DivaSoBlessed

Thank you so much. That is very kind of you to offer. I will keep you posted and let you know what happens and reach out to you for a copy if things don't go as expected. I am hoping that the get every thing that they need this time to make a decision. ????

Hi Kaitlyn yes it was very confusing to read through. The surgeon that I have chosen is definitely at a designated Blue Distinction Center. This center is in fact the only one near where I live. I'm praying that after speaking the surgeon's office this will be resolved soon. Thanks so much for your insight. Sent from my SM-N900T using Tapatalk

Thank you so much for that reminder because I may have forgotten to do just that. I will definitely make sure I ask who it is that I am speaking with and document the conversation. I am feeling much better now so I going to get into the ring and come out a victorious winner. Thanks again. Sent from my SM-N900T using Tapatalk

@@Indygirl1 So sorry to hear that you had to go through this as well. I will be giving them a call first thing Monday morning. I have an appointment coming up with them so I can also bring the letter in with me to get everything figured out so that they can do another review with all of the necessary paperwork needed to reach their decision. Thank you so much for your input. It is truly appreciated.

@@cbrown1 Thank you so much for your insight. That makes so much sense. I can see how the insurance companies would not have the time to go back and look for missing pieces of paperwork. It would take them far too much time just to look for every missing document. I will definitely contact them first thing Monday and ask to speak with billing to find out what was not sent or what is now needed for them to complete their review and give their final decision. Your input has definitely helped me to understand what these letters are saying because it was so confusing as I was reading each one. Now I can breathe a little better. Again I really appreciate your help on deciphering this information. I feel much better now.

@@Miss Mac Thank you! I can definitely see how people can become very frustrated with this process because you definitely jump through hoops to get to where you need to be. I am going to remain strong and not give up so easily out of frustration. I am stronger than that. I just had to vent because it has been a long day and that was the icing on the cake. I'm more level headed now that I have had a chance to calm down. If this is the hard part then I can't wait to get to the easy part of post-op and continue with my fight. I am doing so well right now and I don't want to sabotage my work thus far. I'm gonna pull up my boot straps and get busy first thing Monday. Thanks again for your kind words my friend. I appreciate every response made here.

@ Thank you so much. I won't give up because you are right quitting is definitely not the answer. There definitely has to be a mix up with the paperwork is what I am thinking because the surgeon assured me that I didn't need anything from my PCP and that I just needed to get clearance through a pulmonologist, cardiologist, and psychologist which I did and submitted all forms. I walked two of them into the office myself. I am not sure what happened after that but I hope that everything is figured out soon. I'll be on it first thing Monday morning.

Whew!!! That was a close one! That's my girl! Really, whenever you're questioning your journey or have hit another wall, come here and post. You probably can't come up with a problem that someone on this site has not had to tackle at some crossroads on their WLS journey. If you do come up with a situation that none of us have had to solve, just think of the conversation thread that would make!!!! Wow! It will go on for miles and miles. --but in the end I'll bet we will come up with a solution. We are all on the journey together. Sure we each have to walk the walk alone, but right next to us is a friend keeping pace along side.---only a hand hold away. Lol Valentina that is exactly why I posted here trying to understand what was happening knowing that someone else might have experienced this same issue. I am happy to be on this journey with all of you because outside of my husband know one else really understands so I don't bother bringing it up. I am so grateful for the support that I can get here from friends. I will let you know how it goes for sure.

It's Blue Cross Blue Shield PPO+ So if I am reading you right this is not really a denial but that they just don't have all of the info needed from my surgeon? I don't understand why so many people are having paperwork issues when it comes to insurance. This is just annoying.

@@Valentina Thank you so much. That's a great idea! I have an appointment coming up with them so I am not leaving until we all sit down and figure this out. I have come too far for this to go all down hill now. I will keep you all posted on what happens.

@@Proud2BMe Thank you for your response. I choose not to give up but please know that this isn't about whether you sympathize with people who do because none of us knows each other's personal journey and what we have gone through. I have empathy and a heart and I understand that not everyone is blessed to have the opportunity to have the coverage that they need to have surgery done. I applaud you for your persistence in making sure that you saved to have the surgery done. Not everyone is able to do this because of limited budgets and it is because of that I empathize with people. Is surgery the only way to lose the weight no but for some people it is literally their only hope and choice between life and death so being understanding of a person's human emotions. No one here can say that went through this process without feeling some sort of emotion especially frustration. We can also sometimes say things that we don't truly mean out of being emotional. Congratulations to you and I wish you well.

