Appeal denied

Jeanne T.
on 8/19/11 7:00 am
Well I guess the wonderful sleeve was not meant to be for me.  But I still have two options.
Which really I have one option, as I will not get the band.  So I have an appointment with my surgeon to discuss the gastric bypass.  I know I should be grateful that I do have other options open to me.  But you know I really think the sleeve was the best.  But I will find out more on Friday.   Thanks to all of you for all your encouragement and support.

Blessings,
Jeanne
                        
Kristy R.
on 8/19/11 7:17 am - Santa Clara, CA
 I am sorry to read this.  Try not to be discouraged.  If my sleeve was denied, I would have had GB.  It would not have been my first choice, but if you are careful and vigilant you should do just fine.  My SIL had GB 10 years ago and she has done beautifully.  
~Kristy~ VSG 3/29/11 ~ 15 pounds lost pre-op, SW - 240/GW - 150
 
sourcherriex
on 8/19/11 7:21 am - CA
 If the sleeve is what you really want, keep trying! Don't give up and end up with a surgery you don't want. Did they tell you why it was denied? I would keep pushing. Insurance companies want you to give in and do things their way because it's easier for them. I won't let mine tell me no, that's for sure. I hope it all works out for you. Much love
 ~Marisa~
       
kats-mom
on 8/19/11 7:22 am - TX
VSG on 02/15/11 with
Sorry that you were not approved for the sleeve.  I'm not sure which insurance company you have.  I was denied twice and finally approved with the third try.  I have BCBSIL.  It took me about 8 months from start to approval.  I'm so happy that I went through all the hoops and had my doctor's office "fight" for me!!  The sleeve was the best option for me, I know.  If you have comorbidities, have the doc's office use them!!  Best of luck to you in your "fight"!!
   Lorraine    kats-mom
        Highest Weight-285  /  1st Nutritionist Appt-275  /  Pre-op Diet-257  /  
                               Day of Surgery: 246  /  Day Home-257
          
Jeanne T.
on 8/19/11 7:24 am
They said it wasn't an option.  Even with the Drs. companion letter.  It is just not covered.  So I will talk with the surgeon and figure it out.  I know people who have had the GB and have done very well.  I guess I just need time to adjust and to process as I just found out about and hour ago. 
                        
rosapain
on 8/19/11 7:28 am - Amityville, NY
Hi, Jeanne dont throw in towel just yet.I know of two people who went in to have gastric and the doctor at his discretion choose to perform the sleeve. Please speak to your surgen about this when you meet. also I dont know what insurance you may have if its BCBS  as of 08/29/11 change some of their rules for the better. I hope it helps I am rooting for you.
Jeanne T.
on 8/19/11 7:39 am
Thanks for your words,  can a surgeon just decide on his own about what surgery he performs once he's in there?  I have BCBS, do you know what changes they are going to make?  I guess the problem is the type of BCBS we have.  You would think that it would be the same, but they have to make it difficult.

Jeanne
                        
Ms. Cal Culator
on 8/19/11 7:51 am - Tuvalu


"It isn't an option" because ____?  Because they don't cover the sleeve?

My sister had that experience with PacifiCare two years ago and then PacifiCare was purchsed by United Health Care which DOES cover the sleeve, so she's on her way.

Do NOT have your stomach butchered into a weird configuration unless you are absolutley sure that you cannot get around this.
Jeanne T.
on 8/19/11 7:57 am
yes, that's what they say, the sleeve is not covered it's considered instructional and won't consider it.
My ins person at the WL center that I am going to said their wouldn't be any point in doing it again because of the type of Ins we have.  And she was the one who was so sure they would approve it with the appeal.  So we'll see.
                        
Ms. Cal Culator
on 8/19/11 8:18 am - Tuvalu


Instructional or investigational?  And do you have it in writing?  And do you have access online to your policy?  And do you know if there is in your state...like there is where I live...an insurance commission or agency that oversees insurance companies where you can take it up to the next level?  (This info is in your policy.)

And...there are a lot more questions, but they don't matter much until you have the answers to the ones above.
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