Appeal After Appeal After Appeal!
Nothing has changed with my City Insurance since before the lap band surgery. I was turned down twice in 2005 - each time for a different and changing reason and they are doing the same thing to me all over again! 
First they say that they never got records that the doctor's office faxed them. My doctor's office faxed them over 30 pages of clinical data but Care Allies must have just decided to lose selected pages... Then they decided that since I had an Rx for Protonix that I no longer have reflux. I JUST HAVE IT 24 HOURS A DAY!!! They don't care that my BMI is over 40 and slowly climbing back up. They don't care that I still have high blood pressure, type II diabetes, arthritis and have not had a moment without this reflux since Easter Sunday!!! Yesterday would have been my surgery day, instead I mailed my external appeal to the New York State Department of Insurance. I am sick and miserable and they couldn't care less. They just want me to forget about it or die so that they don't have to pay for my surgery... I can't let them get away with this. I deserve to have my band removed and I deserve a revision to RNY. Tomorrow I have an appointment with a new gastroentorologist. Maybe he can think of something. Better yet maybe he can prove that my band is causing all of this pain and burning. This is no way to live.
First they say that they never got records that the doctor's office faxed them. My doctor's office faxed them over 30 pages of clinical data but Care Allies must have just decided to lose selected pages... Then they decided that since I had an Rx for Protonix that I no longer have reflux. I JUST HAVE IT 24 HOURS A DAY!!! They don't care that my BMI is over 40 and slowly climbing back up. They don't care that I still have high blood pressure, type II diabetes, arthritis and have not had a moment without this reflux since Easter Sunday!!! Yesterday would have been my surgery day, instead I mailed my external appeal to the New York State Department of Insurance. I am sick and miserable and they couldn't care less. They just want me to forget about it or die so that they don't have to pay for my surgery... I can't let them get away with this. I deserve to have my band removed and I deserve a revision to RNY. Tomorrow I have an appointment with a new gastroentorologist. Maybe he can think of something. Better yet maybe he can prove that my band is causing all of this pain and burning. This is no way to live.
"The Joy of the Lord is your strength." Nehemiah 8:10
I'm so sorry Marcia! These insurance companies are just hurting us all! Just keep appealing. I'll say a prayer for you! Good advice to call Kelley - she may have an idea of how to submit it all! I'm so sorry you are still so sick. Just keep the faith and keep at it - something good will happen for you - you deserve it!! Carolyn
I was reading your post that you were denied from Empire B/C B/S New York City HealthLine for your revision. Is Empire your primary insurance or do you also have GHI. I went through the same situation when I was having my RNY. GHI approved me and Empire did not b/c of the same reasons that you went through. I had to use the services of Walter Lindstrom to fight my appeal .I am meeting with my surgeon tomorrow to discuss the Stomaphyx procedure. I found out that GHI will cover it, but I don't know about Empire. What I don't understand is they are covering the hopsital stay not the procedure. It just makes me so mad. I hope everything works out for you.
Lisa
Lisa
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