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So I Got Denied Today

DreamsOfSkinny

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DreamsOfSkinny    53

DreamsOfSkinny
Posted

So I called again and got ref. number for call stating that I only need 1 co-morbidity and bmi of 35+ for past 5 yrs although the medical Dir. Of Ins. Said I was denied bc I didnt have bmi of 40+. Second issue the insurance chose 2 of my lowest weights for 2 yrs and didnt even mark down for a whole year EVEN THOUGH my dr. Submitted all health documents! I talked to my ins. Coordinator at Dr office today

And she said the insurance is just trying to find anything to not approve me. The Med. Dir. Called their office for a peer to peer at lunch time and left a message with the answering service. When my ins. Coordinator called back the ins. Said the peer to peer was already done. She was livid when i talked to her today. Coordinator said she scheduled it for Thursday an gave the Dr's cell phone to make sure they are reached this time. I am really not hopeful at this point and it'll probably go to an appeal but the coordinator said theres no reason they shouldn't approve me by their criteria bc I meet it all. So I'm just praying! I do have a a follow up appt with my surgeon this Friday which we were hoping to use as pre op so I guess if it gets approved I'll be ecstatic as I'll have pre op appt done and can schedule!!! Prayersssssss

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MrsBenson    29

MrsBenson
Posted

My insurance coordinator said the same thing. That they are trying to find any excuse not to approve me. I finally got approved. It was an 11 month process but I've heard people going through it for 3 years before being approved. So don't give up!

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DreamsOfSkinny    53

DreamsOfSkinny
Posted

My insurance coordinator said the same thing. That they are trying to find any excuse not to approve me. I finally got approved. It was an 11 month process but I've heard people going through it for 3 years before being approved. So don't give up!

Omg!! 11 months! I think I'd pay OOP lol not patient at all

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MrsBenson    29

MrsBenson
Posted

Well in order for my insurance to pay I had to do a nine month supervised diet. Then I got a few denials for little stuff.

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rxtine    20

rxtine
Posted

Well in order for my insurance to pay I had to do a nine month supervised diet. Then I got a few denials for little stuff.

What were the little things you were denied for? I start my 90 pre op nut visits next week!

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DreamsOfSkinny    53

DreamsOfSkinny
Posted

Well in order for my insurance to pay I had to do a nine month supervised diet. Then I got a few denials for little stuff.

Wow! 9 months is a long time.

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MrsBenson    29

MrsBenson
Posted

Well first because they said I had no Co morbids. So my doctor had to write basically why I needed it. Example ... if she doesn't have this she is at risk for diebeties, HBO, cholesterol, ect.) And my insurance coordinator wrote that my insurance covers it with no comorbids as long as my bmi is over 40. Then I got another denial saying I needed my regular pyscologist to give me a clearance even though I already got a clearance from the psychologist THEY wanted me to see. Then I got denied saying I needed a Pulmonary clearance. That took a little more time cuz I had to use a cpap for two weeks cuz they saw I had sleep apnea(minor case) then finally was approved.

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MrsBenson    29

MrsBenson
Posted

And yea it was long but. Less than a year of work and now I get the surgery completely free to me. I could never afford this on my own.

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DreamsOfSkinny    53

DreamsOfSkinny
Posted

And yea it was long but. Less than a year of work and now I get the surgery completely free to me. I could never afford this on my own.

Well if you get it 100% free that's great. I have $2k more for my OOP max but that includes any medical treatments me and my family have so the surgery may cost me like $1500 after any other tests I need.

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DreamsOfSkinny    53

DreamsOfSkinny
Posted

Well first because they said I had no Co morbids. So my doctor had to write basically why I needed it. Example ... if she doesn't have this she is at risk for diebeties' date=' HBO, cholesterol, ect.) And my insurance coordinator wrote that my insurance covers it with no comorbids as long as my bmi is over 40. Then I got another denial saying I needed my regular pyscologist to give me a clearance even though I already got a clearance from the psychologist THEY wanted me to see. Then I got denied saying I needed a Pulmonary clearance. That took a little more time cuz I had to use a cpap for two weeks cuz they saw I had sleep apnea(minor case) then finally was approved.[/quote']

Congrats on getting approved!! You are inspiration for me to not give up just yet.

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MrsBenson    29

MrsBenson
Posted

I just got the call today and am scheduled for January 7th! I have to be there at 11:00am! The bad thing is Ill b on a 2wk diet and I can't drink on new years. But its worth it!!!! 7 weeks to go. And yea its 100% free.

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mike010906    14

mike010906
Posted

I just got the call today and am scheduled for January 7th! I have to be there at 11:00am! The bad thing is Ill b on a 2wk diet and I can't drink on new years. But its worth it!!!! 7 weeks to go. And yea its 100% free.

