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Jessiegurl2686

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Jessiegurl2686    104

Jessiegurl2686
Posted

Hey guys new to this forum!!!! So I've been dealing with this process since June 2012.... I'm 26 years old, 5'5 weigh 217. I've had a hell of a time getting all the correct info from my coordinator which finally quit or got fired. So I got denied last month because I never did my 6 month diet and did not enroll into the biriatric program.... So I was like allright should be easy to complete right! So I had my pcp sign a form with complete 6 month diet info. And then tried to enroll in program. So gave them all my info and they said there nurses are 2 weeks behind but someone WILL call me. Waited for a month and called them come to find out they UN enrolled me because now I need TWO cormorbites..... I was never told any of this info since June . And they could have called and told me i was UN enrolled. I have diabetes did my 6 month diet ... sleep study and saw the phyco. So my next step is getting a attorney to appeal for me. Has anyone been though this before?!!

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AmandaRaeLeo    2,146

AmandaRaeLeo
Posted

WLS is completely excluded from my insurance. Period. No exceptions. So I'm a self pay and I'm going to Mexico in March.

Amanda Rae

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Jessiegurl2686    104

Jessiegurl2686
Posted

What gets me I've had same insurance for 6 years.... Never had any surgreys .... Hardly went to dr. And the one time I need something for them they make it the hardest thing to get accomplished. There is always something . I think when I get my income tax I'm going to get an attorney to appeal it for me..... They have been doing this for 17 years and they said I would be a good candidate..... Ughhh just want this sooooo bad. I already told myself I was getting it. Now I'm like so upset they crushed my dream.

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AmandaRaeLeo    2,146

AmandaRaeLeo
Posted

What gets me I've had same insurance for 6 years.... Never had any surgreys .... Hardly went to dr. And the one time I need something for them they make it the hardest thing to get accomplished. There is always something . I think when I get my income tax I'm going to get an attorney to appeal it for me..... They have been doing this for 17 years and they said I would be a good candidate..... Ughhh just want this sooooo bad. I already told myself I was getting it. Now I'm like so upset they crushed my dream.

Gotta love insurance companies. *sarcasm*

Amanda Rae

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lovietobeme    45

lovietobeme
Posted

Who do you have insurance through if you don't mind me asking?

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JennyBeth    127

JennyBeth
Posted

It sounds like your issue lies mostly with the surgeon's office rather than the insurance. Although if their requirements are 2 co-morbitiies and you only have 1 then you won't qualify no matter what you try and do. Did the insurance un-enroll you from the bariatric program or did the insurance? Insurance companies will try and make it as difficult as possible so that you get frustrated and walk away. I have always thought that the surgeon and their insurance coordinator are the ones that help you to appeal the insurance's decision or your PCP. If the doctor is telling you to use an attorney then to me that should be a red flag to find a new surgeon because they should do the work to get you approved-after all they are the ones that will be getting paid.

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SoCalDixieGal    172

SoCalDixieGal
Posted

I'm insured through them as well. I know they vary though around the country. I called them some time ago about what their policy was on WLS. Yeah, the 35-40 BMI needed 2 co-morbidities, which I dont' have so then it's all cash.

Considering how much money you'd spend on the attny, you might want to research the Mexico route. I initally didn't think I'd ever do that, but the difference in $ was enough to get me researching.

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Jessiegurl2686    104

Jessiegurl2686
Posted

Thanks girls! In just getting frustrated with this whole thing. Got my hopes up for nothing . I had a friend go through this same weight and everything but I guess her insurance wasn't as strict . And she had no cormorbities ..... So should I call my surgeons office and ask them why I need an attorney and ask if they can appeal it???

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tessies    224

tessies
Posted

Thanks girls! In just getting frustrated with this whole thing. Got my hopes up for nothing . I had a friend go through this same weight and everything but I guess her insurance wasn't as strict . And she had no cormorbities ..... So should I call my surgeons office and ask them why I need an attorney and ask if they can appeal it???

I guess I'm confused. Why would you need an attorney to appeal? Seems like a waste of money. I would head to Mexico before I did that. That's what I'm doing. Not wasting another moment on the insurance BS!

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Geminidrive    389

Geminidrive
Posted

When starting with this process the best thing you can do is research and be informed, one call to your insurance company and you would have been armed with the insurance requirements before any doctors visits. If you don't meet the requirements what are they (Surgeon) suggesting that the attys will be able to

do?

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

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    • 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.
      · 0 replies
      1. This update has no replies.
    • 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. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.
    • KimBaxleyWilson

      KimBaxleyWilson

      Three months and four days ago... I was in Costa Rica having a life changing surgery! Yesterday we had a followup visit with Dr. Esmeral via video chat and this morning my middle number changed.  I'm down 47lbs and two pants sizes. I can wear a Large tshirt for the first time in like... 14 years! Woot!! Everything is going great. I have zero regrets. I went down to the riverwalk with a friend and walked 2 miles on Monday without even getting fatigued. And no more snoring or chugging pickle juice for crazy leg cramps! I need to go to the gym more... I'm making new shirts next week so that will motivate me. LOL But I'm also just not as TIRED all the time! I have a LONG way to go...but seeing the progress on the scales and in the mirror is a huge motivator!! Thank you all for cheering me on and supporting me!!
      · 0 replies
      1. This update has no replies.
    • bellaamey

      bellaamey

      https://alluniqueguide.com/java-burn-coffee-reviews/
      · 0 replies
      1. This update has no replies.

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