::Sigh:: I have been denied...

[Guest guest]

I do not post here much, but I read every dern thing, so I know how

some of you feel now. I got 2 letters in the mail yesterday and

the 'D' word was SO very large. I am not sure in what form the

breakdown came in, the Doc's office or PHCS/Guardian but a breakdown

none the less.

I do not get it. There is 1, one flippin criteria for me to meet

according to my health booklet. I meet that plus 3 co-morbid's. The

reason for denial is 'non-certification'. Does anyone know what that

means? Also, it states 'clinical info required: In order to obtain

a better understanding of the case, the following clinical

information is required from the attending physician: What are the

weight, dieting history and symptoms?' This was all stated in a

letter the doctor sent, I got a copy of it and I KNOW PHCS/Guardian

got one too. PHOOEY & BAH! They have no idea, none whatsoever!

[Guest guest]

I do not post here much, but I read every dern thing, so I know how

some of you feel now. I got 2 letters in the mail yesterday and

the 'D' word was SO very large. I am not sure in what form the

breakdown came in, the Doc's office or PHCS/Guardian but a breakdown

none the less.

I do not get it. There is 1, one flippin criteria for me to meet

according to my health booklet. I meet that plus 3 co-morbid's. The

reason for denial is 'non-certification'. Does anyone know what that

means? Also, it states 'clinical info required: In order to obtain

a better understanding of the case, the following clinical

information is required from the attending physician: What are the

weight, dieting history and symptoms?' This was all stated in a

letter the doctor sent, I got a copy of it and I KNOW PHCS/Guardian

got one too. PHOOEY & BAH! They have no idea, none whatsoever!

[Guest guest]

Call your insurance company immediately and find out what they

want. Tape the conversation if you feel comforatble. Write down the

persons name that you talk to. It sounds like they want your diet

history and a letter from the doctor explaining how this will

improve your health. How thorough is your diet history? Be sure

to include every diet that you have been on and the extent of the

diet ex(date started date ended weigh loss, weight regained

medically supervised?)

I supplied all of this info to my surgeon but my Insurance company

never got it. Luckily the finance person at MT Sinai was top

notch and alerted me immediately when the insurance company tried

to pull a fast one. I immediately created a table in MSWORD which

listed my diet history for the last 10 years. I faxed this to him

and he faxed it to the Insurance company and followed through to

make sure that they did not pull a fast one.

Try to get a copy of what the doctor submitted. There may be

something missing and those sneaky little people are looking for a

way out. Find the hole in the loop and close it. When you have

done all of that you can begin looking at legal action.

> I do not post here much, but I read every dern thing, so I know how

> some of you feel now. I got 2 letters in the mail yesterday and

> the 'D' word was SO very large. I am not sure in what form the

> breakdown came in, the Doc's office or PHCS/Guardian but a breakdown

> none the less.

>

> I do not get it. There is 1, one flippin criteria for me to meet

> according to my health booklet. I meet that plus 3 co-morbid's.

The

> reason for denial is 'non-certification'. Does anyone know what

that

> means? Also, it states 'clinical info required: In order to obtain

> a better understanding of the case, the following clinical

> information is required from the attending physician: What are the

> weight, dieting history and symptoms?' This was all stated in a

> letter the doctor sent, I got a copy of it and I KNOW PHCS/Guardian

> got one too. PHOOEY & BAH! They have no idea, none whatsoever!

[Guest guest]

Call your insurance company immediately and find out what they

want. Tape the conversation if you feel comforatble. Write down the

persons name that you talk to. It sounds like they want your diet

history and a letter from the doctor explaining how this will

improve your health. How thorough is your diet history? Be sure

to include every diet that you have been on and the extent of the

diet ex(date started date ended weigh loss, weight regained

medically supervised?)

I supplied all of this info to my surgeon but my Insurance company

never got it. Luckily the finance person at MT Sinai was top

notch and alerted me immediately when the insurance company tried

to pull a fast one. I immediately created a table in MSWORD which

listed my diet history for the last 10 years. I faxed this to him

and he faxed it to the Insurance company and followed through to

make sure that they did not pull a fast one.

Try to get a copy of what the doctor submitted. There may be

something missing and those sneaky little people are looking for a

way out. Find the hole in the loop and close it. When you have

done all of that you can begin looking at legal action.

> I do not post here much, but I read every dern thing, so I know how

> some of you feel now. I got 2 letters in the mail yesterday and

> the 'D' word was SO very large. I am not sure in what form the

> breakdown came in, the Doc's office or PHCS/Guardian but a breakdown

> none the less.

>

> I do not get it. There is 1, one flippin criteria for me to meet

> according to my health booklet. I meet that plus 3 co-morbid's.

The

> reason for denial is 'non-certification'. Does anyone know what

that

> means? Also, it states 'clinical info required: In order to obtain

> a better understanding of the case, the following clinical

> information is required from the attending physician: What are the

> weight, dieting history and symptoms?' This was all stated in a

> letter the doctor sent, I got a copy of it and I KNOW PHCS/Guardian

> got one too. PHOOEY & BAH! They have no idea, none whatsoever!

[Guest guest]

Also, make sure ALL CO-Morbidities are included, medications you've

taken,etc.

Marcia

> Re: ::Sigh:: I have been denied...

>

>

> Call your insurance company immediately and find out what they

> want. Tape the conversation if you feel comforatble. Write down the

> persons name that you talk to. It sounds like they want your diet

> history and a letter from the doctor explaining how this will

> improve your health. How thorough is your diet history? Be sure

> to include every diet that you have been on and the extent of the

> diet ex(date started date ended weigh loss, weight regained

> medically supervised?)

