CA DHMC IMR information- Look at what I found!
I just discovered, two days too late, unfortunately, that you can go onto the DHMC website and search all IMR decisions made since 2001. It was very interesting to look at why appeals were denied and why they were overturned! Honestly, for the most part, the decisions that upheld the HMO's ruling were improperly documented- either incomplete or did not provide the documentation required by the NIH to prove medical nevessity.
Before you appeal to the DMHC, check this out. I wish I had seen it before I sent in my request for an IMR.
For CA the link is: http://wp.dmhc.ca.gov/imr/search.asp
Before you appeal to the DMHC, check this out. I wish I had seen it before I sent in my request for an IMR.
For CA the link is: http://wp.dmhc.ca.gov/imr/search.asp
Pre-band highest weight: 244
Pre-band surgery weight: 233
Lowest: 199 ( for, like, a day)
CW: 260 (yes, with the band!)
Current Fill: 5cc in 10cc band
BMI: 49
Pre-band surgery weight: 233
Lowest: 199 ( for, like, a day)
CW: 260 (yes, with the band!)
Current Fill: 5cc in 10cc band
BMI: 49
IMR stands for Independent Medical Review. DMHC in the Department of Managed Healthcare in CA. In CA, if you have an HMO, you can appeal to the DMHC if you have exhausted your appeals with your insurance. An IMR is conducted by an independent party, in my case, a bariatric surgeon, who decides whether or not I can have revision surgery from a band to a DS. My insurance decided that removing my band is not medically necessary, so I am trying to prove that it is medically necessary. I was excited that I found this website but it was AFTER I sent in my request for an IMR!
Pre-band highest weight: 244
Pre-band surgery weight: 233
Lowest: 199 ( for, like, a day)
CW: 260 (yes, with the band!)
Current Fill: 5cc in 10cc band
BMI: 49
Pre-band surgery weight: 233
Lowest: 199 ( for, like, a day)
CW: 260 (yes, with the band!)
Current Fill: 5cc in 10cc band
BMI: 49
Lori,
How are you doing? Hanging in there alright?
I have been thinking of you!!!!!
-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**
Hi Jamie! Thanks for checking on me. I'm just laying low, waiting for my answer around Nov. 18th. I am trying not to think about it, so I've been lurking around OH but not participating much. It makes me get my hopes up when I see all the DS success stories out there. Again, I can't believe I'm complaining to YOU! Your decision date is just around the corner too. How are you holding up?
Thanks for checking on me!
Lori
Thanks for checking on me!
Lori
Pre-band highest weight: 244
Pre-band surgery weight: 233
Lowest: 199 ( for, like, a day)
CW: 260 (yes, with the band!)
Current Fill: 5cc in 10cc band
BMI: 49
Pre-band surgery weight: 233
Lowest: 199 ( for, like, a day)
CW: 260 (yes, with the band!)
Current Fill: 5cc in 10cc band
BMI: 49
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