DENIED!!!!!!!!!!!!!!! What to do now?
Lady Jones
on 4/5/10 9:14 am
on 4/5/10 9:14 am
My paperwork was submitted on March 5, 2010 for a revision from lap band to bypass. I was banded at the end of 2007. I now have a dilated esophagus and pouch. 
I can not keep a fill. Either I am too tight, throwing up everything and can not eat or I am too lose and can only eat slider foods. Well....Today I received a letter saying that I am denied. The reason stated in my denial letter is: No documentation of my compliance with the previously prescribed postoperative dietary and exercise program. Now what does this mean? I did exactly what I was supposed to do and my doctor should have documentation of this. Since I was cash pay, I did not have to see a nutritionist but the doctor did give me a diet to follow and the caloric goal for me. I did join a gym and went the first year. What do I do now? I spoke with the case manager at my doctors office and she seemed to not care about this and told me to call my primary care doctor and see if he can put me on a supervised diet for 3 months. WTF!!!! I did not give my primary care doctor 15 thousand dollars! I game it to this doctor!!!! Why is he not helping me now? He should have the documentation that I need. I saw him faithfully for 2 years....He knows my history with this band. Needless to say, I am in tears!!!!
I can not keep a fill. Either I am too tight, throwing up everything and can not eat or I am too lose and can only eat slider foods. Well....Today I received a letter saying that I am denied. The reason stated in my denial letter is: No documentation of my compliance with the previously prescribed postoperative dietary and exercise program. Now what does this mean? I did exactly what I was supposed to do and my doctor should have documentation of this. Since I was cash pay, I did not have to see a nutritionist but the doctor did give me a diet to follow and the caloric goal for me. I did join a gym and went the first year. What do I do now? I spoke with the case manager at my doctors office and she seemed to not care about this and told me to call my primary care doctor and see if he can put me on a supervised diet for 3 months. WTF!!!! I did not give my primary care doctor 15 thousand dollars! I game it to this doctor!!!! Why is he not helping me now? He should have the documentation that I need. I saw him faithfully for 2 years....He knows my history with this band. Needless to say, I am in tears!!!! 
I'm sorry to hear of your insurance denial. I can only imagine how it must feel. I was approved for a revision to LapBand but have decided on the DS instead - I'm nervous my insurance company won't approve it.
The only thing I can suggest is to call your insurance company tomorrow and ask to speak with someone who can answer your questions. Ask them specifically what it means and what specifically they would like to see you complete to meet these requirements.
Once you have the answer from them on what they want then you can attack it. Maybe your doctor just needs to reword the request or provide some additional documentation to prove you were in compliance.
Good luck! Just remember, if you want it tat bad you CAN make it happen....eventually. Don't gie up!
Kerry
The only thing I can suggest is to call your insurance company tomorrow and ask to speak with someone who can answer your questions. Ask them specifically what it means and what specifically they would like to see you complete to meet these requirements.
Once you have the answer from them on what they want then you can attack it. Maybe your doctor just needs to reword the request or provide some additional documentation to prove you were in compliance.
Good luck! Just remember, if you want it tat bad you CAN make it happen....eventually. Don't gie up!
Kerry
If I were you, I would get my records from the doctor for all your visits, I would also get some kind of paper work to show you did comply and do exercise at a gym. All the insurance wants is documentation. Get everything you can. Get a copy of the diet that you followed and along with the doctors records. Send everything into insurance along with a letter from you and your doctor. Tell him you need something to let the insurance know this did not work for you and you didn't lose all your weight. I have heard of this before and the insurance wants more. You can do this. Get to work and go get every documentation from your surgeons and primary care doctors and your gym papers. Don't give up!! Good luck to you.
Ms. Cal Culator
on 4/6/10 12:02 am, edited 4/6/10 12:04 am - Tuvalu
on 4/6/10 12:02 am, edited 4/6/10 12:04 am - Tuvalu
Edited...
1--what state are you in?
2--what is your insurance cpmpany's wording--in your policy--for revision criteria?
3--did you lose weight for a while? Is that info in any medical records?
4--do you have a way to get receipts for the gym?
Edited again...
When did your esophagus become symptomatic?
1--what state are you in?
2--what is your insurance cpmpany's wording--in your policy--for revision criteria?
3--did you lose weight for a while? Is that info in any medical records?
4--do you have a way to get receipts for the gym?
Edited again...
When did your esophagus become symptomatic?
Most Active
Recent Topics
