Denied again

I feel like I am being jerked around from my insurance company. I was denied because they state that surgery is not needed since my medication is controlling my symptoms.  I am 45 and 5'9 and weigh about 375.  I have sleep apenea, High Blood Pressure, High Cholosterol, Diabetes, severe Orthopedic problems with knees and ankles, all things are documented. Did the 6 months nutrition counseling, psych eval, and then they say I dont need it. Thank God the medication is controlling it for the most part or I would be dead already. My blood sugars are high, also documented, but they said they are not that bad. And I also gained about 5 lbs. during my 6 months nutrition counseling. They did not like that. I have eating issues, are they stupid or what? As I feel like I'm going down fast here. I am almost immobile, my feet hurt so bad. I have 3 Doctors letters stating I need this. My PCP, my WLS surgeon and an orthopedic. What the hell else do they want. I appealed and they denied me again. What now? It is United Health Care and it is thru medicaid. I even told them I can barely get around at work and I do not even have a physical job. I need to work, I am a single mom to a 3 year old. I want to work. Any advice?

I know what you're going through and I know how it sux! But please, please don't give up - you know that's what they're counting on, right? If this is really what you want and what you know you need you'll fight for it! 

Im not sure taht tihis will help but i do know in PA on the HMOs that are thru medicaid on the 6 month supervised weightloss you can not loose more than 10% of your weight or gain 5 pounds they take the 5 pound gain as non compliant with your diet, and if you loose 10% of your weight you can do it yourself.  So i would try to appeal again if you can or at worse try to start the process over , hopefully  it will all work ot for you and good luck

First, find the specific requirements for your insurer. You cannot appeal properly unles syou can have their cirteria in front of you first. Then you have to make sure you met each and every one. If there cirteria says you must have a BMI above 40 or BMI above 35 with 2 co-morbid conditions (many say this) than you qualify on your weight alone and other health conditions should not matter. Your denial letter should list the exact criteria you did not meet. For example, "the documentation provided does not meet our criteria for participation in a physician directed weight loss program" I list this one because I had CIGNA deny a patient because blood pressures were not recorded on al diet visits. Like blood pressure would make a difference, it doesn't they were just looking for any reason to deny! Anyway, you can get more details and counter each one! You can do it, be persistant! Bonnie

Insurance companies are not doctors, so you'll need to find out what the next step is for appealing this.  APPEAL!  APPEAL!  APPEAL!   Can your surgeon do a peer to peer as there is something in the way the documentation is being written that is giving the insurance company the impression that medication is controlling this.  You may need to help your PCP and surgeon in writing up your appeal.  Start searching others that have been denied for this same reason and get to writting this yourself.  After all, this is for you and no one will care about this more than you will.   Whatever you do, do NOT give up.  Take if from someone that was denied twice and then sent for a phone interview w/doctor's, etc.  You can get them to approve this and only you have the ammo to do it. Good luck.