I WAS DENIED!! HELP!! I NEED ADVICE!

I can't do this today...It has already been a rough couple weeks and now this! I just got off the phone with the insurance company and they said that at this point its denied because i need 6 months physician sup diet and exercise. I CAN'T EVEN WALK, HOW AM I GOING TO EXERCISE. And they wont take anything from the past either, it has to be 6 months up until today...yet they told me nothing about it originally otherwise i would have started this back in june. I don't know what to do at this point. I don't have the money to spend on a phy sup diet! let alone a health club! I am out of work right now and my husband is the only one working to support us. This is the stupidest thing I've ever heard of...I'm so sick to my stomach. Has anyone gone throught his and if so please give me some words of wisdom. I feel like i am in a corner and people are just dangling this right in front of my face but if i move it goes farther away just out of my grasp.

There's no need to sign up for any expensive gym membership or diet center. A medically supervised diet is just that...a diet that your doctor knows about. It can be as simple as you going in for an appointment each month in which you get on the scale and discuss weight loss strategies for the month. You may have been denied RIGHT NOW, but no one's saying that you won't be on the operating table in 6 months. I know it's lousy to have to wait, but 6 months will be over before you know it! Just think, we soon have the holidays coming up to fill your time, and by the time we get through Valentine's Day, you'll be scheduled for pre-op exams. Hang in there! Pamela -135

Hi, so sorry for your struggles with this. Just wanted to say that I know every ins co is different and I persaonlly know that sometimes it just depends on who's desk your paperwork lands on and the sort of day they are having. That's not fair but true. For my 6 mo supervised diet, I turned in the typed list of my life history of diets.....dates, type of diet amount lsot and regained and also the last couple of years of Dr docuymentation of weight goain and efforts to lose. My Dr had given me a heart healthy diet booklet at one point and that was noted.....nothing really specific on it though and all of htis together got me through it. With some ins companies though, I know this hasn't worked. ( I had BCBS of CA at the time) On the other hand, I always beleive things happen for a reason....just one of those people. ; ) Soooo, if you have to go through this 6 mos, use it to get more education about WLS and be as prepared as you can. Maybe that's why you are being given this 6mos. Maybe you aren't ready? Just some thoughts. Stay positive though! Just believe if it's meant to be, it will be and you keep doing what you have to do to make it happen!! Good luck! HUGS! Tami

Jacqueline, I am in the fourth month of my dr supervised diet/exercise plan. I have MedPay at Missouri State which is a self-insured plan. I suggest you speak to someone at your insurance carrier and ask them exactly what they want from you. I have submitted all my history but they won't waive the six months, however, they are paying for my time at Hammons Heart Institute for the exercise portion and for the consults with the nutritionist and exercise physiologist. Since they require it I explained to them that I felt they should pay for it and so far so good. I have to pay for the monthly visits at my PCP but that's because I haven't met my insurance deductible for the year. I really must say the time has flown by and I've learned lots in the process. I am just extremely careful to document everything because I don't want Ins to have any excuse to deny me. However, I sort of expect to get denied the first time and to have to fight througth an appeal. I will fight though and my PCP is very supportive. Don't give up and try not to get too discouraged. This will pass and you'll be thinner and healthier for the rest of your life. Lana

I've been working on this since last fall, my BMI is 74 and I'm 463lbs with a low of health issues. Ive been denied 3 time prior to completing a 6 month Doctor supervised diet. I've just completed that process it didn't seem long but I understand the frustration. The Surgeon's office called Cinga today to only have 3 people give them 3 dieeferent answers. One was that I had to go thru a National appeals unit, next person didn't have a clue, and the last was to send it in to the predetermination unit. I really can't afford a lawyer but I'm going to find a way if necessary. Bypass is a covered benifit under my plan and I've met all of Cigna's requirements. Wish you luck I personally know how depressing it can be.