Question:
Is there hope? Is there a reason to keep trying?

My denial letter arrived today. "No life threatening reasons to approve". In a nutshell. Irony is a witch. Next letter in my mail behind that one is from my pulmonologist. I have sleep apnea. She wants me to make an appt to get treatment. The depression I felt gone for good has hit like a ton of sugar loaded in a brownie. I am not sure what to do now. Do I appeal? My liason with my surgeon's office, "Susan", came across making me feel I'm wasting time. I wanted this surgery for many reasons. Main one being I'm scared to death of continueing being fat. My sister is 11 yrs older than me and suffering such major health related problems I worry every night about ending up like her. "Susan" said that I have not tried enought diets. My argument was they only wanted to know about "Dr overseen" diets. I admitted I never died many diets overseen by a Dr. (Only 1). Me and my husband were trying to make ends meet with 2 kids so we didn't have much money to go to a Dr and pay out the butt on diet drugs. I tried to lose weight by myself. Slim Fast, calorie counting, exercising, etc. But that is not what the insurance company or "Susan" wanted to know about. So I feel as if I've lost hope. Since Dr. Selinkoff put me on Sugar Busters I've lost 30 pounds in about 2-3 months. "Susan" didn't care or ask. Maybe I'm placing blame but at the moment I feel as if everything is hopeless and that I may as well go gorge myself on a pint of Ben & Jerry's since I feel I have just lost my lifeline. Please help.    — Renee V. (posted on June 12, 2001)

June 12, 2001
Doris - without knowing too many specifics...a lot of insurance companies deny routinely. They only get serious when we do. My insurance company denied me too, at first. Then I sent a big fat letter disputing their claim that I had no life-threatening co-morbities....and I was approved! I'll send you a copy of my letter .... hope it helps. Don't give up five minutes before the miracle happens!! Good luck to you.
   — blee01

June 12, 2001
It sounds as if you definately have a leg to stand on with an appeal. You have a life threatening condition that can be improved by significant weight loss. If that's their criteria, and you were recently diagnosed, then your appeal should be easy. God was good to send this report from the pulmunologist today. Dont give up hope!!
   — Jeannet

June 12, 2001
Definitely forge forth. I too was just denied, but had had the feeling all along they would. Kaiser just wasted my time not to mention a few hundred dollars to jump thru all their damnable hoops. In anticipation of the denial I had contacted the obesity lawyer Walter Lindstrom: you can reach him at 619.656.5251 or email him at [email protected]. His fee is VERY reasonable and depending on the plan you go through will cost you either $350 or $750. I think it is money well spent to have the guidence and support, not to mention someone dealing with your appeal that has the legal knowledge and experience to take the insurance companies on. I don't know about you, but I too hit a real low point of depression a few months ago. I was so tired and discouraged by Kaisers games, but then I got mad. I am determined to have this operation and I am determined to follow up with whatever Kaiser department and Federal/State insurance department overseers to express my outrage and being treated like I have been. So my advise would be to get mad, and call or email Walter. Good luck to you. Head up,chin out and a smile in your soul is the advise my grandparents always gave me when I felt blue..hope it will work for you. Terilyne
   — Terilyne R.

June 12, 2001
Doris.. sleep apnea IS a life threatening co-morbidity, so there is an ace in your hand right there. If your surgeon's staff don't seem willing to listen or assist you FIND ANOTHER ONE.. you're the patient, you're the one paying their salaries! It never ceases to amaze me to read about people working for surgeons who do WLS who seem so insensitive to the difficulties of obesity. I'm in the process of seeking approval myself, and though I've yet to be submit my info I've written out my life history, from my earliest memories of life as a fat child to the present, which I plan to submit. Don't give up hope Doris.. I agree with what's been said so far as initial denials.. APPEAL..call Walter Lindstrom of you have to.. but persevere! As your pulmonologist to write a letter showing diagnoses of your apnea as well! I wish you the best of luck, please feel free to email if you like. ~Peace!
   — Joscelin

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