I got denied but i dont understand
Get all the info together that proves you did participate in an exercise program and have your surgeon re-submit it. The insurance company is hoping you will go away!! Just get what they are asking for. Also if you PCP has it documented get the notes from his visits that talk about.
Don't roll over when they say NO....dig in and fight harder!
You can succeed!!!!
Hugs,
Ginger
Don't roll over when they say NO....dig in and fight harder!
You can succeed!!!!
Hugs,
Ginger
Open RNY 3/27/01 400 lbs - 170lb. Please visit my blog at www.gingerrock.blogspot.com. You can also find me on facebook www.facebook.com/GingerRock and Twitter www.twitter.com/GingerRock
~Ginger~ 
Sounds like what your surgeon submitted maybe wasn't clear enough. Call your surgeon and ask what they suggest. Also call the 800# for your insurance to get clear insructuons of what they consider an acceptable exercise program and how what needs to be documented.
Which insurance and which employer do you have? Maybe someone else on the board has experience with that company and can guide you through the process.
The appeals process is same as the initial submission, but sometimes it can take longer. I appealed a non wls issue with Cigna and it took 30 days. It likely would have gone quicker, but I was recovering from my wls and didn't stay on top of it.
Call and e-mail daily and DOCUMENT EVERYTHING!!!!!! The e-mail will give you a paper trail to use as proof of what the nsurance guys tell you.
Ask the insurance company if they can assign you to a case manager. Having an individual assigned to you helps navigate the system. Also if they get to know you, they tend to be more sympathetic and can advocate for you in a tight situation. My case manager helped get my papers rushed through and I was approved in less than 3 hours! She still calls me every week or so to check on me.
Good luck, and keep us posted on what happens.
Which insurance and which employer do you have? Maybe someone else on the board has experience with that company and can guide you through the process.
The appeals process is same as the initial submission, but sometimes it can take longer. I appealed a non wls issue with Cigna and it took 30 days. It likely would have gone quicker, but I was recovering from my wls and didn't stay on top of it.
Call and e-mail daily and DOCUMENT EVERYTHING!!!!!! The e-mail will give you a paper trail to use as proof of what the nsurance guys tell you.
Ask the insurance company if they can assign you to a case manager. Having an individual assigned to you helps navigate the system. Also if they get to know you, they tend to be more sympathetic and can advocate for you in a tight situation. My case manager helped get my papers rushed through and I was approved in less than 3 hours! She still calls me every week or so to check on me.
Good luck, and keep us posted on what happens.
**** I AM AN OH SUPPORT GROUP LEADER ****
WHY I CHOSE DS: No dumping. Highest percentage of weight loss, Best long term results, Won't regain weight! Eat normal sized meals, 96% diabeties, 90% high blood pressure, 80% sleep apnea cured. I 
MY DS!
My doctor told me to stop having intimate dinners for four unless there were three other people. ~Orson Wells
It is possible that the way the Dr wrote up your notes that it was not worded the way the ins wanted it. That happened to me. My ins said it had to state that diet and exercise was mentioned at every appt. Check with your ins company and ask them specifically what they want from you. Go back to your dr review the notes and go from there. You can do it!!!
Dont give up!! Its probably something simple that can be fixed!
Good luck!!
Ginger
Dont give up!! Its probably something simple that can be fixed!
Good luck!!
Ginger
Starting Weight: 325; Pre Surgery Weight: 314
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