Guest guest Posted November 29, 2006 Report Share Posted November 29, 2006 keep your chin up. It will work out in time, where there is a will there is a way! Check out obesityhelp.com They may have resources to help you. Sincerely, Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 29, 2006 Report Share Posted November 29, 2006 I found out yesterday that my insurance co denied my surgery again. I was so bummed yesterday I couldn't even post to tell yall about it. My BMI is right at the edge 40.2 and they want co morbidities. Insurance changes Jan 1 to 20 % co insurance for me which is a lot of $. This is so frustrating. It took me a long time to research this surgery and make the commitment to go thru with it. Now it's so frustrating that I am facing the big bad insurance co and their denials. Sigh. I'm going to try to write my own appeal letter and explain to then what it would mean to me and my family. The surgeons office suggested I ask my PCP to order a sleep study for Sleep Apnea. I don't sleep well and haven't in years but never knew about Sleep Apnea. I wake up lots of times at night and toss and turn. My back " locks up " and aches constantly especially when i wake up. I have no idea if I snore as My DH is profoundly deaf and wouldn't know. sigh. I'm discouraged and sad. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 29, 2006 Report Share Posted November 29, 2006 Hey Cindy, I would follow thru with the sleep study. The description of your sleep sounds very much like Obstructive Sleep Apnea. I'm so sorry the insurance company denied you again. I know it's frustating, but please have faith. If it's meant for you to have WLS, you will. Do you have any other health problems that can help you qualify? Nit pick every little thing. > > I found out yesterday that my insurance co denied my surgery again. I > was so bummed yesterday I couldn't even post to tell yall about it. My > BMI is right at the edge 40.2 and they want co morbidities. Insurance > changes Jan 1 to 20 % co insurance for me which is a lot of $. This is > so frustrating. It took me a long time to research this surgery and > make the commitment to go thru with it. Now it's so frustrating that I > am facing the big bad insurance co and their denials. Sigh. I'm going > to try to write my own appeal letter and explain to then what it would > mean to me and my family. The surgeons office suggested I ask my PCP to > order a sleep study for Sleep Apnea. I don't sleep well and haven't in > years but never knew about Sleep Apnea. I wake up lots of times at > night and toss and turn. My back " locks up " and aches constantly > especially when i wake up. I have no idea if I snore as My DH is > profoundly deaf and wouldn't know. sigh. I'm discouraged and sad. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 29, 2006 Report Share Posted November 29, 2006 --- cindy hold on i know how upsetting this can be. i was denied. appealed it n still nothing, then my company changed insurances n the new one approved.. keep appealing them... do not give up.. good luck n best wishes c ya donna In GastricBypass- LOSERS , " Cindy Gilbert " wrote: > > I found out yesterday that my insurance co denied my surgery again. I > was so bummed yesterday I couldn't even post to tell yall about it. My > BMI is right at the edge 40.2 and they want co morbidities. Insurance > changes Jan 1 to 20 % co insurance for me which is a lot of $. This is > so frustrating. It took me a long time to research this surgery and > make the commitment to go thru with it. Now it's so frustrating that I > am facing the big bad insurance co and their denials. Sigh. I'm going > to try to write my own appeal letter and explain to then what it would > mean to me and my family. The surgeons office suggested I ask my PCP to > order a sleep study for Sleep Apnea. I don't sleep well and haven't in > years but never knew about Sleep Apnea. I wake up lots of times at > night and toss and turn. My back " locks up " and aches constantly > especially when i wake up. I have no idea if I snore as My DH is > profoundly deaf and wouldn't know. sigh. I'm discouraged and sad. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 29, 2006 Report Share Posted November 29, 2006 Cindy, I too was denied once.......Keep fighting Mike T Re: Denied again. > --- cindy hold on i know how upsetting this can be. i was denied. > appealed it n still nothing, then my company changed insurances n > the new one approved.. keep appealing them... do not give up.. good > luck n best wishes c ya donna In GastricBypass- > LOSERS , " Cindy Gilbert " > wrote: >> >> I found out yesterday that my insurance co denied my surgery > again. I >> was so bummed yesterday I couldn't even post to tell yall about > it. My >> BMI is right at the edge 40.2 and they want co morbidities. > Insurance >> changes Jan 1 to 20 % co insurance for me which is a lot of $. > This is >> so frustrating. It took me a long time to research this surgery > and >> make the commitment to go thru with it. Now it's so frustrating > that I >> am facing the big bad insurance co and their denials. Sigh. I'm > going >> to try to write my own appeal letter and explain to then what it > would >> mean to me and my family. The surgeons office suggested I ask my > PCP to >> order a sleep study for Sleep Apnea. I don't sleep well and > haven't in >> years but never knew about Sleep Apnea. I wake up lots of times at >> night and toss and turn. My back " locks up " and aches constantly >> especially when i wake up. I have no idea if I snore as My DH is >> profoundly deaf and wouldn't know. sigh. I'm discouraged and sad. >> > > > > > We are a very active support group. > If the email becomes overwhelming, > please change your setting to NO EMAIL! > Please contact Group Creator > Robyn@... > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 30, 2006 Report Share Posted November 30, 2006 Two words...ankel weights (the next time your doctor weighs