chumbly
Denied for the 2nd time.
Oct 24, 2007
Well, I just got the news yesterday that they denied me again. I just finished the 6 month supervised diet that they said I had to do. I needed to lose 10% of my body weight and have documentation that I was seeing my PCP every month along with a dietition. I did everything they needed and more. I even lost over 10 lbs more than was requiered. Now they come back saying that there isn't proof that it is a medical necessity. What the heck?? I went through what their criteria was line by line to make sure nothing was overlooked. Nothing is stated about it having to be a medical necessity. I have a BMI of around 60 and high blood pressure. I have gone on a doctor and nutritionist supervised diet for 6 months in which time I lost 54 lbs. Aside from appearing half dead, I don't know what else they expect me to do. My PCP is furious since we followed their guidelines to the T. He was going to contact my cardiologist, and surgeon and they are going to make a call to the insurance company themselves to argue the denial. I don't know what to do. I guess I will wait to hear from my PCP and start preparing my second appeal. Sorry so long, but I was certain that I would get approved this time. I was hoping to have the surgery before the end of the year and now I don't know what is going to happen. 
My 6 months are over!
Oct 11, 2007
I will take the final step in completing my 6 month supervised diet this afternoon when I go to see my PCP. I do a follow up with him after I see the nutritionist every month. I have lost a total of 54 lbs during these 6 months and am feeling very proud of myself. I am excited and nervous about what will happen next. I will keep you posted...
Month 4
Aug 08, 2007
Well, I just completed my 4th month with the Nutritionist/6 month supervised diet and I have lost another 12 lbs. At least I am going in the right direction. I have lost a total of 36 lbs. I have made some serious changes in my eating habits and I am trying to increase my activity as much as possible. But of course, as you all know, being overweight makes being active sometimes almost impossible. I am anxious to see where I am at after this 6 month diet. I have the determination to follow through, I am just afraid that the insurance company will find another reason to deny me. I guess only time will tell...
Progress
Jul 20, 2007
I am now in my third month of my doctor supervised diet. I see my PCP once a month as well as a nutritionist. I have lost 24 lbs so far and I feel pretty pleased with myself. It is a far cry from what I need to lose, but right now, I have a good frame of mind and am really trying hard to succeed in this 6 month thing that is demanded of me. I would really like to lose about 10 lbs a month, but I don't know if I can do that. I will certainly give it my best shot. Anyway, that's where I am now. I'll report again later.
Appeal
Apr 11, 2007
Well, I have filed an appeal with my insurance company in hopes that they will reconsider the denial. I have no problem complying with their rules and understand that there is a certain criteria that I have to meet. That's fine. What I do have a problem with is the fact that they left out very pertinent information from the beginning. I am going along on this journey believing that I was doing everything needed, even calling them and double and triple checking, and I was assured that I was doing what I needed to do. I finally get everything lined up and send in my paperwork and they come back with a huge list of things that was never mentioned in the beginning, not printed in the handbook, and never told to me on the multiple phone calls that I made to them. I feel they totally mislead me and now that will possibly cost me another 6 to 12 months of waiting. Sigh!
Denied
Apr 05, 2007
Well, I officially got denied by my insurance company on March 30th. What devastating news. I knew there was always a chance they would deny me, but I didn't think it would happen. Anyway, I am now going to redouble my efforts at gaining approval. I have submitted my first appeal and am waiting to hear from them. I will keep you posted. I will reach my goal. One baby step after another.
Patiently waiting
Mar 12, 2007
Right now, I am waiting for the surgeon to review my file and see if he believes I am a good candidate for the surgery. If he accepts me as his patient, he will write a letter to go along with all of the other information I have collected to send on to my insurance company. I think he is to review my file tomorrow, so hopefully I will hear something this week. I am crossing fingers and toes. Wish me luck.
