Guest guest Posted September 22, 2000 Report Share Posted September 22, 2000 , 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 22, 2000 Report Share Posted September 22, 2000 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 25, 2000 Report Share Posted September 25, 2000 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 25, 2000 Report Share Posted September 25, 2000 wtg suzanne hugs marg Quote Link to comment Share on other sites More sharing options...
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