Hi Ladies.... I am so sad

I have been holding back but as I sit here and type this I just want to cry. Over a year ago when I began researching GBS I called my Insurance company Great West PPO and asked what the requirements where. I was told that as long as it was deemed medically necessary the surgery was covered. From then to know Great West has merged with Cigna and now the requirement in 1 YEAR of medically monitored diet! I am so sad because I found out after the surgery symposium, and after I had already talked to the doctor and he had said approximately 6 weeks for my surgery date. He also discovered that the open hernia I had repaired in July is opening up again, of course due to my weight. I just wanna cry thinking that I will be wasting another year of life to get a surgery that I so desperately need :(

 

I would contact the Department of Managed Health Care and see if  you can appeal that.  Don't give up!!!  I don't pretend to know but I think they cannot put you off for 12 months.  I think you have to show that you've been under a Dr's care and have tried to loose weight but if you've been with a certain Dr for over a year, this should be no problem.

Don't give up, fight for what you want and keep on climbing the ladder all the way to Sacramento, the Department of Managed Health is a State agency that oversees HMO's and PPO's so go there, it's toll free call too.

Good luck,
Hugs,
Barb

Hey there!
I'm trying to get the information on what to do if insurances wont pay or postpone even if it is medical nec. as in your cause.

Also...something just passed in July that all insurances must cover the WLS.  My insurance approved me orignially...then denied me...and then reapproved me because they had made a mistake...

They said...All policies that renew after July of 2009...will automatically cover WLS...check and see...might be just Maryland...but you never know...

I wish you the best and keep on fighting...just because they merged...it is not your fault...appeal it and keep going..

Best of Luck...

Do ur appeals frist.
I could online find an law office that helps in these cases.

Keep us posted...

Contact my attorney Walter Lindstrom at Obesity Law, they can help you file an appeal and will consult with you for free. They are amazing and know the system like the back of their hand. They helped me get approved for both my WLS and my plastics.

www.obesitylaw.com

 

Don't give up hope.

Good luck and wish ing you the very best!!!


HUGS
JOY

Don't accept the insurance companies first response to you. Many times as a practice, insurance companies reject all claims knowing more than 50% of the people won't challenge their decision. I needed surgery on both of my feet and each time the initial response from my insurance company rejected the surgery, but I appealed with them both times and the second time I was approved. It's a stupid game, but sometimes needs to be played for the benefit of our health.

Don't give up!! You are worth it!!!!

MsBlues

Please dont give up...I had a something like this happen to me. I had Kaiser insurance and went through the 6 months of classes and was at the point of being placed on the surgery scedule when I loss my insurance with Kaiser. When I got my new coverage with Blue Cross of California they said I had to wait a year before I could apply for it. I took them at their word not knowing any better but unfortunately the company I was working for moved all its operations back east and lost my job.
 
Wife put me under her insurance and told the doctor I wanted WLS. They submitted and it was denied. Reading the posts here I wrote an appeals letter to Aetna outlining the classes, programs and the qualifications for the surgery and they approved me on the first shot.

Remember everything you have done counts (Weigh****chers, Jenny Craig, prior attempts and the classes you already have gone through. Dont let them win. Let us know if we can help

Have a great day...............Rick

P.S.

Im not a lady but I thought I would throw my 2 cents in LOL

Whoa hold up cal girl. You know I am probably gonna get crap for saying this. I know many will tell you that you can go to dept of managed care get an attorney etc etc etc.  I do believe that things happen for a reason and if you have been doing something keep it up it only makes your wt loss easier. So i hope that it all works for you
Liz