Question:
Can they deny me because of past depression?
I have done everything to get approved. I provided all information and went to all appointments. After the third denial they are saying that I have had a history of depression and they do not feel like I have proved that I would be able to follow the postop way of life. I would think that being on Jenny Craig for 33 weeks and attending weekly meetings, and getting down to a weight of 134 pounds would suggest otherwise. What can I do?? Please email me any suggestions [email protected] — jtyler (posted on April 22, 2004)
April 22, 2004
Hmmmm. Are they denying you because you've sought and received treatment
for depression in the past? If so, shame on them ... obesity and
depression go hand-in-hand for many of us. If they're suggesting you are
suffering from untreated depression, and further suggesting that it might
interfere with your ability to succeed with WLS, they may have a point. (I
doubt it, because it's generally all about saving money by denying the
operation by any means necessary, but we can play along with them here.
;-p). If you're not sure, and if it's the latter, I would try to enlist
the help of a WLS-friendly psychiatrist or psychologist (or social
worker/counselor), to demonstrate that you are getting treatment for
depression (IF you are, in fact, depressed). That would seem to plug
*that* particular loophole. This is a crummy reason to be denied, though.
Hang in there, and keep on trying!
— Suzy C.
April 22, 2004
I would fight this. I was treated for anxiety. Big deal. They can only
follow the law and the policy and it does not say gee will she follow the
new way of life? Well if you dont you'll get sick. However, if there is a
history of serious depression with suicide ideations they are more
concerned that you will forget your vitamis, meds etc.
Fight them hard.
Gary Viscio
www.obesitylawyers.com
— gary viscio
April 22, 2004
Depression is NORMAL for MOs. Cant get around and live life like others,
poor self image. and other causes/ We REALLY need to get a law passed
requiring WLS coverage, just like mental health care. Insurance companies
are just trying to save money.
— bob-haller
April 22, 2004
Thankyou all for the responses. I have been treated in the past for
depression. I have had depression probably most of my life. I am not,
however, psychotic nor do I have suicidal ideation. I definitely feel like
I am being jerked around. I don't know what to do to fight this. I feel
like this surgery was my last hope of living a normal life. I have, like
most of you all, tried everything. I have been successful and lost weight
and then gained it back. They say that they are not convinced that I will
adhere to the way of life...how can they say that about anyone??? Any
suggestions on ways of fighting this would be much appreciated! Thanks!
— jtyler
April 22, 2004
In my opinion they are walking a very fine line of discrimination. I'm
assuming you had a psych eval that determined you were good to go for
surgery. If so they have a lot of guts saying the doctor doesn't know what
he or she is doing.
<p>Based on their answer I sure would have never gotten approved as I
have been treated for depression, at times quite severe, since 1995. It
has been very well controlled for the past 4 years but I must continue to
take my meds. That is one reason I wanted my treating psychiatrist to do
the psych eval than a total stranger that didn't know me from adam. If you
have not had a psych eval that would be the first thing I would get done.
If you did, ask them to send you to another psych for a 2nd opinion.
<p>What was the reason for the first two denials? It sounds like
each time they are changing the tune. This may well be a case where a
lawyer will be successful, especially if it looks like discrimination.
Basically they are not saying they won't cover the surgery but coming up
with bogus crap to avoid it. Good luck! You do not deserve to be treated
this way. Depression is a disease and nothing to be ashamed of. Treated
properly someone with depression can live a very normal life.
— zoedogcbr
April 22, 2004
This sounds really fishy. What jerks! Normally depression is considered
another justification FOR surgery, not against it. Remind them that you are
aware that this is the norm according to the medical establishment.
"Following the postop way of life" can only be proven through
doing it, and tell them you're more than happy to see a nutritionist and
counselor (which they should pay for anyway!) to ensure you're on the right
track. Fight this tooth and nail! Good luck hon!
Christie, 7 mo post, -170
— christied
April 22, 2004
Does you policy refuse to cover treatment for alcoholism because someone
was treated for depression in the past? I doubt it. I would appeal this as
far as I could go. Sounds to me like they are grasping at straws in order
to deny your surgery.
— koogy
April 22, 2004
I assume this is your insurance saying no, not your doctor, right? Have
you seen a psych doc? If so, and they felt favorable toward you having
surgery, they should be able to write you a letter stating that you are a
good candidate and your depression is under control and may improve
w/surgery, etc, etc. Have you done this? BTW- it DOES sound like
insurance grasping at straws. You should push them.
— LMCLILLY
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