Peer-to-Peer Review = Denied Again

Imissthe80s
on 8/25/11 11:02 am - Louisville, KY
DS on 02/27/12
This is a bunch of crud.  Makes me want to spit. 
That clover is for you, Shelli. (:


Valerieb09
on 8/25/11 11:35 am - Seacoast, NH
My revision from the lapband to the RNY was originally denied by my insurance company, Harvard Pilgrim Healthcare HMO.  My surgeon appealed the decision on the grounds of medical necessity.  I had developed bad acid reflux in addition to regaining the 35 lbs. I had originally lost in the beginning.
I guess this doesn't really help you in any way but I wanted to encourage you to keep fighting this decision. My revision was approved a week after receiving the denial letter. His Admin. Asst. told me he sent them a letter with additional information. 
I didn't have to do anything on my end.  It's too bad you couldn't get your doctor to write the letter on your behalf....I think that would carry more weight in your appeal.
Good Luck!

Valerie

 

 

 



Revision June 9, 2008
Lapband to RNY
117 lbs. lost as of 09-08-10
Dr. David B. Lautz~~~~~Simply the Best!
Brigham & Women's Hospital

Boston, Massachusetts

 

 

 

gak
on 8/25/11 11:37 am
Revision on 06/21/13
Hang in there, keep fighting ! It will be worth it and I know you know that as well

Ginger<><  
 Revision #2 Dr John Rabkin June 21, 2013; First Revision DS - Dr Maguire
  5-18-09; First DS 7-15-2003 Dr Clark Warden = Third time is the charm   


 



 

Sexyvt123
on 8/25/11 12:16 pm
Hi Shelli

I am so sorry for your denial but this is not the end. Actually its just the begiinning.  You know all the hell I went through and my peer to peer was also denied.  Make sure your appeal letter is GREAT.  Did any of the vets help you write it or did you do it on your own.  You have to kill them with kindess but be as stern as possible.  Dont worry you will get approved.  Im sure of it.  cheer up.

Lori F.
on 8/25/11 4:04 pm - Chula Vista, CA
Ohhhh noooooo. You get 24 hours to mope and then off we go fighting again. We'll all help you. With my appeal, we might even be getting switched around the same time too...because I KNOW we're going to get this to work.
Band to DS
on 8/26/11 8:45 am, edited 2/3/12 10:56 pm
Unfortunately, I had to delete this post due to privacy concerns.

Got a lap band in 2008. Tried hard, but didn't lose much weight & developed swallowing problems. Fought my insurance company for almost a year & finally had a band to DS revision on 5/11/12. Have now lost 125 pounds. Yay!

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