Denied

 I have Mercy Care (ACCCHS) and they just denied me. I met all the criteria, not just one but 2 six month weight loss attempts with a doctor, the right BMI, the clear pych evaluation, even proof of going to the gym and meeting with a personal trainer for the last 2 years. I had records for year 1, 2, 4, 7, and 10, of being obese. In the missing years I had no insurance, and it turns out the ER does not reocrd weight on the medical reocrds. They ma denied today for not having official medical docuemtnations of also being obese in year 3 and 5, as if I was secretly thin. What can I do? I am so desperate, and out of ideas. 

Talk to patient service to get a clear explanation of why you were denied.  Ask if there are any other type of records you can provide, such as W****chers, etc. where weights were recorded.  Lastly, you might consider appealing the denial.  Dave

I agree with Dave, by all means file an appeal.  Your denial notification letter should have instructions on how to do so, or if not, go to your company's website or plan information brochure.  I don't know for certain, but I think in most cases it is standard insurance company practice to deny everything on the first request.  They hope you will simply give up and either finance the procedure yourself, or not have it.  Of course, if you end up paying for surgery yourself, they will happily reap the benefits of your better health because it costs them less money for prescriptions, doctors visits and the like! 

You might also check the website of your state's insurance commissioner's office for information on how to appeal insurance company denials, or how to file complaints against insurers.  Keep up the pressure on them, and in the meantime see how much more information you can gather (maybe from Weigh****chers' records, for example) on your obesity.  Bury them in paperwork and appeal like crazy!

Good luck!

 Thank you for the adivce, but I already gave them all the paperwork I could think of, I gave them more then required, I did more then required. It was not required I go to a gym with logged hours, but I did and I got it documented. It was not required that I attempt the 6 month physician supervised diet twice, but I did. It was not required that I send in my fathers medical records also of him being 450 pounds and diabetic, but I did to establish the enevtible costs of not aproving me, I also got leters from parents, grandparents, and uncles explaining their diabetes and severe obesity, I hoped the more paper I gave them then perhaps they would not notice I had no offical documentation of my wieght for those 2 years. I will appeal, but I am running out of time, the state has already froze all benefits for all new applicants, and the system forces us to re-apply every 6 months, my block runs out in October. 

You could also do a new 6 month weight loss attempt  now...

Think hard about a doctor or specialist visit that you had in those missing years where you may have been weighed.

Were you on any meds during those missing years related to any co-morbids ?

Did you hang out on Facebook or any other social networking site where you may have shared about a doctors visit ? Go back and start re-reading and maybe it will trigger a memory.

 That is the problem, I had no insurance so I would have to go to the ER when I was sick or injured, so I paid for all my hospital medical records, and guess what? They do NOT record the weight! Everything but it seems, I know they always asked me my approximate weight but it never made it to the official record! Then I lied at the DMV, like all women do, men say they are taller, women say we are thinner, so not even that counts. I have racked my brain and I can not think of anything, i was not expecting the hospitals to no include weight on ER records. 

Do you have any pictures of yourself that are dated during those two missing years or If you were on weigh****chers during that time If so, you may want to include them in your appeal. I was denied for something similar. I had lost weight during one of those required years and my BMI fell below the required number. I appealed and I proved to them that the weight came back quickly. They agreed but then came back with some dumb stuff saying that I didn't get psych clearance which I did. So now I have a teleconference with Aetna on Tuesday. Don't give up. That is what they want you to do.   Good luck.

 Thank Rebeca, I tried to submit pictures but the woman that works at my doctors office said they would not take them, said they can not be dated. I had a family portrait from a couple years ago that showed there is virtually no one in my entire family under 300 lbs, most are far over, I thought it would help explain why phentrimine don't work anymore, and even with adkins I lost then gain back twice as fast as I lost. I gain 3 pounds a day sometimes, just this year I gained 90 lbs, again, and am on a diet. 

Update:

Appeal was not successful, they then pointed to the 2 lbs I gained in the last month of my weight loss program.

However, I have spent all this past year working to get approved again, starting back at the beginning. 

I am a week away from submitting a new coverage request for surgery. 

Wish me luck, I worked very hard this time.