Denied Twice by HIP for DS. Anyone know about filing an external appeal through NY state?

So I was denied for my appeal to get the Duodenal Switch.  I know I could get a pretty fast approval for the RNY but my heart is really set on the DS as I feel it is the best surgery for me.  Does anyone know how long this appeal through the state normally takes and what my chances are at getting approved?   I typed out a piece of the letter, but obviously am not going to type the whole thing.... but basically the important part....

I need some advice or your opinion...  Would you go ahead with the appeal or am I just wasting my time?  Should i just go ahead and get the gastric bypass... I seriously am losing patience in this uphill battle that feels like I'm just waiting and waiting and waiting.... HELP!!!

the following is in the letter they sent:

It states that "hip health plan of new york will acknowledge your appeal within 15 calendar days of receiving your appeal.  Hip health plan will let you kjow our decision in writing within 30 calendar days of reciving your pre-service appeal and 60 calendar days of your post service appeal.  Hip health plan will notify you within 2 days after we decide your standard appeal, but no later than the decision timeframes described above.  If HIP health plan does not decide your appeal in this timeframe, the service will be deemed approved. 

If you file a standard internal appeal, your timeframe to file may expire.  You will lose your right to an external appeal sithin 45 days of receiving this letter.

If hip health plan of new york has issued a final adverse determination on your appeal, you may have the right to file an external appeal.  To file an external appeal, you must complete and send the attachrd external appeal application ot the New York Ste Insurance Dept within 45 days of receiving HIP health plan of new york's final adverse determination.  There is a $50. external appeal filing fee. 

I appealed to New York State after GHI turned me down to have my lapband removed and a revision to RNY.  They said it was not medically necessary while I had 24 hour a day reflux and couldn't keep down any solid food!  The State overturned the decision.  Make sure that you include copies of every piece of paperwork you have from all of you doctors including every medical problems you may have that make this surgery medically necessary. There is no doubt in my mind that this appeal was worth it.
Good luck to you!
Marcia

I'd recommend seeking legal advisement from an experienced bariatric lawyer..here are 2 to consider...Appeals are tricky and once you appeal you maynot have another chance so making the best of it is imperative IMHO!

They can best review the appeal and policy to uide you on choices and options. I agree going for tool you want is best but if for some reason there is no way to get that it can help you decide if another procedure will be ok for you. Self pay is always an option many folks do not think of this....Many go to Spain to have Dr. Balastar do it with great feedback........
http://www.bodybybaltasar.com/
http://www.drbaltasar.com/

http://www.obesitylaw.com/articles_01.php

Obesity Law & Advocacy Center Established by Walter Lindstrom
http://www.obesitylaw.com/
Mail Address: Obesity Law & Advocacy Center, 1392 East Palomar Street, Suite 403-233, Chula Vista, CA 91913
Telephone: 619.656.5251 FAX: 619.656.5254
email: Walter Lindstrom [email protected]
email: Kelley Lindstrom [email protected]
~~~~~~~~~~~~~~~~~~~~~~
Stacy Posner WLS/attorney
www.wlsadvocates.com
350 Broadway Suite 405
New York, N.Y. 10013
Fax (212) 343-0712
Email: [email protected]
1-866-733-4WLS

Did you post this on the DS board too? A lot of people really have to fight to get the DS so I bet there are people there that could offer you some helpful advice. Maybe not for NY specifically but in general.

Good luck!