Denied and Distraught

[Tamlyn 107]

That's awful! I'm so sorry. Our health insurance is Blue Cross, but my husband's company has a "no weight loss surgery" coverage clause, so even though we actually have rather good insurance, I have to do self-pay, too.

FWIW, I'm having my surgery done by Dr. Alvarez in Mexico next month, and they've been super professional. I feel very comfortable with it now, but I was super nervous and mad at my health insurance for a while when I first found out.

[ForeverFat? 9]

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?

I feel your pain. I just got my denial today. I have BCBS of IL. I got a lap band in 2010 and was self pay. The band IS NOT for me. I should have gotten RNY from the start, but I was looking at the monetary bottom line, and the band was cheaper. I now have BCBS with bariatric benefits, yet they told me there isn't significant failure of the band to warrant a revision. I had an upper GI that shows the acid reflux is burning my esophagus, plus I have a dilated pouch with constant vomiting. HOW DO WE BEAT THE INSURANCE??????????????????

[AZDee 138]

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.

Eggface used the same surgeon I used in Ensenada, unfortunately Dr. Aguirre is no longer practicing there are plenty of great surgeons that offer many types of WLS at a affordable price. I even did the hcg diet to lose my regain and also finally get to my goal weight (102 lbs total lost) so there are options, do not give up hope, when there is a will there will always be a way...

[Melanie36 71]

I'm back! Just an update-- i appealed and as I suspected, I was denied my appeal despite a very convincing, well written letter.

I did my best to readjust my attitude about the situation. I used it as a life learning experience. I knew in my heart this wasn't over, so I was going to apply what I learned to my life and channel my disappointment into eating better and starting a workout program.

And... Great news! I changed insurance starting January 1st and this coverage allows bariatric surgery!! Since I already finished the approval process with my surgeon, all the have to do is resubmit my paperwork. They either did it this last week or hopefully this upcoming week. I should know soon. I'm hopeful that I'll be on the losers bench in about 30 days or so!

[della street 213]

@@Melanie36 Yea for you!!!!!

[ktbbailey77 3]

WOW CONGRATS IN YOUR JOURNEY!!!!

[jillstl 55]

I feel your pain. My insurance policy has an exclusion for weight loss surgery. Might look into having it done in Mexico unless I can finance it.

[Melanie36 71]

And now I got a letter that my claim is pending... They have reached out to my doctor for more info??

They want MD notes and findings, diagnostic test results, and previously tried treatments and medications.

This doesn't sound good.... Feeling nervous and like I'm on a roller coaster again.

I wonder how common it is to ask for more info from the doctor.

[Melanie36 71]

Approved!!!!!! I'm approved!!!!

For those that have been previously denied, hang in there. If you're denied, make a choice to live as healthy of a life as you can until you can find a way to get approved!!!!

So happy! (And now getting scared! Lol)

[Salonboi 353]

Approved!!!!!! I'm approved!!!!

For those that have been previously denied, hang in there. If you're denied, make a choice to live as healthy of a life as you can until you can find a way to get approved!!!!

So happy! (And now getting scared! Lol)

Congratulations!!!!!

[MrsGibson711 10]

Approved!!!!!! I'm approved!!!!

For those that have been previously denied, hang in there. If you're denied, make a choice to live as healthy of a life as you can until you can find a way to get approved!!!!

So happy! (And now getting scared! Lol)

Congratulations!

[duncanb007 12]

In Australia - if your GP refers you to a surgeon. Then the insurance doesn't have a choice. I pay a few small out of pocket expenses. We don't have to apply and await confirmation.

Isn't there a net economic benefit to people becoming healthier in the first place?

[toohighofa# 14]

Cigna is my insurance company and the company I work for has a exclusion to wls yet cigna said anything is possible. So I began jumping through hoops and approvals and then to a bariatric surgeon with all my approvals and two years later it's still denied. I'm frustrated with it all and heading to Mexico on March 31. My primary dr. Agreed its a good idea but informed me that if cigna finds out I went to Mexico they will cancel my policy. Has anyone seen this happen?