relaxers. I went in for

my regular monthly check in and GAINED 7lbs and my blood pressure

was up from the shock! So that was the day I asked for ANOTHER

medical necessity letter... He wrote about my dangerous situation

with the sleep apnea, my strained back from all the weight I was

carrying around, and my increasing blood pressure.... I got my

acceptance letter about 3 weeks later!

Something else my surgeon's office suggested.... Write a letter to

your insurance company and spell out all your health risks. Let

them know that by denying you this surgery, they are in fact cutting

your life span short, blah, blah, blah... and have lots of " medical

quotes " ... And WHEN you die due to some complication that could have

been reduced by this surgery, your family will all know who to " go

after " ... then at the bottom, let them know you have also sent a

copy to all your family and your ATTORNEY! Maybe that will work for

you??

I was denied 3 times before I finally got accepted... you just have

to keep pushing! I was too willing to give up easily because I just

didn't have the energy to fight... Had it not been for the

willingness of my family DR, I would have given up... I think the

insurance companies give you so much " crap " because they want to

know how serious you are about having it done. They don't want to

fork out all that money! Keep fighting, don't give up! Jenni

>

> Hello everyone,

> I haven't been around for a long while,just waiting for my

insurance

> to approve my surgery.

> I got a call from my to be surgeons office,Monday,saying my

> insurance,Gateway Health plan,denied my surgery.

> They claim it is not medically necessary for me.

> They said I didn't do a required documented monitored diet by a

> dietician for 6 months,(I did 4 w/dietician & 2 on my own with my

> pcp).They also said my thyroid levels are high & nothing is being

> done to control it (I am on synthroid for 6 1/2 years now) and

they

> said I didn't have a psych evaluation or clearance to do the

> surgery.This too was completed & All this info was faxed to

them.My

> DR appealed their decision & The insurance company uphealed the

> appeal.My DR said there is nothing I can do,they just don't want

to

> pay for it.

>

> I REFUSE to give up because I KNOW I need this surgery!I called my

> insurance & said I want to file a complaint.I am supposed to get a

> call Monday morning from someone to tell me what will happen then.

>

> Has anyone else gone through a denial?

>

> If so I would be really apprecative to hear about what you did.

>

> I really need help.I have to get this done!

>

> Thanks for listening everyone!

>

> Kim - raoulbabu@... or wickedcarver@...

>

[Guest guest]

I wouldn't listen to the doctor............... you need to take control

............. your pcp is going to have document the two month weight control

program, you'll need to get your thyroid under control............. these are

all things that aren't too much for you to work on............ just remember

it's a delay......... it's taken me close to a year, with EKG, gall bladder

scan, colonoscopy, current pap, current mammogram, tread mill, six month class

dieting, documented evidence of exercise attempts, and much much

more.......................... just think of it as a premature submission, and

get it

finished............ nail down the requirements and meet them..............

best

of luck to you. Hogan

[Guest guest]

I've Been denied as well... Our insurance company refuses to do anything.. I

have to pay for anything that is weight loss related ... And My Dr said I

should have the surgery! Insurance said NO WAY!... Has anybody had this

happen?? What did you do?? where do people like us go for help from

here?.... Thanks... .

>

>Reply-To: GastricBypass-LOSERS

>To: GastricBypass-LOSERS

>Subject: Re: I've been denied the procedure

>Date: Mon, 01 May 2006 21:24:16 -0000

>

>

>

>

>

>

> >

>

> > Kim,

>

> > 

>

> > Did you do the dietician during the first 4 months or the last 4 

>

>months? 

>

> > What would the insurance company say if you did another  six

>

>months (or 2 if the

>

> > dietician was the last 4 months) of dietician monitored  diet?  

>

>What kind of

>

> > documentation do they require for the thyroid?  I  have been told

>

>by my

>

> > doctor that if there is any deviation from the  prerequisites

>

>established by the

>

> > school district that I work for, the surgery  will be denied. 

>

>This includes

>

> > monitoring by physician, dietician and a  documented exercise

>

>program for six

>

> > months.  I hate the idea of waiting six  months, but I can't

>

>afford to pay for

>

> > the surgery out-of-pocket.  I wish  you luck in filing your

>

>complaint. 

