ObesityHelp

RNY to DS Revision Surgeons


Dr. Rabkin, Dr. Keshishian, both are located in California

(((((I had a face-to face consult with Dr. Keshishian March 2, 2011. I do have his cash pay fees:
These are just the Surgeons FEES Only!!!!
Open DS: $8650.00
Lap DS: $9525.00
Sleeve: $2000.00

REVISIONS:
Revision - Lap Band to DS: $8650.00
Revision - RNY, VBG, Fobi Pouch, or other unknow bariactric procedure to DS: $11,000.00
(I was told that the $4,000.00 program fee is included in this $11,000.00 fee)
On my paperwork, The hospital fee (I think it was for a 4 day stay) was $17,500.00)))))
So, a revision from RNY to DS surgeons fees are $11,000.00 and the 4 day hospital stay is $17,500.00 for a total of $28,500

See May 2012 for current list of doctors doing RNY to DS revisions.

I received my denial letter in yesterdays mail.  Good thing I did not have my hope up too much, so it was not such a let-down.

Here is what the letter said:

Dear Mrs. ________:   The Appeals Committee for (my insurance company) recently met to consider your request for coverage of gastric bypass revision surgery/duodenal switch procedure.   The Committee relied on the medical review information presented and took action to uphold the denial of coverage of these procedures.  This is based on the Plan’s Exclusions and Limitations, listed on pages 36 and 37, which state:
                  
Services which are primarily for weight-loss (except surgery for morbid obesity which has received prior authorization from the Administrative Office); and  
                
Any medical services which are not medically necessary (see page 71).  

The January 2010 Summary Plan Description is enclosed for your reference.   If you apply for benefits and are ruled ineligible, or if you did not receive the full amount of benefits to which you are entitled, or if you are otherwise adversely affected by any action of the Trustees, you have the right to appeal to and request the Board of Trustees to conduct a hearing in the matter.  Such a request must be in writing and submitted to the Trust’s Administration Office within one hundred and eighty (180) days after the date of mailing to you of notification of such ruling or decision.  The full Board will then conduct a hearing at which you will be entitled to present your position and any evidence in support thereof.  You may be represented at any such hearing by attorney or by any other representative of your choosing.  Thereafter, the Trustees will issue a written decision reaffirming, modifying or setting aside the former action.      

Sincerely, Blah Blah Blah


And, I have mailed off a letter requesting a hearing.  I did NOT waste any time on that one!!!!
The Board meets quarterly.  Next meeting is end of October.  7 weeks away for them to meet & who knows how long for me to get the determination!!!!!!