DENIED- for being Non-Compliant.

So I was denied for being Non-Compliant with my previous bariatric procedure. They said I did not follow diet and exercise. Anyone get denied for this and what did they submit to get approved?

That is my worst fear. I only have a sleeve and Im over a year out and can eat anything.  I do protein first and all that, I am just so scared they won't believe I am trying.  I hope it works out for you and that you win your appeal.

I am not in  your situation but I would have to ask how can they prove you were non-compliant? Sounds like insurance bull to me. I would print out journal articles that show regain is common with RNY surgery. DSfacts.org has some decent articles. You can also go to PubMed and do a search.  Also, can you get your PCP to write a letter stating you were compliant and the surgery just wasn't right for you? I doubt your RNY surgeon would be willing to do it but since you see your PCP more often I would think a letter coming from him/her would be taken seriously. It may take an appeal or two but it will be worth it.

Yes i think I will do that.  Just waiting for the su gical coordinator to call me back.  She said Dr Roslin will have a peer to peer.

Gina, I was denied first too, my insurance told me that my BMI had to be >40 without co-morbs to qualify for surgery.  By the time I followed up with Doc. Roslin my BMI was over >40 but he had scheduled a peer to peer with Oxford and next thing I was approved.  Don't worry you will get your approval.

Frankie

Frankie, how are you feeling?  How is every thing going?  How long did it take you to recover?  I need to call Mary today.  She was supposed to call me on Friday but I have not heard from her.

I am feeling much better, eating has gotten a lot better as well.  I was in the hospital for 3 days and I went home not needing any pain meds.  I was constantly thirsty and getting in all my protein shakes.  Foods were a lot harder for me to get in.  I went back to work on 10/31 and my first week back wasn't bad at all and I bring in all my foods, protein shakes etc so that way I won't have to worry about what to eat.  At 1 month post op I am eating better and I am down 34lbs.  Sometimes Mary doesn't call back, I would call and ask for Iris.  She gets back to you and she works with Mary.  Or if you can I would make an appointment to go see Mary.

Good luck you will get your approval soon.

Wow 34 pounds.  That is great.  Im glad to hear you are feeling good.  Did it take you 4 weeks to feel better to go back to work.  Im asking because I work for tax preparers and I go back to work The third week in December.  So im hoping to get approved and feeling well before than,  If not I will have to wait until tax season is over in April.  Also, thanks for the tip on Mary.

My only issue was fatigue, plus I am anemic.  So taking the vits and getting rest really helped.  Plus a week before I was scheduled to go back to work I started going to bed early and getting up like I was going to work and stayed out all day (to kind of prep myself).  That helped me along with getting those vitamins in.  It depends on how you feel too.  when you had RNY, how long did you stay out?

Read the following post by a great surgeon:

http://www.obesityhelp.com/forums/ds/4416755/Must-Read-Trans cript-of-Dr-Roslins-Presentation-to-ASMBS-on/


Best wishes,