Appeal
Got the official word....................
"You will have to appeal to the Board of Trustees for coverage since the preauthorization was denied on two occasions by the medical consultant."
X-Posted on the Revisions board as well
-Jamie
RNY 2/26/2002 DS 12/29/2011
HW 317 SW 263 BMI 45.1
SW 298 CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003
Normal BMI 24.8 is my GOAL!!!
GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**
The insurance company uses a consultant company: Medical Review Institute of America in Salt Lake City, Utah. The lady who did the review is ""The physician who provided this review is a Diplomate of the American Board of Surgery. This reviewer is a fellow of the American College of Surgeons and the International College of Surgeons. The reviewer has completed a fellowship in laparoscopic procedures. The reviewer is currently a hospital Director of Bariactric Surgery performing both open and laparoscopic procedures. This reviewer is a member of the American Medical Association and the American Society of Bariactric Surgeons. This reviewer has been in active practice since 1998.""
Ya, the insurance company has hired out the consultants with "the BIG GUNS" Just to turn everyone down in my eyes!!!!
-Jamie
RNY 2/26/2002 DS 12/29/2011
HW 317 SW 263 BMI 45.1
SW 298 CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003
Normal BMI 24.8 is my GOAL!!!
GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**
Also, does your state have an insurance commission? I got my revision approved by Virginia's insurance commission on an external appeal. The external appeal is done by a completely neutral third-party medical reviewer and is not associated in any way with insurance company. I used Walter and Kelly Lindstrom, attorneys in CA, to get my revision approval. Legal fees weren't bad and were totally worth it!
Duodenal Switch on February 21, 2011
Surgery weight: 276; Current weight: 122; Height: 5'5
Plastics scheduled for 10/3/14: BL/BA, LBL, TL
Glad to know that (and sad too) someone has walked in this before me. I am sure I might be bugging you in the near future.....
Thank YOU for the insight & advice!!!!!!
-Jamie
p.s. Yes, when it is all said and done (and I am bald from pulling my hair out) IT WILL BE TOTALLY WORTH IT!!!!!!!!!
RNY 2/26/2002 DS 12/29/2011
HW 317 SW 263 BMI 45.1
SW 298 CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003
Normal BMI 24.8 is my GOAL!!!
GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**
