Fw: Re: Crying but fighting

[Guest guest]

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