There is hope...another denial reversed! (Thanks, Gary Viscio) :-)

Hello! I 've been lurking around the OH Alabama message board for almost a year now. I am very much overweight, but I didn't meet the weight requirements of a 40 BMI for my insurance company. They did not want to consider my comorbidities of diabetes, sleep apnea, high blood pressure, high cholesterol, and good ole "Arthur...in the knees." After a lot of prayer...a good lesson in patience...and a long battle with my insurance company...hiring an attorney, by the way who was very responsive and extremely supportive (Gary Viscio, obesitylawyers.com), my case was sent out for an independent medical review. They reversed their decision and said they considered it medically necessary. Yeahhhhhhhhhh!!! My surgery date is September 16 in Anniston, AL with Dr. Freeman. For those of you who are still fighting the battle...hang in there. Our health and well being is too important to give up! Bama Gal

How exciting!!!! I am also using Gary Viscio and just waiting to hear. I love this kind of post because it gives me hope for the same results. Thanks for that! Cindy

Cindy, As I'm sure you already know, Gary Viscio has a genuine interest in helping others achieve their health and weight loss goals. He knows from first-hand experience--he, too, has benefited from gastric bypass surgery. While the waiting is the hardest part, Cindy, please keep the faith...and never give up! I wish you all the best with your denial. Bama Gal

Bama Gal, How long was the wait from sending your info to Gary to recieving an approval. The waiting seems to be the hardest part thus far. Thanks again, Cindy

Cindy, Gary filed with my insurance company in early June and I received a reversal on their decision based upon medical necessity in late August. I know how difficult it is to wait it out, but hang in there...you are worth it! Pammy

You can't go by someone else's appeal as everyone's is different. Some people get lucky and their appeal gets approved much faster then others and I think it also depends on the insurance company you have. Some people never get approved. My appeal went out around June 1st and my Insurance Company has yet to respond. It's been over 90 days. Don't think just because you have a lawyer backing you that the insurance company is going to get scared and approve you right away. Donna

Hi Donna, You are right...everyone's appeal is different, as is everyone's contractual agreement with his or her respective insurance company. It is not even necessary to hire an attorney to file an appeal for you, and my attorney, Gary Viscio, had the integrity to advise me that this was something that I could do on my own. I don't really think hiring an attorney to "scare" your insurance would even be effective, but, in my opinion, hiring an attorney to represent your legal rights under an insurance contract in which you pay premiums is quite another story. I think that most insurance companies expect that the majority of folks to walk away after a denial. That is always an option, but not for me! The insurance companies have lawyers to represent their interests, and since I'm not a lawyer, I felt better about having someone who had the legal knowledge of insurance contracts to represent my interests. I pay insurance premiums and feel that if surgery is medically necessary, I should not have to fight the bureaucracy of my insurance company to obtain medical coverage--no one should! Even though this long drawn out battle has been extremely stressful, I'm thankful that my tenacity paid off. I wish you the very best of luck as you continue to pursue medical coverage from your insurance company. I pray that your tenacity will pay off, as well. Please, don't give up...you are worth it! Bama Gal

You are very right about each case is different, but hearing about someone else's expirence makes me hopeful that I will have the same positive outcome. Isn't this why we read each others profile? Cindy

Hi Donna! I thought that the insurance co had between 30-60 days to review and get back to you on an appeal. I have BCBS IL and in my booklet it states a determination will be made within 30 days of the appeal. It also states that if a second appeal is made, they will respond within 30 days or 'as soon as administratively possible'. I guess what I am getting at is why is it taking so long for your decision to be made? Heather

I don't have a booklet and BCBS of IL won't talk to me because I have a lawyer representing me but I just pulled out the letter they wrote and it states the fallowing on the back of the letter. You will receive a written decision within 60 days of receipt of your appeal.