>

> > 

>

> > Joan

>

> >

>

> >

>

> >

[Guest guest]

Hi Kim,

Nice to see you online. However, I have 2 years working in insurance

defense law. ly, you haven't complied with the insurance

company requirements.

1. YOU CAN NOT GET AROUND THE 6 MONTH SUPERVISED DIETARY

REQUIREMENT. THE COURTS HAVE UPHELD THIS REQUIREMENT. Why did you

violate their standard of being supervised by a dietician. They said

6 months with a dietician. That means 6 months with a dietician.

PERIOD.

2. Everyone needs a psych clearance. You are no exception. Before

the insurer spends $40,000 for your weight loss surgery they need

proof that you understand the life long changes as well as proof

that you have the capacity to deal with the massive emotional and

physical changes brought on by massive weight loss.

3. If your thyroid levels are too high you are not medically stable

for surgery. Your kidneys will not be able to synthesize the

paralyzing agents of the anesthesia and you will never wake up from

the surgery or remain comatose.

You need to contact your insurance company and speak to your claims

rep. Ask him/her what you need to do to qualify for surgery. Be

calm, be respectful and LISTEN to what you are being told. Moreover

COMPLY with their instructions.

Good luck to you,

Robyn

>

> Hello everyone,

> I haven't been around for a long while,just waiting for my

insurance

> to approve my surgery.

> I got a call from my to be surgeons office,Monday,saying my

> insurance,Gateway Health plan,denied my surgery.

> They claim it is not medically necessary for me.

> They said I didn't do a required documented monitored diet by a

> dietician for 6 months,(I did 4 w/dietician & 2 on my own with my

> pcp).They also said my thyroid levels are high & nothing is being

> done to control it (I am on synthroid for 6 1/2 years now) and

they

> said I didn't have a psych evaluation or clearance to do the

> surgery.This too was completed & All this info was faxed to

them.My

> DR appealed their decision & The insurance company uphealed the

> appeal.My DR said there is nothing I can do,they just don't want

to

> pay for it.

>

> I REFUSE to give up because I KNOW I need this surgery!I called my

> insurance & said I want to file a complaint.I am supposed to get a

> call Monday morning from someone to tell me what will happen then.

>

> Has anyone else gone through a denial?

>

> If so I would be really apprecative to hear about what you did.

>

> I really need help.I have to get this done!

>

> Thanks for listening everyone!

>

> Kim - raoulbabu@... or wickedcarver@...

>

[Guest guest]

OOPS! TYPO!

This should have read 26 years working in insurance defense law.

Robyn

>

> Hi Kim,

>

> Nice to see you online. However, I have 2 years working in insurance

> defense law. ly, you haven't complied with the insurance

> company requirements.

[Guest guest]

If you have a policy exclusion for weight loss surgery you are out

of luck. Can you change insurance policies during open enrollment at

work?

If you are disabled for one year or longer apply for Medicare

benefits.

If you are indigent try seeking medical benefits in your local

county.

Most of all don't give up the battle of obesity. Start walking.

Start cutting back on unhealthy food choices. Be proactive in your

fight to regain your health. If you don't have the ability to have

WLS then try another weight loss method.

Robyn

> >

> > >

> >

> > > Kim,

> >

> > > 

> >

> > > Did you do the dietician during the first 4 months or the last

4 

> >

> >months? 

> >

> > > What would the insurance company say if you did another  six

> >

> >months (or 2 if the

> >

> > > dietician was the last 4 months) of dietician monitored 

diet?  

> >

> >What kind of

> >

> > > documentation do they require for the thyroid?  I  have been

told

> >

> >by my

> >

> > > doctor that if there is any deviation from the  prerequisites

> >

> >established by the

> >

> > > school district that I work for, the surgery  will be denied. 

> >

> >This includes

> >

> > > monitoring by physician, dietician and a  documented exercise

> >

> >program for six

> >

> > > months.  I hate the idea of waiting six  months, but I can't

> >

> >afford to pay for

> >

> > > the surgery out-of-pocket.  I wish  you luck in filing your

> >

> >complaint. 

