***Urgently Need Help*** Insurance Appeal

[Guest guest]

Hi everyone,

Debbie has asked that someone post this to this board ... here it is.

Subj: [MGB-PostOp] ***Urgently Need Help*** Insurance Appeal

Date: 11/9/00 7:04:06 AM Eastern Standard Time

From:    ddrissel@... (Debbie Drissel)

<Reply-to: <A HREF= " mailto:MGB-PostOp (AT) egroups (DOT) com " ><MGB-PostOp (AT) egroups (DOT) com</A>

To:    MGB-PostOp (AT) egroups (DOT) com

Hi all,

Well, the insurance that approved my MGB without much problem has

denied this procedure for my daughter.  I haven't received the

official letter yet, but here's what I was told.

* She did so well losing weight in 1995-96 using Phen-Fen.

* This was the only physician documented weight loss program.

* We didn't establish a history of her being chronically morbidly

obese.

While it's true, she did do fantastic on Phen-Fen - that treatment

option is no longer available, because it is unsafe.  I'm thankful

that she doesn't have any long term problems from taking it!  She has

done many weight loss programs (WW, Deal-a-meal, Nutrisystem) with me

as well as exercise regimens.  She has tried Metabolite and other

herb supplements.  This year she tried Meridia, but the side effects

were too incapacitating for her (affected her work at university).

I'm angry that the insurance thinks she needs to go through 3-5 years

of yo-yo dieting in order to qualify for this surgery.  I guess they

don't think she's suffered enough.  FYI - she has knee problems,

elevated cholesterol, GERD, etc.- and she's only 22. 

Seems to me that once one is morbidly obese - the NIH, etc. indicate

that the only way to obtain PERMANENT weight loss is surgery.  Yes? 

I know that in the past couple months, there've been posts on studies

that confirm this statement/conclusion.  Anyone know where I can find

these?

While I'll 'self pay' for her to have this, I also plan to appeal the

decision. 

So, specifically, what I'm looking for are example letters, web

addresses for information on obesity, statistics, studies, yo-yo

dieting, mortality, etc.  Certainly, I plan to exhaust the resources

on Dr.R's site, but I like to thorough and complete. 

If you have information for me, please send messages directly to me

(rather than posting).  If it's any help, please call me.  I can be

reached Fri-Sun at home . 

Also - I've not been able to log on here for about 10 days.  Is the

other site opened again?  If not - would those of you who digest

there be able to post this message to that site?  I don't have time

today to figure out how to go about that.  I know many folks are on

that site who have experienced similar problems.

Thanks to all for your support.

Kind regards,

Debbie

MGB 7-27-00

256/216 (3 months)