Denied and Distraught

[Melanie36 71]

Just got my denial letter today. I guess I'm not sick enough. I'm so upset. I've been weepy all day. :-(

So- where do I go from here? I feel like mentally I was totally prepared to do this.... And now what? I can't go on like this.... I'm miserable and feel like my last resort was pulled out from under my feet. What do you do when your last resort is gone?

[moose18201 24]

You can appeal the denial. Don't let them win.

[weightlossdiva1234 13]

Just got my denial letter today. I guess I'm not sick enough. I'm so upset. I've been weepy all day. :-( So- where do I go from here? I feel like mentally I was totally prepared to do this.... And now what? I can't go on like this.... I'm miserable and feel like my last resort was pulled out from under my feet. What do you do when your last resort is gone?

Did the denial have anything to do with your benefits policy? If so, contact your Benefits Director or Manager and ask them if they will reverse the denial. I had to do that. I was denied and approved within a day. Don't give up. Hang in there .

[Melanie36 71]

I'm fairly certain this denial will stick. Our monthly support group last month was all about the insurance changes and how my insurance company, which is very popular in my geographical area, is declining nearly 100% now with no appeals going through. :-( I still had a chance since my plan was grandfathered. Ugh.

[weightlossdiva1234 13]

I'm fairly certain this denial will stick. Our monthly support group last month was all about the insurance changes and how my insurance company, which is very popular in my geographical area, is declining nearly 100% now with no appeals going through. :-( I still had a chance since my plan was grandfathered. Ugh.

I encourage you to appeal it. My plan had a 1 per lifetime clause. I went from lap band to bypass. My employer had to tell the insurance to grandfather me in. Best of luck!

[greensleeve 457]

Always appeal. Every employer has a slightly different policy with the insurance companies.

Is your BMI low so they need to see comorbidities?

[Melanie36 71]

BMI is over 40. And the Bariatric Coordinator called me last night. There's basically nothing I can do. I can try to appeal, but she doesn't feel it will change anything. Starting in April of this year, they changed their requirements (insurance) so that you basically have to be dead or disabled to qualify. She urged me to become politically active to try to see change, but I was essentially ushered out the door. :-(

I will appeal, but I'm done. I asked her "what is next for me?"..... She suggested a job change for different insurance, but that's not realistic for me. So- again- what happens to us bariatric rejectees? Gah-- this feels awful- knowing that my only options are to do the same darn things that haven't worked for me for the last lifetime.....

[RNBSN786 206]

I also tried to get approval with my insurance in 2011-2012 and was denied and then I got another job in 2013 and started the paper work again and got approved. So the only thing would be to switch jobs. I know you don't want to do that and if you have appealed and nothing happened, then the only option is to pay out of pocket. What else can you do?

[greensleeve 457]

Are you in the US?

[Sparklingbeauty53 202]

It is cheaper in Mexico. Look at the blog The World According to Eggface. She went somewhere in Mexico and had an excellent result. Start researching. There is also a place that sponsors people who have been denied. They only support 1 or 2 people per year but that is in the US. I will research that and get back on here to give you the information.

[jjinWA 511]

I went through your same emotions a few days ago. Not for me, but for my daughter. She and I were going to go through this journey together. My ins approved but hers did not. We were truly crushed! I had my surgery few days ago. All going well and as expected. I see the disappointment everyday in my daughter's eyes even though I know she is happy for me. We wanted this sooooo very much for her as well. Basically she was denied for a very simple clause. We applied in June 2014. She had to be over 40bmi for past two years. Our facilitator did not tell us that until too late. Anyway, she was 40.1 dec 12 and 40.3 dec 13. They asked for weight from dr chart in June 12. She was 38.9. With no comorbities her 38.9BMI in June 2012 eliminated her ins approval and coverage. That is something we cannot argue. It is fact.

So now the next step. After much research, thought, and prayers, we have determined that her health, well being, and happiness should not be determined by some arbitrator working in an insurance company! We have decided to self pay and have the sleeve surgery in Mexico with dr Illan. She is scheduled for July 22 and I will be going down with her. Nervous. Yes a bit. But I have to be honest, since I recently went through this same surgery a few days ago, it does not carry the stigma that it did before I had the surgery. Serious surgery, yes.... But surgery that has been done by hundreds and hundreds of people before me. I love my daughter more then the. I can express. She is truly my best friend. I must weigh the risk of surgery and her current quality of life to determine the course of action to take. Do nothing or move forward and go to Mexico. $4600 and 2 plane tickets and we will be on our way to getting her on the other side of the journey where she can join me on the losers bench.

This decision is a personal one that we had to make. Your decisions are personal as well, but do not rule out Mexico surgeons. Search the posts here. There are many positive posts here on this site about several of the surgeons in that area.

[Crosby 303]

I am so sorry. I feel your pain and hopelessness. But reach down and find the fighter that exists in you. In doing research for myself I found this. They seem to have some good reviews from what I see. http://wlsappeals.com

Good luck. I am pulling for you.

[Cupcake 801]

I would contact my insurance company to see why was denied then I will began the appeal letter asap, I am sure your doctor can write you a letter stating why you need this surgery. Good luck.

[greensleeve 457]

Can you sign up for Obama care?

[peteyrulz 82]

I'm part of the denial downers too! We should start a club. I got my letter on Monday of this week. My BMI is 38.86 but I'm not medically desperate enough , I guess. I was crying a lot ystdy, but today I've done some research. First I am contacting Lindstrom Obesity Advocacy, www.wlsappeals.com. If that doesn't work then I'm seriously considering either Dr. Guillermo Alvarez (endobariatrics.com) or Dr. Lopez (specializedbariatrics.com), both in Mexico. Dr. Lopez is approx. half the cost of Dr. Alvarez. I'm still researching both. Mexico scares me a bit but the more I've read about it the more feasible and attractive these options seem to me.

Good luck! Let us know if you have any luck.