> >

> > > 

> >

> > > Joan

> >

> > >

> >

> > >

> >

> > >

[Guest guest]

Jenni,

I was told that even if it's medically necessary, Its EXCLUDED and they

will not cover it.. My dr sounds your dr Im sure he would fight this with me

as well.. And to add to the mix I have a severe thyroid disorder.. Do you

think That helps or hurts my chances? Have any of you ever BEEN excluded

from coverage?? If So, what did you do? Is it the same process of

advocating to get your surgery!? Thanks for the help guys... ...

>

>Reply-To: GastricBypass-LOSERS

>To: GastricBypass-LOSERS

>Subject: Re: I've been denied the procedure

>Date: Mon, 01 May 2006 23:10:21 -0000

>

>

>

>

>Don't give up hope!  I have been fighting the process for 2 years

>

>now and I am set for surgery on May 22nd!  It's been a long, hard

>

>road, but I'm getting there!  My insurance also said it was not

>

>medically necessary and I'd have to go through a 12 month DR

>

>supervised diet.  12 months sounds like a really long time, and I

>

>did not have the patience for that, so I gave up... then last fall I

>

>decided to try again... My biggest supporter was my family DR.  He

>

>was willing to do whatever to help me be accepted!  He agreed to see

>

>me monthly and monitor my diet/wt/exercise.  A friend of a friend

>

>was accepted after she " failed " the sleep apnea test, so I figured

>

>I'd ask for that test... I failed it too!  I was moving and pulled a

>

>muscle in my back and my dr gave me muscle relaxers.  I went in for

>

>my regular monthly check in and GAINED 7lbs and my blood pressure

>

>was up from the shock!  So that was the day I asked for ANOTHER

>

>medical necessity letter... He wrote about my dangerous situation

>

>with the sleep apnea, my strained back from all the weight I was

>

>carrying around, and my increasing blood pressure.... I got my

>

>acceptance letter about 3 weeks later!

>

>

>

>Something else my surgeon's office suggested.... Write a letter to

>

>your insurance company and spell out all your health risks.  Let

>

>them know that by denying you this surgery, they are in fact cutting

>

>your life span short, blah, blah, blah... and have lots of " medical

>

>quotes " ... And WHEN you die due to some complication that could have

>

>been reduced by this surgery, your family will all know who to " go

>

>after " ... then at the bottom, let them know you have also sent a

>

>copy to all your family and your ATTORNEY!  Maybe that will work for

>

>you??

>

>

>

>I was denied 3 times before I finally got accepted... you just have

>

>to keep pushing!  I was too willing to give up easily because I just

>

>didn't have the energy to fight... Had it not been for the

>

>willingness of my family DR, I would have given up... I think the

>

>insurance companies give you so much " crap " because they want to

>

>know how serious you are about having it done.  They don't want to

>

>fork out all that money!  Keep fighting, don't give up!  Jenni

>

>

>

>

>

> >

>

> > Hello everyone,

>

> > I haven't been around for a long while,just waiting for my

>

>insurance

>

> > to approve my surgery.

>

> > I got a call from my to be surgeons office,Monday,saying my

>

> > insurance,Gateway Health plan,denied my surgery.

>

> > They claim it is not medically necessary for me.

>

> > They said I didn't do a required documented monitored diet by a

>

> > dietician for 6 months,(I did 4 w/dietician & 2 on my own with my

>

> > pcp).They also said my thyroid levels are high & nothing is being

>

> > done to control it (I am on synthroid for 6 1/2 years now) and

>

>they

>

> > said I didn't have a psych evaluation or clearance to do the

>

> > surgery.This too was completed & All this info was faxed to

>

>them.My

>

> > DR appealed their decision & The insurance company uphealed the

>

> > appeal.My DR said there is nothing I can do,they just don't want

>

>to

>

> > pay for it.

>

> >

>

> > I REFUSE to give up because I KNOW I need this surgery!I called my

>

> > insurance & said I want to file a complaint.I am supposed to get a

>

> > call Monday morning from someone to tell me what will happen then.

>

> >

>

> > Has anyone else gone through a denial?

>

> >

>

> > If so I would be really apprecative to hear about what you did.

