.

Edited March 5, 201511 yr by Mom0f3inOC

Oh my gosh I am shocked and absolutely RAGING angry!

I have 35 bmi and 1 co-morbidity, Upper GI documenting problem with band. I fit exactly what BC says I have to fit.

Nevertheless DENIED!

They say too experimental. WHAT THE???? The policy says they do revisions if you meet the qualifications and I DO fit the qualifications. WHAT THE @$#%$^%^&

I feel totally hopeless and beyond angry. What did my doctor say in that submission to screw it up? What did he do and why? I should have been a slam dunk! I am seeing RED!!!

Appeal.

You should definitely go ahead with the appeal. Right now you feel like all hope is lost, but you still have a chance with the appeal. You have NO CHANCE without it.

It's unfair to blame your doctor before you know the details.

You can give up or you can appeal. Insurance companies can be particular and arbitrary. What may often look like a slam dunk can and has been denied.If you want this, fight for this. Do the appeals and work the process.

or sit home mad.... Your choice.

Just curious, have any of you been denied and successfully appealed?

Edited March 5, 201511 yr by Mom0f3inOC

.

Edited March 5, 201511 yr by Mom0f3inOC

And if worse come worse, save up and go to Mexico, cheap, safe, and no hoops to jump threw. Best of luck!

And if worse come worse, save up and go to Mexico, cheap, safe, and no hoops to jump threw. Best of luck!

That's what I did. I didn't stand a chance with my insurance company because they required a five year documented weight history of a BMI over 40 or 35 w/comorbidities. Shame on me for at least TRYING to do it "on my own" and having lost 90+ pounds back in 2010/2011. That put my BMI well below 40 until it slowly crept back over 40 this past summer. So my options were self-pay or stay fat for another 3-4 years to meet their stupid requirements!

I feel ya! You should be super mad, I would too and it's only normal. After a day or two when you see a lighter shade of red, becuase you will prob still be upset just think about it a little more, but dont give up. Keep it moving, I'm sure it will work itself out. I had a situation about two weeks ago where I finished all the req. and had the paparwork submitted to have it kicked back due to BC having new 2015 requirements (requirements changed from 3 month weight monitoring to 6 month weight monitoring). I was origionally told that the new rules would go into effect until March, so I felt hopeless as well when I found out. I felt my body in a rage and I was in tears becuase it's one thing when you dissapoint yourself, but when someone else dissapoints you after you have done your part, that was the worst for me. So i hear ya but take a day or two then think about it, then do what's best for you.

i was denied twice and made it on the third appeal. im two months post op now, so it does work.

And how many of you were denied and successfully appealed? Any?

There are actually several people on this forum who have appealed and won. Some even had to a peer to peer review. I was fortunate to be approved the first time out but I know from personal experience that appealing insurance company decisions works. I have done them for other things and won. What will not work is having a defeatist attitude such as this:

I have no hope that this will work out. I don't even see the point in trying. No reason to have any confidence in the process or the doctor. I am beside myself. If It was denied wehn I do fit all the qualifications why would it be approved with a face to face. NO hope. Sorry for the type os. I'm too mad to care about correcting them.

if you want this, fight for it.

Peer-to-peer scheduled for Tuesday afternoon.

Edited March 5, 201511 yr by Mom0f3inOC

@@Mom0f3inOC - Don't give in attitude is everything. Fight to the very end and make them believe this has to happen!

appeal or catch a flight to mexico... good luck

@@Mom0f3inOC, it's not risky in Mexico at all. I would choose them over any doctor here as I feel they are at least held accountable for their work, can't say the same for American doctors. I went alone, and met so many wonderful people. I plan to go back for a little renovation work on my giggly parts. There was not one second that I didn't feel safe, and there you get GREAT surgeons, to me peace of mind and to be able to do what I know needs to be done was important, not to have a buch of people decide for me what's important and what I need. Just my thoughts and opinion.

I hope the insurance company comes threw for you as the sleeve is the most important thing I have done for myself EVER.