Guest guest Posted June 27, 2001 Report Share Posted June 27, 2001 My first consultation was on 6-21 and yesterday I got a call from DR E's office and said that the Roux EN Y was approved but the DS was denied. I am getting ready to appeal this decision, does anyone have any suggestions? Or has anyone else been through this? I have Trigon Blue Cross Insurance... Thanks!!! Amy Yowell BMI 43 Dr E... Insurance Appeal Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 27, 2001 Report Share Posted June 27, 2001 Amy, check out the files on this site, there are some sample letters in there. a great place to start. did you ask your insurance company to approve the RNY and the DS? Cindy > My first consultation was on 6-21 and yesterday I got a call from DR > E's office and said that the Roux EN Y was approved but the DS was > denied. I am getting ready to appeal this decision, does anyone have > any suggestions? Or has anyone else been through this? I have > Trigon Blue Cross Insurance... > > Thanks!!! > > Amy Yowell > BMI 43 > Dr E... > Insurance Appeal Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 27, 2001 Report Share Posted June 27, 2001 Amy; Your line of attack should be informed by their exact reason for denying the surgery. As Cindy mentioned, there are some great examples of Appeal letters under the files section of this group. Also, and I'm assuming the reason is that they consider the DS investigational, I uploaded a list of recent studies that have all been published in journals and periodicals. If you get copies of these (you'll likely have to pay), you can include educated reason as to why this surgery is NOT still in its investigational stages. There's one thing I would recommend that you do first. Make a formal inquiry to your insurance company as to 'what they are basing the decision on'. In other words, make them substantiate their claim that the DS is investigational.This is VERY important because what you're going to end up doing is getting them to commit to the facts they are basing their assumption on. For instance, one insurance company gave the insured member a list of the studies they used and there were three studies on the DS. All the rest of the studies had to do with the R-n-y. The dates of the DS papers were from 1989, 1990 and 1991. So, you see they were using data that was all a decade or more old. If you get them to prove what they are basing their decision on first, it will be simple to present them with a plethora of current studies and data. I hope this helps and let me know how it goes. gobo DS Sched. 7/9/01 Dr. BMI 55 > My first consultation was on 6-21 and yesterday I got a call from DR > E's office and said that the Roux EN Y was approved but the DS was > denied. I am getting ready to appeal this decision, does anyone have > any suggestions? Or has anyone else been through this? I have > Trigon Blue Cross Insurance... > > Thanks!!! > > Amy Yowell > BMI 43 > Dr E... > Insurance Appeal Quote Link to comment Share on other sites More sharing options...
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