I WON!!! And I didn't even have to chew out their livers!

[Guest guest]

Yep, it's official.

After my second-level medical appeal on Tuesday, someone from the

review committee called to let me know that, instead of my insurance

company paying for the D/S under my out-of-network coverage option,

THEY WILL PAY FOR MY SURGERY AS THOUGH IT WERE IN-NETWORK BECAUSE NO

D/S SURGEONS OPERATE WITHIN MY AREA! WOO HOO! This means that I

don't have to pay my deductible OR my $1000.00 maximum-out-of-pocket

copayment!

They also agreed to pay for my EGD (the procedure that I was stupid

enough to say was a preoperative <read: screening> procedure) but I

had to do some FAST backtracking with that one! All kinds of crap

about how my mild, chronic gastritis was probably owing to a patulous

lower esophageal sphincter and pylorus, and on, and on. Lastly, they

will pay for all of my follow-up visits with Dr. Gagner as long as

they follow a set time schedule, eg. 3 months, 6 months, 12 months,

etc. Man, that EGD would have cost me another $1500.00 at least,

and, well, we KNOW what Gagner charges!

So, then. My 3 arguments for needing the D/S instead of the RNY

worked! (1. Already have stomach problems; RNY's ulcer-producing

tendency would exacerbate them. 2. Taking my large and frequent

doses of non-steroidal anti-inflammatories to control pain is

contraindicated with the RNY. 3. Anxiety/panic disorder would be

exacerbated with RNY because " dumping " produces similar symptoms.)

I have found that trying to argue academically about how the D/S is a

better surgery than the RNY DOES NOT WORK. First of all, I'm barely

equipped to do it, but more importantly, it IS an academic argument.

I've gotten much farther with everyone involved by arguing about my

specific and individual case. I hope that some of you can help me

come up with more RNY contraindications. We could compile a list of

persuasive items and keep it in the " files " section of this list and

the D/S insurance list.

Cheers,