Here's the latest!

Well gang, I haven't been on in a couple days. I've been busy running around town gathering information cuz I got my denial letter. And the worst part about it is, it was denied because my PCP did not submit any clinical data to them regarding my case. No height, weight, labs, nothing! DUH! How can they approve me for surgery if they don't even know my height and weight? Last night I went to the Henry Ford Hospital WLS support group meeting with Kathie K. At the meeting I met a guy I've been chatting with on the Yahoo HFH WLS support group. He gave me the phone number for the main lady (Jeanette) in the referral department at HAP and told me to call precisely at 8 am or I won't get through to her. I called at precisely 8 am and got her voice mail. About 20 minutes later Ann called me back and told me that she called my PCP a while ago and said she told whoever she spoke with exactly what was needed from them regarding my referral but nothing was ever sent. She also said she gave them plenty of time to send it, in fact, more time than usual. Eventually, they had to send the denial letter based on the fact that they have no clinical data about me. So I called my PCP afterwards to tell her what they said. My PCP said, "That sounds like an excuse to me" Regardless, the information was still needed. So she claims that she will work on it tonight. In the meantime, I went to my previous doctor's office today to get copies of my labs and my x-ray report related to my back pain to send with my grievance letter. My lipids are high!!!! Sad how that makes me excited isn't it? Cholesterol: 259 = High (should be less than 200 and borderline is 200-240) Triglycerides: 176 = Borderline high (should be less than 150) LDL (bad cholesterol): 182 = high (should be less than 100 and borderline is 100-129) cholesterol/HDL Ratio: 6.2 = Increased cardiac risk (should be less than 4.0 for reduced cardiac risk and normal cardiac risk is 4.0-6.0) Not to mention these labs are from May of last year and it's almost a year later, so I'm sure they're worse now. This is what's called hyperlipidemia and is a co-morbidity for approving the surgery. Of course when I stopped in to see my PCP yesterday, I left with her my receipts from my previous PCP which state the reasons I visited him. They all say hypertension (high BP), some also say hypercholesterolemia and one says obesity. These receipts are all in my favor for approval as well. (I called her back and she said she'd try to mail them to me tonight even though I told her I'd come into the office and pick them up. She said the office is closed til Monday and she will be in and out this week, so if she drops them in the mail, I'll be sure to get them.....We'll see!) So it should be just a matter of time before I'm approved unless they try to catch me on the "medically supervised" diet for a minimum of one year thing. And I have been to 2 diet docs in the past, just hasn't been for a whole year each, maybe combined they might equal a year. So I hope they don't get that nitty gritty cuz the one was so long ago, I don't know if he's still around and if he is, if he'll have my records still.

Hi, I too had trouble getting all the info I needed I finally took my chart to my (former) PCP and said this info is going to insurance for evaluation. I do not want it to go without a letter from you. No weights are recorded in my chart even tho I was on diet pills. I gave him a diet and weight history that sat on his desk for 3 weeks. Finally I made him so uncomfortable he called me into his office and typed it in front of me. I work in the same clinic so in a way I had the extra access but the point is be a pest if you have to. It is your health you are fighting for. Laurie

Mary, don't give up. Keep hounding them and make a pest of yourself. They will complete anything you want just to get you off their back. This is your life we are talking about, not an elective cosmetic surgery for gosh sakes!!!!!!!!!!!!