Denied.....now what!
Ok, the title says it all. My insurance company has denied my preauthorization for the gastric bypass. They said that I did not present information proving that I'd failed a medically supervised weight loss plan. That's what the letter said. I'd received the news from a phone conversation I had with the company before I got the letter. In that conversation, the person indicated that "they just need to make sure I'm not doing this for cosmetic reasons". That's funny. Yeah, I'm 320#, have high blood pressure, high cholesterol, sleep apnea, arthritis, GERD, and other bariatric conditions I will leave unmentioned - but I might be in it to have abs like David Hasselhoff....RIIIIGGHT......
Ok, I realize that most folks who undergo this surgery have to jump through some hoops to get approved, like participating in a doctor supervised weight loss plan for 6-12 months, but at this point it seems like such a waste of time. I know I can lose maybe 10# if I starve myself and work out like a fiend, but according to the NIH, the only true method of attaining long term weight loss for the morbidly obese is with bariatric surgery.
I plan on drafting an appeal letter, providing information regarding my failed "medical weight loss program" in 2001, and my attempts since then. I will also include the NIH studies I mentioned, and will become the most stubborn phone caller since the invention of telemarketing. Might work, might not - either way I'll keep dieting as much as I can, and in 4 months I'll have the right amount of "time served" to go for approval again.
Bummer though - I was really psyched up for getting this done and over with and on with my new life.
Any ideas, I could use em.....
posted by Jeff at 11:05 PM
1 Comments:
Jeff,
Yeah, I went through this too. Unfortunately, insurance companies are sticklers on this point.
First off, make your first monthly appointment right now with your PCP. Get the ball rolling by getting on the physician-supervised diet. This is a requirement the insurance companies will not waive. And I don't believe for a second it is just to "make sure", but rather it plays on the immediate gratification part of the psyche that many overweight people have problems with. I've known many people who have given up because the 6 months seem so daunting, and that is exactly what the insurance companies want.
As for me, my company would take history for up to 2 years. I requested a copy of my records, and on four of my doctor visits, they had the ICD-9 code for "Obesity" (278.00 or 278.01). This pretty much ensured that my insurance company wouldn't pay for the appointment. I was upset at the time, but it worked to my advantage. I told them to fill out the diet sheets for those appointments because that was the least they could do after repeatedly screwing up the ICD9 codes. At first, they resisted, but they eventually gave in (thank you Herb Cohen). I then got my other two by going to appointments, and afterwards, my insurance approved it within two weeks.
Don't get discouraged. If you don't have any medical history regarding PCP supervised weightloss, just get started on it now. Make sure you have all of your ducks in a row by the time you have the 5th month of info. Getting started now will put your surgery around April, and believe me, that is when you want it. I've heard it is not as easy when you have it in the fall, as with the walking requirements, spring and summer are much better.
Best of luck. You know how to get ahold of me if you have any other questions.
The Unseen One - GBP Post-Op.
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