By: Phoebe Tyesha

Phoebe Tyesha — Sun, 10 Apr 2005 06:30:17 +0000

Oh, Marie, I’m so very sorry. It looks like your insurance company is
looking for a way NOT to pay for this surgery. I had a similar problem
with BC/BS of Florida. Not to mention getting different messages about
what they would accept than what the docs’ office was told. So,
ultimately I’m self-pay. Personally, I would ask the insurance company
to send you the requirements in writing. I know it’s a PITA, and they
might not do it, but even with the "lesser" requirements that the doc
office said I would have to have, at 55, and with a company insurance
contract coming up at the end of the year, I just didn’t feel I had the
time to wait.
Pam in Niceville
preop
Lap RNY 11/20/02
Dr. Champion/Atlanta

Yes, I was denied on the day before surgery (8/19). As I mentioned
before, I was concerned about not hearing anything from my Dr’s office
on my approval. I finally spoke with Roxanne at the Dr’s office first of
last week. She said everything looked fine according to the nurse at the
ins. company. However on Friday last, the call came in that I was
denied. What a blow! When Roxanne called and told me, they are now
asking for 6 months Dr’s recorders of weight loss, although I gave over
a year of Weight Watchers weekly weigh-ins. The ins. is also asking for
5 years of records pertainning to my weight loss attempts supervised by
my doctor. Roxanne and the nurse at the ins. com. had never heard of
such a request before. I called my doctors office right after I hung up
from UCSF, the request for records and phone call from the ins. had
already been sent to their office. Just a waithing game again.

My husband said to look at it as a plus, since I am still recovering
from my foot surgery. But on Friday there was no plus about anything. I
have been eatting a bit more than I had been doing. Now I am afraid I
will continue and put on weight.

Marie — San Leandro –

By: Joni Glover

Joni Glover — Sat, 09 Apr 2005 21:52:15 +0000

Dear Marie:
So sorry about such a low blow. But, all is not lost. (First) If you can
document more time with dr. supervised weight loss attempts, so be it. But, you
should not have to. Programs like Weight watchers are well organized, properly
supervised programs. And except within the medical community. My doctor has
recommended that I go to WW so if I weigh with him and am telling him that I am
attending and whatever, whatever and he tells you to keep going. Then,
indirectly you are being supervised by your physician on this weight loss
progra. They evidently don’t know what they are doing at this insurance
company. Get information on as many programs that you have attended if you
already have not. Verify them all thru doctors that may have discussed your
participation in these programs. The doctor does not have to be handing you a
menu in order for him to be supervising you while participating in these
programs. Most doctors know very little about diet and weight loss anyway. A
program like WW etc. is the best information source. (Second) : Contact your

State Insurance Commission, file a complaint against the insurance company. On
the basis that they are denying you medical treatment regarding serious medical
conditions brought on by your obesity. (3rd.) Make an attempt to get the
Americans with Disabilities to act in your behalf. I understand that Obesity is
considered a disability. AS a matter of fact I know it is. (4th.) Contact
your state legislators and make a formal complaint. They will contact the
insurance company to try to act in your behalf. (5th) Write to the insurance
company and explain about how bad your health is relative to your weight. How
it effects your walking because of arthritis, foot problems whatever, heart,
hyperlipidemia, high blood pressure. Whatever. Explain again about all your
diet attempts. Tell them how your weight is ruining your life. You don’t feel
like living your life like it is. Also, now tell them you have contacted all
the above organizations for their assistance in getting this approved for you.
It wouldn’t hurt to throw in that if its not approved you are considering filing
a lawsuit for unlawful descrimination due to your disability of obesity. Don’t
play the letter game with them. Let them know that you are not going away. You
may want to write the letter first and then start calling the agencies for
assistance. Call one or two first to see what they say. It may take you 2 to 3
days to get it all done. But, I think they will come around. Good Luck and
take care, the foot too.
WLS Love,
Pat Cannon

My husband said to look at it as a plus, since I am still recovering from my
foot surgery. But on Friday there was no plus about anything. I have been
eatting a bit more than I had been doing. Now I am afraid I will continue and
put on weight.

Marie — San Leandro –

Comments on: :( denied

By: Phoebe Tyesha

By: Joni Glover