Re: [duodenal switch] Once and For All, Please Explain Something to me

[Guest guest]

Dee,

Which surgeon are you planning on using? My letter to PacifiCare referred to my

BPD/DS as global Bariatric surgery. Dr Deveney with Dr Welkers assistance wrote

up the letter for medical necessity. Dr Welker is very good at this. He knows

just what to say.

I realize each plan is different. Have you called United Health Network? They

are the ones that make the decisions for PacifiCare. They are also the ones that

told me I was covered for this procedure.

Take a deep breath Dee. Things will work out. Please do not panic just yet.

I am praying for you,

Hugs,

[duodenal switch] Once and For All, Please Explain Something to me

Over 3 weeks ago, Pacificare sent me a letter saying:

Intestinal Bypass Surgery is not a covered benefit " .

Then it went on to say I could appeal it, etc.

When their letter was sent to me, my PCP hadn't yet

submitted his Letter of Medical Necessity. Pacificare

was responding to my phone call where I asked for

proof the DS wasn't covered.

So does that count as a first denial letter? I'm

wondering because if so, I gotta get moving to send in

my appeal.

Also, does the RNY have an " intestinal bypass "

component? I just don't understand. If so, I was

going to use that on my appeal letter.

By the way, I called my PCP and he STILL hasn't sent

in the Revised Letter of Medical Necessity! Three

weeks!!!!!!!!!! I gave him the sample letter - all he

has to do is have it copied on his letterhead, sign it

and send it in. Jeez! I told the nurse that I was

running out of time and offered to pick up a blank

letterhead stationary, run home and paste the sample

letter with my fill ins (which I also gave to him!),

print it and run it right back for his signature. She

said he wouldn't allow it. But she's putting the file

on his chair with a note that I have to pick it up

tomorrow.

, remember when I first posted, saying my doc

was going to sign the letter and I would then have my

surgery? You were so right to slow me down and make

me realize it's not that easy!!!

Thanks,

=====

Dee

Waiting for Ins. Co. Approval

313/Want to be 165

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