sharonk

Thanks chrissylu. I literally just got a call from my drs office and they discussed my case and are confused at the 3rd denial. Apparently when i called to request all the documents it must have lit a match under their butts. My dr says that the last he spoke to the insurance dr he was asked to submit a document and did so. He NEVER had an official conversation about my case. So why did the insurance dr deny the appeal is a mystery now to us all. My dr has agreed to try aonther dr on dr review but he is going to be out of the country till april 1st. More waiting....but at least they are trying again which they didnt say they were oing to do earlier today

I just got denied a 3rd time! I dont know what i want to do at this point. Im angry sad confused! Finally emotionally drained at the thought of appealing on my own behalf, which insurance said i could do. I called the drs office and told them i would like to come by and pick up all the documents that were submitted. They told me they will have to put everything together and will call me next week when its ready. Wait, why isnt it ready now?! Wth?! Didnt they just resubmit my info this week?! I dont get it!! I started at 39 bmi now im 40 bmi so i dont need the comorbids and my dr office states that the 40bmi is what was submitted this past week for the dr on dr review. ive done my 6 months, pysch exam, test, consults. Trust me when i say i have done EVERYTHING my insurance medical policy has stated!! Ive read it a trillion times!! I cant get an exact answer from insurance rep because the info hasnt been entered into their system yet. So basically im back to waiting and trying to figure out in my head what it could be. Maybe my drs office has something wrong?! I dont know?! They did seem a little weirded out that i was requesting all the paperwork but hey this isnt their life so why would they be as particular with the info, right?! Any who, im going to TRY not to think about this too much over the weekend maybe a few drinks will help me forget. i think i will review my packet and then decide from there what to do. Thanks to those out there in band land listening to me vent! I pray others have better luck than me.

Maybe i should now change the subject line to....DENIED FOR THE 3Rd TIME. all i can do is cry and get angry at the very same time. I dont know what i want to do at this point. Keep appelaing or let it go?! I want this so much but do i want to sit here and continue to not try and lose weight on my own so that i keep a bmi of 40 or do i give in and give up to move on with my life and start my yo yo dieting habits all over again?! What a way to start a weekend!

Maybe i should now change the subject line to....DENIED FOR THE 3Rd TIME. all i can do is cry and get angry at the very same time. I dont know what i want to do at this point. Keep appelaing or let it go?! I want this so much but do i want to sit here and continue to not try and lose weight on my own so that i keep a bmi of 40 or do i give in and give up to move on with my life and start my yo yo dieting habits all over again?! What a way to start a weekend!

I gotta give you mad skills for hanging in there that long. I honestly dont know if i could do it all over again. Although, i didbwomder how i was going to get through the 6 months when i first started! Lol Heck, april will be 1 full year since i started this whole thing.

Well as of this afternoon im being told by the drs office that my paperwork was resubmitted on tuesday as 40 bmi and we are awaiting the dr on dr review or answer or whatever it is. Originally iwa submitted as a 39 bmi but i didnt have any serious enough medical problems to qualify. I guess the drs office thought otherwise?! My insurance also tried to say the 6month supervision paperwork was not substantial enough FOR A 2nd TIME. If i WAS in fact resubmitted this week at 40 then they SHOULD approve me since i ahve gone through ALL of the steps. I have read my medical policy at least three times so im pretty well rehearsed on the qualifications. Thanks for your encouragement!!! Im hoping tomorrow i will have an answer and it will be that i am approved!!

Yay for ap! Will you all be adding a place for one's own profile editing?

Yay for ap! Will you all be adding a place for one's own profile editing?

I took phentermine a few years ago and lost a bunch of weight but as soon as the dr stopped writing the prescription i have gained it all back plus a bunch more. It definitely cut back my hunger big time. Sometimes i would go all day without eating and ended up getting dizzy. In the beginning it messed with my sleep but i soon got past that and was able to sleep again. I tried it again a year later and it didn't work at all the 2nd go round! Guess my body got immune to it since i took it for like 5 months. I def don't recommend because its only supposed to be used for a few months at a time and like i and others have already said, you gain it all back in lightning speed.

I took phentermine a few years ago and lost a bunch of weight but as soon as the dr stopped writing the prescription i have gained it all back plus a bunch more. It definitely cut back my hunger big time. Sometimes i would go all day without eating and ended up getting dizzy. In the beginning it messed with my sleep but i soon got past that and was able to sleep again. I tried it again a year later and it didn't work at all the 2nd go round! Guess my body got immune to it since i took it for like 5 months. I def don't recommend because its only supposed to be used for a few months at a time and like i and others have already said, you gain it all back in lightning speed.

