Xpost - YEP... Anthem BC PPO Denied my VSG today...

due to "investigational"...and I am not mad about it either.   I knew it was coming thanks to my OH family.  I will appeal first thing in the morning.   Fellow Marchers... I won't be on your journey in March however - I WILL see you in the winner's circle soon!

All the best for your continued success...

To Be Me Again

Since its been denied you can file a complaint to CA Depat of Managed Health Care and I have seen them overturn the denials on GS abd DS time and time again

Thank you so much for this info.  Certainly worth researching right now.

Happy day to you...

-To Be Me Agai

 Do you have a HMO or PPO? You can contact the CA DMHC  http://www.dmhc.ca.gov/  if you have a HMO, and your insurance is based out of CA,  but if you have a PPO I think you need to contact the Dept. of Insurance (not really sure about this because I've never had a PPO). The DMHC does overturn most, if not all, denials if you meet NIH criteria for WLS.  I know they overturn them for RNY and DS.  I just won an IMR through the DMHC for the DS, but I had to exhaust all my internal appeals through my insurance company first. Have you thought about getting the DS? The DMHC is very pro DS and WLS in general.  I think that the DS offers the best excess weight loss and maintence of that loss because of malabsorption. The DS has been performed since 1988 and has multiple studies and peer reviews showing it's effectiveness.

That being said: I found these three IMR decisions that might help you in your appeal to your insurance company and in your future IMR (if it gets that far and you qualify for IMR). Best of luck to you in whatever you decide. It's your body and only YOU know what's best for you. CaliMom

http://wp.dmhc.ca.gov/imr/detail.asp?id=5882&optFormat=html&cboDetermination=Overturned+Decision+of+Health+Plan&cmdSearch=Search&cboMC=Morbid+Obesity&cboTreatment2=0&cboDiagnosis2=0&cboDT=0&cboType=Experimental/Investigational&txtDetails=

http://wp.dmhc.ca.gov/imr/detail.asp?id=3834&optFormat=html&cboDetermination=Overturned+Decision+of+Health+Plan&cmdSearch=Search&cboMC=Morbid+Obesity&cboTreatment2=0&cboDiagnosis2=0&cboDT=0&cboType=Experimental/Investigational&txtDetails=

http://wp.dmhc.ca.gov/imr/detail.asp?id=4802&optFormat=html& cboDetermination=Overturned+Decision+of+Health+Plan&cmdSearc h=Search&cboMC=Morbid+Obesity&cboTreatment2=0&cboDiagnosis2= 0&cboDT=0&cboType=Experimental/Investigational&txtDetails=



Edited: to say oops I just noticed you said you have a PPO. You should still contact the DMHC and ask them what you need to do if you have a PPO. I'm sure those IMR decisions will still be beneficial to you since the DMHC is a state agency and they are overturning denials of the VSG.