Received a letter from BCBS TN stating that my surgery has been denied, the reasons are:

My five year weight history does not show a presence of morbid obesity.

I knew that I did not have this proof going into the process. I don't go to the doctor unless I'm seriously ill so as it happened my weight was down (Due to dieting) at the one time in the year that I was at the doctor. My surgeons office assured me that would not be an issue. I questioned this at my first visit and took paperwork in on a second visit and discussed it with the nutritionist. I also have it in writing with a PA in the office stating, "It will not be a problem."

They did not receive documentation of a co-morbidity.

Not sure why this would not have been submitted as I had a sleep study and was diagnosed with Sleep Apnea

They did not receive documentation from attending physician that I followed a non-surgical weight loss program within 2 years of surgery.

I've been on one type of diet or another for the bast 20 years. Like many obese people I didn't check in with my doctor prior to going on any of them.

I did not achieve or maintain 10% of weight loss

I did not know this was a requirement. My surgeons office didn't mention it, in fact they stated I wanted to be careful not to go below the 35 bmi. I had checked in with my insurance and this was not on the documentation sent to me.

This member only participated for 4.5 months a minimum of 6 months participation is needed.

I met with a nutritionist for 6 visits. Six months in a row. Evidently it was not submitted correctly.

A person from the surgeons office (not the particular office I've went to but one of their offices) called today to say that due to the missing 5 year history the surgeon will not do a peer to peer with the insurance office. After all that is a requirement by the insurance company and their isn't anything they can do about MY insurance.

To top it off I have a preop appointment with my pcp tomorrow as my pcp's office called me to set up an appointment since they were sent a date of May 5 by the surgeons office. When I asked the surgeons office about the date today she said, "Oh, we just put a date on the form for insurance purposes."

I'm at a loss. Trying to decide rather I sign up for Nutri-System again, or Weight Watchers etc. I've got to do something as I got rid of all my summer "Fat" clothes when I started this process as i was determined that I would be a thinner me by summer since I started this last August.

Anyone know of any wonderful diets that work.

I am so sorry that you are having so much trouble with this process. I went through a smaller version of the struggle. It took 2 denials and an appeal. Stating everything from I had not excepting the necessary lifestyle changes to i was not mentally stable. I believe that the insurance companies pick random people to push the limits with. Just an option. But you will get there, you are working very hard for what you want.

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What is your BMI? You don't have any of your information filled out. Are you around 40 BMI?

I am so sorry that you are having so much trouble with this process. I went through a smaller version of the struggle. It took 2 denials and an appeal. Stating everything from I had not excepting the necessary lifestyle changes to i was not mentally stable. I believe that the insurance companies pick random people to push the limits with. Just an option. But you will get there, you are working very hard for what you want.

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I can't imaging going through 2 denials and an appeal. It's such a roller coaster. I really thought my surgery would be in March and now here I am still working at getting approved. I'm not going to give up on it. I figure this gives me time to start losing some of my weight so I'm ahead of the game.

What is your BMI? You don't have any of your information filled out. Are you around 40 BMI?

I'm at exactly 40 and I have a comorbidity so I could actually lose a bit and should still be okay. Truthfully, I'd love to lose it and keep it off without the surgery. Through experience I'm pretty sure that won't happen.

What is your BMI? You don't have any of your information filled out. Are you around 40 BMI?

Wow! OutsideMatchInside. I just saw your weight loss. That is fantastic. You must feel fantastic about your success in such a short time.

I am so sorry that you are having so much trouble with this process. I went through a smaller version of the struggle. It took 2 denials and an appeal. Stating everything from I had not excepting the necessary lifestyle changes to i was not mentally stable. I believe that the insurance companies pick random people to push the limits with. Just an option. But you will get there, you are working very hard for what you want.

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I can't imaging going through 2 denials and an appeal. It's such a roller coaster. I really thought my surgery would be in March and now here I am still working at getting approved. I'm not going to give up on it. I figure this gives me time to start losing some of my weight so I'm ahead of the game.

I know how that is, I thought my surgery was going to be last August but it did not happen until March 16th. It gave me even more time to make sure this is what I wanted. There is always a reason for everything that happens. You will get your approval when you least except it and it will be when it's the best possible time. Keep me updated.

Sent from my SM-G925P using the BariatricPal App

I am so sorry that you are having so much trouble with this process. I went through a smaller version of the struggle. It took 2 denials and an appeal. Stating everything from I had not excepting the necessary lifestyle changes to i was not mentally stable. I believe that the insurance companies pick random people to push the limits with. Just an option. But you will get there, you are working very hard for what you want.

Sent from my SM-G925P using the BariatricPal App

I can't imaging going through 2 denials and an appeal. It's such a roller coaster. I really thought my surgery would be in March and now here I am still working at getting approved. I'm not going to give up on it. I figure this gives me time to start losing some of my weight so I'm ahead of the game.

I know how that is, I thought my surgery was going to be last August but it did not happen until March 16th. It gave me even more time to make sure this is what I wanted. There is always a reason for everything that happens. You will get your approval when you least except it and it will be when it's the best possible time. Keep me updated.

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When I started this process back in July I couldn't understand when people said the 6 month wait was a good thing. I was prepared and wanted it NOW. I can't say that I felt the 6 months of nutrition appointments were helpful but, for some odd reason since the denial I've accepted that it is going to happen it will just not be on my time schedule. In the past week since the denial I've eaten healthier than I did during the whole nutrition experience. For some reason that stressed me out and I'm a stress eater.

Thank you for your comments. It is appreciated.

1) collect and send in your own paperwork if stuff is missing 2) get on medically supervised diet for 6 months 3) you must have weighed in higher at some doctors appointments sometime in the past OR just finance your surgery and get on with it. I had no choice and honestly you all go through hell trying to get insurance to cover it. And yes I will own one less car in my life and the car I currently have will have to last me another 5 years, but it's worth it. It's the best thing I ever did. Also is your current doctor a bariatric surgeon or some other kind of doc? Bariatric surgeons offices are usually very good about the paper work because they only get paid right if the paperwork is right. Good luck[emoji4]

@@FocusOnMeNow I've already been through the 6 months of nutrition visits. I don't have the patience for insurance appeals, and yet the thought of self pay angers me. Like most people I pay a large amount of money for insurance. I've hired an attorney to do the appeals process for me. It isn't a guaranteed positive result, but I'm sure their success with an appeal will be much greater than my efforts at one would have been.

Your results are fantastic and perhaps I will end up being self pay. I will fight the insurance battle first before I make that decision.

Isn't it said that with WLS you are expected to lose 60% to 90% of excess weight? But you seeking to lose 25 pounds?

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Isn't it said that with WLS you are expected to lose 60% to 90% of excess weight? But you seeking to lose 25 pounds?

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Insurance requires a 10% loss which is 25 lbs. My goal is to lose 100 lbs.