/Appealing out-of-network insurance denial

[Guest guest]

Hi ,

I am probably one of the most recent people on this list who have

fought the out-of-network denial successfully. Just got my Appeal

granted last week and found out this week that I got a date for the

DS on June 25th!! I am VERY PSYCHED!

You can read my story on my AMOS PROFILE PAGE from the link in the

signature line below. It's a bit long, but I've been using it kind

of as my weightloss surgery journal, so you should get lots of

details if you like that sort of thing.

Also I put sample copies of letters that I think helped me win the

appeal in the files section of the Yahoo Groups duodenalswitch

Egroup. They are slanted towards making a PCP and insurance co see

that not all gastric bypasses are created equally; the differences

from the RNY (most common form of GB) and why the DS is better for my

situation.

If I can be of any assistance to you, or if you have trouble

accessing any of the references I mentioned, please feel free to

email me. Good luck!

Terri Hassiak

BMI 60

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

Appealed " Out-of-Network " Ins. Denial - AND WON!!!

BPD/DS with Dr Pomp on 6/25/01

email(no spaces): bunsofluff @ hotmail.com

> Hi all,

>

> I just found out that I was denied from my insurance, I already put

in a

> request to have them investigate, but I am to go ahead and put

together a

> letter to send back in with my denial letter as soon as it gets

here. The

> reasons for denial are the type of procedure and it being out of

network,

> well I live in Western Pa. and there are no docs. that perform it

here, so

> it will have to be out of network, and now they are telling me to

go ahead

> and have something else done here. Well I don't want something

else, I want

> this done.

>

> I was trying to get an ok to go to Dr. Elariny, so now I am open to

any

> suggestions on what to do or what to put in my letter back to the

insurance

> company. I will have to make them understand why I want this

surgery vs.

> the RNY or VBG! I am ready to start typing, just not sure what

will win

> them over... LOL

>

> TIA

> in Pa.