Re: Game Plan - Need Opinions Please

[Guest guest]

Dee,

Don't compromise! Basically if you say you'll pay Dr J's fees, you're basically

telling them, 'Yes, you're right, this is just a preference issue', not that Dr

J performs a better surgery than offered by Dr . If anything, you may want

to comment on their referral and let them know you do not want to goto an

inexperienced surgery such as Dr who also performs a less effective type

of surgery than the one you requested be approved!

Anita

> Sorry for the cross posting... My hands are killing me

> today.

>

> Pacific(we don't give a sh@t)Care denied me the

> surgery saying I have to see Dr Orloff (who will

> recommend me to Dr who does only RNY) since Dr

> J is out of network.

>

> I was thinking of calling Pacific(we don't)Care and

> asking for a compromise. If they'll pay for the

> surgery with Dr J at Cal Pacific Med Center (instead

> of with Dr at UCSF) then I'll pay Dr J's

> surgeon fees. My reasoning is that Dr J is a much

> more experienced surgeon compared to Dr .

>

> Does anyone have any suggestions?

>

> Thanks so much!

> dee

>

>

> __________________________________________________

>

[Guest guest]

Hi, Dee.

I agree wholeheartedly with Anita. This is how I'm going to attack

my insurance company next week during the second-level medical appeal:

Letter One: from my surgeon claiming that, aside from the fact that

my BMI (46) justifies a more potent surgical procedure and studies

that show weight loss is more durable with the BPD/DS, I have two

specific medical conditions that indicate BPD/DS is the best choice

for me. 1. I have mild, chronic gastritis which would likely be

exacerbated by the probably-ulcer-producing RNY. 2. I take large

quantities of non-steroidal anti-inflammatory drugs to control pain,

which is contraindicated with the RNY. What kind of pain is your

decision. I used my ruptured disc and plantar fasciitis as excuses.

Letter Two: from my PCP--reinforces points one and two, but she's

not qualified to discuss which surgery is actually BETTER.

Letter Three: from my psychiatrist who claims that the RNY would

exacerbate my panic/anxiety disorder because the RNY dumping syndrome

mimics panic/anxiety attack symptoms.

These are the only specific medical indications that I could find

that would contraindicate the RNY. These jerks have not been swayed

in the least by academic arguments and studies which show that the

BPD/DS is the better surgery, although it can't hurt to throw in (as

an aside) all the scary (and expensive!!) statistics about RNYers

having to be roto-rootered, etc.

Just let 'em try to & #@$ with me! If they do, they get a frightening

letter from my lawyers. I can't wait to sink my teeth into these

people!

Best,

> > Sorry for the cross posting... My hands are killing me

> > today.

> >

> > Pacific(we don't give a sh@t)Care denied me the

> > surgery saying I have to see Dr Orloff (who will

> > recommend me to Dr who does only RNY) since Dr

> > J is out of network.

> >

> > I was thinking of calling Pacific(we don't)Care and

> > asking for a compromise. If they'll pay for the

> > surgery with Dr J at Cal Pacific Med Center (instead

> > of with Dr at UCSF) then I'll pay Dr J's

> > surgeon fees. My reasoning is that Dr J is a much

> > more experienced surgeon compared to Dr .

> >

> > Does anyone have any suggestions?

> >

> > Thanks so much!

> > dee

> >

> >

> > __________________________________________________

> >