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Peer to peer

Brenda Sherwood

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Brenda Sherwood    64

Brenda Sherwood
Posted

My isurance (a form of medicaid) denied me as they are saying they require comorbidity even with high BMI. My Dr is fighting for me and has a peer to peer scheduled. Wondering how many people have had a successful outcome from peer to peer? Did it or didnt it work for you? Considering hiring a bariatric attorney

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britknee    8

britknee
Posted

Praying it will work out in your favor. I too have Medicaid in Illinois and will be meeting with my surgeon soon and then having my insurance submitted for prior authorization. I think it will

Work out in your favor though.

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melyssafaye    181

melyssafaye
Posted

I have Medicaid in Illinois as well. I went to UIC, which was in network for my managed care plan. I followed the requirements, did the 6 month supervised diet and had surgery on 3/31. There was no problem with approval so long as my BMI was over 40. The biggest thing I learned was that I had to follow every doctors instructions 100% and follow through, even when I may not have wanted to, because they will object if you are "non-compliant". Good luck and I hope you get approved after a peer-to-peer.

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Brenda Sherwood    64

Brenda Sherwood
Posted

I was on a 6 month diet, insurance changed requirement to 3 mo right at my 3rd appointment so they had me jump though all the other hoops super fast (ekgs, psych, blood, stress, preggo, etc) and I was 5 days into my liquid diet when I found out they said no. Super bummed. Did everything they said to a T and lost 28lbs in the process. Insurance came back saying I needed proof that I had conditions making me disabled due to my obeisity even though BMI of 46

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britknee    8

britknee
Posted (edited)

Wow that's crazy. I hope after peer to peer you get approved. I think that just might be your insurance company's way of deterring you but don't give up. Keep us posted. I know how anxious u must feel but I truly believe this will work out in your favor. The doctors know exactly what to say to get you approved and it's great that they're going the Extra mile. Hang in there and keep us posted!

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Edited by britknee

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melyssafaye    181

melyssafaye
Posted

I had high blood pressure, but it wasn't being treated with meds. I did the sleep study and snore but no apnea.

My managed care company didn't require comorbidites with BMI of 40 or over.

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Brenda Sherwood    64

Brenda Sherwood
Posted

No word. Peer to peer in a couple weeks. Im in no hurry now because I cant get surgery til end of July because my job is crazy busy late May til mid July

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WantToBe    77

WantToBe
Posted (edited)

Brenda - my insurance company denied my lap band removal! My surgeon did a peer to peer and approved the removal. I hate to say this - is there anything you could document as a comorbidity? Maybe go deep into your records and find something? I wish you good luck with insurance company.

Edited by WantToBe

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Brenda Sherwood    64

Brenda Sherwood
Posted

Brenda - my insurance company denied my lap band removal! My surgeon did a peer to peer and approved the removal. I hate to say this - is there anything you could document as a comorbidity? Maybe go deep into your records and find something? I wish you good luck with insurance company.

They have family history listed and my mother had every problem possible and died at 62 so we are going to try and use that. I told them i have bad knees that most likely will need replacing in the next few years, my aunt died in her 40s and was close to 600lbs, a couple other things. We will see...

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Go To Topic Listing Insurance & Financing

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    • Alisa_S

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      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

        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

      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

        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

      CaseyP1011

      Officially here for a long time, not just a good time💪
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