Anyone appealed CMR?

Has anyone had to file an appeal with CMR ? My husband is with the IBEW and was I denied due to being given the wrong info. I was told I needed to be on a 3 month dr sup diet within the past 6 mos,come to find out it was a 6 mo. diet I needed to be on. My dr  sent info for the 3 month diet info and I was told I needed to appeal with the board of trustees  from the union and I only have one appeal. If this doesn't go through I'm unsure of what to do next. Has anyone dealt with anything similar? Help

take a look at the written policy

I also have CMR (through Carpenter's Health & Welfare).  CMR won't tell you anything - and are very vague with even your Dr.   If your written policy is anything like mine.....it doesn't say anything specific at all. I was initially denied for Lap Band - reason given was "no documentation of medically supervised diet".  I called CMR to ask EXACTLY what I needed to do for the diet.  They would not discuss it with me.   My PCP called and was told that I need to keep a diet log, showing consumption of food, caloric intake and exercise and to keep my "regularly scheduled" appts with my PCP.  I have seen my PCP every 3 months for about  1 1/2 years. CMR told my PCP I did not have to come in for monthly weigh ins. Luckily, I'm meticulous at record keeping and last April set up on Excel a diet log similar to WW format.  I had 8 months of that (April thru November).   My PCP sent another letter, in stating my weights and notes she had taken on what diet/exercise I was following at the time of visit.    I sent all that (2 - 3" of papers in diet logs and PCP's letter) in to CMR and was approved.  My BMI is like 36 and I have  High Cholesterol and GERD.   I was approved.   I did not appeal, I just sent in what they said I was missing.  Don't know if IBEW is similar to Carpenter's plan, but CMR is a 3rd party administrator (actually GHP). Don't know if any of this will help, but I thought I'd respond anyway. Good luck. Ann 

Thanks for your responding . My appeal is pending so its pretty much in there hands now.When is your surgery date? I'am going thru New Start and hoping Dr Richardson will do my surgery once i get approved. Let me know how you are doing and how the Dr and hospital was. Good luck! thanks for the input Darlene P.S. I have a BMI  of 41 and have degerative disc disease high colesterol Gerd and incontinece so the documented diet is frustrating especially when they gave me the wrong info.I was told 3 month diet within the past 6 months and had that info.Anyway they are not easy to deal with so wish me luck on the appeal.

I'll keep you in my prayers. I don't have a surgery date yet.  When I started the process, I was interested in the band.  I recently started learning about the VSG (vertical sleeve gasectromy) and it sounds like a better option for me.  New Start is just now approved to do the VSG, so they had to send a new letter of medical necessity to insurance asking for that procedure.  I'm waiting to see if my plan covers it or not - if not, I'll proceed with the band.  I liked Dr. Richardson too.  Good luck to you.  Ann