Question:
well, i have bad news!!!!!!
just as i suspected, i have to wait the 1 year before i can get my surgery,,, i went thru the referrel with my pcp, then the weight loss dr. office called me that they has talked withmy insurance and i will have to wait the full year, because of the insurance policy being so new, and pre-existing med. conditions, so i have the wait until october 2008,,, so i guess i will wait patiently,,,,, is there anything i can do about this? — cbryant (posted on December 17, 2007)
December 16, 2007
Every insurance company has it's own rules. If you have the option of
changing insurance companies in the upcoming new year, you may want to find
a company that doesn't have this waiting period. Or you may have an appeal
process within your insurance company. I've heard from many patients at
support group meetings where denials have been appealed and people have had
their surgery. If you have a surgeon in mind to do the surgery, their
office may be able to help you with the appeal process. Meanwhile, take any
prescription medications, and try to take vitamins and calcium to avoid
further complications.
— Dave Chambers
December 16, 2007
I know just how you feel. My insurance company is the same way. i am glad
because it takes that long to learn what to eat, and how to eat it,you are
going tobe retraining yourself and you are worth the time.you will have
time to make yourself mentally prepared too, and that is alot to do in one
year. you wont be bored thats for sure..Best wishes friend.
— [Deactivated Member]
December 17, 2007
Yep you can! You can appeal their denial by doing research online about
how they are putting your life in danger by making you wait (especially if
you have co-morbidities) and especially check out the FDA website and the
NIH (national institute of health) website on the dangers of obesity etc.
Be sure and include the web links to whatever you find in your appeal. Be
sure to tell them if you can't buckle your seatbelt in your car because of
your weight (as by law you are to wear your seatbelt everytime you get in a
vehicle which puts your life in danger) etc etc. Look up lawsuits that were
won by other people and the NIH forced the insurance companies to pay for
the surgery as obesity is NOT a pre-existing condition! There is also a
place on here to speak to a representative for lawyers on here, but I have
no clue where to find that out--maybe do a search. Good luck and God
bless!
— crystalsno
December 17, 2007
If you have health problems related to your weight I would get my doctor to
write a letter explaining why you need this now. Good Luck
— John C.
December 18, 2007
I would get a copy of your insurance policy and see how they define
pre-existing condition. I am in the process of meeting my insurance
requirements to have the lap band, and they define pre-existing as having
seen a doctor about your condition before. If you have never seen a doctor
about being overweight, then you should be fine. On the other hand, my
insurance requires a 6 month doctor supervised diet before they will pay
for the procedure, so if you start the diet in January or February, then
you will be ready by the time October gets here. However, if you wait
until October to start your diet, then you will have to wait until April of
2009. I would advise you to not let this discourage you and remember that
this is a time consuming process, so you need to be working on it every
step of the way, and not just wait until your insurance says they will pay
for it.
— joshbearden
December 19, 2007
I don't know anything to do about dealing with the insurance company. But
you could start practacing the things you will need to do as an wls
patient. these are things that you will need to learn to do so they are
second nature to you for the rest of your life.
1. take small bites, chew throughly,
2. put fork down between each bite.
3. eat food in this order
a. protein
b vegstable
c. fruit
d carbohydrates ( only eat If you are still hungery)
4. stopping drinking any fluids once you have had your first bite.
5 wait one hour after taking your last bite, to start drinking your
fluids.
6. drink 65-100 oz of fluid per day
7 avoid caffiene, carbonation, and sugary drinks ie soda, ice tea, etc.
8 visit web sites and or support groups for other wls patients and
— gabluecrab
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