Question:
appealing with /Mail Handlers/First Health

I've heard so many people say they were approved so easily with First Health. I'm sad to say I was denied on 11/2003. I have 6 months to appeal, which I plan to do. If anyone has experience with appealing first health would you please email me [email protected] Thank you! God Bless!    — [Deactivated Member] (posted on January 29, 2004)

March 5, 2004
Call Mail Handlers and ask to speak with the nurse handling your review. Request a copy of the requirements for pre-certifing gastric bypass or ask what you are missing of their criteria. I was told the following: 1) They looked for 3 doctor's visits in the past year regarding a problem related to obesity. 2) A co-morbidity (the examples she gave were degenerative joint disease or diabetes) 3) Your Primary Care Physician's recommendation that the surgery would most likely improve the above condition(s) 4) Psyc Eval 5) Medical records, Physical, & Notes from Primary ----- After the information was submitted, they also wanted Notes and Physical from the Surgeon (to ensure that the surgeon had actually seen and evaluated my condition and ability to go thru the surgery. Don't let this discourage you - that is what insurance companies try to do!!! Find out what they want and get it for them. It's your health - FOLLOW-UP and keep name, notes and dates of all conversations. Luck to ya!
   — Cee C.