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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?

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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. :-)

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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.

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

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@@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.

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

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@ 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.

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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!

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@@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.

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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!

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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.

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

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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!

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

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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!

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    • LeighaTR

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

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      · 2 replies
      1. Selina333

        I'm so happy for you! You are about to change your life. I was so glad to get the sleeve done in Dec. I didn't have feelings of regret overall. And I'm down almost 60 lbs. I do feel a little sad at restaurants. I can barely eat half a kid's meal. I get adults meals often because kid ones don't have the same offerings at times. Then I feel obligated to eat on that until it's gone and that can be days. So the restaurant thing isn't great for me. All the rest is fine by me! I love feeling full with very little. I do wish I could drink when eating. And will sip at the end. Just a strong habit to stop. But I'm working on it! You will do fine! Just keep focused on your desire to be different. Not better or worse. But different. I am happy both ways but my low back doesn't like me that heavy. So I listened (also my feet!). LOL! Update us on your journey! I'm not far from you. I'm in Houston. Good luck and I hope it all goes smoothly! Would love to see pics of the town you go to for this. I've never been there. Neat you will be traveling for this! Enjoy the journey. Take it one day at a time. Sometimes a few hours at a time. Follow all recommendations as best you can. 💗

      2. Doughgurl

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    • 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. LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • 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

        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

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