Ug.

Still no appeal letter filed by my doc after being denied 2.5 months ago. Becoming very frustrated with this whole system. BXBS still sux.

Cheryl, Hun I am sorry that you have to deal with all this stuff....what does the Dr say when you ask them why it is taking so damn long??? Keep us posted hun and do not give up, it is all a game to set us to back out of the surgery! Take care Debra P

Hi Debra!! The doc hasn't seen me since my 1st appt. with him in July. I get to see a nurse who only weighs me...Hmmmm, wait 1 1/2 hours to get in for a 3 minute appt. I'm a fighter for sure, but I would have liked more support from the doc in this appeal process. I do have an attorney standing by for the final stage of the appeal if necessary. Thanks a bunch!

Cheryl, Good do not give up and it is a good thing to have an alt plan... I would think the Dr would WANT to work faster/better with/for you......are you really set on that Dr or is there a chance of looking into another? I know after all the testing and stuff it is so upsetting to have to change. Keep us posted! Debra P

I certainly will keep you posted! My plan is to request to see him to find out whether he is going to follow through and send that appeal letter. If not, my records will be transferred to another center/hosptial, etc... Muah

I hate to suggest it, but maybe it's time to find a 2nd surgeon. I know the 1st surgeon gave me the run around, and had me do all my pretesting before they would even submit the approval for the insurance. My 2nd surgeon's office sent from approval with just the nutritionist letter, Psych clearence and his recommendation for surgery. Either that or go to the office in person and ask to see him. Sometimes you just can get more done when your in someones face. Scott

I will absolutely do that. I'm presently going to a place in Sryacuse, NY that is not considered a Center of Excellence, yet. In time they will have that qualification. My other choice is going to Bassett Hospital in Cooperstown, NY (Home of The Baseball Hall of Fame). The have an incredible lapband support group as well as incredible medical staff, from what I've heard from some banders I've emailed with. I had my psych clearance within 2 weeks of my 1st appt. at my present facility. Everything has been in order since June. My denial was 7/11/06. I have attended the 3 recommended support groups and will continue to go. I just feel I'm spinning my wheels at this place. I'll see what my October appt. brings. If the appeal hasn't been written as promised, I'm outta there. that will give me just under 3 months to complete the appeal elsewhere. I guess I will ask to see the doc when I go in for that October appt. Thank you for that advice. I guess we are our best and only advocates! danke!

Cheryl: First a few ? (forgive me if you haveposted this in past, I do not know or remember the answers). Does your insurer cover WLS (RNY/Lap BAnd) or is there an exclusion? Do you have a copy of the policy (if not call them to get it) listing the criteria for approval. What was the denial based on? (Lack of documentation, or simply exclusion, or do you not meet criteria, or do you need to undergo more eval/tests/preop documented medically supervised diet for specific amt of time (usually 6-12 months) w/o missing a month or they make u start again! Is your surgeon interested in operating on you? Fighting the insurer? familiar w/ appeals? If he needs to see you again can you get an appointment to discuss these issues? Personally someone who in 2-3 mo has not worked on my behalf (and I can say it is usually ancillary staff who do appeals the Doc usually signs off) if they are good at it! Know how to fight, or if it is as simple as a phone call and they haven t/wont etc i'd SERIOUSLY consider looking for someone who will! Are you limited where u can go? ie do you have to go to a COE? Take Care, Jamie Lap RNY 10/9/02 Dr. Singh 320/163 5'9'' (lost 45# before surgery) Plastics 6/9/04 & 11/11/2005 Dr. King http://www.obesityhelp.com/morbidobesity/members/profile.php?N=c1132518510 "Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"

Morning Jennie, I haven't posted in a while, but came back to read and view photos for support, since this is the only place I feel I can get it. The first month I began the whole process I completed my psych. Everything else was completed with my primary before she even made the referral to the Bariatric Center. Unfortunately, the center is in the process of becoming a COE. BXBS would approve RNY for me yesterday. I prefer lapband, which hsa been denied because they feel it's experimental. Another unfortunate situation is, my Dr. was kind of forced into doing lapbands because the doc who does them, left. There was nothing about my referral that was denied, just that. This is what frustrates me. I feel I'm being forced to make a decision to either have RNY or nothing. I'm am a fighter. I won't give up my fight, but might have my hand forced to seek surgery elsewhere. There is limitation in where I go to have surgery. Thank you~~

Hello, I am sorry that you are going through this with the insurance ...Make sure you keep on your docs office. Call them often until you get what you need. IT should not take that long to get an appeal letter typed up....Keep on them and dont give up... Hang in there LisaMarie