>

> >

>

> > I really need help.I have to get this done!

>

> >

>

> > Thanks for listening everyone!

>

> >

>

> > Kim - raoulbabu@... or wickedcarver@...

>

> >

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>We are a very active support group.

>

>If the email becomes overwhelming,

>

>please change your setting to NO EMAIL!

>

>Please contact Group Creator

>

>Robyn@...

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

Hi .

If WLS is excluded from your policy and is NOT a covered benefit the

insurance company will not pay for the procedure. Your thyroid

illness can help you qualify for WLS IF it is under control and you

are medically stable for surgery.

Robyn

> >

> > >

> >

> > > Hello everyone,

> >

> > > I haven't been around for a long while,just waiting for my

> >

> >insurance

> >

> > > to approve my surgery.

> >

> > > I got a call from my to be surgeons office,Monday,saying my

> >

> > > insurance,Gateway Health plan,denied my surgery.

> >

> > > They claim it is not medically necessary for me.

> >

> > > They said I didn't do a required documented monitored diet by a

> >

> > > dietician for 6 months,(I did 4 w/dietician & 2 on my own with

my

> >

> > > pcp).They also said my thyroid levels are high & nothing is

being

> >

> > > done to control it (I am on synthroid for 6 1/2 years now) and

> >

> >they

> >

> > > said I didn't have a psych evaluation or clearance to do the

> >

> > > surgery.This too was completed & All this info was faxed to

> >

> >them.My

> >

> > > DR appealed their decision & The insurance company uphealed the

> >

> > > appeal.My DR said there is nothing I can do,they just don't

want

> >

> >to

> >

> > > pay for it.

> >

> > >

> >

> > > I REFUSE to give up because I KNOW I need this surgery!I

called my

> >

> > > insurance & said I want to file a complaint.I am supposed to

get a

> >

> > > call Monday morning from someone to tell me what will happen

then.

> >

> > >

> >

> > > Has anyone else gone through a denial?

> >

> > >

> >

> > > If so I would be really apprecative to hear about what you did.

> >

> > >

> >

> > > I really need help.I have to get this done!

> >

> > >

> >

> > > Thanks for listening everyone!

> >

> > >

> >

> > > Kim - raoulbabu@ or wickedcarver@

> >

> > >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >We are a very active support group.

> >

> >If the email becomes overwhelming,

> >

> >please change your setting to NO EMAIL!

> >

> >Please contact Group Creator

> >

> >Robyn@...

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

Hey Robyn,

Thanks for reply.. My numbers look good this month.. My doc is really

working hard to get my numbers looking good. I also due to my thyroid have

adrenal failure as well.. Im curious, You think I can get coverage for my

thyroid?? OHhhhh please do tell!!! This is all new to me so forgive all the

questions.. And Thanks so much in advance with all ur help! .

>

>Reply-To: GastricBypass-LOSERS

>To: GastricBypass-LOSERS

>Subject: Re: I've been denied the procedure

>Date: Tue, 02 May 2006 00:26:08 -0000

>

>

>

>

>Hi .

>

>

>

>If WLS is excluded from your policy and is NOT a covered benefit the

>

>insurance company will not pay for the procedure. Your thyroid

>

>illness can help you qualify for WLS IF it is under control and you

>

>are medically stable for surgery.

>

>

>

>Robyn

>

>

>

>

>

> > >

>

> > > >

>

> > >

>

> > > > Hello everyone,

>

> > >

>

> > > > I haven't been around for a long while,just waiting for my

>

> > >

>

> > >insurance

>

> > >

>

> > > > to approve my surgery.

>

> > >

>

> > > > I got a call from my to be surgeons office,Monday,saying my

>

> > >

>

> > > > insurance,Gateway Health plan,denied my surgery.

>

> > >

>

> > > > They claim it is not medically necessary for me.

