Peer-to-Peer Review = Denied Again
My revision from the lapband to the RNY was originally denied by my insurance company, Harvard Pilgrim Healthcare HMO. My surgeon appealed the decision on the grounds of medical necessity. I had developed bad acid reflux in addition to regaining the 35 lbs. I had originally lost in the beginning.
I guess this doesn't really help you in any way but I wanted to encourage you to keep fighting this decision. My revision was approved a week after receiving the denial letter. His Admin. Asst. told me he sent them a letter with additional information.
I didn't have to do anything on my end. It's too bad you couldn't get your doctor to write the letter on your behalf....I think that would carry more weight in your appeal.
Good Luck!
Valerie
I guess this doesn't really help you in any way but I wanted to encourage you to keep fighting this decision. My revision was approved a week after receiving the denial letter. His Admin. Asst. told me he sent them a letter with additional information.
I didn't have to do anything on my end. It's too bad you couldn't get your doctor to write the letter on your behalf....I think that would carry more weight in your appeal.
Good Luck!
Valerie
Revision June 9, 2008
Lapband to RNY
117 lbs. lost as of 09-08-10
Dr. David B. Lautz~~~~~Simply the Best!
Brigham & Women's Hospital
Boston, Massachusetts
Hi Shelli
I am so sorry for your denial but this is not the end. Actually its just the begiinning. You know all the hell I went through and my peer to peer was also denied. Make sure your appeal letter is GREAT. Did any of the vets help you write it or did you do it on your own. You have to kill them with kindess but be as stern as possible. Dont worry you will get approved. Im sure of it. cheer up.
I am so sorry for your denial but this is not the end. Actually its just the begiinning. You know all the hell I went through and my peer to peer was also denied. Make sure your appeal letter is GREAT. Did any of the vets help you write it or did you do it on your own. You have to kill them with kindess but be as stern as possible. Dont worry you will get approved. Im sure of it. cheer up.
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