DENIED FROM INSURANCE

[ronr 3]

Hello,

I was denied by my insurance company for vertical sleeve surgery. 9 months of meticulous mayo Clinic, University of Minnesota, Fairview Baratric in Minnesota. 2-3 k in personal expenses evaluated and being evaluated. I have every t crossed and i dotted. I'm in the medical business as well. BMI over 40, diabetes, kidney failure, neuropathy in feet, and on and on. My insurance covers 1 time surgery for weight loss and still they found loop holes in my policy I never seen to deny me. How disgraceful! Will try to appeal, my company may fire me for it. This is the most under utilized surgery in the US. Thousands a month in meds which they would rather pay. I have been on Atkins, Mayo Clinic diet, Medifast. Emily program all with limited success. Not a good day at my house.

Ron

[Valentina 2,642]

Is your Dr. willing to do a Dr. to Dr. conference call? Many times that will tipped the decision in your favor.

Its worth a try.

Good luck and keep us posted

[ronr 3]

Valentina

Thanks for the advice.

regards

Ron

[Valentina 2,642]

Valentina

Thanks for the advice.

regards

Ron

You are very welcome, Ron.

Please don't give up. "The sqeaky hinge gets the grease".

Keep us posted. Good luck!

[JamieLogical 8,684]

Makes me feel almost blessed to know my insurance wouldn't approve me from the start so I didn't waste all that time and money only to get denied. I really hope you can appeal and still get approved. Did they tell you why you were denied? Is it anything you can work to remedy and reapply?

[ronr 3]

Ladies thanks for your comments.

Denied because: Our peer clinical reviewer has determined: Non-certify proposed laparoscopic gastrectomy (CPT 43775).

Based on information provided, this patient is morbidly obese, with life-threatening clinical co-morbid conditions. No documented BMI. What? There is on documentation that the patient has failed conservative weight loss treatment ( 2 year period that immediately precedes the request, one structured diet program for 6 months; or two structured diet plans for 3 consecutive months.) Ok you don't want to pay! I start my appeal process tomorrow 2/28/16

Stats 62 year old male. Confirmed diets Medifast 1 year. Emily 3 months, Atkins 3 months, work out 5 times a week. Weight is maintaining. BMI 40.5 Now I'm reading a blog from a PhD on this site that states that most people will regain there weight after 3 years or another addiction will pop up like drinking, pain kills, sexual activities if I don't spend 10k or more getting to the root because that is what long term mental health treatment cost over a year to address the potential underlying problems that caused the food addiction in the first place. Oh now that helps about right now, but may or may not be true because there is no confirmed data on the success long term of getting WLS. I know it is a tool and up to me. 100,000 patients. How many return to original weight, develop other addictions, die, and so on, where is that data. I've had 3 severe colon surgeries in my life. Not just normal resections. I spend 40 days in the hospital with several. I'm just pissed at my insurance company and myself today and have never voiced my thoughts. I have one sister that's 400lbs 5.00 feet tall another that has had the band and my best supporter, a brother that weighs 110 labs at 68 looks sickly. I have been over weight since 12. But in general have had a Ok life with 5 kids and 5 grandkids. So admire all of you for the guts and strength you have had to push forward with this WLS.

Ron

​Ron

[JamieLogical 8,684]

I self-pay at all an option for you? While there are no guarantees, the long term success rate of WLS is much higher than that of traditional diet and exercise alone. It sound like you could truly benefit.

[fernandfj 469]

Ron, Just keep at the company. I was initially denied by BCBS Fed and I contacted customer service to appeal. They requested a bunch of additional documents, but as I was about to submit those, the initial call had generated an appeal that overturned the initial decision. Just keep pressing them and hopefully you will have a positive outcome. Good luck!

[ronr 3]

Thank you for your response. Congrats on your great success fernandjf. How was your transition to the life changing diet routine? Was it painfull for you?

Ron