>

> > >

>

> > > > They said I didn't do a required documented monitored diet by a

>

> > >

>

> > > > dietician for 6 months,(I did 4 w/dietician & 2 on my own with

>

>my

>

> > >

>

> > > > pcp).They also said my thyroid levels are high & nothing is

>

>being

>

> > >

>

> > > > done to control it (I am on synthroid for 6 1/2 years now) and

>

> > >

>

> > >they

>

> > >

>

> > > > said I didn't have a psych evaluation or clearance to do the

>

> > >

>

> > > > surgery.This too was completed & All this info was faxed to

>

> > >

>

> > >them.My

>

> > >

>

> > > > DR appealed their decision & The insurance company uphealed the

>

> > >

>

> > > > appeal.My DR said there is nothing I can do,they just don't

>

>want

>

> > >

>

> > >to

>

> > >

>

> > > > pay for it.

>

> > >

>

> > > >

>

> > >

>

> > > > I REFUSE to give up because I KNOW I need this surgery!I

>

>called my

>

> > >

>

> > > > insurance & said I want to file a complaint.I am supposed to

>

>get a

>

> > >

>

> > > > call Monday morning from someone to tell me what will happen

>

>then.

>

> > >

>

> > > >

>

> > >

>

> > > > Has anyone else gone through a denial?

>

> > >

>

> > > >

>

> > >

>

> > > > If so I would be really apprecative to hear about what you did.

>

> > >

>

> > > >

>

> > >

>

> > > > I really need help.I have to get this done!

>

> > >

>

> > > >

>

> > >

>

> > > > Thanks for listening everyone!

>

> > >

>

> > > >

>

> > >

>

> > > > Kim - raoulbabu@ or wickedcarver@

>

> > >

>

> > > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >We are a very active support group.

>

> > >

>

> > >If the email becomes overwhelming,

>

> > >

>

> > >please change your setting to NO EMAIL!

>

> > >

>

> > >Please contact Group Creator

>

> > >

>

> > >Robyn@...

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >

>

> > >    

[Guest guest]

Thank you ! I need all the support I can get right now.My family

(Husband & mom & dad etc.)is all against this surgery.My dad thinks

it is the easy way out,although I know that is not so.Your process

sounds alot more extent than mine.Good luck to you & Thank you again!

Kim

>

> I wouldn't listen to the doctor............... you need to take

control

> ............ your pcp is going to have document the two month

weight control

> program, you'll need to get your thyroid under

control............. these are

> all things that aren't too much for you to work on............

just remember

> it's a delay......... it's taken me close to a year, with EKG,

gall bladder

> scan, colonoscopy, current pap, current mammogram, tread mill, six

month class

> dieting, documented evidence of exercise attempts, and much much

> more.......................... just think of it as a premature

submission, and get it

> finished............ nail down the requirements and meet

them.............. best

> of luck to you. Hogan

>

>

>

[Guest guest]

In a message dated 5/1/2006 2:24:49 P.M. Pacific Daylight Time,

raoulbabu@... writes:

wish someone had gone thru this so I'd have some info to know what

to expect or not expect to happen.

You must take control and obtain what is needed........... ask your doctor

for a copy of what he submitted to obtain approval and I bet you'll spot the

problems. H.

[Guest guest]

In a message dated 5/1/2006 4:36:39 P.M. Pacific Daylight Time,

Bigred2some@... writes: Insurance said NO WAY!... Has anybody had this

happen?? What did you do?? where do people like us go for help from

here?.... Thanks... .

Not all insurance policies provide care for obesity. Look at your

policy...... is there a section on treatment for obesity? a section on weight

loss

above a certain level? you must read the policy, not all cover this.

H.

[Guest guest]

In a message dated 5/1/2006 4:48:43 P.M. Pacific Daylight Time,

Robyn@... writes:................................... Be

calm, be respectful and LISTEN to what you are being told. Moreover

COMPLY with their instructions.

Good luck to you,

Robyn

PERFECTLY STATED EMAIL ROBYN........................

[Guest guest]

In a message dated 5/1/2006 5:23:54 P.M. Pacific Daylight Time,

Bigred2some@... writes:

Jenni,

I was told that even if it's medically necessary, Its EXCLUDED

THERE ARE MANY POLICIES LIKE THIS.......... YOU MAY HAVE TO CHANGE

COMPANIES, IF POSSIBLE. H.

