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Rocksjourney13

Feeling Defeated before I even get started

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Today I received a call from the Bariatric Insurance Coordinator/Procedure Scheduler to advise me that my procedure was denied by my insurance due to the fact that they could not identify sleep apnea and there is not conjunction with a significant co-morbidity. Meaning I have no other weight related illness or disease. As for the sleep apnea I was denied coverage for the test months ago because I have insomnia which keeps me from sleeping at least 6 full straight hours for them to be able to do a sleep study. So they would not approve the test to do the sleep study and they have denied me because there is no proven data to support sleep apnea. Really? As for all the other weight related issues I do not yet have, well that is the point of this surgery. I am trying to lose weight and get healthier to avoid these in the future.

The pre surgery odyssey has been going on for about 10 months now. I have gone to every doctors appointment, every Nutrition meeting, every dietician meeting, every nurse practitioner appt, every additional weigh in because they need a recorded weight for every month even if you were not scheduled for anything that month. All the while missing hours of work,driving over 50 miles to get there (sometimes taking 3 hours one way in Chicago rush hour from where i live). I jumped through every hoop they asked me to and it is all for not. How did they not know that they had refused my sleep study.Why not tell me they would deny my request on that fact alone. Before you even get scheduled for any appointments you fill out a long application listing any and all illnesses, including whether or not you have had a sleep study and what the outcome of that test. They knew my history from before they ever scheduled my 1st appointment. I feel emotionally drained, I feel as if a year of my life has been wasted, stolen. They have labeled me obese, but not sick enough to need help? Will they approve my surgery if/when my health starts to deteriorate as I was told I will eventually suffer from weight related illnesses. I am feeling broken.
I was told by the coordinator that she has never seen this happen before with Cigna who is my insurance company. She stated that they will appeal and that my doctor would speak as to my candidacy for this surgery, of course not until he gets back from his vacation which will be several weeks. So I guess I will continue to play the waiting game. This has become a far more emotional battle than I ever expected and today has devastated me. Not sure if I can take much more. I haven't bothered to tell my husband yet as he is really not on board with the surgery but says he will support my decision. He is scared. Just yesterday he asked me what day it was going to be so he can request a weeks vacation to care for me. When I tell him this news he will probably tell me it's a sign. Who knows, maybe it is.
#frustrated

Rant over.

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Comments

  1. Fae's Avatar
    I'm sorry. I can imagine how disappointed you are. I just turned in what I hope will be the final requirement---thought I was through. Oh well. Good luck with your appeal.
  2. Rocksjourney13's Avatar
    Quote Originally Posted by Fae
    I'm sorry. I can imagine how disappointed you are. I just turned in what I hope will be the final requirement---thought I was through. Oh well. Good luck with your appeal.
    Thanks Fae, I hope your outcome will be better than mine. Good luck to you.
  3. sociologist's Avatar
    So sorry youre having issues with the insurance company. They should not be anle to regulate how an individuals medical care should be carried out. If a dr says you need a surgery to improve your quality of life, it should be a done deal. Keeping my fingers crossed for you on an appeal.
  4. Mich-D's Avatar
    Definitely apeal to have the sleep study. Although I don't have Cigna, my sleep study confirmed my breathing was stopping an average of 123 times (per at least twenty seconds each time) a night. Are you waking up with migraines? Or feeling tired all long? If so, include these symptoms in your appeal request for a sleep study. Good luck.
  5. SbyGal's Avatar
    Sorry for your disappointing news. I agree, I'd appeal; I had no co-morbidities (not even sleep apnea) but did have chronic back, knee & foot pain...even though they're are not "typical" qualifying issues, my doc was able to get me approved with them.
  6. kenson's Avatar
    I am hoping that you can get this decision reversed. Hopefully, your surgeon will be able to fight for you and make it happen. I also had no other co-morbities.
  7. Lee6Lee's Avatar
    I'm so sorry. I had the same thing happen and just aimed for Mexico. I didn't try fighting the insurance company.
  8. Rocksjourney13's Avatar
    Quote Originally Posted by sociologist
    So sorry youre having issues with the insurance company. They should not be anle to regulate how an individuals medical care should be carried out. If a dr says you need a surgery to improve your quality of life, it should be a done deal. Keeping my fingers crossed for you on an appeal.

    Thank you for your thoughts. I am hoping they will change their minds.
  9. Rocksjourney13's Avatar
    Thank you all for the kind words. Hopefully they will change their minds with the appeal.

    I do suffer from knee and back pain which makes exercising, walking, running very painful. I keep hearing "work through it, as you lose weight it will be less painful" Yeah that is probably so but the pain can be unbearable. I do have headaches too though they have never been diagnosed as migraines, and as for being sleepy and lethargic, yes all day long I never get a full nights sleep which also has me too tired to exercise. I feel as though my health is being compromised by my extra lbs and truly believe this tool could help me live a better quality of life. Thank you my sleever friends for allowing me to rant, This is my only place to sound off about this issue. I appreciate this forum beyond what words can describe.
  10. Aquajog's Avatar
    Sorry that you were denied . Hopefully the Doctor will appeal and you will get approved. It seems that you should have to apply to insurance first before going through all the loops and than getting denied. I had to complete everything that both my doctor and insurance company required before sending for an approval . As you said it gets expensive in both time and money if denied. Good Luck.
  11. edubb99's Avatar
    So sorry for all your insurance issues. Hoping the appeal goes through.
  12. Kindle's Avatar
    Good ole US "healthcare" system. I had no desire to waste my time and energy with my insurance company, so I had my surgery at Obesity Control Center in Mexico. I was back home, recovering and losing weight before I would have even had my first consult with a local surgeon. Sorry they've kept you hanging on and jumping through their hoops for so long....
  13. thinmeskreamin's Avatar
    Same here.. went to Mexico.. not as bad as you might fear.. but was less costly than my deductibles and co pay.. and I didn't have to wai.. wait and wait. To ultimately be denied
  14. amyswisher's Avatar
    After jumping through all of the hoops years ago when trying to get approved for a band...I gave up when the costs for all of the Dr appts and consults exceeded $3000 (again this was with insurance lol)....my late husband said we just couldn't afford for me to have the surgery. When I decided to have the sleeve, I knew I wasn't gonna go through all of that again...so, like a lot of people here, I'm heading to Mexico too. Since you have already been through all of that, I would still follow through until the actual surgeon says there's nothing more that could be done. Sometimes appeals work. I would call the insurance company myself too. Explain the situation with the insomnia and such. They may figure out something hon.

    And I am so sorry you have this disappointment. I know you must feel devastated.