Received my denial letter
So I received my denial letter in the mail yesterday. it states the reason for the denial is that no documentation was given supporting that I have stopped any and all alcohol consumption and also that I have gained weight (12 lbs) since my initial claim submittal last Feb. I WILL be appealing again.
So have you stopped all alcohol consumption? And if so, was documentation submitted? If you have stopped drinking but documentation was not submitted, then submit it. I'm not sure what kind of documentation they might want. A letter from doctor, maybe?
I don't know what to say about the 12 lb gain. That doesn't seem like a huge gain in almost a year, to me. And to me, it kinds just goes to show that you really need WLS. Will they cover it if you lose the 12 lbs? Maybe your surgeon's office can help you with that issue.
Kelly
Please note: I AM NOT A DOCTOR. If you want medical advice, talk to your doctor. Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me. If you want to know what your surgeon thinks, then ask him or her. Check out my blog.
So I received my denial letter in the mail yesterday. it states the reason for the denial is that no documentation was given supporting that I have stopped any and all alcohol consumption and also that I have gained weight (12 lbs) since my initial claim submittal last Feb. I WILL be appealing again.
That is a new one to me, I have never heard about alcohol consumption being a requirement pre-op.
Do you have a requirement to lose a certain amount of weight pre-op?
You have been getting denied and appealing for 10 months?
HW333--SW 289--GW of 160 5' 11" woman. I only know the way I know & when you ask for input/advice, you'll get the way I've been successful through my surgeon & nutritionist. Please consult your surgeon & nutritionist for how to do it their way. Biggest regret? Not doing this 10 years ago! Every day is better than the day before...and it was a pretty great day!
I was originally denied in March and just let it go until late Oct when I decided to appeal and have just been denied again. Because I was consuming alcohol occasionally earlier in the year during my whole pre-surgical work-up the Dr. told me I needed to stop all usage because of not being able to drink/ high incidence of alcohol abuse after surgery. Because this latest appeal did not show any documentation from the Dr that I have met that requirement along with gaining 12 lbs since March is the reason for the denial. I just have to play their (ins co) game.
Its crazy what the insurance companies use to exclude someone from surgery. My sil was denied because she hasn't been fat enough for long enough. Crazy! I'd call them and find out exactly what type of documentation they require. As for the weight gain, I can't believe that a small gain like that in a year is substantial enough to exclude you from qualifying. Don't give up. Find out how to jump those hoops and you should be approved. Best wishes on your journey.