Good for you!!! I know you are ecstatic as you should be!!! I was denied because I needed (cardiac and) pulmonary clearance as well. My info was resubmitted to the insurance onTuesday. Now I'm patiently waiting for a yay or nay :-/

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Piplula    709

Piplula
Posted

Good luck and don't give up..mine took 8 months for approval! Glad to stuck with it!

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Go To Topic Listing PRE-Operation Weight Loss Surgery Q&A

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    • LeighaTR

      LeighaTR

      Four days post surgery. I am sipping as fast as I can and getting NO WHERE near the goal of 60 - 80 grams of protein or the 64 oz of liquids. I just feel FULL. I don't know if it can still be the gas build up (I would think by now that would be gone) but it is a struggle to drink. And so far I have not had the nausea or spasms and don't want to wander into that territory by pushing too hard with liquids. I about passed out today as it was my most "strenuous" day. Went from second story to basement for shower and I was sure I was going to pass out. Looking back on my last few days I have had a total of less than 1000 calories. Am I just not getting enough nourishment in me? Once again a friday where I can't get ahold of the doc until Monday rolls back around so I am hoping maybe someone here has some experience on how to keep energy going. I do have fibromyalgia too and that may be where some added fatigue comes into play. How did you all fair with the goals the week after surgery?
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Doughgurl

      2 days until I fly out to San Diego to have my Bypass Surg. in Tiajuana Mexico. Not gonna lie, the nerves are starting to surface. I don't fear the surgery itself, or the fact that I'm traveling alone, but its the aftermath that I'm stressing about the most, after this 8 week wait. I'm excited to finally be here, but I am really dreading the post surgical chapter. I know its going to be tough, real tough and I think I'm just in my head to much now that the day i here. Wish me luck, Hopefully I'm one of the lucky ones, and everything goes smoothly. Cant wait to give an exciting update,. If there is anyone else have a June bypass or even a recent one, Id love to have someone to compare war stories with. Also, anyone near San Antonio Tx? See ya soon with the future me. 💜
      · 3 replies
      1. Phil Penn

        Phil Penn

        Good Luck this procedure is well worth it I am down to 249.6 lb please continue with the process..

      2. Selina333

        Selina333

        I'm in Houston so kind of near you and had the sleeve in Dec. Down 61 lbs. Feeling better. Was definitely worth it. I hope the everything is going well for you. Update us when you can!

      3. Doughgurl

        Doughgurl

        I am back home after my bypass surgery in Tiajuana. I'm post op day 4. Everything went great! I guess I'm one of the lucky ones who have not encountered much pain at all, no nausea thus far and I'm having no problem keeping down broths and water. Thank you for your well wishes. I cant wait to keep up this journey and have a chance at better health and simply better quality of life. I know there will be bumps in the road ahead, and everything won't be peaches and cream, but at least I have a great start so far. 😍

    • LeighaTR

      LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 2 replies
      1. Selina333

        Selina333

        I'm so happy for you! You are about to change your life. I was so glad to get the sleeve done in Dec. I didn't have feelings of regret overall. And I'm down almost 60 lbs. I do feel a little sad at restaurants. I can barely eat half a kid's meal. I get adults meals often because kid ones don't have the same offerings at times. Then I feel obligated to eat on that until it's gone and that can be days. So the restaurant thing isn't great for me. All the rest is fine by me! I love feeling full with very little. I do wish I could drink when eating. And will sip at the end. Just a strong habit to stop. But I'm working on it! You will do fine! Just keep focused on your desire to be different. Not better or worse. But different. I am happy both ways but my low back doesn't like me that heavy. So I listened (also my feet!). LOL! Update us on your journey! I'm not far from you. I'm in Houston. Good luck and I hope it all goes smoothly! Would love to see pics of the town you go to for this. I've never been there. Neat you will be traveling for this! Enjoy the journey. Take it one day at a time. Sometimes a few hours at a time. Follow all recommendations as best you can. 💗

      2. Doughgurl

        Doughgurl

        Thank you so much for your well wishes. I am hoping that everything goes easy for me as well. We don't eat out much as it is, so it wont be too bad in that department. Thankfully. Also, I hear you regarding your back and feet!! I'd like to add knees to the list. Killing me as we speak! I'm only 5' so the weight has to go. Too short to carry all this weight. Menopause really did a doosey on me. (😶lol) My daughter also lives in Houston. with her Husband and my 5 grand-littles. I grew up in Beaumont, so I know Houston well, I will be sure to keep in touch and update you on my journey. I may need some advice in the future, or just motivation. Thank You so much for reaching out, I was hoping to connect with someone in the community. I really appreciate it. 💜

    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      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.
      · 1 reply
      1. LeighaTR

        LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

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