Hello all!

I just got home from the hospital. I had chest pains on Friday and was admitted because I tested positive for blood clot but they could noty find it because it was not in my leg and they were supposed to do ct scan of chest but said they could not because of my weight. Imagine that I could have a blood clot floating around and they can't even do what is neccessary to find it because of my size but they turned me down for surgery. Also, they said my blood sugar was high once I got admitted and there was the diabetes scare. I am home now and they sent the letter but did not tell me why. I am so sad but trying to keep going.

Oh no! Did they treat you with blood thinners or something? I'm confused about the letter. Did they so no to WLS? I've heard of people having filters put in. Do you see a cardiologist? Don't quit fighting for your health. Keep us informed.

Oh Melissa, I am so sorry to hear this! How scary!!!!!!!!! This is something you need to include in your appeal letter. Do not give up! This is even more proof that this surgery is medically necessary for you!!!!!!!!!!!! Now that you have the letter of denial, call them and demand specifics. Let them know that you are willing to provide whatever they need but they must tell you what they require. We're all pulling for you!!!

I called and asked for specifics and they could not provide me specifics they just keep saying that I did not satisfy the 6 mos requirements. It seems to me that they are saying the doctors did not document it the way they wanted but they just said Dr. monitored diet they did not say it had to say specific things. Now they are saying that the Dr. has to say certain things and I don't know what it is that we did wrong still. I called Dawn and she said she still didn't know. I am sure it will all work out somehow but now I don't know if I have to start all over or what. They said I needed to see the Dr. and we need to read the notes. Honestly, I don't think Dawn read what she sent. She should know better, if this is what you do and you know they have to say certain things why would you not read before you send to make sure it is what you needed or if not then i could have went back to the Dr. and said it has to say this, that and the other. I know that you all have had great experiences with Dawn but I just think that she is not as thorough as necessary. Just my opinion. I don't feel like I am any closer to knowing what is wrong then I was and I think all this stress is wearing me down. It isn't fair cause I feel like I have no control over this. I get punished because others did not do their part right. It sucks! I just hope I don't have to wait 6 more months... Thanks for the support all!

Hi Melissa. I am very sorry to hear about your health scare. Like everyone else said, that does prove how much you do need to have this surgery. As far as your 6-month diet - Did you go to your PCP once every month or did you skip any month? Also, your Dr has to code your visit as an "obesity related" visit. Also, did you already visit a nutritionist and a psyciatrist (both are required by Cigna)? I believe you mentioned before that you had Cigna. If so, go to this website http://www.cigna.com/health/provider/medical/procedural/coverage_positions/medical/mm_0051 _coveragepositioncriteria_bariatric_surgery.pdf It will show you exactley what Cigna needs in order to approve the surgery. Only the first couple of pages will apply to you. Make sure you have done all of the requirements and that your DR has noted the reason for your six monthly visits. Also, I was declined because of my 6 month diet and when I did it and resubmited everything, I was approved. I have a letter I personally wrote and submitted to Cigna with my resubmission. I found something close online and used it as an example. I made sure to include all of the points that Cigna requires and that I completed each one in the letter. If you want a copy of the letter I wrote, email me and I will email it back to you. My email address is [email protected] Good luck and hang in there and just do what you need to. Let me/us know if there is anything we can help with. Misty

Melissa, I agree with Susan, I believe that this is just more proof that you need this surgery more now than ever, please do not give up. Do not give up on Dr. Spaw's office and Dawn, I know that you did not have a good experience with her a few weeks ago, but I think you should give it another chance. Also, try to come to the next support group meeting at Dr. Spaw's office on April 3rd @ 5:30 maybe someone their can help with some ideas, if not seeing and hearing others in person is always a lot of help. Best of luck with you, don't give up!! Shelia