Major Bump In The Road

[aldmb2 24]

Well, I was scheduled to have my sleeve done tomorrow 2/29/12. Or so I thought. What was actually given to me was a 'tentative date'. Turns out my insurance has denied me. After I spent 2 weeks on a liquid diet, prepared my self mentally, got my family on board, and filled out the FMLA for work I found out I don’t 'meet the criteria'. Apparently I have to have a BMI of 50 or more. Mind you I went through 6 months of hell & even lost 15lbs in the process. Now to be told I'm not eligible. My heart is broken. Insurance said I can have gastric bypass (no thanks) or the band (Not sure). My only hope now is my surgeon. He is going to call the insurance to try at persuade them into letting me have the sleeve. So, now more waiting (Surgeon cannot call till Thursday). So much for my leap day sleeve. New 'tentative date' is 03/14/12. I just hope I can have the sleeve. I could really use some good vibes from everyone. thanks!

p.s. My Surgeons office definitely dropped the ball somewhere for letting me go on for 6 months thinking I was getting this. Then, 2 weeks of liquid for no damn reason.

[lookingahead 7]

I'm so sorry to hear this. I can only imagine how disappointed and frustrated you are. Hopefully paperwork will get squared away and you'll be able to get another date on the calendar quickly. All insurance is different, but a BMI of 50 seems high -- but again insurance all varies.

[tasherie 35]

I was denied for the same reason, but I wrote an appeal. (You can see this on my blog), and got approved the same day they received it.

[aldmb2 24]

I'm hoping that my Surgeons call will make the difference. Tasherie, did your Dr. call at all?

[yecats 109]

So sorry to hear that! Keep your mind in it. It will happen, I did not have insurance and it looked bleak , if it is meant to be it will. Look at the appeals letter, like the previous poster said and get going on it. I will pray , let us know!!! For some reason it just was not suppose to be right then but do not get discouraged, you will see in the future looking back how it is in the best timing. Keep believing!!!!!!

[tasherie 35]

He did but they still denied it until I put all my research and arguments in front of them.

[Lissa 2,631]

Wow! How disappointing! I agree that you should look at Tasherie's appeal and tweak a copy to fit your situation, then get it turned in ASAP. Perhaps your appeal, with the surgeon's call, will help sway the insurance approval process. I'd definitely include that you have already started the liquid diet and gone through the approval hoops in that appeal letter. Every little bit helps.

Good luck! We're still saving you a spot on the loser's bench!

[PreciousCargo 55]

Good luck.. I can understand the frustration. I was denied and had to appeal my case due to my psych testing. After I went through the necessary loopholes I got approved. Keep your faith.

[nowatgoal 77]

Oh my goodness, I can only imagine the emotional roller coaster this must be for you. I remember the anticipation of my surgery date and it was all I could think about. To have your surgery denied after all of the mental and physical preparation you have done must be heart breaking. I agree with those that have recommended an appeal. I think the suggestion to save yourself some work and borrow/rework one that's already been written in order for it to fit your situation is a good one because that might lesson some of the stress involved.

Fight the good fight because you are worth it!

[Caradina 65]

Oh you poor thing. I would be devastated! I opted to self pay in Mexico to avoid the whole insurance nightmare. It's frankly been worth it to me to have the peace of mind to know that it is only my decision to have this... and that some insurance company and their ignorance won't stop me. Good luck with the appeal, and keep your head in it. It'll happen for you, one way or another.

[bella143 8]

Well' date=' I was scheduled to have my sleeve done tomorrow 2/29/12. Or so I thought. What was actually given to me was a 'tentative date'. Turns out my insurance has denied me. After I spent 2 weeks on a liquid diet, prepared my self mentally, got my family on board, and filled out the FMLA for work I found out I don’t 'meet the criteria'. Apparently I have to have a BMI of 50 or more. Mind you I went through 6 months of hell & even lost 15lbs in the process. Now to be told I'm not eligible. My heart is broken. Insurance said I can have gastric bypass (no thanks) or the band (Not sure). My only hope now is my surgeon. He is going to call the insurance to try at persuade them into letting me have the sleeve. So, now more waiting (Surgeon cannot call till Thursday). So much for my leap day sleeve. New 'tentative date' is 03/14/12. I just hope I can have the sleeve. I could really use some good vibes from everyone. thanks!

p.s. My Surgeons office definitely dropped the ball somewhere for letting me go on for 6 months thinking I was getting this. Then, 2 weeks of liquid for no damn reason.[/quote']

Im not sure I'm doing this right-replying to Your post. I'm new to this.

I'm in the same boat as you. I was scheduled for tomorrow for sleeve surgery but my insurance hasnt denied or approve me yet. I was originally schedules for the 15th then the 29th and now who knows! It's so up setting. I have Cigna and thy make you do 6 months supervised visits. It's been 7 months. Hope everything works out for you.

[aldmb2 24]

I hope it all works out & I'm not giving up even though I want too. Tasherie that letter is phemoninal. Would you mind if I used some of it? @ Bella, it sucks having to do this. Have you appealed? And do you have a pre-op diet? I'm hoping my Surgeons word will help, if not I will be pleading my case to the "board", which is basically one person. Im also on month 7

[bella143 8]

I was given the pre ole diet as well.. I've done everything. It's so depressing. I may have to use that appeal letter too! If you all don't mind.

[bella143 8]

Forgot to ask if you don't mind... Why did they say you dont meet the requirements?

[aldmb2 24]

Yesterday! 2 days before I was scheduled to go in. I'm so frustrated.