insurance problems
Who is your surgeon, Mary? His/her office should be very well versed in fighting hard to get this surgery covered. Your PCP should write a strong letter of medical necessity as well. Can you share a bit more about yourself so that we can give appropriate advice? Who is your surgeon, how involved is your PCP in this whole process of WLS, how much weight do you have to lose, what are your co-morbidities, etc. Let's start there and we'll see if we can help at all. M.
Okay, Mary, I got your email. It sounds as if you are a prime candidate for WLS and you have the one of the best surgeons in Dr. Aranow. You will need to APPEAL. First: call Lois at Dr. A's office and ask her what their experience is with your particular insurance company. Have they successfully appealed the decision with other patients? Ask Lois what they will do to assist you with the appeal. Second: there should be contact information on the determination letter you received from your insurance company - the name and phone number of the insurance rep. that you can talk to. Call that person and find out WHY they denied coverage. Find out specifically why they denied. Then inform the rep. that you need to appeal immediately and find out exactly what you need to do. Third: call your PCP and ask for a letter of support of medical necessity; ask that he/she fax it to your insurance company right away. Be prepared to provide all contact information to your PCP - name of rep., address, phone, and fax numbers. The appeal process can be daunting and will definitely take time. You will just have to jump in there, be pro-active and demand what is rightfully yours -- coverage for a procedure that will most likely irradicate all your co-morbidities and medical complications resulting from obesity. You deserve this. Fight for it. Hope this helps, M.
Most Active
Recent Topics
