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,

One other thing about Walter. The site for his organization

(www.obesitylaw.com/maximize) had an excellent article regarding your

letter to the insurance company.(Maximizing Your Chages of Getting an

Insurance Approval the First Time) I used bits and pieces of it in

my appeal letter. I suspect the article would be helpful for any

letter regarding a weight loss surgery - MGB, RNY whatever. The part

I found most helpful is that a California law set a precedent that

insurance companies are bound to disclose to you what criteria they

use. In other words, what are they basing their denial on? The law

states they must provide the criteria, the authors of the criteria,

and the last time the criteria was reviewed and updated. I tucked it

in with my appeal letter. Today, when I called to check on the

status of the appeal (I was kind of hoping to have news today as I am

leaving for Durham on Sunday and Dancing on Thursday) the insurance

representative (no doubt, a skinny person)told me the letter had not

been received - would I please send another copy. Suprise, suprise.

That's the same thing they said with Dr. R's request letter. Right

now I'm looking at like a game. I may go but I certainly will not go

quietly. On advice from in Missouri, I have kept a file of

every telephone call, every letter, everything related to the

request. If I have to jump through all the hoops, I will be armed

with documentation. In the meantime, I took out a loan.

is still fighting and you saw from her earlier post today that she

has lost almost 100 pounds since January. By the time the appeal is

settled, I could be nearly 100 pounds lighter. Just thought someone

may be able to benefit from the information in the article.

While I breathe, I hope.

Tarri in Missouri

Dancing 09-28

> Someone posted about not being sure why Walter is on the

list.....he is on

> the list because Dr R invited him here some time ago. The MGB is

still

> fairly new (only about 3 years out) so that is why it is

experimental.

> Before someone gets crazy, I'm NOT saying its wrong ...just

experimental.

> " Wrong " is not for me to say, but I can say it's wrong FOR

ME!!There are

> some insurance companies that WILL NOT cover because of this

reason, but

> they are more than happy to cover the RNY which is what I have

decided to

> have. I too am on the lighter side (yea right). I have talked to

several

> people who started out the same as me 5'3 " 240. Everyone I have

talked too

> is slow losing if they started out at 275 or below. If I wanted to

lose 30

> pounds in 60 months. I could probably take prescription diet pills

and get

> the same effect. I spoke to my insurance co this morning. They said

" No " to

> the MGB but " Yes " to the Lap RNY. I have researched RNY for 5 years

and feel

> comfortable with it. The only reason I had researched the MGB was

the

> shorter op time and hospital stay. I have decided I'd rather stay

in the

> hospital 3 days instead of 1 and I choose 2 hours in OR instead of

30

> minutes to be sure to get the " effective " tool that I need to

succeed with

> this.

>

> , Ms

> 5'3 " 240 Lbs

> BMI 41.6

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Someone posted about not being sure why Walter is on the list.....he is on

the list because Dr R invited him here some time ago. The MGB is still

fairly new (only about 3 years out) so that is why it is experimental.

Before someone gets crazy, I'm NOT saying its wrong ...just experimental.

" Wrong " is not for me to say, but I can say it's wrong FOR ME!!There are

some insurance companies that WILL NOT cover because of this reason, but

they are more than happy to cover the RNY which is what I have decided to

have. I too am on the lighter side (yea right). I have talked to several

people who started out the same as me 5'3 " 240. Everyone I have talked too

is slow losing if they started out at 275 or below. If I wanted to lose 30

pounds in 60 months. I could probably take prescription diet pills and get

the same effect. I spoke to my insurance co this morning. They said " No " to

the MGB but " Yes " to the Lap RNY. I have researched RNY for 5 years and feel

comfortable with it. The only reason I had researched the MGB was the

shorter op time and hospital stay. I have decided I'd rather stay in the

hospital 3 days instead of 1 and I choose 2 hours in OR instead of 30

minutes to be sure to get the " effective " tool that I need to succeed with

this.

, Ms

5'3 " 240 Lbs

BMI 41.6

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Everyone I have talked too is slow losing if they started out at 275

or below.

>

> , Ms

> 5'3 " 240 Lbs

> BMI 41.6

Hi ,

My MGB was on 7/17/00 and my starting weight was 254 (under 275).

I've lost 40 lbs in a little over two months and that is with no

exercise ( I plan on starting soon, but my life has been really

hectic lately)and eating anything I want. I agree that it is your

decision as to what surgery you have and if you feel that the MGB is

not the surgery for you, I respect that decision. I just wanted you

to know that there are people out here under 275 who are not losing

weight slowly.

Suzanne in NC

MGB 7/17/00

254/214

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