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The nightmare continues...



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This whole process of getting my insurance to approve this surgery is a freaking nightmare. I started this whole process in August of 2020. I did everything the surgeon and insurance required of me. Got a tentative surgery date of 12/9/20. I was so excited! My insurance denied me in November. They said they needed more info and I needed more classes ( I had already done 12, I just did all of them in 2 months). So my team added on 4 more classes, once each month and resent all of my info highlighting the info ins. claimed to not have. Got a new date of March 19. End of Feb. I got ANOTHER denial because they are STILL claiming to not have all of my info. My team sent it yet again and got confirmation that it was received. I was rescheduled again and again and again, each time having to have it pushed because the ins needed more time. Always more time. It's finally to the point that I stopped scheduling because the back and forth with the ins. is endless. I got another denial last week because now it's different info that they didn't get. Stuff that was previously sent on multiple occasions but now is just magically not in my file. So my team sent it all again and the waiting starts all over. I have strayed so far off course I have gained back everything I previously lost and then some. I know I need to get back on track just in case by some divine intervention my insurance actually approves my surgery I'm not scrambling to get back down at the last minute but it's so hard. I've fallen back into my depression pit and just feel hopeless. There is no way I can self pay. I don't want to give up but that little nagging voice in my head just keeps telling me it will never happen for me. That I'm just not worth it. I wish I could afford an attorney or an advocate aside from surgical team but that's not in the cards for me either. Blah... Sorry to be a Debby Downer, I just don't have many people that understand where I'm at that I can vent to.

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I understand how you feel...helpless and frustrated. When I had gastric sleeve surgery on 2/13/2014, it was in Tijuana (cost was less that $5,000 at the time)! This was because of insurance denying my initial attempt (I wasn't going to appeal since my health was in jeopardy. Now I need a revision to gastric bypass, I kinda expect the same response. Of course, now with COVID, Tijuana is high risk, if I was allowed to go and it was safe. But do not give up, nothing will change if you stop trying.

Pain stopped me from working in October 2018, and due to lots of meds, I have gained almost all the weight that I lost, and kept off over five years. I share your frustration-let's keep going until we get what we need!

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I'm so sorry you're going through this. I have a chronic condition and have spent my entire adult life battling insurance companies to the point where every time I have to call them I start crying from the anxiety. They are so terrible.

My advice is to keep a copy of everything you send them and write the date on it, like if you fax it to them keep the fax confirmation. If you email it, save the email in your sent folder. I don't know that this will work.

I understand about gaining weight when you are frustrated, but if you can, try to work on this, because you will need to be able to stop using food as a coping mechanism after surgery if you want the surgery to be successful. Try to talk to a therapist, if your stupid insurance will cover that. Or, maybe try Better Help or Cerebral or another online therapy service that is somewhat affordable. Or, maybe you have a faith person who does counseling for free if that's your sort of thing. Or find something you can do to distract yourself. Many people find exercise helpful, even mall walking or gardening (my idea of he**).

I really feel your pain. I haven't submitted for insurance yet and I dread it. I hope you get approved soon!

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6 hours ago, Ddavis5759 said:

I understand how you feel...helpless and frustrated. When I had gastric sleeve surgery on 2/13/2014, it was in Tijuana (cost was less that $5,000 at the time)! This was because of insurance denying my initial attempt (I wasn't going to appeal since my health was in jeopardy. Now I need a revision to gastric bypass, I kinda expect the same response. Of course, now with COVID, Tijuana is high risk, if I was allowed to go and it was safe. But do not give up, nothing will change if you stop trying.

Pain stopped me from working in October 2018, and due to lots of meds, I have gained almost all the weight that I lost, and kept off over five years. I share your frustration-let's keep going until we get what we need!

I am going to Tijuana, Mexico for my sleeve on May 10th and the cost is the same today as it was in 2014. Although there is an additional fee of $80 because the first place they take you once they pick you up from airport is to a clinic to perform a CT scan because of COVID. It's a nominal fee, IMO.

I do not have a fear of flying during the pandemic but I understand that might be a showstopper for others. And the hospitals there take the same safety precautions as we do here in the States. And now that vaccinations are available to most everyone now, that can always be taken care of before you go. :)

I'm really just saying all this because I don't want you, or even the OP, to be deterred from taking that route even in the world of COVID. I would never have been approved here. I don't have any significant underlying medical issues due to weight and my BMI does not quite reach the requirements to qualify. Mexico was my only, and financially best, option.

JaysWife - If you get another denial, why don't ask your doctor what they think of surgery in Mexico. Personally, my physician cheered me on. Good luck to you. I know how much this means to you.

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