Re: Fw: Re: Crying but fighting

[Guest guest]

Sandy, Ditto to Janice's e-mail! If you wouldn't mind

Ccing them to me too, I'd greatly appreciate it! My

e-mail address is angelquilt1@... Thanks! Angel

--- Finch rfinch@...> wrote:

>

> Re: Re: Crying but

> fighting

>

>

> Hello Sandy,

> I too am having to fight for pre-authorization

> to go out of network for the DS with Dr.

> without the aid of my surgeon of choice. I feel

> so alone out here but I will keep slugging away. I

> made a copy of your letter so that I might grab any

> ideas to use in mine. I hope that was OK. Let me

> know if it is not please and I will honor your

> wishes. You mentioned that you have more reports

> showing why the DS is a more preferable surgery from

> medical standpoints. This is exactly the argument I

> need to hopefully win my case. Can you share these?

> I was told by my Appeal Coordinator (you get one of

> these when you go to the appeals process and I am at

> my second of three) that the panel of persons to

> which I will be talking will not care about my

> quality of life post-op(she was lots less blunt here

> than my words) ONLY why is it Medically Necessary to

> go out of network when the VBG and RNY are available

> in network. They will be looking at WLS as an

> elective even with my comorbidities. And even

> though they agree that I meet all requirements for

> needing WLS then they feel choosing the DS over the

> VBG and RNY is definely elective. I need concrete

> medical information why the DS is preferable and I

> have to work on this paper this weekend. Also, you

> mentioned having many actual emails and webpagelinks

> from RNY revision patients who are being revised to

> DS and their horror stories. This is also exactly

> one of my arguments. Will you share these too

> please?

> Please contact me privately at

> rfinch@... . I wish I had something to

> share with you but you seem to have " been there,

> done that " already. I, at least, will be there for

> others if they need me. I have found that the

> Rutledge's MGB site has Letters of Medical Necessity

> that work as good guides and the site also has other

> types of letters that can be used as well. Maybe

> these could help you. Thank you so much.

>

> Janice in Texas

> Pacificare HMO

>

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