You are right KR..it took more than 30 days to appeal it so you are lucky your Dr.s office know how to work the system well! It only took 4 days on the first submittal! I'm now waiting to hear about a Dr on dr appeal. The office told me that they would call me when they find out something. So i asked them what was a reasonable time to wait and she said this Friday. Ugh

Thanks for your input G!...i have tried asking my insurance to tell me why they denied it but they say they don't have that info available to them?! Something about their system wont allow the reps to see it. Not sure what else i can do to get the info i need?! I'm guessing they are going to say that my 6 months of Dr./ diet supervision wasnt substantial enough but i did what my band Dr recommended. I really don't know though, I'm sure they can deny it on the slightest things. Argh

I think they try to find snags ANYWHERE they can. I'm right there with you on the waiting! It sux big time!

I think they try to find snags ANYWHERE they can. I'm right there with you on the waiting! It sux big time!

I just printed the medical policy for my insurance (bcbs) and i don't think any of it can ever be totally clear to the average person. I think they do that on purpose . Sorry to hear about your struggles c. I hate to say it cuz i don't wish this on anyone bit i am glad I'm not alone when it comes to this annoying insurance crud! Good luck to you also!

Thanks guys...I'm going to give it one more shot! I just hate waiting!!! I don't want to do out of pocket because I'm too worried about having complications and such and then having to fork out even more money that what was expected. Plus the fact that i don't have that kind of money.

Just called my insurance and found out they have denied me for the second time! :( i have a bmi of 39 and must have a comorbitity. Well the first time they said there wasnt enough paperwork submitted by my pcp. This time i have yet to find out why until they send the letter in the mail but my drs office believes its because they think I'm too skinny and I'm only borderline comorbitity! They are going to do the Dr on Dr call next but i have a feeling I'm going to be denied across the board! So dissapointed and totally don't think its fair that insurance makes you take all these steps only to find out your not going to be covered! Ive been on this journey since mar2011! Something is just plain wrong with this! I know everyone says keep at it but damn this is emotionally draining and unfair!!

Yes, let us know what you think! My sis tried themand didn't like them but she didn't try the angle hair version. I'm not sure olive could get past the fish smell tho...eek

Thanks!!! I'm hoping insurance holds to their words and gives me an answer this week! Lets hope its the answer i want!

Android app= yay

I wish you could skip to more recent pages/comments per individual topics on the mobile website. I know i used to see that option before but now i can't. Makes things very frustrating.

I wish you could skip to more recent pages/comments per individual topics on the mobile website. I know i used to see that option before but now i can't. Makes things very frustrating.

Well i have gone through my 6 months of supervised visits and did all the other necessary tasks for my insurance company's (Highmark BCBS) requirements to be consired for the surgery. All of this was completed back on Nov 1st 2011and i'm STILL waiting for approval! ARGH. Well i should say i was denied within 1 weeks time the first go round (Dec 12th or something like that) on the basis that my dr. did not submit a more complete review of my 6 month supervision. He sent in a summarized version of it and apparently that is not enough. Well it took about 1-2 weeks for that to get resubmitted and now i have been waiting for an answer ever since. Each time i call my insurance to check the status they give me a different answer to my case. One minute the case has been closed/denied and the next it's open and still under review. I'm so sick of trying to get an accurate answer from these people and i feel like my paperwork has slipped through the cracks. Long story short, they (insurance) say they have until 2/9 to get me an answer because that is the date the Dr. submitted as a predetermined surgery date (not my actual date for surgery). I want to call insurance every day still to see if my case has been finished but i know i will just hear the same roller coaster answers as before and i really don't feel like explaining what is going on since how do i know what they are now telling me is true/accurate?! The dr's office has been getting the same answers too so they are no help either. Any who, just venting! Hope others are having better luck than me, just wish it was my turn now! i hope this long wait is a sign that they will approve me the 2nd go round since the denial only took a week!! Cheerio

Oh...gotcha! There are soooo many steps that i dont even know whats reaaly next. I guess i just assumed they wont schedule my surgery date until we find out if im approved. Hope this week flies by for you!!

Best of luck to you!! Why are you waiting till 11/11? I have bcbs, the company i work for is out of PA so its called Highmark but since im in VA i believe its Anthem...heck, i dont know, health insurance just confuses the heck out of me. Lol