XP- Hearing UPDATE
The insurance company called me regarding the hearing yesterday. I discussed with the insurance company, that basically, they want to not have the FOCUS of my prior WLS, but if in my present condition, weight & health-wise, if I qualify.
Here is a "cut & paste" from the letter that was e-mailed to me regarding our conversation:
"This email follows our phone conversation of earlier today. Thank you for taking the time to discuss your appeal with me. As we discussed, two things were decided at yesterday's meeting regarding your case.
1. Your appeal is denied. We do not have independent medical evidence that the surgery you request is medically necessary. A more detailed opinion will be sent to you on this w/in 30 days. You should have that by by Friday, Dec. 16.
2. The board is requesting an additional independent medical opinion. We believe our advisors may be too focused on your prior surgery. We want to be sure that their denials are, in fact, based on the language of the plan. The question is not whether your prior surgery needs to be "fixed". We think the question is, instead, more along the lines of whether the surgery is medically necessary based on the evidence we have concerning your present condition.
I will provide you with a copy of the opinion when we receive it. If the opinion is favorable it should change our position on your requested surgery."
I do, according to the NIH gudelines QUALIFY!!!!!!! I need to take another look at the wording in the policy itself.
236 pounds = BMI of 40
(They are going by when I submitted my claim, after I saw Dr. Keshishisn back in March)
Sleep Apnea
So, things are looking UP!!!!!! I should hear mid-December
-Jamie
(I also posted this on the DS board)
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**
Thank You!!!! I honestly am VERY positive for this!!!!
-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**
Lori,
I have been at this nearly 3 years...... If I am approved, I guess I will be an inspiration for other, who are having to jump through hoops, just to get denied..... and read a post from me, and KEEP FIGHTING!!!!!!
-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**
Thank you, Shele. I appreciate the kinds words!!!!!!
-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**
