Very Depressed From Insurance Denial Today

[aknaturelvr 10]

I don't know what went wrong, but it appears my primary care physician did a sketchy job of providing documentation for my approval. The insurance denied approval on the basis of not being given evidence of six months of consistent monitored dieting. They completely overlooked the fact that I am on two types of insulin, high blood pressure meds and my bone joints are falling apart from the excess weight.

I was first recommended gastric banding more than 3 years ago and have worked so hard to prove to the dr I could lose the weight without surgery. The past 15 months I have lived on a diet and my weight refuses to budge. Knee and back problems severely limited my ability to walk, but I stuck to high density nutrition with caloric content that should have allowed me a 1 to 2 lb loss per week. What did I get? 5 pounds in 15 months. I have become hopeless and thought feel both the quality and duration of my life has been compromised. The only two high points in my life the past year were 1) when my Dr prescribed a drug called Victoza for my diabetes. I lost all desire to eat and lost 8 lbs in less than 2 weeks before I had a severe allergic reaction to the drug and had to be taken off of it. Then 2) last August when I had a heart to heart with my dr about weight loss surgery. I had seen the Dr Oz show where he advocated so strongly for the surgery in reversing diabetes. (I was put on insulin last January and still my sugars will not come down without high doses of insulin). My Dr totally supported the decision and told me my approval would not be a problem. I feel in my heart, this will change my life... give me a chance at life that I can't seem to get on my own. I've been through the dietary consult and the psych eval with flying colors. I've read every book I could get my hands on and studied the pre op diet plan till I know it in my sleep.

Right now I am very very upset. I've not told anyone but needed to vent so I came here.

I would appreciate any advise regarding how to deal with insurance denial. Thanks, robin

[Kinley7390 80]

Ask your PCP to correct the paperwork by giving a more complete, thorough picture of your dietary attempts the past six months! Clearly you've been trying and it sounds like the slip up on behalf of your PCP is the reason for denial. Incomplete information was submitted and I would be very angry and voice that concern to your doctor. If you don't get anywhere, switch PCP's! You can also try to call the insurance company, and explain your frustration and your perception of the reason the coverage was denied and see what they advise you to do. I wouldn't give up hope yet. You have all of the co-morbidity factors in your favor (diabetes, high blood pressure and joint pain). It sounds like you might be in the right range as far as your BMI from what you described, so I can't imagine why you would be denied this surgery if not for an error on the part of the physician in providing a comprehensive picture to your insurance company. Please advocate for yourself and stay strong. It sounds like you want this, so do what you can to turn this around and be optimistic. It is easy to want to throw in the towel when you've done all the prep work on your end, when you feel so run down and defeated by the health issues and unsuccessful dieting, but this is when you need to find all your inner strength and talk confidently to your doctor and express your feelings. Give him or her a chance to rectify this, and if they won't, find someone who cares enough to provide the right documentation. You deserve no less. Call the insurance co. in the meantime. They have patient advocates (usually) or case managers who will listen to you and advise you. Good luck, keep your chin up, and please keep us posted!

[lassie 247]

Hey Robin, I was denied three times, once because I had lost too much weight. It took a year for me to get approval but final it came through. I also did not have six months of documentation from the nutritionist ( I only had three months) so I made sure I kept going and got my six months. Then I lost to much weight and they denied me again, I did not give up, I gained back the 10 pounds and finally got my approval. Please do what you need to do, keep going it will work out in the end. Hugs

[aknaturelvr 10]

I deeply appreciate your responses. It's not my nature to just give up, but being denied was completely unexpected. Something keeps telling me I don't have the time to wait for people who don't do their jobs properly.

Maybe I should just go to bed early and get some sleep then take up the fight tomorrow.