feeling defeated

I'm supposed to have my second weight loss management appointment today and I don't even want to go. I was told my insurance probably won't cover the sleeve and I really have no interest in any other surgery. I called the insurance company before I even started the process and they said they go by surgeon recommendation for approval. Then the doctor's office told me they probably won't cover it. I called them back and they said "Well we can't be sure it won't be covered, but we definitely cover the RNY." I called the surgeon's office back and they said they just a lot of denials by my insurance. I guess they can submit for it, but it will most likely be denied. Insurance said I can appeal, but I'm just feeling very defeated. It's like I want to do something to help myself and there's a wall. I don't feel comfortable with the RNY and I definitely don't want the lap band. I'm also not comfortable travelling to have the surgery and I have limited funds. 

I would not have gotten the RNY just because insurance covered it and not the sleeve.  The plumbing per wiring just to dang much.

I'd have either self paid for the sleeve or just stayed fat.  IMHO, the sleeve is the only viable WLS.

That's honestly how I feel. I know it might sound silly to some people because if I wanted help I'd just do the RNY, but I'm not comfortable with it. My husband said to just go through everything and see what happens, but I don't know what to do now. I have no problem changing my eating, like I would in prep for surgery, but why go through all the tests and what not if I'm just going to be denied. I'm really torn on what to do now.

Carefully read the manual that you receive from your insurance.  Often you can beat them with their own words.  See if you meet the criteria as listed in their own manual and be prepared to fight if you have a chance.  Good luck.

The way the policies are written they can be very vague. So totally fight for what you want.

This is really good advice.  You can request an "Evidence of Coverage" document that may have it, but you can also get a "Medical Policy" from the utilization management team that will break it down by procedure.  Many insurances actually have both of these documents online too.

I agree with hubby...go through whatever they want...if denied, appeal it...you never know who may be looking over the paperwork that day, and decide you should have the sleeve.  Also, if you do all the tests (as long as ins is paying) you may find out something you didn't know about, and that could change the outcome.  Not that I'd hope they find something, no, but you never know. Good luck!!
Sophie

Thank you for the support. 

I think you should listen to your husband and do the paperwork. Also plead your case with the doctors office as to why you want the sleeve. Are their any underlying cir****tances that would make it better. With me I had irritable bowel syndrome and because of that alone my dr didn't want to mess around with my insides and potentially make it worse. The doctor should be able to give your insurance valid reasons for you to have the sleeve vs the RNY. Honestly if your doc can't give good reasons I would look for a second opinion. Insurance companies care about saving money, if this surgery will save them more money they will think twice. I don't know your weight and how much you need to lose, but if it gets you off even half your meds ( assuming you take meds), that number yearly as a savings would be worth it. I know it's frustrating, but it seems like there are always hoops to jump through, if you really want this keep jumping, it shows them your determined. Your insurance company may have a policy where they deny all weight loss requests the first time, I know that sounds terrible but if you want it they make you work for it. It's your body and you should get the surgery you want, don't settle, just stay determined, things will work out. Start lining up those ducks, quack, quack :)

best wishes,

Lisa

I completely agree... if your surgeon isn't on board with you going for the sleeve... find a new surgeon that will back you 100%.  You need them to go to bat for you with the insurance company, so to speak, so you want someone that know exactly what you want and can help you get it.  I was SO lucky with my surgeon and the staff there, they were fully supportive, handled the insurance and everything and was wonderful.  There are ALWAYS hoops to jump through, but IT CAN BE DONE... you can get this covered.  Just do everything they say and follow it to the letter.  Go to every single support group offered, make sure you go to every single appointment as well.  Maybe even try getting a letter from your PCP and your surgeon on why you need to have the sleeve vs. RNY.  Put your mind to it, I know you can do it! :)