This is going to be long, so I apologize. I'm just frustrated. I'm almost 2 years post VSG and have developed a significant case of GERD. It's so severe, and not controlled by medication, that my surgeon feels we can't just let it go. He has recommended that I undergo a procedure called stretta, which seems promising. We submitted for approval to my insurance company which promptly rejected the request (took them all of 3 business days) on the grounds that the procedure is experimental and there are well accepted alternatives, including pharmaceutical therapy and Nissen Fundoplication. Well, I'm not controlled by medication and the only combination that provides any relief Protonix/Dexilant was already rejected by the Company (they won't pay for the Dexilant and at almost $400 a month, the cost is almost prohibitive). Also, given that I no longer have a fundus, a fundoplication isn't available to me (nice going insurance co . . . way to review my medical records). My final option is conversion to bypass, which I really don't want to do. Other than my GERD, I LOVE my sleeve. It's allowed me to lose 130lbs and live an active lifestyle I've only dreamed about. I like having my pyloric valve and not having to worry about dumping, reactive hypoglycemia, etc. Also, the thought of another major surgery is not thrilling me. Anyway, my surgeon gave me the cost for both Stretta ($5,000) and conversion ($100,000). We decided to seek approval for conversion just to have it in our back pocket while we appeal the denial to my state Department of Insurance. Wouldn't you know it, they approved the $100,000 surgery. This is a prime example of what's wrong with the insurance industry. Why would you approve a $100,000 solution to a $5,000 problem???? Just frustrated beyond belief and knew this was a good place to get out my aggression . . . here and in my kickboxing class where I visualize the Ins. co's medical director's face as my target!

So if you have a DOI product, I'm guessing you have P P O coverage. As I understand it, no matter the product, in CA you definitely have the right to IMR.

Yes, I have PPO. You have the right to request an IMR. The DOI has the right to evaluate whether the claim qualifies for an IMR. If so, they have 30 days from the date they receive a response from the insurance co to rule

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