It has been one of those days to say the least. I called my insurance to check the status of my recently submitted papers for approval for bariatric surgery. To my dismay I was told I was denied because it wasn't medically neccessary. How can that be? My BMI is currently 66 and my weight is 422. I have sleep apnea and yes I sleep with a machine. I am borderline diabetic. I have high blood pressure. I have high cholesterol. I've got arthritis in my lower back, right hip, and my pelvis, making it very painful to do anything. I have Sciatic Nerve damage. I have Carpel Tunnel in both arms, and hands. I am ALWAYS out of breath. EVERYDAY I live in misery from the pain, and yet they say its not "Medically Neccessary". Are you kidding me? So now they are requesting a Peer to Peer with my bariatric surgeon, and yet the lady that handles the insurance stuff at the doctors office says she hasn't gotten a request. When they told me they sent one over, and their waiting on a response by tomorrow or else that's their final decision. I don't know what to do. I have come to far to give up now. I made sure I got clearance from my PCP, the Pulomonary Doctor, the Cardiologist, and the Gastroenterologist, and they ALL said it was "Medically Neccessary" for me to have the surgery. I also sent the last 10 years of medical papers showing that I have been battling with my weight forever. So now what? Does anyone know about Peer to Peer meetings and what are the chances of approval after having one?

I'd go to my Dr office tomorrow & call my insurance company on my phone & then hand the phone to the insurance lady at the Dr office. That way you know they have talked to each other. Kinda crazy but it might work. :-)

I don't know about the peer to peer process but I would say please don't give up and hang in there! With all the issue that you have described I don't see how they denied you and I'm sure you'll get the approval after the peer to peer.

Wow @@Beauty+5 what insurance do you have? I'm so so sorry they denied you. I'm in utter disbelief they denied you.

@@phatfatgirl I have Amerigroup Medicaid. I was and still am in disbelief. I mean I have EVERYTHING wrong with me and I'm in my 30's. Hopefully the outcome will be good in the end I go see my surgeon tomorrow so hopefully he can work some kind of magic. Lol.

@@MichelleTN that is some good advice. I am going to do just that too. Lol. They know I am VERY straight-forward.

@ Martene81 I was saying the same thing it just doesn't make any sense to me. I even have a Vitamin D deficiency where I have to take 50,000 IU of Vitamin D weekly, I get B-12 shots, because it is so low. That's just a couple of more things. You would think the size and the Sleep Apnea would be enough. For goodness sake if I don't sleep with my CPap I literally stop breathing numerous times through the night.

That's absolutely ridiculous! Your BMI alone qualifies you. And your other health issue only reinforce it. Whatever happens you must appeal. They don't have a leg to stand on. I wish you the best of luck!

@@Beauty+5 I am so sorry to hear this news.

Don't give up. The surgeon might be able to advocate more for you.

This makes absolutely no sense.

DON'T DO ANYTHING until you contact Lindstrom Obesity Advocacy. They can help you, I know. My peer-to-peer for band to bypass procedure was denied last week so at the advice of many on this site, I contacted them and THEY are appealing my case. Google them for contact information. You won't be sorry. I have a great deal of confidence that my decision will be overturned!

Doesn't make sense. You should qualify easily, APPEAL but take a look at the paperwork to make sure all the requirements are fulfilled, the denial could have been due to a technicality. Your BMI alone qualifies as medical necessary.

Don't give up, keep fighting for you life because you are literally fighting for your life!

Good news everybody, my patient coordinator called the insurance company herself. The doctor she spoke with there is no need for a peer to peer, after reviewing my file she see's I am more then eligible for surgery. She said it is definitely medically necessary and it was APPROVED! Yay! Look at God work. Now my journey starts!

That's WONDERFUL, WONDERFUL news!! CONGRATULATIONS!!! You will rest well tonight!

I'm so happy they came to their senses. And most importantly that you weren't forced to go through a long drawn out fight to achieve the same outcome. You have a wonderful, bright, and healthy future ahead of you now!

Thank goodness! You're on your way!