How do I respond or even should I?

TiffanyNicolle
on 8/6/08 2:52 am - Colorado Springs, CO
VSG on 02/28/13
So I e-mail my Appeal and all the other information forms and this is the response I got this morning from the Benefits Manager.

"I appreciate the information. We will not lift our exclusion of bariatric surgery and the like in the foreseeable future. We do monitor medical developments to see if our benefit plans do include the latest, proven wide range of medical procedures. "

How do I respond to this? Or even should I? I am so angry right now!!! I sent my e-mail at 9 pm last night and he sent his to me at 10 am. I doubt he even read it. I feel completely helpless.
Larissa P.
on 8/6/08 3:08 am - Denton, TX
I'd gather all the medical studies that have been published, then the NIH guidelines, and send it to him with a tin of cookies. Ass.

If you want help, PM me. I'm not a professional or anything, but I like a good fight and this one has me miffed.

Come to think of it, you should contact the local press to see if anyone will do a story on your fight. Nothing like bad publicity and public shame to get a company to change it's mind...
Duodenal Switch hybrid due to complications.
 
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TiffanyNicolle
on 8/6/08 3:35 am, edited 8/7/08 5:01 am - Colorado Springs, CO
VSG on 02/28/13
Oh I'm so glad you reponded, I was hoping you would! I would definitely appreciate any help you can offer me.

There is something here in Colorado called "Call for action" and it does consumer stories and such. I'd love to do this but am worried how it will affect my husbands job. I know they're not supposed to "take it out on him" but they will and because he's the one bringing home the bacon I'm holding back.

So should I repond?


TiffanyNicolle
on 8/7/08 5:11 am, edited 8/7/08 5:12 am - Colorado Springs, CO
VSG on 02/28/13
My response to that a-hole is below  

“Are you suggesting that Bariatric Surgery is not a proven medical procedure? Even Medicare and Medicaid acknowledge that it is and offer it to those who met the criteria.

Is there a board of directors or such that may consider making an exception on a case by case basis for an individual?

Sincerely,”
TiffanyNicolle
on 8/7/08 5:04 am, edited 8/7/08 5:07 am - Colorado Springs, CO
VSG on 02/28/13
AllisonWonderland
on 8/8/08 6:23 am
Your denial is not based on medical necessity,  Either you are enrolled in a product where there is no benefit for bariatric surgery OR your employer group has decided to exclude it.

Medical necessity has nothing to do with it.  You have no benefit for it to begin with. 
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