Not yet denied but a bunch of hoops

National Institutes of Health National Heart, Lung, and Blood Institute These are clinical guidelines developed for physicians to understand and treat obesity in their patients. Everyone should be well acquainted with the guidelines. Check out the link: http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf

Roberta, Thanks for the website; I will check it out. I am at a loss as to how to proceed. I haven't even got an appointment with the surgeon scheduled yet! I turned in all my paperwork last week, and am supposed to wait a week or so before bugging them for my consultation date. But, I don't have a week or so!! If I need to do something (like diet or drugs) before 45 days, I need to get on it quick. I don't know how much initiative to take here. I am not sure if I should call insurance directly? write insurance directly? wait for my surgeon to write? or ask my PCP to write a more detailed letter? Plus, I want a lap band NOT gastric bypass, which he requested. I belong to a union which will fight denials if the time comes, but they have not responded to my calls. I'm not sure they want to get involved in this type of appeal. I am wondering if I should hire an obesity lawyer ... then would he work with my union's lawyers? Right now, self pay is sounding pretty good. :slinking off into the sunset: Donna C

I would not give up if I were you. As another poster said, the insurance company is counting on you to give up. About 2-3 years ago I was watching some sort of congressional hearing on CSPAN regarding managed health care systems and the denials and hoops patients were having to go through for medical treatment they needed. One person giving testimony was a former employee of a managed health care system -- she was the person who evaluates claims, etc. She said her employer instructed her to deny the first 3 claims as a matter of routine!! It was outrageous and I believe that's why she left their employ. You might think you're dealing with a bunch of idiots -- but they are very clever indeed..... Keep up the good fight and I wish you the best!!! Cheri