[Guest guest]

In a message dated 5/1/2006 8:22:32 P.M. Pacific Daylight Time,

raoulbabu@... writes:

did have a psych evaluation & my surgeons office insurance person

told me she personally faxed this to the ins co. I DID have it

done.They are saying I did NOT.I understood why it was being done &

completed this requirement.Just can't understand WHY they said I

didn't.

DID YOU PICK UP THE PHONE AND ASK THEM WHY? DID YOU PULL OUT YOUR COPY OF

THE PSYCH EVALUATION AND COPY IT FOR THEM, DID YOU CALL THE SHRINK AND ASK TO

HAVE THE REPORT RESUBMITTED, DID YOU GO TO THE OFFICE AND ASK THEM TO SEE IF

YOUR THINGS HAVE BEEN MIS-FILED SO THEY MISSED IT? Get going girl, you

have a lot to do. H.

[Guest guest]

In a message dated 5/1/2006 8:22:32 P.M. Pacific Daylight Time,

raoulbabu@... writes:

Kim.... maybe your file and some one elses are mixed up?

[Guest guest]

Keep your head up Kim, it is going to work out. I know how frustrating this can

be when you have been waiting. I thought I was going to die waiting... it sucks.

Shauna

wrote:

Hi Robin,

My dietician knew I was supposed to have 6 months but she signed me

off at 4 months & said I could finish with my PCP.I figured she knew

what she was doing & went with what she said.I trusted that she was

right since she did this before with other patients preparing for

surgery.

I did have a psych evaluation & my surgeons office insurance person

told me she personally faxed this to the ins co. I DID have it

done.They are saying I did NOT.I understood why it was being done &

completed this requirement.Just can't understand WHY they said I

didn't.

The thyroid levels are another mystery to me because I take the

synthroid medicine everyday & I get regular blood tests from my

pcp.They are always satifactory,or he would have to raise my meds.I

also had this test completed but they are still saying it is

uncontrolled.My PCP never explained how or why they would claim this.

This is why I am so upset over this because I felt I did as I was

told.I am not trying to get away with something,just trying to

figure what went wrong.(now I see the diet was a problem)My pcp just

wants to drop the whole thing after it was his idea to begin wi.th

I am awaiting the claims person to call me back so I can clear up

the problems & get this right.

Thank you for all your info.It was really helpful

Kim

>

> Hi Kim,

>

> Nice to see you online. However, I have 2 years working in

insurance

> defense law. ly, you haven't complied with the insurance

> company requirements.

>

>

> 1. YOU CAN NOT GET AROUND THE 6 MONTH SUPERVISED DIETARY

> REQUIREMENT. THE COURTS HAVE UPHELD THIS REQUIREMENT. Why did you

> violate their standard of being supervised by a dietician. They

said

> 6 months with a dietician. That means 6 months with a dietician.

> PERIOD.

>

> 2. Everyone needs a psych clearance. You are no exception. Before

> the insurer spends $40,000 for your weight loss surgery they need

> proof that you understand the life long changes as well as proof

> that you have the capacity to deal with the massive emotional and

> physical changes brought on by massive weight loss.

>

> 3. If your thyroid levels are too high you are not medically

stable

> for surgery. Your kidneys will not be able to synthesize the

> paralyzing agents of the anesthesia and you will never wake up

from

> the surgery or remain comatose.

>

> You need to contact your insurance company and speak to your

claims

> rep. Ask him/her what you need to do to qualify for surgery. Be

> calm, be respectful and LISTEN to what you are being told.

Moreover

> COMPLY with their instructions.

>

> Good luck to you,

> Robyn

>

>

>

We are a very active support group.

If the email becomes overwhelming,

please change your setting to NO EMAIL!

Please contact Group Creator

Robyn@...

[Guest guest]

>

>

> In a message dated 5/1/2006 8:22:32 P.M. Pacific Daylight Time,

> raoulbabu@... writes:

>

> did have a psych evaluation & my surgeons office insurance person

> told me she personally faxed this to the ins co. I DID have it

> done.They are saying I did NOT.I understood why it was being done

&

> completed this requirement.Just can't understand WHY they said I

> didn't.