>

> I supplied all of this info to my surgeon but my Insurance company

> never got it. Luckily the finance person at MT Sinai was top

> notch and alerted me immediately when the insurance company tried

> to pull a fast one. I immediately created a table in MSWORD which

> listed my diet history for the last 10 years. I faxed this to him

> and he faxed it to the Insurance company and followed through to

> make sure that they did not pull a fast one.

>

> Try to get a copy of what the doctor submitted. There may be

> something missing and those sneaky little people are looking for a

> way out. Find the hole in the loop and close it. When you have

> done all of that you can begin looking at legal action.

>

>

> > I do not post here much, but I read every dern thing, so I know how

> > some of you feel now. I got 2 letters in the mail yesterday and

> > the 'D' word was SO very large. I am not sure in what form the

> > breakdown came in, the Doc's office or PHCS/Guardian but a breakdown

> > none the less.

> >

> > I do not get it. There is 1, one flippin criteria for me to meet

> > according to my health booklet. I meet that plus 3 co-morbid's.

> The

> > reason for denial is 'non-certification'. Does anyone know what

> that

> > means? Also, it states 'clinical info required: In order to obtain

> > a better understanding of the case, the following clinical

> > information is required from the attending physician: What are the

> > weight, dieting history and symptoms?' This was all stated in a

> > letter the doctor sent, I got a copy of it and I KNOW PHCS/Guardian

> > got one too. PHOOEY & BAH! They have no idea, none whatsoever!

>

>

> ----------------------------------------------------------------------

>

[Guest guest]

Also, make sure ALL CO-Morbidities are included, medications you've

taken,etc.

Marcia

> Re: ::Sigh:: I have been denied...

>

>

> Call your insurance company immediately and find out what they

> want. Tape the conversation if you feel comforatble. Write down the

> persons name that you talk to. It sounds like they want your diet

> history and a letter from the doctor explaining how this will

> improve your health. How thorough is your diet history? Be sure

> to include every diet that you have been on and the extent of the

> diet ex(date started date ended weigh loss, weight regained

> medically supervised?)

>

> I supplied all of this info to my surgeon but my Insurance company

> never got it. Luckily the finance person at MT Sinai was top

> notch and alerted me immediately when the insurance company tried

> to pull a fast one. I immediately created a table in MSWORD which

> listed my diet history for the last 10 years. I faxed this to him

> and he faxed it to the Insurance company and followed through to

> make sure that they did not pull a fast one.

>

> Try to get a copy of what the doctor submitted. There may be

> something missing and those sneaky little people are looking for a

> way out. Find the hole in the loop and close it. When you have

> done all of that you can begin looking at legal action.

>

>

> > I do not post here much, but I read every dern thing, so I know how

> > some of you feel now. I got 2 letters in the mail yesterday and

> > the 'D' word was SO very large. I am not sure in what form the

> > breakdown came in, the Doc's office or PHCS/Guardian but a breakdown

> > none the less.

> >

> > I do not get it. There is 1, one flippin criteria for me to meet

> > according to my health booklet. I meet that plus 3 co-morbid's.

> The

> > reason for denial is 'non-certification'. Does anyone know what

> that

> > means? Also, it states 'clinical info required: In order to obtain

> > a better understanding of the case, the following clinical

> > information is required from the attending physician: What are the

> > weight, dieting history and symptoms?' This was all stated in a

> > letter the doctor sent, I got a copy of it and I KNOW PHCS/Guardian

> > got one too. PHOOEY & BAH! They have no idea, none whatsoever!

>

>

> ----------------------------------------------------------------------

>

[Guest guest]

I have PHS/Guardian and I was approved in 2 days. My BMI was 40 and

I had no co-morbities. There had to be something that was missing

from the LOMN. Call PHS and ask them what they need. Good luck.

Jane J.

230/185

Lap BPD/DS

April 26, 2001

Dr. Ren

NYU Medical Center, NYC

> I do not post here much, but I read every dern thing, so I know how

> some of you feel now. I got 2 letters in the mail yesterday and

> the 'D' word was SO very large. I am not sure in what form the

> breakdown came in, the Doc's office or PHCS/Guardian but a

breakdown

> none the less.

>

> I do not get it. There is 1, one flippin criteria for me to meet

> according to my health booklet. I meet that plus 3 co-morbid's.

The

> reason for denial is 'non-certification'. Does anyone know what

that

> means? Also, it states 'clinical info required: In order to

obtain

> a better understanding of the case, the following clinical

> information is required from the attending physician: What are the

> weight, dieting history and symptoms?' This was all stated in a

> letter the doctor sent, I got a copy of it and I KNOW PHCS/Guardian

> got one too. PHOOEY & BAH! They have no idea, none whatsoever!

[Guest guest]

I have PHS/Guardian and I was approved in 2 days. My BMI was 40 and

I had no co-morbities. There had to be something that was missing

from the LOMN. Call PHS and ask them what they need. Good luck.

Jane J.

230/185

Lap BPD/DS

April 26, 2001

Dr. Ren

NYU Medical Center, NYC

> I do not post here much, but I read every dern thing, so I know how

> some of you feel now. I got 2 letters in the mail yesterday and

> the 'D' word was SO very large. I am not sure in what form the

> breakdown came in, the Doc's office or PHCS/Guardian but a

breakdown

> none the less.

>

> I do not get it. There is 1, one flippin criteria for me to meet

> according to my health booklet. I meet that plus 3 co-morbid's.

The

> reason for denial is 'non-certification'. Does anyone know what

that

> means? Also, it states 'clinical info required: In order to

obtain

> a better understanding of the case, the following clinical

> information is required from the attending physician: What are the

> weight, dieting history and symptoms?' This was all stated in a

> letter the doctor sent, I got a copy of it and I KNOW PHCS/Guardian

> got one too. PHOOEY & BAH! They have no idea, none whatsoever!