Denial Madness- Dr taking sweet time on appeal.. Grr!

I have had the band for 4.5 years. I originally lost 50lbs w/ in the first year. Soon there after came the acid reflux, chest pains, port pains, not being able to tolerate any food until early afternooon and randomly getting stuck on water. I had fills/ unfills back and forth until I decided I wasn't playing the game anymore. I had the fluid taken out of the band little bits at a time.. When I started having severe stomach pains I had the rest taken out in August to get a scope to figure out my issue. There are no mechanical issues with the band, although there is unexplanable irritation around my stomach where the band is placed.
I originally started the process in May for a conversion to RNY after much thought. All of my requirements have been met, I had a surgery date tentatively set for Oct 3.. On August 26 I recieved my denial letter. I immediately faxed it to the Bariatric center to get the appeal rolling as they said they did not get a copy. My Dr. suspected I would be denied by Harvard Pilgrim on the first shot.. The denial stated that my BMI is 38.8 which is 1.2 points below the required BMI for bariatric surgery w/o comorbidities. They used my weight from one of my previous visits, but not the most recent. They used 212lbs but my last visit w/ them had been 219. At this point with all of my fill out, I am 228.25:(
Since the Bariatric Center got a copy of my denial they have done nothing. I have called 9 times at this point between Aug 26 and today, Oct. 17. I understand they have 180days to appeal, but why wait that long?! My deductible is payed and I've reached my max out  of pocket for the year and I see my opportunity slipping away. I am sooooooo frustrated! The secretary tells me every time I call that my chart is on his desk, she'll get after him tomorrow. As of today, the appeal is not even started. What the heck do I do? It's sooooo maddening! I know he's busy, I know he has loads of other patients, but come on?! Where do I stand?
 Anyone have any suggestions, I'm at my wits end and don't know where to turn:( Thanks in advance for suggestions, and so sorry for the lengthy post.. I seriously needed to vent;)

 Can you take your records and maybe go to another doctor?

I have never had any dr appeal on my behalf, nor would I want to.  Your dr doesn't know your adhesion contract, as it is specific to you, he can appeal on medical, but a good appeal should encompass, medical, contractual, govering agencies etc.  I would not put my future in someone else' hands....good luck with your revision....

Hi

I had the same issue with my lapband and now im revised to the DS which is sooooo much better.  As airbender said I would not wait for the Dr to do your appeal.  I was denied a couple of times and did my appeal myself.  Most people step in and do their own appeal and win.  You need to go to the Dr and let them weigh you and then get a copy of the official office visit.  Gather all your paper work and call your insurance for the fax number of where you can send your appeal.  Write a nice letter explaining to them that you do indeed meet all the required BMI for bariatric surgery w/o cormorbdities and that attach paper work will show this.  Don't wait for the Dr office to do this type of work when you can do it yourself.  Im sure once you do this you will be approve. 

I agree with the others if the doc won't get off his rear then get your paperwork and go for it yourself. Best of luck!

Thanks guys for the response! I actually had no idea that I even had the option of writing my own appeal. I sent a records request today, we'll see how long it takes them to get my records to me.  I have no idea where to start, but am excited to find out I AM in control of this.
Does anyone have some experience with writing an appeal for a revision?

 Give the doctor a couple of days and if you don't get the response you want, go to his office and make them give you what you need right then.  It will probably irritate them, but SO WHAT??  Right?  Best of everything to you!