Newbie question

[Guest guest]

I have just been a member for a very short while , reading and

lurking. I feel I need this surgery but have an exclusion in my

policy . Has anyone ever gotten past this ? Is states for obesity and

I am morbidly obese. I am 5 ft. tall and weight 228 lbs. Just curious

if this is something I could get my ins. to see that I need this. I

have alot of physical problems that could be elevaited with this .

Thanks

[Guest guest]

First, visit all your doctors to solocit a Letter of Medical

Necessity. Select your surgeon and give them copies of these

letters to add to their letter and request for coverage. Your

surgeon's office coordinator is a great asset, doing most of the

work for you. Begin compiling a list of previous diet attempts,

most insurance companies want to see you have exhausted other

routes. Many insurance companies routinely deny first requests, so

go in prepared with both barrels loaded. The more documentation

for 'medical necessity' the better. I even had a letter from my

Ears, Nose, Throat doc for gastric reflux. Dont think you have

sleep apnea? Get your PCP to order a sleep study; you just may have

it and not know it. Heel spurs? Get a podiatrist or your PCP to

document it. Urinary Stress Incontinence? Get your OB/GYN or PCP

to document it. Bad back, knees? Get your ortho to document it.

Varicose veins? Diabetes? High Blood Pressure? Elevated cholestral,

Triglycerides? Infertility? Gallstones? Arthritis? You see where

Im going. If denied, dont stop there. APPEAL. Denied again?

Write your state's insurance commissioner.

Get to work. You are worth it.

Good Luck

~~Pat~~

Orlando, FL

252/203/160

BMI 37/

52 Years Young

LAP-RNY 12/10/03

Wayne English, MD

Ft Lauderdale, FL

> I have just been a member for a very short while , reading and

> lurking. I feel I need this surgery but have an exclusion in my

> policy . Has anyone ever gotten past this ? Is states for obesity

and

> I am morbidly obese. I am 5 ft. tall and weight 228 lbs. Just

curious

> if this is something I could get my ins. to see that I need this.

I

> have alot of physical problems that could be elevaited with

this .

> Thanks

[Guest guest]

Thanks for the info and I can get my other drs. to get me those

letters. and the insurance just paid for shots in my knees that cost

$1700.00 a visit for 3 visits so I guess they have some info of how

much I might be costing them in the future because if this doesn't

work ...I'll need new knees lol but it's not really funny.

[Guest guest]

Pat,

Thank you so much. I would never have thought to get my podiatrist to do a

letter about my hell spurs. I will do that. I feel I am going to be in a fight

as well and am ready for it. I have to have this surgery and I am not going to

take no for an answer.

Re: Newbie question

First, visit all your doctors to solocit a Letter of Medical

Necessity. Select your surgeon and give them copies of these

letters to add to their letter and request for coverage. Your

surgeon's office coordinator is a great asset, doing most of the

work for you. Begin compiling a list of previous diet attempts,

most insurance companies want to see you have exhausted other

routes. Many insurance companies routinely deny first requests, so

go in prepared with both barrels loaded. The more documentation

for 'medical necessity' the better. I even had a letter from my

Ears, Nose, Throat doc for gastric reflux. Dont think you have

sleep apnea? Get your PCP to order a sleep study; you just may have

it and not know it. Heel spurs? Get a podiatrist or your PCP to

document it. Urinary Stress Incontinence? Get your OB/GYN or PCP

to document it. Bad back, knees? Get your ortho to document it.

Varicose veins? Diabetes? High Blood Pressure? Elevated cholestral,

Triglycerides? Infertility? Gallstones? Arthritis? You see where

Im going. If denied, dont stop there. APPEAL. Denied again?

Write your state's insurance commissioner.

Get to work. You are worth it.

Good Luck

~~Pat~~

Orlando, FL

252/203/160

BMI 37/

52 Years Young

LAP-RNY 12/10/03

Wayne English, MD

Ft Lauderdale, FL

> I have just been a member for a very short while , reading and

> lurking. I feel I need this surgery but have an exclusion in my

> policy . Has anyone ever gotten past this ? Is states for obesity

and

> I am morbidly obese. I am 5 ft. tall and weight 228 lbs. Just

curious

> if this is something I could get my ins. to see that I need this.

I

> have alot of physical problems that could be elevaited with

this .

> Thanks