Peer-to-Peer Appeal on hold--AGAIN.

Backstory: I was sleeved in 2009. Lost 70 pounds in the first six months (30 pounds short of goal), then a slow regain started (lots 'o reasons, none good). I had reflux before the sleeve and reflux after the sleeve. I have erosion in my esophagus now, I aspirate sometimes at night, I just had a (thankfully benign) polyp removed from my stomach (theory is it was caused by PPI use), and PPIs only work for a few months and then quit, and I have to switch and they have long-term side effects and.... Argh. Anyway....

I need Gastric Bypass to fix my hiatal hernia and GERD. (Oh yeah. I have a large hiatal hernia too.) The usual procedure they do for it, I can't have because of the sleeve. (I guess they take the stomach and wrap it around and stitch it down. But I have no stomach.) My grandmother died of esophageal cancer. Six months from diagnosis to dead. She lived with us. And, granted, it was years ago, but it was HELL to watch. I don't want that to happen to me!

But the insurance company has denied the surgery because it is "weight loss surgery" and not a covered benefit. Even though I'm a relatively low BMI. (I've gained back 30 of the 70 so still have 60-70 to lose.) Even though it is the procedure my gastroenterologist says I need. Even though NOTHING ELSE WORKS. So I'm just supposed to let my esophagus erode until I have cancer and THEN they can say, "Ooops. Sorry!" to my widower???? And my children and grandchildren?

So my surgeon was supposed to do a peer-to-peer appeal today, but the insurance company said it needed a written letter first! But not until today at the scheduled phone conversation time! GAH and ARGH!!! Why are insurance companies allowed to dictate medical decisions? And why are they allowed to drag their feet and put up roadblocks like this? And why is there an time-limit for an appeal???

My surgeon is renowned in his field. He is on that short list of revision surgeons that gets passed around here. He has spent years and years learning to be a surgeon, has done thousands of surgeries, has board certifications up the wazoo, and yet some inexperience, uncertified ding-dong at the insurance company is allowed to tell him what is medically necessary????? I am feeling a complaint to my state insurance commission coming on!

Thanks for letting me whine.

Wow the reflux sounds like me,  we are starting the process now..  I have anthem blue cross.  I hope they are kinder with their decision.   Good luck

That is not my insurance company so hopefully they will have a great answer for you!!! Good luck to you too!!!