Re: I've been denied again!

[Guest guest]

Oh Babs, Im sick to hear about this!

Is there some way you can get on disability and qualify for medicare which

pays for the surgery?

Hugs, Judie

[Guest guest]

Babs,

What do your exclusions say? Why do they say you're denied? Do they allow

for any " outside review " to be done? My insurance had unbelievable criteria

to meet but the outside review bypassed all the criteria and approved the

gastric bypass...we are still working on the DS approval. I wrote a

multi-page letter detailing my struggle since birth with my weight. I

listed EVERYTHING that I had ever joined, taken, subscribed to (books, mags,

clubs, etc.) videos or such bought or anything else I could think of that

was an effort to control my weight. I went back to report cards that had

weight and height listings and got a growth chart from my local health unit

and was able to prove that even as a child I was bigger than 90 out of 100

children. I got records from EVERY doctor that I could...GYN included. I

made color copies of pictures of me that I could date showing my gains and

losses over the last 25 to 28 years. I detailed the health problems that my

mom suffers from. I wrote about my sister who is diabetic but not morbidly

obese and all the troubles that she has. I listed that problems that I

presently have. I did not go into a " poor me " attitude. My letter was very

" black and white " about my health and weight history. I searched until I

found a wonderful PCP who agrees with my decision to seek WLS and he

included a great letter.

It took me about 2 months to get this all together. It was about an inch or

an inch and a half thick package. It was mailed certified by Dr. Booth's

office with his LOMN. Now, I may be fixing to have to fight the DS vs RNY

battle....but hey, I can drown them in paperwork!!

Good Luck to you! If I can be of any help, just let me know!

Jerry, Southern gal from Louisiana...1/2 approved!!

>

>Reply-To: duodenalswitch

>To: duodenalswitch

>Subject: I've been denied again!

>Date: Sat, 15 Dec 2001 00:59:19 -0000

>

>Hi everyone,

>This is my second battle with a second insurance. I can't believe

>this is happening all over again. I haven't gotten my official letter

>but I called today and got the news. My pain is increasing from my

>back and degenerative joints that I feel like I can't handle it

>anymore. The thoughts of another fight makes me exhausted. I'm

>another year older, more overweight than I've ever been and going

>through some rough times personally with family health and deaths.

>Who do these medical review people think they are. I can barely walk

>or stand and some jerk sits behind a desk and decides my life isn't

>worth making it better. I feel like I've been handed a jail sentence.

>First Optimum Choice and now Blue Cross Blue Shield. What about my

>pain? Doesn't that matter to anyone? My primary care doctor told me

>that no drug could help my pain unless I want to go around with IV

>morphine.

>Sorry to be such a bummer. I take that back, I'm not apologizing for

>my feelings. Not that you asked me to. I just need to vent but its

>not helping.

>Babs in Baltimore

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