Waiting on insurance now.

[more2adore]

Wow, I didn't know insurance companies had started writing in clauses that your comorbids had to be UNRESPONSIVE to treatment in order to cover WLS! They just keep trying to think of requirement after requirement to keep from paying for it. I'm calling them four-letter names in my head... Liz might kick me off the board if I typed them all out right now.

 

[DianaCox]

It reads, The member has a BMI greater than 35 with at least one documented high risk, life limiting comorbid medical condition capable of producing a significant decrease in health status that are demonstrated to be unresponsive to appropriate treatment. There is evidence that significant weight loss can substantially improve the following comorbid conditions:
Sleep apnea.
Poorly controlled Diabetes Mellitus while compliant with appropriate medication regimen.
Poorly controlled hypertension while compliant with appropriate medication regimen.
Obesity related cardiomyopathy.

Those limitations do not comport with ANY standard of care guidelines. BMI 40 or greater, and NO comorbidities are needed - that is the very definition of morbid obesity, and with or without comorbidities, you qualify for surgery, whether under NIH guidelines, ASMBS guidelines, Medicare guidelines or any other bariatric standard of care - including the VAST majority of insurance policies that adhere to the medical specialty-recognized guidelines.

 

[southernlady]

Wow, I didn't know insurance companies had started writing in clauses that your comorbids had to be UNRESPONSIVE to treatment in order to cover WLS! They just keep trying to think of requirement after requirement to keep from paying for it. I'm calling them four-letter names in my head... Liz might kick me off the board if I typed them all out right now.

Nope cause I am probably thinking them too!

 

[robs477]

@jim1969 ....I am really sorry you’re getting jacked around like this. PLEASE listen to Diana and do every single thing she tells you and file an appeal. Failure can NOT be an option, your happiness and health depend on this. I know it will be tough, but, you got no choice. That being said, if it were me, I would start crafting a backup plan, a plan “B” just in case the appeals fail. For me, it would be either getting Dr. Greenbaum to do it or Dr. Ungson in Mexicali. If you don’t have the money or can’t get a loan for the $12K or so, start a “Go Fund Me” account for the down payment. There has got to be a way. If my appeal failed, I would also do a full blown press release and media blitz to put the heat on them as well as file complaints to any and all Govt agencies. You have to fight back and put the heat on them, then maybe they will see the light. We’re with you though the whole way, keep on keeping on, Rob

 

[brooklyngirl]

Wow, Jim. So sorry to hear that, but I'd be willing to wager that they're betting that you'll just give up, so don't even think about it! Give em hell!

 

[Dave0168]

Someone else mentioned something along this line already I believe but here goes....

They want to bury you with bullshit until you give up. DON'T DO IT!. Keep at it until they approve you and they will once they see you are serious about this and won't go away until you get what you need.

Insurance co's (ALL of them, car, home, life, health) piss me off. We pay and pay but when we need them who comes first? The shareholders.

When did providing peace of mind THAT WE PAY FOR become more about the bottom line for investors?

 

[robs477]

Someone else mentioned something along this line already I believe but here goes....

They want to bury you with bullshit until you give up. DON'T DO IT!. Keep at it until they approve you and they will once they see you are serious about this and won't go away until you get what you need.

Insurance co's (ALL of them, car, home, life, health) piss me off. We pay and pay but when we need them who comes first? The shareholders.

When did providing peace of mind THAT WE PAY FOR become more about the bottom line for investors?

Yes, IMHO, the world has drastically changed in the last 20 yrs and has gotten even exponentially worse in the last 10 yrs. Corporate GREED and LYING has become the order of the day. Almost every advertisement you see now days is a Flippin LIE. It used to be stretching of the truth or an exaggeration maybe, but now, it has become the norm and expected to just flat ass out lie! 20 yrs ago, the average CEO in this Country made about 20 times the amount of the average worker, today; it averages 220 TIMES the amount of the average worker.

Those of you that are “clueless” enough to want to blame either the Democrats or the Republicans are falling in to the exact trap that ALL politicians want us too. If they can keep “We The People” divided, and not focus on BOTH parties lies, deceit and corruption, then they can conquer us. It is the most basic of military strategies and is what is happening right now today.

The big GREEDY insurance Companies and ALL of BIG GREEDY Corporate America have ALL the politicians bought and paid for and it is at our expense as in the case with poor ole Jim. Sorry for the RANT also…....but, not really! Something has got to change!

 

[chevtow]

Yes, IMHO, the world has drastically changed in the last 20 yrs and has gotten even exponentially worse in the last 10 yrs. Corporate GREED and LYING has become the order of the day. Almost every advertisement you see now days is a Flippin LIE. It used to be stretching of the truth or an exaggeration maybe, but now, it has become the norm and expected to just flat ass out lie! 20 yrs ago, the average CEO in this Country made about 20 times the amount of the average worker, today; it averages 220 TIMES the amount of the average worker.

Those of you that are “clueless” enough to want to blame either the Democrats or the Republicans are falling in to the exact trap that ALL politicians want us too. If they can keep “We The People” divided, and not focus on BOTH parties lies, deceit and corruption, then they can conquer us. It is the most basic of military strategies and is what is happening right now today.

The big GREEDY insurance Companies and ALL of BIG GREEDY Corporate America have ALL the politicians bought and paid for and it is at our expense as in the case with poor ole Jim. Sorry for the RANT also…....but, not really! Something has got to change!

YES, the system is broken. --- " The tree of liberty must be refreshed from time to time with the blood of patriots and tyrants." - Thomas Jefferson

 

[robs477]

YES, the system is broken. --- " The tree of liberty must be refreshed from time to time with the blood of patriots and tyrants." - Thomas Jefferson

Absolutely! I am a HUGE Thomas Jeffersonian! And I personally believe that time to "Refresh" is right now. EVERY single GD politician that is in office should be removed from office, forcibly if needed. Anyway, I promised to never talk politics on here, so I will shut up after this.

Jim, sorry for the sidetrack, but your plight really makes me angry and got me going this morning.

 

[Dave0168]

YES, the system is broken. --- " The tree of liberty must be refreshed from time to time with the blood of patriots and tyrants." - Thomas Jefferson

Wish I could like this more than once

 

[Dave0168]

Absolutely! I am a HUGE Thomas Jeffersonian! And I personally believe that time to "Refresh" is right now. EVERY single GD politician that is in office should be removed from office, forcibly if needed. Anyway, I promised to never talk politics on here, so I will shut up after this.

Jim, sorry for the sidetrack, but your plight really makes me angry and got me going this morning.

It's easy to get sidetracked because of this issue.

I think we're all pulling for you Jim, don't get discouraged and DON'T GIVE UP!