Well....Crap!

I got a call from a nurse at my insurance company yesterday and I have received my first official denial for surgery. She said the reason for the denial is that I have not had 6 months of a physician supervised diet...ummmmm...HELLO...yes I have! She said that the doctor did not make detailed enough notes about what we talked about regarding my obesity but she knew that he had sent me to a dietician and tried me on a weight loss medication...go figure. So...I had to go to the doctor today and have him write up a note that he had supervised my diet for six months...I got that...plus they want me to do a drug screen...pee pee test...has anyone else had to do this??? I already had to have a letter from my doctor stating that I have not used drugs, alcohol or tobacco for at least 2 months and now they want a pee test....what the freak??? I have never used drugs or smoked in my entire life and I think the last time I had alcohol was a glass of wine in february sometime...but I'll do it because I want my surgery so bad. I have my script to go get my pee test which I will do later this afternoon when I get out of school and I already have the letter about the diet which he wrote out on his prescription pad...but I will have to wait for the results of the drug test before I send everying off. They said I should go through the surgeons office but I am almost tempted to send it directly to the insurance company after the nightmare I had with the lady at Dr. Huse...or maybe I'll send a copy to both and keep the originals for myself...lol...covering my ass-ets :) Thanks for listening guys...you are a great group. Steph

Steph, Wow..you don't happen to have MPlan, do you? When I first checked into WLS, 18 months was the standard supervised dieting required. I had 2.5 years. See if this doesn't sound familiar: They denied me because...and I quote..."don't like the way the doctor kept his notes". I asked in what way, and they wouldn't elaborate..they just told me to go back to the SAME doctor and do it for an additional 18 months! I switched to Anthem the next January and they thought his notes were just fine!                                                                                                                               I would ask your family doctor's office to send the stuff into the insurance. Afterall, it is HIS note on HIS script pad and I am quite sure HE is the one who will be getting the lab results...right? If you have to go into appeal, sometimes, it helps if the insurance's appeal panel is willing to talk with your pcp (which, can be done on the phone). The one I had wasn't willing to do this...but I have heard of some people having success.                                                                             You are far more patient that I would have been with Dr. Huse office. Myself, I would have switched surgeons. I just figure if I can't get a response pre-op, how well will they be there for me post-op...? No office is perfect though. It was VERY hard for me to wait 2 weeks for a surgery date for my hernia repair..and then it get post-poned (due my white count being too low) and then have to wait another 2 weeks for yet another date.                                          Sherri

Hi Guys, I have MDWise which is a division of Indiana Medicaid. I am a full time student right now so my income is very limited...I only had one other option at St. V's for a surgeon that would take my insuance and people have told me not to go to him...sooo...I'm kind of between a rock and a hard place...lol...I am going to stay positive though...I really need this surgery and come hell or highwater I am going to make the insurance company agree with me :) Thanks for all the support I really appreciate it right now. Steph

Sorry to hear about the roadblock.  I personally hand delivered my information to the Dr.'s office or faxed it my self.  I also have a copy of everything sent.  I did not rely on my pcp to send anything for me, although she offered.  I wanted to know it was done in a timely manner.  Hang in there, you will get your approval Hugs Deborah

I got my first denial for the same exact reason.  But my insurance required 18 months.  I had to go in for 18 months straight, once a month and weigh and have a little chat with Dr. about how everything was going.  Submitted at the end of the 18 months and was approved within two weeks......Hang in there and keep on trucking....good things come to those who "weight"!!

Hi Steph!   Bless your heart, I do hope this all gets settled fast for ya'. Hang in there, kido. What courses are you taking? Blessings...Dawn