Denied again!

I have no more tears. They are punishing me becasue I was forced to change PCPs because the other Dr. was not providing appropriate care for my blood clots. Now I have to wait three more months. Just though I would let you know. Dawn knew yesterday and did not call me. I guess she waited and does it matter the answer is the same.

I am so sorry Melissa. I just knew you would get your approval this time. Did they at least give a reason this time? What is the 3 month wait thing about? I am absolutely heartbroken for you. I know how bad you want this surgery. If your insurance covers the surgery, and you definitely meet the BMI requirement, I just don't understand their reason for a denial. Unless they are testing you to see just how hard you will pursue this. Please do not give up! This is something that is going to give you your life back! You are worth whatever it takes to get this approval. Is there anything we can do other than pray?

Melissa, I am so sorry hon. I have to agree with susan if yur Insurance covers it and you meet the requirement of BMI why are they Denying? I can't seee changing PCP as a reason for denial. Keep your head up and DO NOT GIVE up!! We are here for you. My prayers are with you as well if you need anything please do not hesitate to let me know!!

Melissa, I am so very sorry that you are having to go through this! I don't understand this if you meet the requirements. I agree with Juanita. They must be pushing to see how far that you will take it. I think a lot of insurances are doing that by making you go through a "medically supervised diet" for 6-12 months. Just DON'T GIVE UP!!! You can wear them down. Try calling them on a daily basis! Just for the sake of calling. Have you called them and explained what the deal was with your last PCP. I'd call them and bug them until they give in! You have to be really aggressive with these insurance companies! (((HUGS))) Janie

Do not give up Melissa! I know you must be incredibly disappointed, but I'm a firm believer that everything happens for a reason..whatever that reason may be... I know you probably feel that it is a bunch of baloney and it may seem so unfair right now, but keep fighting!

I am sorry to hear that Melissa. But like everyone else said, don't give up. The insurance people are used to having people give up and not pursue it after they are given wait times so do not be one of those people. Prove to them you are in this for the long hall. Make sure you find out Exactley why they are denying you. That does not seem like a resaonable reason to deny you (because of changing your PCP). Make sure you find out if there is anything you have to do over these next three months. If you have to go to your new PCP every month or what. You want to do whatever it takes. Also, maybe it would make adifference if your old PCP wrote a letter on your behalf. Would that work and would he? Definatley find out everything you need to - by calling the insurance company directly and asking to speak with the approvals department to get the exact details of what they need and why the denied and if there is something you can provide now to change their minds. Just know that if he brings you to it, he will bring you through it. You have waited this long and have fought this hard and if it comes down to having to wait for three more months, you will and it will go by faster than you realize. We are here for you. Misty

Melissa, I am completly speechless, except whatever you do, do not give up, continue to allow us to be your support and continue to go for the next three months to your PCP and then have Dawn to resubmit it to Cigna. I was denied because I only had four months, I went of the last two months and then I got approved. Lets just pray that the third time will be CHARM like they always say.. I had prayed that it would not take a third time though. Just remember that we will always be here for you during the long months ahead. Shelia

Melissa, I just read this post and thought I would respond. I am so sorry for the hurdle that you have. I remember when I was trying to get the surgery and being denied and facing the hurdles...it was awful and made me angry. The flip side is, that it made me even more determined to get approved. We know what you've been through and all feel your pain. Dawn? Is this Dawn from the Metabolic Surgery Center at Baptist? I hate to say this, but don't rely on her to call, so be very pro-active in calling your insurance company. I called almost DAILY until I got final approval. Just a suggestion. Good luck to you, you will be in my prayers. -Alyssa

OK at this point, its time to go to HR at your work, or wherever you get the Cigna from... plead the case with the lady who does the benefits packages, whoever that might be... she should know the policies and help you fight it. I kept the email box warmed up good with the lady who does it for our employer... I kept her abreast of every change, every obstacle, and practically begged for her help. She may be able to guide you to a contact person, or something! Tell her how frustrated you are, and that you have provided everything they have asked for, etc... if that does not work, call the insurance company and ask to speak to anyone's supervisor that they will give you and plead your case. Do not give up. And even if you do not get anywhere, you will at least have gotten yourself heard, and some of the frustration off your chest, and someone along the way may be able to get you to the right person. I am not joking, I called anyone and everyone I could... then again you can always threaten to call the insurance commissioner and file a complaint. That might help.