I Need Help!!!!!!!

Hello all i am not new to this site but i have not been here in a while . I had rny in 2005 when i didnt have insurance. Now i blue sheild hmo in california and recently met with my primary care provider and he referred me to a surgeon who does revisions to ds. However i got denied by insurance ! i need help and dont know what to do ! can somebody please help me !

 What was the basis for your denial?  Who were you referred to for your revision?  

Sandy

the basis for denial was in exact words "because there is lack of medical necessity." however they do not know that i have had issues, internal bleeding, sever constipation, dumping, admitted to er in 2006 for sever gas, and anemia. I do not know how to get all of my records to them . i know that one they swee it they will probably approve me but i dont know the process. i was referred to dr . wetter in ca . But i called them regarding a dr in san francisco and they sent a request but i am waiting and thinking theyll deny me again ? what should i do ?

 Is the surgeon Dr. Rabkin in San Francisco?  That is who you should see for a RNY to DS revision (or Dr. Keshishian).  You will need to get copies of all your medical records if you haven't already and bring them with you when you go for your consult.  At that point, your surgeon (Dr. Rabkin or whoever it is) will submit all the information to insurance.  Please keep in mind that there are only a handful of surgeons who are experienced enough to perform this procedure.  Please research!!!!

Sandy

Well actrually i submitted a request to go to Dr. Rabkin after i was denied to see another doctor. i just called my primary care and asked them to send a referral for me to go and see him. But my question is if they deny me what do i do ?

First of all, this is a common reason the insurers use for denial. I would recommend you post on the DS board - they have tons of studies and things to help you with your appeal. To say it's experimental is absurd but they do it every day. You need to get in with your surgeon as well - they will help.

Speaking of surgeon you MUST go to a vetted surgeon. Please check out DSfacts and look at the list of doctors. If they aren't on that list, don't use them. Next, ask on the DS board about your physician choice, they will be honest with you but do your homework first. Some of them get a bit salty if you ask a question that is easily found by searching.