Ins. says "Can't comply w/ lifestyle change" Help!

My insurance company said they will not cover me because they do not think I can comply with the lifestyle change required after surgery. I am so depressed. BOOOOOOOOO HOOOOOOOOOOOOO My surgeon's office said they didn't think I had a chance because they could just site the same again and again. I don't want legal action because my insurance is through my husband's self insuranced company. What do I do? Kim M.

That's a new one! I haven't heard that before. I do know a guy who had no business getting the procedure because of self control problems and has constantly been trying to defeat the surgery when he did get it. Was it something you said in the psych evaluation? Try to get a detailed explanation. Good luck. Rich

Actually, my psych eval stated "that although it is impossible to know exactly how a person will respond after surgery, it is our impression that Kim has researched the procedure thoroughly, understands the implications and is ready and willing to make the adjustments to her life in order to succeed." The surgeon's office seemed to think it was the nutrition report. I didn't see his report. Kim M.

Hi Kim ... why does the insurance company have the impression you cannot comply? Did you have a psych eval? Was that stated? This is a first for me too ... and if it WAS a psych eval that did you in, maybe you can arrange to work with a nutritionist and psychologist to get to the point where they think you would/could comply with the lifestyle change? Best wishes, Karyn

Actually Karyn, my psych eval was very favorable for me to have the surgery. My surgeon's office thinks it has something to do with what the nutritionist said. Neither of us know what the nutritionist said. The surgeon's office sure didn' t think positively about sending in an appeal though. They thought the ins. company was just too hazy. Thanks for your input. Kim m.

Well, Kim ... all I can say is that's pretty lame. I definitely wouldn't give up either ... if this is what you really want. Can you call the insurance company and ask why they made that determination? Maybe you can get another nutritionist's opinion? I would definitely push the insurance company. I was originally denied because my COMPANY didn't want WLS covered and had an exclusion. I thought there was NO WAY around that ... but, upon appeal of my surgeon, I was approved. I don't know what transpired between doc/insurance/my company ... but I'm glad it worked out and I didn't give up. Best wishes to you Kim ... Karyn

Don't give up! They can't keep denying you on what they think you will or will not do. If they do not give you a chance, how will you prove it? They just don't want to pay. FIGHT! Appeal, appeal, appeal. Call them everyday! If you need help e-mail me, and I will try to help you. I had to fight my insurance company, and finally got approved.

If this surgeon isn't willing to work with you and it was their nutritionist that did you in...I would try another surgeons office. Make sure you go to one with a very good reputation, chose a center of excellence or one that is working on the COE..Even if you had to go into another state.. If I can give you ideas let me know Brenda Patient Advocate/surgeon liaison