insurance denials

[Guest guest]

Greetings to one and all,

It seems like there have been a lot of insurance denials this week and I just

wanted to chime in and say, " DON'T GIVE UP! I was turned down 2 times until

I finally won my appeal and now my surgery is next week! It took a lot of

hard work and effort on my part and I know it will be worth it. The first

time I just submitted my normal request for pre-approval. When i got turned

down I was shocked. I am 320 pounds, with asthma, diabetes and high blood

pressure and worse I can no longer walk without assistance of a cane or

walker because I have ruptered discs in my back from my weight! I was

devestated and cried for days. Then once I got the denial in writing, I Read

it very carefully and drafted my response. I beieve their excuse was that

this procedure was not the " norm " meaning that they preferred I at least

asked for an open RNY. and also that I hadn't proven a 5 year diet history,

and they wanted a psyc eval because it was their policy that I have 6 months

therapy prior to requesting surgery. It felt hopeless. I called a doctor

that I had been using diet pills from years ago and had them draft me a

letter. I wrote a letter of response and had my PCP write another letter

saying he wanted me to have surgery and finally I had a stupid psyc

evaluation. About 3 days later - DENIED - Okay so now I was really mad! I

went on the the MGB site and found the insurance letters in there. I found

the one that shows a chart of comparision between the different surgeries. I

downloaded it and modified it to match my story. Then I drafted another long

letter making sure they understood that without this surgery I would continue

to cost them the BIG BUCKS and I even enclosed a wedding picture! I figured

what the heck- they are human! When my insurance advocate called - I swear

she was crying. I was approved. She was almost as happy as I was. She said

she sent it to an outside agency for the approval and got it. So off I go.

Don't EVER give up!

Debby (Tucson,Az)

MGB 12-20-2000