Appeal for revison denied

Hello Everyone,

I thought I would vent and maybe be able to talk to someone else who has lost an appeal for a revision due to complications. I had a Vertical Banded Gastro in 1995 and have literally thrown up for the last 16 years. Food gets stuck, stomach/chest pain and there are days when my stomach doesnt digest food for 2/3 days. My stomach pain is terrible. They denied me the first time because I only weighed 209, but I now weigh 226 at 5"3(since I have turned to a soft diet) which makes my bmi 40 now. Should I appeal again? What is important to put in the appeal? The wait time was terrible to only hear that I was denied once again.

Could someone maybe share what they had to go through to get the revision they needed?! I have cried all day and would love to share/vent what needs to be done next.

BTW, I have Tricare Prime and I am living in sumter SC. My husband is retired after 26 years. Would a base such as Fort Campbell do this surgery for me??

I'm at my wits end...blah

God Bless,
Kimberly

I Google appeals letters for revision bariatric surgery it face me several sites where letters were posted I hope that helps good luck .

Hello Micheleshep,

Did you have to appeal?  And did one of these appeal letter setups help you get approved.  I'm so frantic and upset

No I have appt on Tuesday to discuss revision. Plus I will have different insurance next year so we will see . I just look at the post to see what's going on so make sure you Google that I may need it to

DONT GIVE UP BE PERSISTENT. IT MAY ONLY TAKE ONE APPEAL . WRITE A LETTERED YOURSELF HAVE DOCTOR SIGN IT. PLUS YOU MAY WANT TO SEE ANOTHER DOCTOR

I did my first appeal last month and just found out yesterday that it was denied.  How many times should I appeal?

I don't think there's a limit on appeals . If I were you I would not let them wear me down bug the hell out of your insurance company. Plus try another doctor because there office have insurance people to help you with appeals

I wish you the best of luck sweetie.  I would hate for you to go through the same same agony as I am.

Thanks and good luck to you too . Take care

I had a combination rny with vbg, and had my revision due to complications. The failure rate for the vbg was so high, combined with the health issues (I was constantly throwing up, proved esophageal erosion) that blue cross approved it right away. I have no idea why tricare would deny you if there are complications.

What I put in my appeal: statistics on the vbg, why the vbg isn't covered anymore, proof of medical necessity (the esophageal erosion, which leads to Barrett's Esophagus, a pre-cancerous condition), and my bmi, which had slowly crept back to 40. If all else fails, there is a lawyer who specifically deals with appeal cases, and he can advise you on this, Walter Lindstrom.

Not every surgeon is a good revision surgeon, that's another problem. I am hoping someone with more military experience will chime in for you. Good luck!