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10-09-2007, 11:05 AM
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#1 (permalink)
| | Cub Reporter
Join Date: Mar 2007 Location: IL
Posts: 74
Weight Statistics 03/03/2008 Surgery Date:
5' 4"
Height:
276 lb Start Weight:
160 lb Current Weight:
145 lb Goal Weight:
116 lb Weight Loss:
15 lb Lb Left to Lose:
42.0289855072 % % Lost:
10/2009 Goal Date:
Body Mass Index47.3701171875 BMI Start:
27.4609375 BMI Current:
24.8864746094 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
 |  Have you ever heard of this?????
Hello again, here I am to rant some more. The office manager called me this morning. She told me the reason I am being denied is that I haven't lost enough weight on the 6 month diet. That is fact she has been doing this a long time, and that it is 6 months they have. That she doesn't know why they are lieing to me at the insurance company. I just want to cry, I know the insurance companies are tough, but if I could lose weight dieting why would I need the RNY? She told me its not an official denial that is it being reviewed now. She also reitterated though that the reason for the denial at this point is lack of weight lost. I have a weigh in next week and I know I am not even close to losing the 10 pounds she told me the insurance would want. What do you think, call the insurance company back? I know I should keep fighting, but I totally feel like giving up. I have done everything, have all the papers that I could give them, been to all the Dr.'s I was suppossed to see. I have clearance from them all. I am just starting to think, maybe this isn't going to happen for me, maybe its not meant to be. I just don't know what step to take next, and am just upset about the whole thing. Especially when she told me the insurance company lied to me. Why would they need to lie?
Cherri
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10-09-2007, 11:16 AM
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#2 (permalink)
| | Seasoned Veteran
Join Date: Jan 2006 Location: SOMEPLACE LONG ISLAND, NY
Posts: 6,809
Weight Statistics June 1, 2005 Start Date:
5' 5"
Height:
310 lb Start Weight:
167 lb Current Weight:
159 lb Goal Weight:
143 lb Weight Loss:
8 lb Lb Left to Lose:
46.1290322581 % % Lost:
Body Mass Index51.5810650888 BMI Start:
27.7872189349 BMI Current:
26.4560946746 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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((((HUG)))))
so hard appeal what more can i suggest.
i KNOW MY surgeon required me to loose 25 percent
of my weight before he would book my surgery.
Its HIS STRONG belief it reduces complications.
I wonder if this is why the insurance companies
deny and saying not enough lost.
FRUSTRAtinG i bet.
i know when i was looseing for my surgery many said
geez lisa if u could loose u wouldnt need the surgery...
but i did it and got my surgery
i hope ur storey changes!
hugs
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10-09-2007, 11:32 AM
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#3 (permalink)
| | WLS Guru
Join Date: Jan 2007 Location: Modesto, CA
Posts: 470
Weight Statistics 12/13/06 Start Date:
December 13, 2006 Surgery Date:
Height:
220 lb Start Weight:
150 lb Current Weight:
145 lb Goal Weight:
70 lb Weight Loss:
5 lb Lb Left to Lose:
31.8181818182 % % Lost:
Dec 2007 Goal Date:
Weight Loss MethodRoux en Y Gastric Bypass
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i am sorry to hear your troubles, i had to lose weight for mine also, but i asked my case worker if it would be ok if i got diet pills from the Dr. she said she didn't care how i lost it, as long as i lost it, so i pleaded with my Dr. and explained if i could lose weight. blah blah, and if she would just give me the pills to lose the pounds required, she did and it was a blessing, i would never have been able to do it on my own, and a little confession..... i know the RN that works in the Dr's office, and i asked her to let me weigh, that very first time, with my purse, which is more like a suitcase, it actually added 7lbs, so the next time i weighed, i had lost the 7lbs, bad i know, but i did whatever i could.
Just hang in their and keep fighting, i had moments of crying also, just keep fighting for what you want. I really thought mine would never happen too.
It can be a very frustrating journey... Good Luck
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10-09-2007, 01:32 PM
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#4 (permalink)
| | Whipper Snapper
Join Date: Aug 2007 Location: Washington
Posts: 33
Weight Statistics 07/24/08 Start Date:
Aug 5th 2008 Surgery Date:
5' 5"
Height:
362 lb Start Weight:
326 lb Current Weight:
165 lb Goal Weight:
36 lb Weight Loss:
161 lb Lb Left to Lose:
9.94475138122 % % Lost:
08-05-09 Goal Date:
Body Mass Index60.2333727811 BMI Start:
54.2433136095 BMI Current:
27.4544378698 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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Have they advised you how much weight they want you to lose in the 6 months? I'm having to do a doc supervised diet as well but they didnt give me a weight goal. I thought they were just looking for commitment?
__________________ -Jennifer  | |
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10-09-2007, 02:56 PM
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#5 (permalink)
| | Seasoned Veteran
Join Date: Jun 2007 Location: Jacksonville, Florida
Posts: 5,162
Weight Statistics July 21, 2007 Start Date:
August 6, 2007 Surgery Date:
5' 3"
Height:
287 lb Start Weight:
151 lb Current Weight:
140 lb Goal Weight:
136 lb Weight Loss:
11 lb Lb Left to Lose:
47.3867595819 % % Lost:
January 1, 2009 Goal Date:
Body Mass Index50.8342151675 BMI Start:
26.7455278408 BMI Current:
24.7971781305 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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I would definately call hte insurance co again and talk to them. YOu are correct that you are getting the RNY because it is something that you can not do on your own. How can someone say that you can not get it because you can not lose the weight on your own? Something sounds strange to me!!
