The dreaded denial is official (LONG)

[Guest guest]

Well, I got the call this afternoon. My insurance is denying my

switch with Dr Pomp because he is out-of-network and they think it

*can* be done " in-plan " . I explained to the case manager yesterday

that there are no in-plan doctors doing the BPD/DS and she wanted Dr

Pomp to write a letter to that effect. Darryl said

essentially that Dr Pomp was not going to do that (which I do

understand, I mean how is he supposed to know that no one in-plan

does the switch?).

I did ask her if they were so certain it could be done in-plan to

give me the name of a surgeon who does the BPD/DS. Strangely they

are not able to " recommend " physicians. So I was told that to pursue

this further I would have to appeal. She suggested I have my PCP

write a letter stating the lack of in-plan DS docs. This will prove

interesting as my PCP has been a rather reluctant player in my

journey. Hopefully, I can get an appointment with him soon and try

again to win him over.

Has anyone been able to succesfully get out-of-network coverage for

the DS because no in-network docs do the DS? What did you send to

your insurance to " prove " your case? It seems to me anything less

than a sworn statement from every single in-plan surgeon stating they

don't perform the DS still leaves the insurance co wiggle room to

reject.

I am fortunate that I can switch insurances at the end of the year to

one that Dr Pomp participates in. But I really don't want to wait

that long. As it is, I am afraid I am gaining too much weight

pre-op.

Has anyone had any luck trying to switch insurances outside of annual

enrollment without a formal qualifying change? Or what can I say is

a qualifying change that will help my case? My spouses employment

status is changing. He is going from full-time student to working

full-time without benefits. Can I justify needing to change health

plans for this reason? Any other creative ideas?

So, I'm down, but not out. At least my insurance didn't deny me due

to the exclusion in my policy or due to DS being experimental. I

think those would be tougher to fight. Sorry about the length of my

post. Just needing to vent a little. I can't say I'm surprised but

I did allow myself to believe a miracle might actually be possible.

And it still hurts.

Thank you for listening.

Terri Hassiak

BMI 60

http://www.obesityhelp.com/morbidobesity/profile.phtml?N=H980366398

May 9th date cancelled due to insurance denial

email(no spaces): bunsofluff @ hotmail.com