Guest guest Posted August 1, 2000 Report Share Posted August 1, 2000 Hey, Kris! My insurance just denied my 1st try for Dr.R. I am writing my appeal letter as we speak! I want to get it out by Fri. In your opinion what were the most important points in your appeal letter? I am using lots of info from Dr.R's web-page and my PCP gave me some pointers for the letter, too! He said they are most concerned with cost, so I will compare Dr. r's costs with the local surgeon who does open RNY's. They approved me 100% for him...although it will be less than half the cost to them..crazy, eh? Any advice you can throw me way would be GREATLY appreciated! Thanks, Tami Stauffer ~Oologah, Ok. Re: Hi from in MD Hi , Just wanted to add my two cents and another vote of support for you. I, too, had a BMI of 38 preop with comorbidity (diabetes, dyslipidemia, etc.) along with a severe family history of cardiovascular disease, diabetes, and premature death (pretty much all of it obesity related). Anyway, I expected to be initially denied by CIGNA and . . . of course, I was. However, though I took out a loan for surgery so as not to put my life on hold, I was determined to fight CIGNA for what I truly believed was my right to have this surgery and their duty to pay. Anyway, I won on my first appeal (a very detailed, factual, well-researched appeal if I do say so myself!). So, as the others have told you, even if you proceed with self-pay, don't just let your insurance company off the hook. It's exactly what they want. They put a lot of barriers in our path to make us stumble in the hopes that we'll give up and walk away. Don't let them get away with that. Even in the worst of circumstances (if you were to lose at all appeals), in the end, you will have benefitted the WLS/MGB cause by being a thorn in the insurance industry's behind -- letting them know that we are here and we aren't going away without a fight. Best of luck to you. If I can help in any way, let me know. Continue to take advantage of the knowledge and support on this list and I have no doubt that you'll prevail in the end. Kris MGB 6/7/00 -41# from preop -73# overall > Hi Everybody, > > I have been interested in the MGB since last May and have recently begun > reading the posts on this list. I am a 26 year-old female from land, > 5'4 " , 225 pounds (BMI 38) with several comorbids. When I first discovered > the procedure on-line and wrote to Dr. R, he sent a short reply saying I > " might " be a candidate, but he doubted my insurance would cover the > procedure. I tend to agree that at present, they won't consider me quite > heavy enough although I have been heavier in the past and no doubt, will be > again. > Thanks for listening. > > in MD > ______________________________________________________________________ __ > Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com ------------------------------------------------------------------------------ ------------------------------------------------------------------------------ This message is from the Mini-Gastric Bypass Mailing List at Onelist.com Please visit our web site at http://clos.net Get the Patient Manual at http://clos.net/get_patient_manual.htm To Unsubscribe Send and Email to: MiniGastricBypass-unsubscribe (AT) egroups (DOT) com Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.