Irritated

[Charisse Jordan 4]

So this happened! I was denied by my insurance because I did not do a year of a weight loss medication first. I cannot take them because my Dr said there isn’t one that won’t interact with my anti depressants so I will fight that. Insurance also said they have no records of having co morbidities that are made worse by obesity. I have a brain disease that puts me at high risk of stroke if I don’t get the weight off as well as GERD and osteoporosis through out my body. I guess the girl handling my pre approval didn’t find out what was needed to get me approved and get the right documentation, now I am trying to get everything for her to turn in with the appeal. I’m a little irritated but I will fight this, getting approved is the only thing left to do, I have come too far

[qtdoll 534]

Yeah that's extremely frustrating. I needed both failed weight loss attempts w my Dr AND comorbidities to get approved. I'm sorry this is so difficult for you. Keep fighting it!

[learn2cook 495]

So sorry to hear it , but stick with it. Your surgeon wouldn’t have done all this work with you if you didn’t need it, (or he/she didn’t think they would be paid for it). My surgeon had to have a phone conference with the insurance doctor, then it got approved. Keep up your good habits because the surgery will act as a sort of lock on your pre-surgery weight loss (not scientifically proven but I chose to believe it.)

[Fred in Pa 231]

Sorry to hear that...who is your Insurance?

[Charisse Jordan 4]

2 hours ago, Fred in Pa said:

Sorry to hear that...who is your Insurance?

Blue Shield of CA

[Fred in Pa 231]

1 hour ago, Charisse Jordan said:

Blue Shield of CA

Can your surgeon do a peer-to-peer call? Sometimes that helps cut through the red tape.

[Jeanniebug 472]

Ask for the name of the person who has denied your claim. Chances are, it wasn't a doctor who reviewed it. Insist that a doctor review your claim.

[aeb10892 3]

That is irritating for sure... I'm pretty sure you can get around the 1 year of weight loss meds with your doctor's advocacy, though. I also was advised not to take any weight loss drugs that were on the market at the time because I have a pretty severe anxiety disorder and some stimulants can make that worse (oddly enough a low dose of Adderall relaxes me though?)

Im also thinking this is not an uncommon issue- for example, stimulants are not advised in patients with certain heart conditions. You know what is significantly associated with heart conditions? Obesity. Which would made better by surgery!

I hope you get it sorted out. Again I'm pretty confident that working alongside your doctor they can waive that requirement, but the process may be unpleasant.