EDITED: Denied! But I will appeal... tips and good wording?
I was denied but I will definitely appeal ...
Saying I don't meet medical criterias... but what crterias: Because in the contract it did say the following: and it has been 2 years as of this Friday:
I have not lost a single damn pound since 9/2009 after fill complication in Sept 09 and tried fill again sept 2010 and had same issue ... two unfills....
I still have sleep apnea .....
I am tired of throwing up food, tired of band slamming shut on me before and after period and during ovulatuion ....
They said other option is to replace my band! Bwhaahahaha... what a laugh ....
I'm angry ..
I'm tired of being fat.. never experienced life as a thin person have been fat since age 11 and i'm 44 now ....
Surgery day weight was 231 and now I"m back to 185 ....
I have very few good days where I can eat without throwing up and some days I can eat a house.
Arghhh
Any tips?? I'm going to appeal, and be very wordy! P.S. my surgeon did say often they deny it but once you appeal, they will pay. They think if they deny you won't fight.
Saying I don't meet medical criterias... but what crterias: Because in the contract it did say the following: and it has been 2 years as of this Friday:
Had previous vertical banding procedure
Has experienced weight loss that is less than 50% of excess weight over a two year period
What part of this don't they understand:I have not lost a single damn pound since 9/2009 after fill complication in Sept 09 and tried fill again sept 2010 and had same issue ... two unfills....
I still have sleep apnea .....
I am tired of throwing up food, tired of band slamming shut on me before and after period and during ovulatuion ....
They said other option is to replace my band! Bwhaahahaha... what a laugh ....
I'm angry ..
I'm tired of being fat.. never experienced life as a thin person have been fat since age 11 and i'm 44 now ....
Surgery day weight was 231 and now I"m back to 185 ....
I have very few good days where I can eat without throwing up and some days I can eat a house.
Arghhh
Any tips?? I'm going to appeal, and be very wordy! P.S. my surgeon did say often they deny it but once you appeal, they will pay. They think if they deny you won't fight.
246 in Dec 2008 before banded 1/28/09 at 215 lbs, band crapped 9/09 at 170 lbs and struggled with it and regained to 203 revised to bypass on 8/1/11 and am very happy.
I don't really have suggestions but to wish you good luck!! My BMI was 36 and I had complications. Had heart burn and pain from band.
I am really surprised that they would even talk about replacing the band.
Appeal and hopefully you can get a peer to peer review and they will approve it.
A peer to peer is a conversation with the nurse reviewing case and dr. and you
Tamara
I am really surprised that they would even talk about replacing the band.
Appeal and hopefully you can get a peer to peer review and they will approve it.
A peer to peer is a conversation with the nurse reviewing case and dr. and you
Tamara
Um, perhaps this is the problem? "Had previous vertical banding procedure"
My understanding is you have had a previous Lapband, not a vertical band (which is the VBG, an entirely different procedure, I think). I've never seen the Lapband or Adjustable Gastric Band called a vertical banding procedure.
Diagram of a vertical banded gastroplasty.
My understanding is you have had a previous Lapband, not a vertical band (which is the VBG, an entirely different procedure, I think). I've never seen the Lapband or Adjustable Gastric Band called a vertical banding procedure.
Diagram of a vertical banded gastroplasty. Most Active
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