x-post: *******s denied me!

Hi Sean, I have no problem telling you.  My insurance company is Oxford by way of United Healthcare.  I am seeking a revision to DS from RNY.  If you don't mind me asking or if you want to PM me, what did you do to get your approval?

I am going to talk with my surgeon to see where we begin. 

I have no problem telling... the post is probably still buried deep around here from back when it happened in Oct/Nov of 2006.

but like I said above, my original denial was then saying the DS was experimental and/or investigational... that it hasn't been "proven" through trials and/or peer reviewed literature to be at least as effective as the other currently available "accepted" procedures like the Band or RNY.

my appeal was basically my collecting all the information I could find showing that the DS WAS an acceptable and as effective as (if not more than) the other popular procedures... I printed out all sorts of medical journal articles, policies of other major insurance companies showing that THEY accept it as a valid procedure, and the recent (at that time) change in medicare's policy allowing the DS.... all in all, my appeal packed consisted of 206 pages.

Like I said above though... that was disproving their claim of the DS being e&i.  YOUR company agrees it's as valid of a procedure as RNY or Banding... but your denial is on medical necessity, not e&i.  You couldn't get approved for RNY either because you're not at 40+, or 35+ with a qualifying co-morb

I went back and re-read my policy and it does state that I have to be in either class of obesity to get approved.  Class I 40, there is no way around it.  I bet I have put on a few pounds so to speak before I got the letter.  I will contact my surgeon and talk to him about it.

Frankie, also get your height rechecked. Some of us shrink a bit as we get older, and if you are shorter than you think, that will raise your bmi.

Larra