Denied and Grieving

[Frustr8 7,886]

I don't , only her rotten insurance people, they are out to maintain their budget, refuse coverage whenever they possibly can. They are not interested in helping people only making and maintaining profits! Meanwhile our Jenna keeps falling and falling into the crack between rocks. I wish I had the right rope to save HER! She really deserves a Case by Case evaluation because on merit al9ne She NEEDS , she DESERVES, THIS SURGERY. To save her emotional mind but even more her body!
And now it seems like she has been kicked to the curb -WRONG WRONG WRONG it's so WRONG!
Is there any other program in her area she can apply to? She's in Arkansas? Has she tried the U of A, seems they might be more conducive, most state or Land Grant colleges are. Even go out of state, I've heard Louisiana is much more reasonably priced, is she anywhere near her state border? I know there are good programs in Mo. Mississippi, even Texas. THERE HAS GOT TO BE AN ANSWER, can anyone else think of alternatives?

[Jemma23 29]

Thank yall so much for the support! Even though you have me crying again, it is great to have someone to vent to. I can’t afford the surgery without insurance help. I can reapply next year, problem is, I need to be losing weight for my health not gaining to wait another year and reapply. I am back on Keto this week... not losing yet, but hope to. I am 50 yrs old, much harder to lose than it used to be. I have probably gained and lost 1000 lbs in my lifetime. I NEED the restriction to keep it off. I have never done keto before because doesn’t seem heart healthy at all, but I have to get the weight off. Yall know of any good weight loss support groups online? Thanks again for your support.

[Azlanie 51]

2 hours ago, GradyCat said:

I know it feels like a letdown, but look at the upside. You're only 200 pounds and your BMI isn't that bad. It might be something your doctor and the insurance company feels you can work on without surgery. You sound like you have a lot of get-up-and-go and are determined, so I bet you can do this. You've got this! Hang in there.

I don't feel that this is a fair post and it can be upsetting to OP. "Only" and "Not that bad" are things most of us have heard all of our lives. I understand that you were trying to help, or be positive but it rubbed me the wrong way.

To OP - if you paid (be it a deductible or something else) ahead of time and were denied, you are entitled to a refund. HOWEVER - call the program office. Denials happen all the time. Call up your insurance company. Light a fire under EVERYONE'S ass.

There are alternatives to the surgical procedures intended for people who have less severe obesity such as the Obalon. Call the insurance and see if they cover it. If not, find out what they DO cover for weight loss assistance for someone of your BMI.

Edited June 25, 2019 by Azlanie

[Frustr8 7,886]

I just wish I or someone else had the funds to give you a "Campership" to BariatricPalMx or similar. With your History and family genes you should not have to wait until 2020, and who is to say you might not get disallowed again. Its a 2'edged sword, if you manage to lose weight non- surgically then Rotten insurance can say " if she can lose on her own, why should WE BANKROLL HER?" Do they comprehend you are having to bet your very life to please them and the program? Or DO THEY FLAT- OUT not care? We used to have Bari- Pals active in the insurance industry who could advise how to maneuver past restrictions to victory. There is a guy in California who has helped on appeals, something close to Walter Lundstom, don't know if you fit his criteria or not. I hate for you to have to give up when you have tried SO HARD.

[Midnightsun 129]

16 minutes ago, Jemma23 said:

Thank yall so much for the support! Even though you have me crying again, it is great to have someone to vent to. I can’t afford the surgery without insurance help. I can reapply next year, problem is, I need to be losing weight for my health not gaining to wait another year and reapply. I am back on Keto this week... not losing yet, but hope to. I am 50 yrs old, much harder to lose than it used to be. I have probably gained and lost 1000 lbs in my lifetime. I NEED the restriction to keep it off. I have never done keto before because doesn’t seem heart healthy at all, but I have to get the weight off. Yall know of any good weight loss support groups online? Thanks again for your support.

