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Denied, fighting depression.



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It's a long story but a year ago I fell and tore a tendon and bruised an ankle bone. It still hurts, I can't walk more than a few blocks without being in severe pain.

I started researching in February and had the surgeon call UHC. They said I just needed a 5 year history over 40 BMI.

I called twice and was told the same thing.

In the meantime I've gone to seminars, support groups, spent hours and hours online researching. I have never spent so much time on deciding anything.

Finally I decided for sure, went to all the tests. Had to make up all the time off work.

They finally submit and I get a denial because they want me to do a six month diet.

I'm 41, I have done every diet known to man, hypnotherapy, supplements, psychotherapy, and exercise.

I've been told if I don't lose my ankle won't heal. But I can't work out because of the pain.

I'm on an antidepressant that causes weight fIn and makes weught loss almost impossible. I have tried numerous times to get off of it. I even have taken other medication and nothing works.

I am trying to get my WW history but they are playing games with me. I was thinning maybe after surgery I might go back but not now. Because I'm not a current member they won't just print off a receipt. After I went through this a week ago and was emailed my receipts for the online tools only.

Today they say they have to fill out a form to have a department email me my reveille which takes 7 business days.

I feel fat and ugly. I hate my clothes. I have moments when I think I don't want to go on if I can't have the surgery.

I'm thinking I may just end up having it in Mexico.

Trying to keep my head up but I feel so down.

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Hey we have all been down that road, but here is a bit of info for you, I didn't get approved either, but I will be getting SLEEVED on Jan 11, 2013, I made the decision to travel to Mexico, I found a GREAT DOCTOR, Dr. Quiones who has a package special going on now for any member of this forum for $4000, he only does 4 surgeries a day, you have your private recovery room with round the clock medical attention, he also is a general surgeon who practices at the state hospital and teaches medical school, he also has no fatalities and a 100% no leak rate, My moto is "if there is a WILL there is ALWAYS a way"

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Start the 6 month diet with monthly checkups with your primary care physician now. In six months, you will have met the requirement and will be on your way to being sleeved. If you don't do this, another six months will have passed and you will be no closer to your goal of being sleeved. Yes, you can self-pay, but that involves trade-offs, too. You are depressed and I have been, too. You can do this.

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I think I'd rather go to Mexico. I have the money on my 401k I can withdraw for medical need.

I feel like if I lose on the diet they will deny me for being under 40 BMI but if I don't lose they will say I obviously can't lose weight.

I have dieted SO much I just can't bring myself to do it again. I just want to cry.

Thanks for your support. Both of you.

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I know you want to cry. I know exactly how you feel. Go to Mexico if you must, but, speaking from my own experience, six months goes by in a flash. If you are interested, check with the surgeon's office about how many pounds you can lose and still stay above the required bmi. I don't mean to sound pushy, just want you to know the other option is doable, too. Keep us informed. You are not alone.

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From the program you only have to lose 3% of your weight

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I feel you frustration. I started my wls about 2 yrs ago and I had to be on a 12 mo super ised diet wi t h my primary Dr and then in Aug 2010 I fell and injured my ankle and my WLS group made me postpone going further until I had my ankle under control.I went to Dr's and specialist and walked on it for a year and my ankle was so swollen and sore. So finally 11mo(July 2011) later they decided to scope it and see what was wrong (of course it is always being heavy-duty aggravates it). I had a fracture and 2 bone chips floating and cartliage and ligaments that were damaged beyond repair. So some were taken out and some reconstructed. I do feel a lot better but some days it just hurts.

I then started back in Jan 2012 and while my ankle was hurt I did do my 12 mo worth of diet. I did not loose a thing! I did join a gym that had a warm Water pool and I started going to water classes anr it helps take the pressure off your injury. Now jumping ahead to Nov 2012, I met all my requirements and clinic submitted it to my insurance and they DENIED it and said it wasn't a covered service (yup had clinic call and verify it was a covered service). WTF!!!! I was beyond livid. I fought with them and threatned to turn them into my states deptartment of insurance. They changd their tune and now its approved and I am just waiting on my surgery date. If I didnt get this done I am 42 and I dont think I would be able to walk in 2 years! I need a double knee replacement!