>

>

>

> DID YOU PICK UP THE PHONE AND ASK THEM WHY? DID YOU PULL OUT

YOUR COPY OF

> THE PSYCH EVALUATION AND COPY IT FOR THEM, DID YOU CALL THE

SHRINK AND ASK TO

> HAVE THE REPORT RESUBMITTED, DID YOU GO TO THE OFFICE AND ASK THEM

TO SEE IF

> YOUR THINGS HAVE BEEN MIS-FILED SO THEY MISSED IT? Get going

girl, you

> have a lot to do. H.

>

>

>

[Guest guest]

,

Thanks for the reply.. Yes I have read thru the policy.. And you are right

they DO not cover anything concerning weight loss .. And It states that WLS

is excluded..Thanks for your help!

>From: nanchogan@...

>Reply-To: GastricBypass-LOSERS

>To: GastricBypass-LOSERS

>Subject: Re: Re: I've been denied the procedure

>Date: Tue, 2 May 2006 21:48:01 EDT

>

>

>

>

>

>

>In a message dated 5/1/2006 4:36:39 P.M. Pacific Daylight Time, 

>

>Bigred2some@... writes: Insurance said NO WAY!... Has anybody had this 

>

>happen?? What did you do?? where do people like us go for help from 

>

>here?.... Thanks... .

>

>

>

>

>

>

>

>

>

>Not all insurance policies provide care for obesity.   Look at  your

>

>policy...... is there a section on treatment for obesity?  a section  on

>weight loss

>

>above a certain level?  you must read the policy, not all  cover this.  

>

>

>H.

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

,

My insurance also had an exclusion for anything weight loss related. It was

absolute and unarguable. I had to self pay. Thankfully my parents stepped

in and helped me, cause my husband and I didnt have that kind of money. My

surgeon gave me a discounted price though. I know that some surgeons will

actually finance the surgery as well so you might check into that route.

Best of luck.

Amity

RNY-April 24, 2006

>

Have any of you ever BEEN excluded

>from coverage?? If So, what did you do?

_________________________________________________________________

Express yourself instantly with MSN Messenger! Download today - it's FREE!

http://messenger.msn.click-url.com/go/onm00200471ave/direct/01/

[Guest guest]

Amity,

Thanks for the reply!.. Well Looks like I have to find a different

route... I know Robyn mentioned maybe I could go with my thyroid disorder..

I don't know how.. BUT .,.. If anyone else maybe knows something,! Im all

ears.. This is gonna have to happen thru insurance. Like you said I DONT

have that kinda of money ...Sooo I will just have to keep trying.. I

appreciate everyone's help tho.. Thanks Again... .

>

>Reply-To: GastricBypass-LOSERS

>To: GastricBypass-LOSERS

>Subject: RE: Re: I've been denied the procedure

>Date: Wed, 03 May 2006 11:44:28 -0700

>

>

>

>

>,

>

>My insurance also had an exclusion for anything weight loss related.  It

>was

>

>absolute and unarguable.  I had to self pay.  Thankfully my parents stepped

>

>in and helped me, cause my husband and I didnt have that kind of money.  My

>

>surgeon gave me a discounted price though.  I know that some surgeons will

>

>actually finance the surgery as well so you might check into that route. 

>

>Best of luck.

>

>

>

>Amity

>

>RNY-April 24, 2006

>

>

>

>

>

>

>

>

>

> >

>

>

>

>Have any of you ever BEEN excluded

>

> >from coverage??   If So, what did you do?

>

>

>

>_________________________________________________________________

>

>Express yourself instantly with MSN Messenger! Download today - it's FREE!

>

>http://messenger.msn.click-url.com/go/onm00200471ave/direct/01/

>

>

>

>

>

>

>

>

>

>

>

>We are a very active support group.

>

>If the email becomes overwhelming,

>

>please change your setting to NO EMAIL!

>

>Please contact Group Creator

>

>Robyn@...

