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Denied

My surgeons office just called me. I was denied. She said she has never experienced this before with my insurance plan. They gave two baloney reasons

First that my blood pressure needs to be higher even though I'm on medication??? WTH does that even mean?? They want to see a constant of 140 over (I don't remember the number) while trying to be controlled

Second. I have not lost enough weight. I'm down to 199 if I get any lower I will now qualify.

I started loosing weight on my own at 245 lbs. I originally went to the bariatric center to get help with medication weight loss. That was when I found out I had high blood pressure and the dr said definitely no she would not give me medication to aid in my weight loss. They took that weight 215 and compared it with the next weight they had 9 months later ( once I decided to go for surgery) I had gained 9 pounds...over the period of 9 months.

Sorry if I'm all over the place with this I'm just so upset. My dr has had to up my high blood pressure medication once because it was not working. I have a appointment with her this afternoon to see if she can fax that to my surgeon. The bariatric center has 14 days to fight it. If they don't win it's a definite denial. My surgeon is going to do an eye to eye?? With the insurance.

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My surgeon got my denial reversed today at the peer to peer!!! Super excited.

Sent from my Y538 using the BariatricPal App

I am so excited for you.

Cocoon to Butterfly

Thank you so much. I was prepared to fight like you did! Thank God I didn't have too.

Sent from my Y538 using the BariatricPal App

Well now they are warming the bench for us. Let me know when your Surgery is. Mine is 1-4-17.

Cocoon to Butterfly

  • Author

My surgeon got my denial reversed today at the peer to peer!!! Super excited.

Sent from my Y538 using the BariatricPal App

I am so excited for you.

Cocoon to Butterfly

Thank you so much. I was prepared to fight like you did! Thank God I didn't have too.

Sent from my Y538 using the BariatricPal App

Well now they are warming the bench for us. Let me know when your Surgery is. Mine is 1-4-17.

Cocoon to Butterfly

Yes yes...awesome we can do it together! I'm so excited. Do you feel completely prepared? Not mentally but as far as everything you think you might need?

Sent from my Y538 using the BariatricPal App

My surgeon got my denial reversed today at the peer to peer!!! Super excited.

Sent from my Y538 using the BariatricPal App

I am so excited for you.

Cocoon to Butterfly

Thank you so much. I was prepared to fight like you did! Thank God I didn't have too.

Sent from my Y538 using the BariatricPal App

Well now they are warming the bench for us. Let me know when your Surgery is. Mine is 1-4-17.

Cocoon to Butterfly

Yes yes...awesome we can do it together! I'm so excited. Do you feel completely prepared? Not mentally but as far as everything you think you might need?

Sent from my Y538 using the BariatricPal App

I sure hope so. I have a bookshelf full of Soup, drinks, and little containers. I go to my doctors on the 21st to sign documents.

After fighting with the insurance, I am excited to get on the bench.

Cocoon to Butterfly

  • Author

My surgeon got my denial reversed today at the peer to peer!!! Super excited.

Sent from my Y538 using the BariatricPal App

I am so excited for you.

Cocoon to Butterfly

Thank you so much. I was prepared to fight like you did! Thank God I didn't have too.

Sent from my Y538 using the BariatricPal App

Well now they are warming the bench for us. Let me know when your Surgery is. Mine is 1-4-17.

Cocoon to Butterfly

Yes yes...awesome we can do it together! I'm so excited. Do you feel completely prepared? Not mentally but as far as everything you think you might need?

Sent from my Y538 using the BariatricPal App

I sure hope so. I have a bookshelf full of soup, drinks, and little containers. I go to my doctors on the 21st to sign documents.

After fighting with the insurance, I am excited to get on the bench.

Cocoon to Butterfly

That's awesome! I'm clearing off a bookshelf tomorrow and stocking up!

You totally deserve this. Best wishes and please stay in touch. I will let you know my date when I get it.

Whoo hoo...new lives for us!!!

Sent from my Y538 using the BariatricPal App

My surgeon got my denial reversed today at the peer to peer!!! Super excited.

Sent from my Y538 using the BariatricPal App

I am so excited for you.

Cocoon to Butterfly

Thank you so much. I was prepared to fight like you did! Thank God I didn't have too.

Sent from my Y538 using the BariatricPal App

Well now they are warming the bench for us. Let me know when your Surgery is. Mine is 1-4-17.

Cocoon to Butterfly

Yes yes...awesome we can do it together! I'm so excited. Do you feel completely prepared? Not mentally but as far as everything you think you might need?

Sent from my Y538 using the BariatricPal App

I sure hope so. I have a bookshelf full of soup, drinks, and little containers. I go to my doctors on the 21st to sign documents.

After fighting with the insurance, I am excited to get on the bench.

Cocoon to Butterfly

That's awesome! I'm clearing off a bookshelf tomorrow and stocking up!

You totally deserve this. Best wishes and please stay in touch. I will let you know my date when I get it.

Whoo hoo...new lives for us!!!

Sent from my Y538 using the BariatricPal App

WE totally deserve this.

Cocoon to Butterfly

Sent from my iPad using the BariatricPal App

Good luck with your appointment. Do you have to start over?

Sent from my Y538 using the BariatricPal App

Sorry, i didn't seen this question before. I had only done 1 Dr visit & a sleep study, so I wasn't too far into the process. Im not sure if I have to do the sleep study over. I will find out in a week when I go for the appointment I guess. I hope I don't have to, but it's been 10 months since I did it so I'm sure I will. I've been drinking Protein, fruit & spinach shakes daily for Breakfast & lunch for 1.5-2 weeks & I'm not losing. Im cutting down my portion at dinner & trying to drink more Water. I need to stop drinking coffee though. That's a killer. I've just started sub teaching after being off work for a while & I'm so far behind at home, but I want to save some of my sub $ for the surgery. And I want to wait to have the surgery in the summer when school is out.

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@@Jazzzyjay praying your surgeon helps to get your approval and your request comes back in less than 14 days. :)

  • Author

@@Jazzzyjay praying your surgeon helps to get your approval and your request comes back in less than 14 days. :)

Thank you. She did! It was approved yesterday????

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AMEN!! Congratulations! :) :) :)

  • Author

AMEN!! Congratulations! :):):)

Sent from my Y538 using the BariatricPal App

  • 2 weeks later...
  • Author

Yay!!! I was reading this hoping to hear good news. I have Medicare share of cost so I hope I don't have the same issues cause I'll be devastated. Good luck

Sent from my iPhone using the BariatricPal App

Thanks! You should be fine. I think the insurance just wanted to be sure my co morbidity was " bad" enough to need the surgery. Even with weight loss on my own and medication adjustments my blood pressure and headaches to this day are out of control.

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  • Author

@@laurak814 How is everything going?

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Hey @@jazzyjay! I'm doing well. How are you doing? I had my consult on Friday & finally told my husband that I was doing this surgery whether he supported it or not. We talked about it on Fri & Sat a bit. He is a master manipulator, I tell you! He has me feeling so guilty for everything already. It makes me so mad & I realize that this is how he has treated me for 21 years, since I was 19yrs old. Like I'm not capable of making a decision for myself.

What's going on with you?

Sent from my iPad using the BariatricPal App

  • Author

Just stick to your guns! You know what's best for you. Never feel guilty for making healthy changes in your life.

I'm doing well. Just waiting for surgery on Jan 17. I'm very excited. I'm planning on moving home to Cali in the summer, hopefully if I save enough money. I hate it here in Nebraska and I'm so isolated.

Sent from my Y538 using the BariatricPal App

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