Bummed & Angry about denial

Hi All, I am so bummed that I was denied my revision.  I am getting all my ducks in a row and have a call into Gary Viscio for my appeal.  I was hoping that I wouldn't have to do this, but kind of suspected it since my BMI is not 40.  I am like 38.1 so I am 9 lbs underweight.   I was told they don't have criteria for revisions.  How do we know what to do from here?  I am not giving up so easily.   I called the Gi Dr. and he told me he won't write a letter for my appeal.  He's the one that sent me to the surgeon in the first place, now I am mad.  He said to talk to my PCP and the Surgeon.  Who does he think I am working with!!!! If any of you can come up with ideas, let me know.

Wear REALLY heavy clothing, shoes and jewelry the next time they weigh you. LOL (Thought you could do with a laugh!)

Can you please post your insurance carrier and plan type? Criteria if you have it too. Thanks.

I have UHC-State of Arizona Employees insurance EPO  I don't have criteria and when Dr. Schlesinger's office asked for them, they were told they didn't have criteria for revisions.

I'm glad you're not giving up Deanne.  You sound like a good 'fighter'!  With these insurance agencies.......we need to know who, what, where and how to handle these denials!   You've done it before...you can do it again!!  You're one tough cookie.

Hey Gwynn, Most of that information comes with the denial letter that they have to send out.  It gives you where to do your appeal, what criteria they used, etc.  So you have to have that first.  I am just putting together the general information first. Deanne

Sorry to hear that Deanne. My insurance denied my claim this week as well, despite having sufficient BMI with a ton of co-morbidities.  Don't know where to go from here.... Richard

Hi Richard, You can do a couple of things.   1.  Hire Gary Viscio (he is the best) he got my first surgery approved, if you can afford it, he does work with people at different cost levels according to what you need him to do.  2. File your own appeal for the first one and if denied hire Gary.  The insurance companies want you to give up.  Don't let them win by just taking their first denial.  Alot of companies automatically deny it the first time.  3.  Gather if you can as many letters of medical necessity if possible.  Obviously, I know now that some will help you and some won't.  4.  Get your PCP to write an appeal letter to go with yours.  (I have to type it up and then have him review and he will sign then and put on letterhead.  It's been 4 years since I did my first appeal.  Luckily I have copies of what I did before or it would be a whole lot harder.. 

It is surprising to me how many PCP's are against the idea of bariatric procedures.  I had to convince my current PCP that this was my best option to become healthy, this after one regiment and another to try and reign in my diabetes and lipid problems.  He did sign my letter of medical necessity, after I ghost wrote the contents. My former PCP was absolutely dead set against the idea of bypass and insisted that all that I needed was to get on a proper diet plan.  Not too surprising that all of these doctors have never had to fight obesity themselves, so it's so very easy to treat you as if you are just a weak minded individual that just needs to take responsibility. It's ironic to me that the insurance company would rather pay an enormous amount of money each month for medicine to treat my symptoms rather than pay for a surgery that will most likely cure me from most of the problems that I have.

Richard, You are so correct.  So many Dr. are not supportive.  Maybe you need to find one who is. Deanne