Guest guest Posted September 19, 2001 Report Share Posted September 19, 2001 Hi , I had to pay out-of-pocket for the initial consultation with my surgeon (Dr Pomp) who was out-of-network - $200 consult fee, no " program fee " at all. Dr Pomp's office handled all the paperwork and submitted for insurance approval for the DS. My insurance denied it stating that " gastric bypass surgery is available in-network " . Of course, not all gastric bypass surgeries are created equally - the only in-plan surgery available was the RNY which was not an option for me. I had to appeal and the point that had to be made was to distinguish between the BPD/DS and the RNY; to show what was different about the DS and why it was better for me -- and that no one in their network performed the BPD/DS. Of course it looks better if these letters come from doctors, so I got my PCP to send a letter as well as an in- network surgeon who does RNYs. I uploaded copies of these letters to the files section of the Yahoo duodenalswitch group (folder called " insurance appeals " ). Hope this helps in your case. Insurance appeals can be won. Another great resource is Walter Lindstrom; an attorney who specializes in helping people get WLS. Let me know if I can be of further help. I wish you all the best. Terri Hassiak BMI 61.8 http://www.obesityhelp.com/morbidobesity/profile.phtml?N=H980366398 Appealed " Out-of-Network " Ins. Denial - AND WON!!! Laparoscopic BPD/DS with Dr. Pomp on 6/25/01 - Down 65lbs in 10 wks! email(no spaces): bunsofluff @ hotmail.com > Hi everyone. I'm kinda the quiet one here, I stick my head in and > out, and read up. > > I do have some questions tho! I was wondering, I recently read > somewhere that to have Dr. Rabkin, you would have to pay $12,000 up > front BEFORE the surgery???? Is that true? Someone also told me that > he won't even see you if you haven't paid the $12,000. > > Next question... I'm trying to get SOMEWHERE! My medical group has > denied me ANY consultations for ANY other surgeries other than RNY. > So, they're saying they will NOT go outside of the medical group. > What I'm wondering is has anyone else had this problem? > > My insurance company told me to write an appeals letter, and send it > in. I'm wondering if anyone has had to do this, and if anyone could > offer any advice on it. > > I had to go no e-mail on here, because I don't get online enough to > stay on top of them, I would have 30-40 when I checked it! WOW! So, > if you could e-mail me directly, I'd greatly appreciate it!!! > > Thanks~ > > blondensweet@y... Quote Link to comment Share on other sites More sharing options...
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