??'S ON IF SEND APPEAL LETTER??

Hi all. I am wondering if I should send the insurance an appeal letter or if I should wait. I have been denied and my doctor appealed the decision, but they denied it again.. said I didn't have the dr. supervised diet the way they want it for the 6 month period. I am having so many problems still with walking sitting standing for even short amounts of time! I have been unemployed since Sept. 2003 because I can no longer tolerate standing to do my job (cooking), so then I went to a place I used to work because it is a sit down job...well, I couldn't tolerate even sitting and was in agony. I didn't even last 1-1/2 weeks there! I have not told my doctor that I haven't worked since last year because I am embarrassed to admit I can no longer work due to the pain...! What should I do? If I wrote the insurance company and told them that I can't work because the pain is too much to bear, do you think it might sway them to approve my surgery? I have to get back to work! I can't afford not to work and don't bring in enough money as it is, but yet, if I do find a job I am scared that I won't be able to handle it again and have to quit. HELP PLEASE!!

Jennifer, It sounds like you are now disabled or partially disabled due to your weight. That's no laughing matter, it's a significant issue. You definately have to tell your doctor. Does he know the pain you are in? Something like that could possibly be the basis to get your appeal overturned - at the very least you should be talking to your doctor about remedies to get you back to work. You have to start somewhere. -Anne

Morbid obesity that interfers with working, etc. is covered under the Social Security Disability Act. If you recieved disability payments, that would verify your very real need for the surgery to your doctor and the insurance company. Also, it would bring in some money to you. Check it out! Good luck to you.

You should definetly let your doctor know about your pain. If you cannot work because of it you might qualify for disabilty benefits from the government or somewhere. The bottom line is though, you need your pain documented as it might be the key in getting your surgery. I have not worked since Sept 2003 myself due to pain and swelling in my feet so bad i could not tolerate the work. Believe me I have run my butt back and forth to the doctor to get everything documented. I am just now beginning to jump through the hoops but with the help of my PCP and my orthopedic doctors i know i have a chance . Don't be embarrassed going to your doctor and telling him about your work situation. I kow it is a hard thng to do, been there , done it. RIght now, with the help of my ortho doctor i am getting ready to go back to work within the next month. While i do not feel 100% better, they realize this and it will be documented also. I now have a AFO for my right leg and an orthotic for my left foot. I need a knee replacement and feel like hell most days. But i have been working with these doctors and they do not put me down. All 3 have bent over backwards to help me and know the surgery is my only option for a full life. So hang in there..and please make another appt with your doctor and tell him about your work situation. It is only going to help you in the long run..........STAY STRONG.

Jennifer, If your doctor has already filed an appeal which has been denied, I would not mess around with doing it on your own. You have the legal right to 3 (and only 3) appeals, so you don't want to take any chances. If I were you, I would contact the Obesity Law Advocacy Center at www.obesitylaw.com - it will cost you a few hundred bucks but they know more than anyone about this topic in my experience. Good luck, Dr. C The Deaconess Surgical Weight Loss Center Cincinnati, Ohio