Peer-to-Peer tomorrow

[JennAsVSG 1]

So I found out about 2 weeks ago that my insurance denied me because my BMI was not greater than 40 and the comorbidities that I submitted (GERD and Hyperlipidemia) they didn't consider obesity related - my BMI is 36.3 - and no I don't have hypertension or diabetes (although I do have an impaired fasting glucose which my MD says if I don't loose weight I WILL become diabetic) - but really - do you want me to 'be sick' first - what about trying to prevent these diseases?!?!?!

So I'm wondering if there are any success stories out there with any of you who have been denied upon initial submission of your paperwork - only to be approved with a peer-to-peer - looking for a ray of hope

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[Amurillo04 109]

Many many people get approved after being denied first and usually peer to peer works very well in that case. I really hope you get approved. Let us know.

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[JennAsVSG 1]

Next hoop - need a sleep study - scheduled for 07-18 - so much riding on one nights sleep

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[JennAsVSG 1]

Well - I was supposed to have an 'in lab' sleep study done (as per the agreement from my insurance company and surgeon during my peer to peer) - well it of course needed a prior authorization - which was denied - the insurance company said to do the 'at home' sleep study first then if I "qualify" for the in lab study (meaning I fail the at home test) - then we would have to do the in lab test - got the order from my MD sent over for the 'at home' test - again needs a prior authorization - again denied.....

I am SO angry with insurance - I pay all this money for private insurance and NEVER use it - and when I finally want to utilize the insurance that I pay for - it's denial after denial after denial....

Of course I can pay (yet again) out of pocket for another test - but how much more should I have to pay for?? I've paid out of pocket for my 6 NUT appointments, my psyche eval; my endoscopy; my consultation - and now a sleep study - that I may or may not pass, and if I don't fail it (meaning don't have sleep apnea) my insurance WILL NOT pay for my surgery anyway - so it'll just be more money that's I've thrown out the window for this process - only not to be able to get it....

And then I keep thinking - maybe it's just not 'meant for me to have this surgery' because if it was - things should just kinda move along smoothly - or at least not having every proverbial door slammed in your face -

So what choices do I have now - gain 15 pounds so I can say poop on you insurance company - my BMI is 40 - or do I try - yet again - to 'get serious' with better eating habits - using some of the lessons that I've learned from my NUT appointments - and continuing with the exercise goals that I made during my NUT appointments....gaining 15 pounds is harder than you'd think - and I'm already uncomfortable in my skin, so adding 15 more pounds I don't think would do me any good - emotionally, physically, or mentally - so I guess it's going to be 'getting serious' - again - and hoping that this IS the time that sticks.

Best of luck to all of you going through your process for WLS.

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[Amurillo04 109]

@@JennAsVSG I'm sorry that your insurance if you such a hard time. I too have private insurance and I only had to pay for my pysc visit. Maybe in January you can try to look for another insurance company? For now if you feel like the best bet is to get serious and lose it yourself then power to you and good luck:)

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[KristenLe 5,980]

@@JennAsVSG Don't give up!!! What insurance do you have? Have you spoken to a Care Manager? Are they denying the sleep study because it was coded incorrectly on the prior authorization request? I can't believe you've had to pay for all that you have! Your insurance sounds useless! Fight for your benefits!

[bari_nurse 2]

I would think the coding was wrong too! Home sleep study should slide right through based on obesity alone! Check on that with MD office. Have them add anything that will help (daytime sleepiness, snoring, fatigue)