Question:
Has anyone ever been turned down for WLS surgery?

I get to meet with the dr. November 1 and I'm scared to death I won't be qualified for WLS. I want the RNY. I am 5'3" and the last time I had the guts to weigh I was 247. I have GERD and I puff 'n blow when I walk. My BMI is 43.4. My insurance apparently pays for the surgery though. I'm just afraid for some reason I'll be turned down and will remain this way.    — [Anonymous] (posted on October 23, 2000)

October 23, 2000
hi, I wanted you to know that my biggest fear was that when i walked into BTC in IL, I would be sent on my way with a "sorry we can't help you". I think it is normal to feel this way when you are approaching unfamiliar ground. take care and GOOD LUCK!!
   — blank first name B.

October 23, 2000
I, too, had the same fear, of being denied by the insurance company. I didn't look forward to writing appeals and all that waiting. Well, today I found out that my insurance company no longer requires pre-approval, so I will have my surgery, then pray that they pay for it. The intake worker I talked to at BTC in Ann Arbor, MI, said she was 99% sure that I met the requirments! Sounds great to me, so I'm off to my first appointment on 11-6-00
   — Kathy B.

October 23, 2000
I was denied by my insurance company, but I appealed through my employer and was approved "off contract." It is important not to accept "no" without fully understanding why you were told know and asking how could this "no" become a "yes."
   — Nanette T.

October 23, 2000
Do not be concerned about a turn down cross that bridge when you get to it. Some of us get turned down a whole lot do not. Your insurance pays, you will be approved. If not you will move on to the next step just like the rest of us. me I changed insurances....You will be approved.......... Think Positive.....
   — Tamaria W.

November 6, 2000
My PCP sent in the referral and it was sent to Los Angeles to a Dr. Hamby. He stated that he did not think it was medically necessary at this time. I caslled to complain that a single DR. that has never seen me,checked me or even talked to me had the right to turn me down for something so important. I called the number on the denial letter was sent to me and they told me that I was entitled to a Appeal Group Hearing. Also the the letter that was received from Dr. Hamby was not a denial. Only the Appeals board can issue a fromal denial. You can have 2 formal denils and then you can request Arbatration. I have 1st Hearing 11/8/00. Let me know your e-mail and I will let you know how it goes. Are you in So.CA?, if you are I can also give you a few names and numbers that could help.
   — MARIE R.

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