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

,

I have been in a BATTLE with my medical group the first denied my request but

this is after the approved my surgery consult and all my pre-op so I appealed

to my INS Blue Sheild and they over turned the dission but i have to go to a

different surgon and have a nother cousult they were trying to get me tyio go

to a weight loss dr. and go to a weight loss " program " like as if ai have not

already done that but thankfully my ins said NO we have approved for a surgon

consult and I will be going to another consult this makes #4 but I will jump

through any hoops I need to I have been wanting this surgery for 4 years now my

other surgon has been great she said she feel itd more importen to have the

sugery and if they want me to go to a different one she said the one they want

me to go to is a friend of hers and he is very good....I go on May 17th so we

will see and the good thing is my INS Is willing to help me and not let the

group get away with anything I hope you

can find someone to0 listen to you and be on your side

Amity Locken wrote: ,

My insurance also had an exclusion for anything weight loss related. It was

absolute and unarguable. I had to self pay. Thankfully my parents stepped

in and helped me, cause my husband and I didnt have that kind of money. My

surgeon gave me a discounted price though. I know that some surgeons will

actually finance the surgery as well so you might check into that route.

Best of luck.

Amity

RNY-April 24, 2006

>

Have any of you ever BEEN excluded

>from coverage?? If So, what did you do?

_________________________________________________________________

Express yourself instantly with MSN Messenger! Download today - it's FREE!

http://messenger.msn.click-url.com/go/onm00200471ave/direct/01/

We are a very active support group.

If the email becomes overwhelming,

please change your setting to NO EMAIL!

Please contact Group Creator

Robyn@...

[Guest guest]

Hey ,

Thanks for the response!! And I feel already have people on my side

thanks to this group.. I have gotten alot of feed back!! I hope all goes

well with you on The 17th!! I may have to go another route. Robin and few

others pointed out No coverage if you have a EXCLUSION .. Im which I do..

Soooo ..... However , I do have a severe thyroid condition And maybe this

may help provide a different route for me... Whooooo knows .. BUT I'm with

you .. In it for the long haul! Good Luck !! Keep us informed how it goes!!

.... .

>

>Reply-To: GastricBypass-LOSERS

>To: GastricBypass-LOSERS

>Subject: RE: Re: I've been denied the procedure

>Date: Thu, 4 May 2006 18:35:26 -0700 (PDT)

>

>

>

>

>,

>

>  I have been in a BATTLE with my medical group the first denied my 

>request but this is after the approved my surgery consult and all my 

>pre-op so I appealed to my INS Blue Sheild and they over turned the 

>dission but i have to go to a different surgon and have a nother  cousult

>they were trying to get me tyio go to a weight loss dr. and go  to a weight

>loss " program " like as if ai have not already done that but  thankfully my

>ins said NO we have approved for a surgon consult and I  will be going to

>another consult this makes #4 but I will jump through  any hoops I need to

>I have been wanting this surgery for 4 years now my  other surgon has been

>great she said she feel itd more importen to have  the sugery and if they

>want me to go to a different one she said the  one they want me to go to is

>a friend of hers and he is very good....I  go on May 17th so we will see

>and the good thing is my INS Is willing  to help me and not let the group

>get away with anything I hope you

>

> can  find someone to0 listen to you and be on your side

>

> 

>

> 

>

>

>

>Amity Locken wrote:        ,

>

>  My insurance also had an exclusion for anything weight loss related.  It

>was

>

>  absolute and unarguable.  I had to self pay.  Thankfully my parents

>stepped

>

>  in and helped me, cause my husband and I didnt have that kind of money. 

>My

>

>  surgeon gave me a discounted price though.  I know that some surgeons

>will

>

>  actually finance the surgery as well so you might check into that route. 

>

>  Best of luck.

>

> 

>

>  Amity

>

>  RNY-April 24, 2006

>

> 

>

> 

>

> 

>

> 

>

>  >

>

> 

>

>  Have any of you ever BEEN excluded

>

>  >from coverage??   If So, what did you do?

>

> 

>

>  _________________________________________________________________

>

>  Express yourself instantly with MSN Messenger! Download today - it's

>FREE!

>

>  http://messenger.msn.click-url.com/go/onm00200471ave/direct/01/

>

> 

>

>         

>

>

>

>    We are a very active support group.

>

>  If the email becomes overwhelming,

>

>  please change your setting to NO EMAIL!

>

>  Please contact Group Creator

>

>  Robyn@...

>

> 

>

>   

>

>

>

>                     

>

>

>

>