you). Sorry tried to lighten the mood. Yeah this does suck. I mean you've really only got a month for approval at the current rate. It would be at the current rate if you were approved? I mean maybe you don't have a chance anyway since you might have to have the surgery actually PERFORMED before Jan 1? I hope not. I would spend time phoning and visiting doctors to generate definite decisions on if you've got co-morbidities. You're on the right track with investigating co-morbidities. I wish you the best of luck. Mike in GR > > I found out yesterday that my insurance co denied my surgery again. I > was so bummed yesterday I couldn't even post to tell yall about it. My > BMI is right at the edge 40.2 and they want co morbidities. Insurance > changes Jan 1 to 20 % co insurance for me which is a lot of $. This is > so frustrating. It took me a long time to research this surgery and > make the commitment to go thru with it. Now it's so frustrating that I > am facing the big bad insurance co and their denials. Sigh. I'm going > to try to write my own appeal letter and explain to then what it would > mean to me and my family. The surgeons office suggested I ask my PCP to > order a sleep study for Sleep Apnea. I don't sleep well and haven't in > years but never knew about Sleep Apnea. I wake up lots of times at > night and toss and turn. My back " locks up " and aches constantly > especially when i wake up. I have no idea if I snore as My DH is > profoundly deaf and wouldn't know. sigh. I'm discouraged and sad. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 30, 2006 Report Share Posted November 30, 2006 Sorry about the bad news Cindy. Obesity Help has some sample letters for appealing to your insurance company. Consider using those as a guide and check the list of comorbidities listed there too, I think you back is considered one. Cindy Gilbert sachsephotography@...> wrote: I found out yesterday that my insurance co denied my surgery again. I was so bummed yesterday I couldn't even post to tell yall about it. My BMI is right at the edge 40.2 and they want co morbidities. Insurance changes Jan 1 to 20 % co insurance for me which is a lot of $. This is so frustrating. It took me a long time to research this surgery and make the commitment to go thru with it. Now it's so frustrating that I am facing the big bad insurance co and their denials. Sigh. I'm going to try to write my own appeal letter and explain to then what it would mean to me and my family. The surgeons office suggested I ask my PCP to order a sleep study for Sleep Apnea. I don't sleep well and haven't in years but never knew about Sleep Apnea. I wake up lots of times at night and toss and turn. My back " locks up " and aches constantly especially when i wake up. I have no idea if I snore as My DH is profoundly deaf and wouldn't know. sigh. I'm discouraged and sad. We are a very active support group. If the email becomes overwhelming, please change your setting to NO EMAIL! Please contact Group Creator Robyn@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 30, 2006 Report Share Posted November 30, 2006 Check with the insurance company to find out what all of the comorbidities are. Maybe you have some that you aren't aware of. > > > > I found out yesterday that my insurance co denied my surgery > again. I > > was so bummed yesterday I couldn't even post to tell yall about > it. My > > BMI is right at the edge 40.2 and they want co morbidities. > Insurance > > changes Jan 1 to 20 % co insurance for me which is a lot of $. > This is > > so frustrating. It took me a long time to research this surgery > and > > make the commitment to go thru with it. Now it's so frustrating > that I > > am facing the big bad insurance co and their denials. Sigh. I'm > going > > to try to write my own appeal letter and explain to then what it > would > > mean to me and my family. The surgeons office suggested I ask my > PCP to > > order a sleep study for Sleep Apnea. I don't sleep well and > haven't in > > years but never knew about Sleep Apnea. I wake up lots of times at > > night and toss and turn. My back " locks up " and aches constantly > > especially when i wake up. I have no idea if I snore as My DH is > > profoundly deaf and wouldn't know. sigh. I'm discouraged and sad. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 30, 2006 Report Share Posted November 30, 2006 Hi Cindy, There is a book called Weight loss Surgery for Dummies and it has lots of great info and samples of appeal letters. I wrote out an 8 page appeal letter just in case I would need it. I didn't need it but man, it was a good letter! Hope this helps, in CA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 30, 2006 Report Share Posted November 30, 2006 I had heard of that book but had not seen it. Fortunately I was able to use my Medicare since I am blind. My wife's state insurance no longer covers WLS and we were hoping that if we had gotten a new governor here in SC, that maybe they would re-instate it in a year or so and she could have the surgery as well, but that was not the case and after seeing the bill from my surgery, there is absolutely no way that we could afford it out of pocket. Lhsh@... American by birth, Saved by the grace of God. Re: Denied again. Hi Cindy, There is a book called Weight loss Surgery for Dummies and it has lots of great info and samples of appeal letters. I wrote out an 8 page appeal letter just in case I would need it. I didn't need it but man, it was a good letter! Hope this helps, in CA -------------------------------------------------------------------------------- No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.409 / Virus Database: 268.15.2/559 - Release Date: 11/30/2006 ---------- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.409 / Virus Database: 268.15.2/559 - Release Date: 11/30/2006 Quote Link to comment Share on other sites More sharing options...
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