__________________ Kim Tummy Tuck 2-17-09 Breast & Arm Lift 4-22-10 Breast Implants 5-11-11 http://www.facebook.com/profile.php?id=1408442896  | |
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10-09-2007, 04:05 PM
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#6 (permalink)
| | Seasoned Veteran
Join Date: Aug 2006 Location: WADING RIVER (Long Island), NY
Posts: 5,122
Weight Statistics 7/16/07 Start Date:
7/16/07 Surgery Date:
4' 11"
Height:
230 lb Start Weight:
130 lb Current Weight:
115 lb Goal Weight:
100 lb Weight Loss:
15 lb Lb Left to Lose:
43.4782608696 % % Lost:
12/31/08 Goal Date:
Body Mass Index46.4492961793 BMI Start:
26.2539500144 BMI Current:
23.2246480896 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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Yeah I Also Never Knew There Was A Requirement Of How Much To Lose? Thank God I Didnt Have To Go Thru Any Of This But When I Hear Ins Co's Say They Want You On A 6 Month Diet I Thought It Was For Commitment Also. Dont You Dare Give Up!!!!
__________________ 230 lbs 7/2007 & 130 lbs 2/2009    | |
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10-09-2007, 04:17 PM
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#7 (permalink)
| | WLS Mentor
Join Date: Jul 2007 Location: Tega Cay, SC
Posts: 1,014
Weight Statistics August 2, 2007 Start Date:
August 14, 2007 Surgery Date:
5' 7"
Height:
283 lb Start Weight:
162 lb Current Weight:
160 lb Goal Weight:
121 lb Weight Loss:
2 lb Lb Left to Lose:
42.7561837456 % % Lost:
Christmas, 2008 Goal Date:
Body Mass Index44.3192247717 BMI Start:
25.3700155937 BMI Current:
25.0568055246 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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Keep fighting and APPEAL. Insurance companies have an appeal process -- don't let them push you down. Just keep going for it.
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10-09-2007, 09:44 PM
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#8 (permalink)
| | Seasoned Veteran
Join Date: Mar 2007 Location: Floyd County Virginia
Posts: 9,400
Weight Statistics September 19th 2007 Start Date:
September 19th 2007 Surgery Date:
5' 10"
Height:
363 lb Start Weight:
220 lb Current Weight:
170 lb Goal Weight:
143 lb Weight Loss:
50 lb Lb Left to Lose:
39.3939393939 % % Lost:
When I get there again Goal Date:
Body Mass Index52.0793877551 BMI Start:
31.5632653061 BMI Current:
24.3897959184 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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Honey I dont understand what you mean buy the insurance company lying to you? If they require a 6 month supervised diet so be it. I think its your surgeon who wants you to lose the amount of weight they have decided on. When you see your Dr next week talk to him. Lay it all out. They go off medical records not what the office manager tells them. Breathe.... it will help.
__________________ Remember Tough times never last Tough people do... This Ribbon is for our Lady Lisa and all the women that fight this ugly disease. RIP Jerry my friend
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10-09-2007, 10:26 PM
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#9 (permalink)
| | WLS Guru
Join Date: Jun 2007 Location: Arizona in the winter - Colorado in the summer
Posts: 454
Weight Statistics about age 12 the first time Start Date:
8/29/2007 Surgery Date:
5' 4"
Height:
268 lb Start Weight:
135 lb Current Weight:
140 lb Goal Weight:
133 lb Weight Loss:
-5 lb Lb Left to Lose:
49.6268656716 % % Lost:
a year from Christmas Goal Date:
Body Mass Index45.9970703125 BMI Start:
23.1701660156 BMI Current:
24.0283203125 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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My prayers are with you for this - I had to prove I had tried to lose weight with Dr supervision over the past year - I had 3 but I wasn't required to lose any amt of poundage. The surgeon said it would easier if I could lose some but I didn't lose more than 3 or 4 because I ate anything that didn't move and that I was afraid I wouldn't be able to eat after surgery = Hang in there and keep at it - your turn is coming for sure
Judy
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10-09-2007, 10:56 PM
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#10 (permalink)
| | Cub Reporter
Join Date: Mar 2007 Location: IL
Posts: 74
Weight Statistics 03/03/2008 Surgery Date:
5' 4"
Height:
276 lb Start Weight:
160 lb Current Weight:
145 lb Goal Weight:
116 lb Weight Loss:
15 lb Lb Left to Lose:
42.0289855072 % % Lost:
10/2009 Goal Date:
Body Mass Index47.3701171875 BMI Start:
27.4609375 BMI Current:
24.8864746094 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
|  continued....
What I mean is the insurance company told me I had only gotten 5 months in. The first weigh in and start to the diet was April 3. The insurance company said April 3 to May 3 is one month and so on. Which would mean Oct 3 or sometime soon after would be month 6. The office told me No they do this all the time and they have the 6 months done. The insurance told me thats why I was denied. The office lady said no its because I did not lose a significant amount of weight. I lost 5 total pounds not sure if I will have lost more by next Monday or not. Thats why she says they aren't telling me the "real" reason. Funny thing is on another board there is someone from the same office, same insurance same requirements. She got denied for the exact same reason. Funny isn't it? She also states certain people could be more empathetic. Hmm same thing I have been saying about certain people at that office. My insurance states must have participated in a Dr supervised diet of 6 months during the 24 month prior to the surgery. I will appeal until I can't appeal anymore. It just seems like I am getting the run around. It never said anything about losing a certain amount for the surgeon either. When I don't lose enough it is claimed the insurance will deny me and its all the insurance not them lol. Who do I believe?
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