Wednesday, March 30, 2011

Ok, maybe it's not so bad...

Perhaps I over-reacted a tad yesterday, as it seems that the reason for the decline isn't all that bad. The insurance company denied the surgery because I didn't have an updated psychological review. The one that my surgeon's office sent was from my lap band surgery approval in 2009, so yeah, they'd want something more recent. So I have an appointment tomorrow with my same behavior modification therapist, Dr. Garcia. It'll take about 3 hours and 500 pages of questions plus the verbal part, but then I should be good to go! She'll write up her evaluation and then fax that to my surgeon's office and then they'll re-submit my request. I'm hoping for a week or so to hear back, but up to two weeks, and then it should be approved. I've gone over the requirements and I meet all of them so there really should be no reason for them to deny me again.


Monday, March 28, 2011


I do NOT understand why it was SO easy for me to get this crap-band put in, but now that I'm trying to revise to a surgery that will actually work for me, it's become the biggest nightmare of my life!! I can't get my insurance company to approve a revision. They said that it's not medically necessary. Despite the fact that my port is disconnected so I can't get filled OR un-filled without going in for a fluoroscope every single time, despite the fact that my band is FULL and I still don't have restriction 100% of the time, but then other times I take 1 bite and I throw up, despite the fact that it's making me sick all the time. So I re-submitted for approval for the surgery only instead of the revision, and I would pay to get the band taken out myself, and I just called and they have denied me again!! I am so livid, I don't know why they denied me, they couldn't even tell me. The crappy part of all of this, is that I'm going through a divorce and my insurance is through my husband's work, so the longer this goes out the riskier it is that I'll get kicked off of his insurance before the insurance company finally agrees. I'm waiting to hear back right now as to WHY it was declined, so that I can appeal immediately. I qualify for the surgery part itself, there is NO reason why I should be denied! I'm going to go cry.