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Denied For The 2Nd Time

sharonk

By sharonk, in Insurance & Financing

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sharonk    23

sharonk
Posted

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!!

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sharonk    23

sharonk
Posted

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.

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ElizabethAnne    40

ElizabethAnne
Posted

I'm sorry this has happened to you. I have BCBS, too, and struggled trying to understand my benefits. I my started this process in July 2009 and was denied the first time in December 2009 because my "documentation of physician supervised weight loss efforts did not demonstrate that attempt was made over a sufficient period of time." My policy required documentation for two years. My medical records showed far more than a two year history of weight loss efforts, so I called my insurance company to get clarification concerning exactly what I needed to do to be approved; it was difficult to get a clear answer. The woman I spoke to on the phone was very nice, but I could tell she became annoyed by all of my questions. I finally asked to speak with her supervisor because the answers I had received were vague at best. I almost gave up.

However, in February 2010, I started regular visits at my doctor's office. During each visit, we specifically discussed in detail my weight loss efforts. The two year time period actually passed by more quickly than I thought it would. My final visit was on February 13, 2012. The insurance company received my paperwork on February 15; I was approved on February 17 and received my approval letter on February 21.

Interestingly, when I first started the process in 2009, a 35 BMI with a co-morbidity was required, but the medical policy was revised in September 2011 and required a 30 BMI with a co-morbidity.

Be persistent and hopefully, you will receive your approval soon. :)

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sharonk    23

sharonk
Posted

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!

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sharonk    23

sharonk
Posted

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!

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ElizabethAnne    40

ElizabethAnne
Posted

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!

Why were you denied?

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sharonk    23

sharonk
Posted

Dont know yet since insurance is not showing it in their system yet. Guess i have to wait for the denial letter or call again next week.

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sharonk    23

sharonk
Posted

Dont know yet since insurance is not showing it in their system yet. Guess i have to wait for the denial letter or call again next week.

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ElizabethAnne    40

ElizabethAnne
Posted

Dont know yet since insurance is not showing it in their system yet. Guess i have to wait for the denial letter or call again next week.

I am so sorry. I can only imagine how dejected you must feel. Once your denial letter arrives, you will be better able to evaluate how you wish to proceed.

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Go To Topic Listing Insurance & Financing

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