I sat here enjoying an afternoon cuppa Starbucks and enjoying my blog reading, it was shaping up to be a nice, quiet afternoon. Actually, I was in the process of writing out a pretty witty BYOC - if I say so myself - when the phone rang. It was the Insurance Guru....
I have been denied by my Insurance Company for Lap Band surgery. I suppose having a BMI of 39.9 with a comorbite of a diagnosed sleep apnea wasn't enough for them, and it matters not to them that it is enough for me.. The reason for the denial is that my BMI isn't high enough and although I am presently using a CPAP (with oxygen), my sleep apnea is apparently not "critical" enough. Right now I just want to chuck the whole kit and caboodle - the CPAP, the arthritis meds, the lap band - right into the pond and be done with it. I am so disappointed and heartbroken, I wish it would all just go away. Right now I just have no fight left.. Perhaps next week I will, but not right now.. I have been told that on Tuesday the Bariatric Doc will do a "Peer to Peer" review with the physician who denied my case, but so much in this process has been such a disappointment to me that I'm not getting my hopes up.. I'm not holding my breath..
I'm sorry for posting such a "downer" of a post, but so many of you have been so uplifting and encouraging throughout, and have walked each step with me during this journey... I just felt I had to give an update and perhaps even cry on your shoulder a bit..
Have a terrific weekend...
Until Next Time...
13 * Your Comments Make My Day Brighter!:
That is so STUPID!! Well, if the only reason that they can give you is because you are less than 40 BMI, then maybe you will need to gain a few pounds to be able to lose a lot of pounds!! (Wink Wink!)
After all, the difference between a 39.9 and 40 BMI isn't much, pound wise, so I am sure that you could gain that amount in no time at all, then have the Doctor re-send the approval off....
As for the Award that you gave me, I want to thank you!! I haven't posted it yet, but I will, I promise!!
Oh Lisa, I just want to cry with you! You need to fight this. Sleep apnea is nothing to mess around with. I hope that your bariatric doc can convince the insurance of that. Keep your head up!
please, please, please don't give up. I know you want to right now, and I don't blame you. You have struggled the whole time with the process. But imagine beating this, eventually getting the approval, and losing all the weight. You will look back and think "it was worth every single tear of frustration and disappointment along the way". (((huggs)))
I'm so sorry you had bad news this morning. I understand not wanting to deal with it right now-- take a few days to be disappointed. When you're ready to appeal, I'm sure there are people who will be happy to share their appeal success stories with you.
((((hugs))))
WHAT THE HECK? They have you do this supervised diet under the guise that you'll be able to get approved afterward... but now that you're BELOW a 40 BMI, thanks to this diet they put you on, you're all of a sudden disqualified? You were too successful on your own or what?
I would fight this. Most definitely.
Oh lovey, I have no idea how medical insurance works not being in the US. But, I'm so sorry that this has happened, I'm sure it will get sorted out but after all this wait it must be heartbreaking for you, I'm so sorry.
I'm sorry!
I'm so sorry, that is so frustrating!!!
If you appeal and are denied again, is self-pay an option for you? I had to go that route with lapband and VSG.
I am so sorry. Take a break from the madness. Hopefully, you will get that fight back and get the surgery you deserve and need!
I am so sorry to hear this! I know how deflating this news can be. I was denied twice by insurance before finally getting approved. The peer to peer call is a good thing. Just make sure you talk to your doc about what he'll be saying beforehand. I know you want to give up right now but sometimes the insurance company just needs to know you're not going away. Sleep apnea that requires a cpap is critical enough. It's absurd that they'd say otherwise. Also, I agree with others...as much as gaining weight goes against EVERYTHING we work for...39.9 to 40 isn't that much..maybe just a few rolls of quarters in your pockets would get it done. Hang in there sweetie! We're here for you.
Love you. Miss you. Hope you're doing okay. *hugs*
I know it's hard, but we're all gonna help you fight this.
I'm sorry about your news. I work in healthcare and I HATE insurance companies. I am also in the pre-band stage and have my last 3-month physician monitored diet appointment on Thursday. We'll see how that goes.
Please don't give up the fight!! I like what Debi had to say way up there on top.........gain some weight to get that BMI up there. Doesn't that sound horrible? But sometimes you just have to work the system. The people that do everything they're supposed to do and follow the rules are always the ones that get screwed over. I am your newest follower, and I look forward to hearing more about your journey and FIGHT!! Don't give up! We're all rooting for you.
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