*sigh* I’ve been going through the motions to get approved for weight loss surgery, specifically Gastric Bypass. I got the letter from my insurance on Friday that I have been denied. I spent the weekend crying.
I’ve been trying to get approval for months. There are so many steps that need to be completed before it ever even gets submitted to your insurance. You have to get a referral from your primary care doctor, there are lots of tests to be done. These vary from surgeon to surgeon, I’m sure, but I was required to get an EKG, full metabolic blood panel, and chest X-ray. I also had to undergo a psychological evaluation to be sure I was stable (HA!). All this took me about 6 months. It’s all just a big waiting game and not for the impatient.
So I had been on pins and needles waiting to hear. Then it came, in big bold letters:
“NOTICE OF DENIAL OF MEDIAL COVERAGE”
Apparently, Cigna thinks that there is a “lack of medical necessity.”
It seems that weighing nearly 300 pounds (yikes, I’ve never admitted that before), being in extreme pain every waking moment, and having an excruciatingly painful hernia that they won’t fix until I lose weight, isn’t “medical necessity.” Stupid Cigna Insurance.
I wish that they could spend one day in my shoes and tell me it’s not necessary to get this weight off of me as quickly as possible. I’d like them to feel the pain with every step I take. The pain I feel when I try to get up and take care of my kids. The hernia pain that puts me in the recliner for hours, unable to walk. It truly sucks eggs.
Anyhow, if anyone reading has dealt with this before, I would love to hear what you did. How did you finally get approval? Did you give up? I need to start planning my “grievance” so that I can appeal their decision. I would love some insight on what to include to get them to understand.
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I am sorry you were denied. I know many people that have had this surgery. Some were successful and others who gained the weight back. I wish you the best and hope that things work out for you.
Hugs! I’ve never been in your shoes but it sure sounds like life is not pleasant right now. Is there an appeal process, anything you can do?
lots and lots of hugs…I know how much you were looking forward to doing this…I’m so very, very sorry!!
Oh Rhea, I am so very sorry to hear this. I haven’t been through a grievance with an insurance approval so I can’t help in that respect. But I know you enough to say that you will write a kick arse letter and get approved. I can feel it!!
Big hugs to you girl!!
I know there are people that can help you fight! I have heard about companies that deny everyone on a particular day and then on another day, they get approved. Are you a member of any large online support group like Obesity Help? Ask, ask, ask for help and how to do it. If your doc doesn’t know how to fight, find one that does. I know a lady in Las Vegas that fought them for a couple of years. You might also check out doing a search on how to beat bariatric denial letters. I’m not saying it’s always possible but don’t go down without a fight. Bless your heart. If you’d like, email me and I’ll see if I can put you in touch with some people that might be able to help you. Blessings,Yvonne (Bariatric Girl)
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