INSURANCE DENIAL :(

insurancecrazy
on 4/4/06 9:38 am - Mt. Washington, KY
I am eight years post op of a Vertical Banded Gastroplasty. I have been to a new surgeon Dr. Geller who is wonderful and wants to redo my surgery to a Rouen Y Gastric Bypass. I have a stricture and my original band is too tight causing me to gain weight because I only eat high calorie foods which are easier to stay down, I also regurgitate a lot. I have already lost 3 molars. Here is the problem, my insurance company's policy does not cover ANY type of bariatric surgery. I put together a wonderful appeal packet with letters, etc and they denied it in ONE day, I don't even know if they read it! Does anyone know of ANY way to get something approved if it is not in your policy? I am not asking for a brand new weight loss surgery, just to feel good again and to be able to eat regular food!! Any advise would be greatly appreciated! I am miserable and sick all of the time and really need to get fixed!! The Doctor says it is medically neccesary, you think they would approve it!!! THANKS!
hessie28
on 4/8/06 6:07 am
My revision was denied because they felt not medically necessary. So I had letters written by my primary. I have alot of other medical problems like Obstructive Sleep Apnea, Slipped Vertabra, Herniated disc, Narcolepsy, Atrial Septal Defect and Mitral Valve Regurgitation. So my primary wrote that some of them would get better with weight loss. I quoted websites which said the conditions would get better. I will send you a copy of my letter if you think it could help. Just email me. I think they deny right away. They figure people won't fight and will give up. It took about 7 months from the time I started gathering paperwor****il the time my appeal was won. My appeal was about 100 pages I think. I attached copies of tests. I got copies of doctors notes from any Dr. I had seen since my 2002 surgery. Had the revision in 2005. It is alot of work but worth it. Good luck with everything.
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