@@Proud2BMe Thank you for your response. I choose not to give up but please know that this isn't about whether you sympathize with people who do because none of us knows each other's personal journey and what we have gone through. I have empathy and a heart and I understand that not everyone is blessed to have the opportunity to have the coverage that they need to have surgery done. I applaud you for your persistence in making sure that you saved to have the surgery done. Not everyone is able to do this because of limited budgets and it is because of that I empathize with people. Is surgery the only way to lose the weight no but for some people it is literally their only hope and choice between life and death so being understanding of a person's human emotions. No one here can say that went through this process without feeling some sort of emotion especially frustration. We can also sometimes say things that we don't truly mean out of being emotional. Congratulations to you and I wish you well.

@@LaurieMore Thank you! I am going to give them a call first thing Monday morning so I can figure this out.

@@Marie2016 Thank you so much! I had to let go of the tears in order to get angry so that I can stand up and fight. I'm not giving up. I'm all in.

@@mizzzzzzT Yes it looks like we both have had long journey's and I am sure that there are many more of us who have been going through a process of trying to get approved for quite a while. My journey for attempting to get this surgery dates all the way back to 2003. It was even harder back then because no one wanted to get on the phone and explain what is covered and what isn't. I just kept being told that I needed to do a six month supervised diet but that still didn't tell me if I had the benefits to get the surgery beyond that. During that time I had other things going on so I stepped back from the entire process to regroup and just started exercising and trying to eat better and for a long while I was doing well. It would take me a day to explain the journey but fast forward to today. My plate is less fuller and I can focus solely on me so I revisited the idea and discovered no more six month supervised diet so I decided to give it another try last year. The paper work says something about a hiatal hernia not necessary but I don't have that so I am more confused now than ever. I will definitely be giving the surgeon's office a call on Monday. Thank you so much for your kind words. I'm still in this fight. I've come too far not to be.

I'm logging on to my computer so that I can respond to you all. Thank you all so much for your input. It helps because I know that I am just thinking irrationally because I am upset.

Thank you! I'm not giving up just yet. I have just come a very long way and I am very emotional right now and confused at the same time. I just opened up the last letter which has me more confused because it says: Bases on the documentation submitted, code number ##### for laproscopy, sleeve gastrectomy (services must be rendered at a Blue Distinction Center) is covered under the member's plan. Howevwr , predetermination of benefits does not guarantee payment.

I just came from the mailbox retrieving 4 letters from my insurance provider. After getting all of my clearances completed some how I still got denied. I am sitting here in tears, and frustrated as well as exhausted with this entire process. The letter says reason(s): Inadequate or no clinical data received to complete review. I have no more words and am feeling like maybe this is just my life and I should except it. Going to bury my head under a pillow now. #sotiredoffighting

@@Vernelly sending prayers your way.

@@prettyCali916 Congratulations! Good luck with your surgery and I am wishing you a speedy recovery. This is a wonderful opportunity and brand new start to your new life. Enjoy it, embrace it, and take it one day at a time.

South Suburbs here Dr. Brian Lahmann will be performing my surgery.

@@thinatheart13 Congratulations! This is a wonderful opportunity of a lifetime. Enjoy it, embrace it, and take it one day at a time. I am waiting on my approval and can't wait to join you on the losers bench.

@@Inner Surfer Girl Thank you! I couldn't have said that any better. Hugs are awesome and powerfully sweet.

@@WLSResources/ClothingExch you are too kind! I am equally grateful for you being here to provide insight into this entire process. I have struggled with my weight for so long that I have learned that the process to recovery is long and patience is key. It's okay to fall off the wagon as long as you remain strong enough to get up, dust off those bruises, and get right back on the ride. No one said that this would be easy but its not impossible. I encourage to choose today as a day of reflection and figure out what areas you can improve in. Once you come up with a plan of attack then make an appointment with your surgeon's office to find out where you are. It's only over when we choose to give up and give in. We are all in this for the fight of our lives. I am rooting for you because I know that you have it in you to be the best that you can ever be. {{{Big Hugs}}} Sent from my SM-N900T using Tapatalk

@@Robin Leighbuchanan LOL! It happens. Not a problem.