HELP - I NEED YOUR ADVICE !!!! I just got denied for surgery because of my doctor's notes (insurance only good for another 100 days)

[Toast4U 6]

Definitely go through the appeal process!! When I was ready to submit my documentation for approval, the girl who I had been working with at the insurance company told me there was a reasonable chance that I would be denied in the beginning. She explained that the first time you submit your paperwork, an administrator goes through your paperwork with a checklist. If all requirements aren't met, you're denied. When you appeal, your paperwork is submitted to a board and they take a subjective look at your documentation and most of the time, you are approved. She said the six-month medically supervised diet isn't given as much weight as it used to. For example, if I would have been successful on my six-month diet, I wouldn't have met the required BMI threshold as I was only several pounds over a BMI of 40. In essence, I had to "fail" at the six-month diet to meet the criteria for approval. Many insurance companies recognize that the six-month diet criteria isn't practical, but the regulators are slow to change. Of course, I don't know how your insurance works, but it's definitely worth a try. Good luck!

[AquarianCrab 8]

It is obvious that your doctor is making excuses because he just doesn't want to do it. Maybe because he's nearing retirement and is cutting back his practice? See a different bariatric surgeon fast for a second opinion and use that in your appeal. Then have that surgeon do the surgery.

That said, I will caution that this procedure is not something to be rushed. I had to go through ten months of meetings with nutritionists, support groups, psychologists, etc. as REQUIRED by my insurance BEFORE they would even make a decision on approval. The only people I know who got banded within 6 months of deciding to do so were self-pay. Everyone I know who was insurance paid didn't get their surgery until about a year after their initial consultation with their primary physician to get the referral to the surgeon.

Good luck.