Need Help with a Letter
Hi Everyone,
Met my PCP today who was more than happy to refer me to a Bariatric Surgeon, however, his hands are tied since the Surgeon I want to see (Rabkin) is out of network.
I spoke with my Insurance Company Paciifcare HMO and they gave me a list of surgeons they do work with, non that I can tell perform a DS, yet there is no limitiation in the policy that states a DS isn't covered. The ones they contract with are Mary Estakhri, Pamela Foster, Yen Chung (Andre) Lee, Dat Tien Nguyen, and Albert Wetter who was my original RNY surgeon.
Rabkins office suggested we pull as much info together as we can including Initial Consultation which is on Wednesday and I'll self pay, the original Surgical notes from Wetters office, the labs I'm having done tomorrow, etc. Rabkins office said the appt. would take 3 to 4 hours.
From there Pacificare said we should submit the information to the Medical Director at Pacificare and see if they'd be willing to cover. They said I should also include a letter as to why I think I need a DS versus an RNY revision and have the surgeon include it with his recommendation, she said that way if you're denied, everything will be together if you choose to appeal. They also said I should mention I'd be willing to self pay above and beyond the rate they contract with the Surgeons they do contract with.
Rabkins office said they haven't had much luck with HMO's recently but if I was willing to fight it, they'd help. So, I'm ready for the battle -
If any of you have a similiar letter that you've had to write, can you send it my way?
Thanks,
Debbie
Met my PCP today who was more than happy to refer me to a Bariatric Surgeon, however, his hands are tied since the Surgeon I want to see (Rabkin) is out of network.
I spoke with my Insurance Company Paciifcare HMO and they gave me a list of surgeons they do work with, non that I can tell perform a DS, yet there is no limitiation in the policy that states a DS isn't covered. The ones they contract with are Mary Estakhri, Pamela Foster, Yen Chung (Andre) Lee, Dat Tien Nguyen, and Albert Wetter who was my original RNY surgeon.
Rabkins office suggested we pull as much info together as we can including Initial Consultation which is on Wednesday and I'll self pay, the original Surgical notes from Wetters office, the labs I'm having done tomorrow, etc. Rabkins office said the appt. would take 3 to 4 hours.
From there Pacificare said we should submit the information to the Medical Director at Pacificare and see if they'd be willing to cover. They said I should also include a letter as to why I think I need a DS versus an RNY revision and have the surgeon include it with his recommendation, she said that way if you're denied, everything will be together if you choose to appeal. They also said I should mention I'd be willing to self pay above and beyond the rate they contract with the Surgeons they do contract with.
Rabkins office said they haven't had much luck with HMO's recently but if I was willing to fight it, they'd help. So, I'm ready for the battle -
If any of you have a similiar letter that you've had to write, can you send it my way?
Thanks,
Debbie
Most Active
Recent Topics