Are you sure it is a year before trying again? That doesn’t make sense. I honestly would try fighting it. Get measured again and don’t stand so tall, put on the couple pounds. Ask your insurance company to send you their requirements in writing so you know exactly what you need to do. If you do keto watch you cholesterols because mine went up. My dr said that is not something maintainable for the long term. Does your surgeon office have a coordinator there who can help guide you through this?

[djgirl19 276]

Can you get a refund and find another dr you like? My surgeons office was incredible with checking prerequisites and staying on top of them. They also got preapproval from insurance long before the surgery was scheduled or any tests were done and all the things that were expensive on the front end. I felt the same way when everything including the website said I was covered and then went through part of the process and found my husbands employer refused to pay and opted out of WLS coverage even though it was standard for my plan. I had to wait 7 months, change insurance, then change surgeons. Then change surgeons again. The whole while I had a 48-50 BMI and declining health but I did not give up. When I had my last meeting with my surgeon he said “congratulations, only 50% of people make it this far” and it sunk in. And I totally see why. The process can be brutal for some of us.

[KarenLR75 518]

3 hours ago, Jemma23 said:

Thank yall so much for the support! Even though you have me crying again, it is great to have someone to vent to. I can’t afford the surgery without insurance help. I can reapply next year, problem is, I need to be losing weight for my health not gaining to wait another year and reapply. I am back on Keto this week... not losing yet, but hope to. I am 50 yrs old, much harder to lose than it used to be. I have probably gained and lost 1000 lbs in my lifetime. I NEED the restriction to keep it off. I have never done keto before because doesn’t seem heart healthy at all, but I have to get the weight off. Yall know of any good weight loss support groups online? Thanks again for your support.

I am 50 and did keto this past year. Well, when I intensely focused on it, in about 9 months and NOT being able to exercise at all due to torn knee and it had not gotten warm enough to get in pool, I lost 45 lbs in that 9 months (although keep in mind I weigh a GREAT DEAL more than you so consider your possible loss on more of a % of ttl basis & if you can manage some things at this time of year like getting on pool, I still think you could lose a nice amt of weight...but I'm also so angry/frustrated on your behalf..but want to encourage you as well if Keto is your only option left)

My primary dr. is huge fan of keto but my bariatric dr is not. I actually do not have cholesterol issues but my primary, who I have known now for over 20 yrs, has had other patients whose cholesterol,diabetes, etc. improved.

However, I think 'impact' of keto on things like cholesterol can be very individualized. Also, my bariatric dr said if people didn't go to the 'extremes of keto' like eating a ton of beef each and every day, if they limited some of the things that we know often impacts cholesterol, then he'd be more a fan of the general approach.

So yes, even at 50, I lost 45 on Keto and that was not working as hard as I could. 18 yrs ago, I lost 80 lbs on Atkins and kept it off for over a decade as I was finally able to be active and yes, was MUCH younger at the time, but hey, I did lose on Keto.

I'm torn for you though and I apologize if you've answered this 100 times...does your insurance not have an Appeals process??

Edited June 25, 2019 by KarenLR75

[SLSH 24]

4 hours ago, Jemma23 said:

Thank yall so much for the support! Even though you have me crying again, it is great to have someone to vent to. I can’t afford the surgery without insurance help. I can reapply next year, problem is, I need to be losing weight for my health not gaining to wait another year and reapply. I am back on Keto this week... not losing yet, but hope to. I am 50 yrs old, much harder to lose than it used to be. I have probably gained and lost 1000 lbs in my lifetime. I NEED the restriction to keep it off. I have never done keto before because doesn’t seem heart healthy at all, but I have to get the weight off. Yall know of any good weight loss support groups online? Thanks again for your support.

Have you considered Mexico? Out of pocket mine was about $7,000 (I was low risk and this includes medicines and flight.)

I had mine done recently with a BMI of 30. They had me lose weight to get to 215 to shrink my liver before surgery. (Check out OCC with Dr. Ariel Ortiz.)

I wouldn't have qualified to have it done here in the United States so I went to Mexico. It was a good experience and I'm so glad I did it.

Please don't give up. Find another way. ❤️

Edited June 25, 2019 by SLSH
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