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Insurance Denied - Appeal? How often does it get approved?



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I am a little upset. On my first visit to the weight loss institute, I went in they weighed me. I was 277 and they asked my height and I told them 5'11. I was a college basketball player and always told people I was 5'11 so that was my first thought. They never measured me. As we went on with my visits I told my nurse that I was not at a 40 bmi and I didn't think my insurance was going to cover. I went on to tell them that I haven't been measure in several years...so they measured me and sure enough I was 5'9 and some. So they said they were going to put a note in with my submission to insurance....well sure enough I was denied. When I called the insitute they had no recalection of all of this, which means they put me in as 5'11. Anyway I went and got measured at my family dr. office and I was 5'9 there too. So they wrote a letter and it is being inputted in the appeal.

Has this happened to anyone? Or, has anyone got denied and then appealed and then it get approved? I am really wanting a lifestyle change and feel this is my last option!!! I feel as if I have tried everything!

Please advise!

Thanks!!!

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This exact thing happened to me....I am 5'11 as well...and when i first went in I was around 268ish..wasn't quite enough the 40bmi..i was like a 37ish. Someone accidently sent it to my insurance and of course I got denied...well my doctor basically said we could try and find some co-morbities like sleep apnea or other things to see if i could qualify with a 35 bmi or i could put on a few lbs to meet the 40. I clearly didn't have any of the co-morbities thank god so i knew my only option was to put on a few lbs. My doctor hated that I had to do that and hated suggesting it but there was no other option...So i had a re-check a month and a half or so later and i was able to meet the 40 bmi. So they just re-submitted it and I was approved! Talk with your doctor, see what they say.

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When i started my research i saw that my BMI was at 39 and that because i didn't have any other health issues i know i would be denied.

So i purposely gained 10lbs to reach the 40 bmi. I got it to 40.8 I figured if i have to gain 10 to lose.... then that's what i'll do. My weight was 213, got it to 223.... approved. I would do it again in a heart beat to lose the 80lbs i have lost. I am not ashamed of what i did.... not one bit. i would probably weigh more than that by now if i had not had LB anyway.

You would be surprised how easy it is to put on 10lbs in one month... ice cream, ice cream.... and milk shakes... lol

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Hydrate to the safe max...lots of loose change in your pockets, etc. 10#'s ...no problem

:)

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When i started my research i saw that my BMI was at 39 and that because i didn't have any other health issues i know i would be denied.

So i purposely gained 10lbs to reach the 40 bmi. I got it to 40.8 I figured if i have to gain 10 to lose.... then that's what i'll do. My weight was 213' date=' got it to 223.... approved. I would do it again in a heart beat to lose the 80lbs i have lost. I am not ashamed of what i did.... not one bit. i would probably weigh more than that by now if i had not had LB anyway.

You would be surprised how easy it is to put on 10lbs in one month... ice cream, ice cream.... and milk shakes... lol[/quote']

Haha!! Love it!

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      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
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