deinied what now

[ALISIA 1]

i hate my life nothing is ever simple i dont know how to appeal it. i dont know how i can pay for it and i dont know how i am going to live like this. someone pleace tell to me something

[BobBayCityMI 111]

Well, can you give us some details? Why was it denied? Was it something they say you did not do? Or not meeting their criteria?

[*susan* 1,709]

I agree, please provide us with more information and maybe we can help you with an appeal.

[Oregondaisy 2,019]

is this type of surgery even covered by your insurance?

[ALISIA 1]

sorry i am a little better now. i did everything fine empire plan approved but bcbs and united healthcare said it is investigational. it can be appealed but now no one at the doctors office is getting to me. the insurance lady told me it is the doc ofice that puts in the appeal but the told me no and just tried to get me to do the band of bypass. if i have to i will take out a loan but i dont know if they will give one to me since i dont work i am just a student. i tried to ask the doctor questions about the procedure and since he didnt think it would be cover he kept try to get me to do another surgery. i told him if insurance doesnt pay i will find some where i can afford like mexico. he said dont do it. all he cares about is making money "we all do but still dont make obvious". i didnt get to find out what size bougie he uses what the pre op diet is nothing. i asked the dietition she couldnt even tell me. i have learn more from this site than i have with any of my visits there. a part of me wants to fight it but if i do i dont think i want to use him but he has been do it for 19 years. he staff is just crazy nice but crazy.

[BobBayCityMI 111]

Yes. Many plans do consider the sleeve to be investigational, although it has been done in Europe for many years with very good, long-term results. It is just a way and a reason that insurances can use to deny the procedure. Plus, my private feeling (nothing to base it on at all) is that some of the insurance companies are in cahoots with the band suppliers. You will have to wait the weekend to get your answers, but know that you are not alone in this sometimes frustrating trek. I was thrilled beyond words to be approved on the first try, but I also know I did a helluva lot of work to make sure everything was done beyond the minimal expected requirements. And I had to have patience, and, goodness, I hate that!

[ALISIA 1]

what insurance do you have? how did you get approved?

[BeardedItalian48 3]

ALISIA---I am sorry hun!! BCBS is very strick.....however if you can get 8700 up and approach the doctor maybe he would do it. Especaially after he gets your file. KEEP YOUR CHIN UP!! THINGS will work out and get another doctor to help you appeal. It doesnt need to be the same one.

SMILE

[BobBayCityMI 111]

I am through a privately insured group with work. We are self-paid. ConnectCare is the brand name. They have a HUGE set of requirements to be approved, but it is OK. Gave me time to think and know it was the right thing to do.

[ALISIA 1]

i dont know what to do really. i want to fight it because i dont know how i would come up with the money to go to mx. taking out a loan maybe but i have so many for school i dont know if anyone would give me another. school is another thing i really want to get this done before schoool starts. the plain fair is another issue, how many times would i have to go back down there for check ups. i would have to fly alone and that is really scary since i am visualy impared. who would pay if anything went wrong while i am up here.? could i even get another doctor to help with an appeal? this is all so overwhelming.

[Phoenixrising 0]

I am by no means an insurance expert and was actually self pay myself but from what I have seen on this an other sleeve boards is that appeals can sometimes be successful.

I believe the key may be to state all the reasons why the sleeve is the best medical option for you, personally. For instances folks with Chron's disease may not be good candidates for the band so VSG is medically the best option.

I recently read a post on one of the boards, and if I can recall I will repost, that BCBS recently started approving the sleeve. Again it was just someone's post so it may or may not be true.

Dealing with insurance can be a struggle, and not usually fun but hang in there.

[Malaika 50]

Sorry Alicia - I wish I could help; however, I know nothing about appeals with an insurance company and wouldn't even know where to start ... somebody on here recently prepared an appeal - maybe she can help you at least know where to get started? Hope you find a way. Our thoughts and prayers are with you.

[ALISIA 1]

thanks you guys. i am just so unhappy it was only 3 days before my surgery. i dont know if i should wait for an appeal. i dont know if i can wait at all my knees have really been hurting and in the fall i am going to be living on the third floor there are no elevators. ooh god i was really looking forward to lose enough weight so less people wil bother me. it is so hard to focus on my work when i am just so scared of being seen and some saying something hurtful.

[*susan* 1,709]

Alisia, first off, you are an absolutely beautiful girl. You should walk around with your head held high and if anyone says anything inappropriate to you, simply ignore it. Do not let anyone get the best of you, if you let them see that their words and/or actions hurt you, then they will just continue to do so. You are a good, sweet person, be confident in your knowledge of that. People who don't see that simply aren't worth your time.

You mentioned trying to get another loan, but also mentioned you already have several student loans. I know it is frustrating, but I think you should try for the appeal first. You don't want to overburden yourself with too many loans and end up in financial trouble.

I am not at all knowledgable on how to go about appealing a decision with one's insurance company. But I did find a couple of websites that offer advice, and even sample letters. I am going to post them here for you:

Health Insurance Quotes and Information Center

Appealing Health Insurance Denials

Health Insurance Denials Process and Links Doctorsinfoweb

[ALISIA 1]

thank you soo very much! i do think i have to try the appeal first too even though i dont want to wait. but i really dont have money and another loan would really mess up everything. thank you again.