So I suggest you do your 6 mo diet and start on Protein Drinks now and maybe join a gym near you with a warm water pool and wait ou your 6 mo. YOU CAN DO THIS!!! Stay strong and everyone is here to help and encourage. Best of luck to you

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After months of documenting and gathering information, doing tests and my doctors recommendation, I was turned down by my insurance carrier. I appealed the decision and was denied a second time. I knew that, even though I was scared and it felt hopeless, I had to find a way. I went through a self-pay option with my surgeon. It was much more expensive than Mexico, but I only had a few days scheduled to get off of work and I had to make it work.

The first month after surgery was really tough and I kept doubting myself and wondering if I had made a huge mistake. At 13 weeks out I now know that it was the best decision that I could have ever made. Easy? No way.

There are options available. Don't lose heart. I have read so many good things here about the doctors in Mexico if you go that route.

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I can get up to six weeks of fully paid short term disability. Hell I might stay in Mexico for a few more days....lol.

My husband thinks Im nuts to even think about Mexico.

I guess I like to be in control and I don't want to spend another six months jumping through hoops to be denied again.

I'm going to submit the WW stuff and write a letter and if it's denied after that I'll reassess.

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Mexico has negative connotations from the photos and movies we see where there is a lot of poverty, but seriously, go to Youtube and check out some of the videos. The facilities look fresh, modern and the accommodations and care are superlative. You may want to do a search up top to see what you can find on threads by people who have had their surgery done there. This may reassure your husband.

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The funny thing is I'm basing this on experience. Two years ago we went to Cancun on our honeymoon. The last day we were there my husband stepped on a piece of glass by the pool on the way back from the beach. The medic came and washed his foot off with a used plastic bottle filled with some liquid with sharpie writing on it.

He knew nothing about first aid. Nothing.

So yeah it scares me. At the same time I know that everything depends on where you go and I'm sure if they are tailoring to Americans and Canadians they are going to have to be good.

I'm just so glad that I have an option.

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The thought of Mexico scared me at first too. But, the more research I did, the less scared and more comfortable and confident I became. All facilities and surgeons are not created equal, whether you are looking in the US or in Mexico and there are great surgeons there and bad surgeons there, just like here!

I am EXTREMELY comfortable going to Dr Ortiz - he is in an International Center of Excellence that exceeds the standards of 95% of US hospitals.

I knew I had no chance with insurance, because my BMI is only around 35 (now, it's been higher many times!) and I didn't want to GAIN weight just to have surgery.

Good luck!!

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I am fighting UHC also. I didn't have the 6 months supervised diet. But I have been denied a few times. I'm gunna keep fighting and hope for them to rule in my favor. If my last appeal is denied then I will self pay, but I'm doing in the states. Most surgeons here do offer self pay pricing, and if that's the route you choose, it's worth looking at Mexico and the US. I looked into Mexico, but I prefer to have it done here. It's a personal choice and no one can make it for you. But I would do the 6 month diet while looking at options. That way if you choose to keep going with the insurance, you already have that started. And if not, then you have already started training yourself for the healthier life post op.

Also read your coverage documents. It should state in there if the diet is required. If its not and they used that to deny you, then you possibly have grounds for an appeal, complaint, grievance, ect. I wish you the best luck on your journey!!!!

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I say do the six months program. At least unless you are sure about Mexico. Six month goes by so fast. Keep your head up. You are not alone. It is frustrating, yes in deed.

Things seem to hit the fan since I been in the program. But i see the benefits from my own 6 month program that I'm in. Its giving me an opportunity to prepare, learn and get ready for Awesomeness that will happen!

We gotta keep trying for better health. Your a winner. I say 6 months bring it on. You can do it.

Be encouraged

Good luck!

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I have called three times asking for a copy of the policy only to be transferred three times and put on hold for twenty minutes. It's through my h's employer.

I'm going to ask him to ask his HR for a copy of it.

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