Appeal #2 filed. Now the waiting begins...again.

I got a copy of my 2nd appeal letter this evening, so here we go again! The arguments made were fascinating.

I never thought of it this way - if an insurance company requires 5 years of diagnosis, and treatment to CURE that diagnosis (which is technically life threatening) is surgery, you are basically withholding life-saving treatment to fit some arbitrary number. When I stopped to consider whether an insurance company would do this with heart surgery, or cancer surgery, it made me pause. 

I'm not sure what their deadline to respond is. 30 days, I think. And, this went directly to my husband's employer. I hope they don't give him any crap over this.

If this doesn't work, we head to external review, which triggers review by a bariatric surgeon who does not work for the insurance company. I have had bouts of feeling very sorry for myself and have really not been on the boards here much at all because it has been hard to see so many people hit the loser's bench while I just hang out, waiting. My weight is climbing and I have been having some pretty serious issues with my knee that still has cartilage intact. My attitude is "why bother" when it comes to trying to take a few pounds off because I know it isn't going to help in the long run, and losing weight has hurt me with insurance qualifications in the past. Bad attitude, I know, but I have never been good at living my life in limbo. Grumpycat has become my new hero lately.

Hope you get your approval this time! Why did they deny you?

The two items in contention are that this company requires that my BMI be >40 and that I have a diagnosis of MO for 5 years. At the time of submission I was bmi of 38 and change. Since 2008, I had worked with my PCP on and off in a medically supervised weight loss program but the insurance co didn't give a lick about that. All they saw was that I was less than 40: denied! I am now over 40, verified and provided to the insurance administrator this go-round, so I think all we have to worry about is the 5 years of MO. I do have records dating back to 2006 showing a BMI >40 at intervals when I was not working with my doc so we will see...



I am so not good at waiting.

i am so sorry you are going thru this i thought my weight was bad.. you trule have good reason to be grumpy. i will say prayer for you for a good outcome (((hug)))

Thanks for the update. I will swing a chicken for you. I would be beyond grumpy with all the fiddlefaddling around. Here's to a quick progression to a surgery date.

My fingers are crossed for you!  I haven't posted much either and just been lurking since I've been so sour about my denial. But I'm fighting and I won't take NO for an answer.  My appeal has been filed and I'm praying the insurance co. doesn't sit on it for the entire 30 days, UGH!

Through this journey I have learned that insurance companies are not there for us...in the end it's all about the dollar to them.