Denial letter recieved...
The official reason I was denied is because:
Evidence of failed attempts of weight loss over the last year.
So if anyone has any suggestions on how a fight this one, I would appreciate it. I am at a loss for this. When I asked them what they needed, they never told me that I have to show evidence of attempted weight loss over the past year, they said I needed to follow a three month medically supervised exercise and weight loss program, which I did. I would appreciate any help that you can give me. I am so down right now, I just don't know if I have the energy to fight them. I do have failed attempted weight loss in the past but none really recent.
Evidence of failed attempts of weight loss over the last year.
So if anyone has any suggestions on how a fight this one, I would appreciate it. I am at a loss for this. When I asked them what they needed, they never told me that I have to show evidence of attempted weight loss over the past year, they said I needed to follow a three month medically supervised exercise and weight loss program, which I did. I would appreciate any help that you can give me. I am so down right now, I just don't know if I have the energy to fight them. I do have failed attempted weight loss in the past but none really recent.
Wanda
HW: 282, SW: 244.4, CW: 211, GW: 140
Same thing happened to me. I asked my doctor to refer me and she did and I got denied and told I had to do a 2 year medically supervised diet! OMG, like I had never tried that before.
She sent me to these meetings every 3 Tuesday of the month or some stupid thing like that and I just stopped going, but every time I went to the doctor she would record my weight and asked about my attempts to loss weight. Then my co-morbidies got bad and she resubmitted it a year later and I got the ok.
So I don't what to tell you to do, but I have seen people post that they got denied because they lost too much weight prior to surgery so the insurance thinks they can do it one their own.
Do you have co morbidities? HBP, diabetes, fatty liver? Put in an appeal and ask for them to reconsider since it is proven that RNY is a true proven way to relieve those diseases.
I'm so sorry! Keep up the fight. Hugs....
She sent me to these meetings every 3 Tuesday of the month or some stupid thing like that and I just stopped going, but every time I went to the doctor she would record my weight and asked about my attempts to loss weight. Then my co-morbidies got bad and she resubmitted it a year later and I got the ok.
So I don't what to tell you to do, but I have seen people post that they got denied because they lost too much weight prior to surgery so the insurance thinks they can do it one their own.
Do you have co morbidities? HBP, diabetes, fatty liver? Put in an appeal and ask for them to reconsider since it is proven that RNY is a true proven way to relieve those diseases.
I'm so sorry! Keep up the fight. Hugs....
The question isn’t who is going to let me; it’s who is going to stop me. ~ Ayn Rand
Do not give up....I don't understand their reasoning? That is why we all come to the place of needing surgery.
This is what I did. When I decided to pursue surgery, I learned my insurance required 2 years of documented weight and co-morbid conditions from doctors. I had not been to a doctor other than a therapist and retinal specialist. They don't weigh. I did not have any documentation. I did complete a 6 month supervised diet, but I actually gained 12 pounds. I was told it was critical to go to my doctor each and every month for 6 months. I was told if I missed one months weigh in I would not be approved.
When it came time for my surgeon to submit my file to insurance, I did a couple things. First I sat down and composed a letter (It took me days) and wrote about every significant diet I had ever attempted. I was 54 at the time, and I could remember each and every one because my life/life events revolved around my weight. I also explained why I did not have any doctors' reports.
Second I also asked my gynecologist to write a letter detailing my weight gains over the years. I asked my retinal specialist to write a letter describing my retinal disease, and I talked about how that impacts my mobility. Sit down and outline the things in your life that negatively impact your weight and think of doctors you can ask to write letters in support of you and how your weight affects your life.
Lastly I prayed. Seriously. I believe in the power of prayer and others began praying that who ever received my file would have compassion. I was told by my surgeon's office it all comes down to who at the insurance company gets the file for first review. She said she has seen it over and over...those who she knew would not get approved and did and those who did not get approved and should have. This is not the end for you. There is a solution.
I know you are discouraged. I think if you can get another doctor to write a letter for you when your file is resubmitted, that will help. I think a letter from you will help too.
This is what I did. When I decided to pursue surgery, I learned my insurance required 2 years of documented weight and co-morbid conditions from doctors. I had not been to a doctor other than a therapist and retinal specialist. They don't weigh. I did not have any documentation. I did complete a 6 month supervised diet, but I actually gained 12 pounds. I was told it was critical to go to my doctor each and every month for 6 months. I was told if I missed one months weigh in I would not be approved.
When it came time for my surgeon to submit my file to insurance, I did a couple things. First I sat down and composed a letter (It took me days) and wrote about every significant diet I had ever attempted. I was 54 at the time, and I could remember each and every one because my life/life events revolved around my weight. I also explained why I did not have any doctors' reports.
Second I also asked my gynecologist to write a letter detailing my weight gains over the years. I asked my retinal specialist to write a letter describing my retinal disease, and I talked about how that impacts my mobility. Sit down and outline the things in your life that negatively impact your weight and think of doctors you can ask to write letters in support of you and how your weight affects your life.
Lastly I prayed. Seriously. I believe in the power of prayer and others began praying that who ever received my file would have compassion. I was told by my surgeon's office it all comes down to who at the insurance company gets the file for first review. She said she has seen it over and over...those who she knew would not get approved and did and those who did not get approved and should have. This is not the end for you. There is a solution.
I know you are discouraged. I think if you can get another doctor to write a letter for you when your file is resubmitted, that will help. I think a letter from you will help too.
Wanda - DO NOT GIVE UP! I agree with Dasie on her response. You can file an appeal and possibly have them overturn their decision. I had surgery and so did all three of my kids and out of 4 of us, 2 were originally denied. I filed appeals on myself and my daughter and the decision was overturned.
Take the two letters that I sent you the other day in a PM and write them out (one from your Dr and one from yourself) and have your Dr sign it. Put in as much detail as you can about how you have failed at weight loss attempts in the past and list the methods that you tried. Do the same in the physician's letter. They are looking for proof of previous failed weight loss attempts, so provide it to them.
In your denial letter there is more than likely the instructions and time frame you have for filing an appeal.
What I did was write those letters and resubmit my entire paperwork to the appeal committee on my own. I didn' not have my surgeon's office nor my PCP do it for me. You can do this!! Do not give up!
Nan
Take the two letters that I sent you the other day in a PM and write them out (one from your Dr and one from yourself) and have your Dr sign it. Put in as much detail as you can about how you have failed at weight loss attempts in the past and list the methods that you tried. Do the same in the physician's letter. They are looking for proof of previous failed weight loss attempts, so provide it to them.
In your denial letter there is more than likely the instructions and time frame you have for filing an appeal.
What I did was write those letters and resubmit my entire paperwork to the appeal committee on my own. I didn' not have my surgeon's office nor my PCP do it for me. You can do this!! Do not give up!
Nan
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
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