Hi all,

I am so upset. I just found out today that I was denied the surgery. They said it was not medically necessary. I have a BMI of 39. If I'm not fat enough, that is truly pathetic. My surgeon's office is appealing the denial. Is that usually the course of action. I was thinking about writing a letter in addition to the surgeon's appeal. What does the surgeon's office do as far as appeals go? I need help. Please let me know what you all think I should do. I was scheduled for July 11th and now who knows when I'll get it done.

Emily

Mert, I'm delighted you found some ammunition you can use. Learning that they have approved other patients should give the insurer pause. I thought the appeal letter was excellent, too.

NancyRN

Em,

I came across this appeals guide, which may prove helpful. Here's the link:

http://www.lapband.com/lapband/documents/6.10%20HM0459%20Appeals%20Guide.pdf

Thanks Randi for that resource. In it they mentioned the LAP-BAND Advocacy Center...hmmm another lead. BTW, your awaiting approval smilies are right on.

mert

When I googled it up I got that LAP-BAND Advocacy Center is part of obesitylaw.com in California. ok. mm

Yep, I'm waiting for insurance approval, but it's likely that I'll have to appeal. The insurance company I'm with readily approves RNY, but not the lapband. We'll see . . .

Thanks Randi for that resource. In it they mentioned the LAP-BAND Advocacy Center...hmmm another lead. BTW, your awaiting approval smilies are right on.

mert

Thank you all so much for the great advice. I am so happy that I found this forum. All of you are full of great ideas and advice.

Randi, That appeals guide is just wonderful. I can't thank you enough. I'm so happy to see that I followed the first step appropriately. This is truly a wonderful guide.

For all of us who have been denied and who are in the process of appeals, let's pray that we will get our appeal overturned.

Keep in touch. Good luck and I will keep you informed. I should find something out by this week.

Happy 4th all.

Em

Hi all,

I called my insurance company today to inquire if any decision has been made regarding my appeal. The woman on the phone had said that they sent my paperwork to a Bariatric surgeon to get outside advice. Do you think this is a good thing? I'm not sure. They said I should call on Friday morning or Monday.

Emily

Emily,

This sounds like a favorable development to me. For one thing, your insurance co. is now seriously considering your application, not just rejecting it outright. And the recommendation will come from a real bariatric surgeon, not just an insurance co. rep. Keeping my fingers crossed for you.

NancyRN

Thanks NancyRN. I was hoping that this was the case. I thank you for getting back to me so soon. I'm praying big time.

Emily

Em, let us know what they say. You are lifted up in prayer.

Mert,

Thank you so much for the prayers. Whatever is going to happen with this, I know God's got it.

Em

Mert,

Gary never returned my phone calls or e-mail that I sent him. However, Walter Lindstrom is willing to take my case. I gave him all my info. He feels that I have a very good chance of getting this decision overturned. I am not hiring his services as of yet. Like I said before, I am waiting for my first appeals to be answered. If my insurance company denies me again, I will use Walter Lindstrom's services.

He has three payments that you can choose from. $450 which includes a look at all your information and an appeal letter sent to the insurance company.

$850 for a letter of appeal, telephone services to client and insurance company, as well as follow up to the end.

$1100 if you need an appeal done within 3 days.

If my appeal doesn't go through, I am hiring him as my advocate for $850. He has a very good reputation. He's with ObesityLaw.com.

I know I told you about Gary, but after 4 phone calls and an e-mail, I don't want to use him. I was very impressed with this lawyer. He was very thorough and gave me all the infomation I need to start the ball rolling. We'll see.

Hope this is helpful.

Em

I'm so sorry to hear that...that is so aweful.

I'm fearing the same here.

I hate insurance companies.

You have to be on your death bed sometimes before they approve anything, and if your lucky

did you have alot of information documented about your health issues?

I have a hugh 1 foot file I think on me at brigham and womens.

Maybe I should have worn weights now just to make it to the 40 mark :scared:

I had one year of documented weight loss from an MD diet doctor (medifast). I also had five years of documented weight from my PCP. I also had open heart surgery. I suffer with irregular heart beats. Sounds bad but my heart surgery was and ASD repair (hole in my heart). I have very high cholesterol. I had cervical spine surgery 3 years ago and a bad lower back. I have chronic hip bursitis and I'm receiving cortisone injections to reduce the inflamation. The hip problem has limited my walking and sleeping. In addition I have a huge family history of heart disease and diabetes.

This was all documented to my insurance company. The denial letter stated that my co-morbitities were not life threatening. Imagine! That's why I'm so passionate about fighting the insurance company. I didn't realize that morbid obesity wasn't a life threatening disease. HA

As far as wearing weights, did you get your last reply on the other thread. One man had said whoever cheats the insurance company doesn't have INTEGRITY. LOL I laughed and had to respond to such an ignorant remark.

Anyway, I think I had the appropriate documentation for my insurance company. My PCP also called the Medical Director of my insurance company today. We'll see what happens on Monday.

Regards,

Emily