RE: NEED HELP WITH APPEAL

HELLO EVERYONE: JUST GOT A CALL FROM MY DR FOR THE WLS AND THE INSURANCE APPEALED MY REQUEST DUE TO THE FACT THAT THE PCP DID NOT DOCUMENT PROPERLY THE 6MO DIET PROGRAM OR WHEN I CAME IN TO WEIGH. SHE JUST WROTE DOWN THE DATE AND THE WEIGHT, NOTHING ABOUT US TALKING ABOUT THE DIET OR WHAT I SHOULD DO. SO WHAT SHOULD I DO ABOUT THIS APPEAL SO I CAN GET APPROVED FOR THIS SURGREY THIS MONTH. ANY SUGGESTION ON HOW TO HANDLE THIS QUICKLY. THANKS FOR ALL YOUR IN PUT MARY

I would go back to your PCP and have him/her draw up a letter stating that you were on a Dr supervised diet program and that although he/she failed to document in detail that it was his/her understanding that this is what you were trying to accomplish. GoodLuck! Hugs, Tonya

TONYA: I CALLED THE PA, SHE IS THE ONE I SAW WHEN I WENT IN TO WEIGH. I TOLD HER FROM THE BEGINNING IT NEEDS TO BE DOCUMENTED. WHAT SHE SENT IN WAS A WEIGHT, DATE AND NOTHING IN DETAIL OF ME TRYING THE 1800 CALORIE DIET. SHE TOLD ME SHE WOULD NOT PUT SOMETHING DOWN THAT WAS NOT HAPPENING, SHE WILL NOT WRITE THE APPEAL STATING THERE WAS A MISS COMMUNICATION TO WHAT NEEDED TO BE DONE. I WENT TO A TRAINER FOR THE FIRST 6 MOS OF THE YR WITH SOME SUCCESSAND HE WROTE THE LETTER. THANKS FOR THE RESPONSE AND HOPE TO SEE YOU SAT TO GIVE YOU THAT HUG FOR YOU NEED. MARY

I'm sorry to hear about your appeal, what insurance company are you going through? I will pray for your approval and wls for next month. God Bless, Tiffany.

Hi Mary, I have the same insurance and I was denied for a similiar reason except my PCP's partner neglected to document just one month. I have gone on the three month plan with tons of documentation from the nutritionist, my exercise person (s) and another letter from the PCP's office. It is in appeal now and I talked with them yesterday...it may take another 6-8 weeks to hear. I have been down and frustrated but know that this will go the way it should. My coordinator said that my packet was one of the best they had ever sent in, and my insurance has a high 1st time denial rate, so between doing what they said to the letter and all the documentation it may be overkill but it seems that is what is needed. Good Luck, barbara

Mary, I have seen advertised here on this site, "obesitylawyers.com" (put the www in front of) I don't know what they do, or the cost, but perhaps they can be of some advise or assistance. -Tami