Re: Re: Official Denial - Please help

December 5, 2001

Hi Anita, thank you for posting. I don't know about

writing on the Rabkin email list because I feel I'm

persona non grata there. But there are people from

his list on the Jossart list so maybe I'll luck out.

Thanks,

dee

--- rowanceleste wrote:

> Dee,

>

> You should ask on Dr Rabkin's list because there

> were definitely a few people that got referred to Dr

> Ostroff, but after appealing managed to have surgery

> with Dr Rabkin. They should be able to give you

> more information. I know this is a blow for you, but

> hang in there and keep fighting for the DS! Many

> people have gotten the surgery through appeals..one

> of the main things to prove is that they don't have

> a " Marin IPA provider " that does the same thing,

> because the RNY is not the same as the DS!

>

> *hugs*

> Anita

> Dr Keshishian 11/08/01

>

> > Well, I've been trying to get the surgery since

> July

> > and today I finally received my first official,

> > written, denial. Here's the wording:

> >

> > Denial Reason: The services requested are from a

> > non-Marin IPA provider. This request was reviewed

> by

> > our Medical Director and determined to be

> available

> > through a Marin IPA provider. We have received a

> > request for gastroplasty from Dr Jossart at CPMC.

> > MIPA did not authorize a referral to this

> provider.

> > You are redirected back to UCSF, Dr Ostroff for

> > evaluation.

> >

> > I guess I've been expecting a denial but still had

> > hope. I just want to cry but I feel so empty.

> Ack.

> > Now I understand why some have written that they

> will

> > settle for the RNY because they have given up. I

> > won't have the RNY but I'm just so tired of it

> all.

> >

> > I'd appreciate any help about how to overturn the

> > denial. THanks.

> >

> > dee

> >

> > __________________________________________________

> >

December 5, 2001

Thank you, . Please post with the results of

your appeal and GOOD LUCK! I'm rooting for ya.

Dee

--- mkfrilot wrote:

> Don't worry yet, Dee. This is only the first

> denial. I'm going

> through the same thing now, except that I went ahead

> and had the

> surgery under my " out-of-network " option. My stupid

> insurance

> company has said the same thing: there are many

> in-network providers

> who perform this procedure. They don't quite get

> that it's not the

> same surgery!! I'm going to participate in person

> next week in my

> second-level appeal. I am armed with letters from

> my surgeon, my

> shrink, and my PCP. They WILL " get it " when I'm

> done with them.

> I'll let you know how it turns out and try to advise

> you accordingly.

> Keep the faith, my dear! It ain't over 'til it's

> over (or until the

> fat lady sings!) You can just get rid of that

> despairing attitude

> and get ready to give 'em hell. Don't get sad; get

> MAD!

> Love,

>