Any help appreciated .
I'm currently trying to revise from lapband to either sleeve or rny.... Due to severe reflux, gastritis , esophagitis, ulceration, vomitting, food intolerance regardless of fill level, 50 lb weight regain after losing 100. My insurance policy states that it covers revision if a medical or surgical complication is proven, my husband is a union employee and our insurance is bcbs of Tennessee but it's considered mid south carpenters regional fund.
My dr had submitted my revision paper work to blue cross 2 times and the reasons for denial were
first time.... No proof that reflux was caused by the band itself, my gastroenterologist wrote a letter saying that it was due to the placement of my lapband. Resubmitted and the second denial letter stated the reason for denial was there was no reintroduction to diet and nutrition education , and no proof of ppi( acid reducing ) medication . Which I have been taking over the counter because my insurance doesn't cover the prescription ppi meds .
So now my union rep says I have one more shot at this, which is a meeting that takes place may 24 and consists of 5-6 carpenters.... Not health care or medically knowledgable people BUT CARPENTERS that make up their " regional counsel" and they will give a FINAL DECISION.
Meanwhile I was getting out of the bath tub and felt a burning rip and stinging pain and my port is now able to be picked up and moved instead of being securely in place . I've been having terrible port pain, and soreness and the port sticks up like its on its side. Left shoulder pain is keeping me up every night .... I'm feeling completely overwhelmed at this process and wondered if anyone could please advise ?
I have contacted lindstrom and will use their services if necessary but the union rep says there is nothing anyone can do if the " counsel" decides the answer is no.
i have put in a call to the insurance commisioner of my state and was told that I needed to address my concerns with the union rep.
Please offer any help you can think of
I'm currently trying to revise from lapband to either sleeve or rny.... Due to severe reflux, gastritis , esophagitis, ulceration, vomitting, food intolerance regardless of fill level, 50 lb weight regain after losing 100. My insurance policy states that it covers revision if a medical or surgical complication is proven, my husband is a union employee and our insurance is bcbs of Tennessee but it's considered mid south carpenters regional fund.
My dr had submitted my revision paper work to blue cross 2 times and the reasons for denial were
first time.... No proof that reflux was caused by the band itself, my gastroenterologist wrote a letter saying that it was due to the placement of my lapband. Resubmitted and the second denial letter stated the reason for denial was there was no reintroduction to diet and nutrition education , and no proof of ppi( acid reducing ) medication . Which I have been taking over the counter because my insurance doesn't cover the prescription ppi meds .
So now my union rep says I have one more shot at this, which is a meeting that takes place may 24 and consists of 5-6 carpenters.... Not health care or medically knowledgable people BUT CARPENTERS that make up their " regional counsel" and they will give a FINAL DECISION.
Meanwhile I was getting out of the bath tub and felt a burning rip and stinging pain and my port is now able to be picked up and moved instead of being securely in place . I've been having terrible port pain, and soreness and the port sticks up like its on its side. Left shoulder pain is keeping me up every night .... I'm feeling completely overwhelmed at this process and wondered if anyone could please advise ?
I have contacted lindstrom and will use their services if necessary but the union rep says there is nothing anyone can do if the " counsel" decides the answer is no.
i have put in a call to the insurance commisioner of my state and was told that I needed to address my concerns with the union rep.
Please offer any help you can think of
the "council" will change its mind real soon if they are being sued. I would get with Lindstrom ASAP and get that ball rolling. Even Lindstrom can't do much if you have exhausted all your appeals.
If you are able to present something to the carpenters listening to the appeal try writing down what it is like on a daily basis for you. Starting from the time you wake up how often the acid lasts, how much pain it is, how often you vomit, what type of foods you have to eat, explain every miserable hour of the day and how it feels and ask them if they would want their wife or daughter to have to live like that for the rest of their lives because unless you get a revision it will keep on happening. Just taking the band out won't solve the issue, I did that and still have the acid.
It also never hurts to mention when you spoke to a lawyer they, get nervous when lawyers get involved. Good luck sweetie!
