My journey continues for now but is unsure

[simplyseahorse]

So - after starting this process in October very upbeat and ready to "do this thing", I just got off of the phone with the insurance company I had to choice but to switch to in January, and guess what? I have been denied. I guess I haven't been fat enough for long enough. Apparently they need 5 years' history of me being too fat, and my primary sent it to my surgeon, but I don't know, was it no enough? The next option is a "peer to peer" conversation between the MD at United Healthcare and my surgeon, and if that doesn't work, a formal appeal. It is looking more and more like I won't be a "sleever" after all, but a fat unhealthy person for the rest of my life. And please, I am not writing this for pity or a pep talk, but I needed to get it out, and nobody else really understands.

[DHB]

So - after starting this process in October very upbeat and ready to "do this thing", I just got off of the phone with the insurance company I had to choice but to switch to in January, and guess what? I have been denied. I guess I haven't been fat enough for long enough. Apparently they need 5 years' history of me being too fat, and my primary sent it to my surgeon, but I don't know, was it no enough? The next option is a "peer to peer" conversation between the MD at United Healthcare and my surgeon, and if that doesn't work, a formal appeal. It is looking more and more like I won't be a "sleever" after all, but a fat unhealthy person for the rest of my life. And please, I am not writing this for pity or a pep talk, but I needed to get it out, and nobody else really understands.

Oh I want to scream for you! You have worked so hard to do it right & get all the documentation, etc. How infuriating! And how stupid!

[Juanita62]

That's just stupid....the insurance company would rather pay for health problems instead of helping you get healthy! When will they wake up???? I'm so sorry, it's just not fair

[simplyseahorse]

Thanks. It is stupid. I am going to see how the peer to peer thing goes, and I will try and appeal, but honestly, I am thinking about checking things out with Dr. Almanza in Mexico as well. I mean, I would have max out of pocket 5500 with insurance anyway. But another country freaks me out a little, and I don't like that longgggggggg plane ride home - I live in Florida.

[KiwiGal]

That's crazy. They should realise how much money they will save in the long run.
We have very little in the way of public funding for WLS in NZ and not many insurance companies (that I know of) offer bariatric surgery. Most of us are self pay. It's a lot of money but it's been well worth it for me.
I can't comment on the process of travelling to Mexico but I'm sure someone here who has experienced this will come along and offer support.

[scogra]

My company changed health companies which ended up in me being denied. My doctor suggested Medical tourism and that several of her patients had been and had success. So, this August, I am traveling to Mexico Bariatric Center with Dr. C Rodriguez Lopez. I've heard nothing but good. My costs, with travel included, will be $6600. I was able to “loan” myself the money from my 401k to pay for mine. It’s cheaper interest than financing surgeries and I am automatically taking out of my paychecks and won’t miss the little extra gone each week. Maybe you simplyseahorse or anyone else out might have this option available to pay for their surgery. I pray success!

[Stacey03]

ARRRRGHHHHHHHHHH! You know what though. I do think you are going to be a sleever. I do! I think you just have to take some other twist and turn in the road on your journey sometimes. I was self pay here in Australia but I do have good health insurance. It ended up costing me $6000. So worth it. I know it is a real consideration to get surgery out of the country or state but I have heard some wonderful stories from Mexico. Maybe people who have had their surgery in Mexico are worth talking to and you can explore a bit more? The surgery is pretty safe and yes there is always risks with surgery so its a consideration. Maybe you could even consider staying an extra week in Mexico to set your mind at ease a bit more?
It does sound a good idea to follow up with the insurance thing too though in case they reverse the decision.

This must be really disappointing for you. It's hard. But I do think you will make it somehow and I refuse to let you go. So there! Stick around and say what you like. Your feelings are very valid. I am sending hugs and good vibes over the miles. Keep going. xxxx

[Alynn]

Sorry to hear, insurance companies are all for themselves and not on the side of the patient. They don’t seem to give a hoot about the doc recommendations. But you are your best advocate and I am sure where there is will there’s a way and you will be sleeved!

Blessings!

[Christie13]

That really sucks. I know how pissed and frustrated you must be. I would totally go for Dr. Almanza if you don't win your appeal. So many people on here have used him and love him.

[simplyseahorse]

*****************************************UPDATE*** ***********************************************

The peer to peer with UHC and my surgeon was today and the denial was overturned! I am back on again. The medical assistant called me today and said that they have to have the actual document in their office (usually only takes a day or two), then they will call and schedule an appointment for my final visit with the surgeon and we can set a date! I cried right there on the phone. After 7 months of planning and hoping and preparing, now it really REALLY might happen!

[sraebaer]

Great news!

[KiwiGal]

Fantastic news. Finally they have seen sense! Good on you for persisting.

[DHB]

*****************************************update*** ***********************************************

the peer to peer with uhc and my surgeon was today and the denial was overturned! I am back on again. The medical assistant called me today and said that they have to have the actual document in their office (usually only takes a day or two), then they will call and schedule an appointment for my final visit with the surgeon and we can set a date! I cried right there on the phone. After 7 months of planning and hoping and preparing, now it really really might happen!

hurray!!!!

[Stacey03]

Yussssssssssss :-)

[Dutchie]

Congratulations!