Appeal

smileyjamie72
on 4/28/11 9:51 am - Palmer, AK

Got the official word....................

"You will have to appeal to the Board of Trustees for coverage since the preauthorization was denied on two occasions by the medical consultant."

X-Posted on the DS board as well
-Jamie

RNY 2/26/2002                           DS 12/29/2011
HW 317                                     SW 263 BMI 45.1
SW 298                                     CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003

Normal BMI 24.8 is my GOAL!!!

GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**

MARIA F.
on 4/29/11 10:50 am - Athens, GA

Here are a couple of resources for you for WLS appeals:

www.formerlyfluffy.com/bariatric-surgery-insurance-appeal/

www.formerlyfluffy.com/weight-loss-surgery-insurance-approval-resource/

Good luck!

♥ FormerlyFluffy.com ♥

smileyjamie72
on 5/5/11 9:35 am - Palmer, AK

DS on 12/29/11

Thank YOU!!!! I have these bookmarked now!!!!

Great resources here on the board!!!
-Jamie

RNY 2/26/2002                           DS 12/29/2011
HW 317                                     SW 263 BMI 45.1
SW 298                                     CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003

Normal BMI 24.8 is my GOAL!!!

GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**

(deactivated member)
on 4/29/11 3:11 pm - San Jose, CA

DS on 08/05/03

Well, the GOOD news about that is that it sounds like your insurance is self-funded, which means that your employer can chose to pay for your surgery if they want to - and that it is somewhat less impersonal than an external medical review.

Let's hope your employer LIKES you!

smileyjamie72
on 5/5/11 9:40 am - Palmer, AK

DS on 12/29/11

My primary has a WLS exclusion plan, and I have gotten denied each & every time, so I have basically been dependent on my husband's insurance for an approval. But have been denied by them 3 times, now the secondary has 'offered' for me to do an appeal.
On my primary insurance, my employer likes me, but denied another employee for WLS since I have been here. She paid cash for her WLS. But that was in 2006-2007. Maybe they might have changed their minds by now??!!??

I am still keeping my fingers crossed that my secondary insurance overturns the denial when I submit my appeal.

-Jamie

RNY 2/26/2002                           DS 12/29/2011
HW 317                                     SW 263 BMI 45.1
SW 298                                     CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003

Normal BMI 24.8 is my GOAL!!!

GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**

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