May 15, 2018
As some of you know, I was denied a revision surgery due to an exclusion on my insurance. It states that bariatric surgery is not covered for the purpose of weight loss. However, I was going to challenge the exclusion, stating that the surgery was medically necessary due to GERD and hiatal hernia.
Last week, I went to the ER with severe chest pains. Turns out that I had been having an esophageal episode which included spasms, soreness, and difficulty swallowing. I was also vomiting constantly, with blood mixed in the mucus. This is more likely caused by the combination on GERD and the hiatal hernia. As you can imagine, this was VERY painful! I decided to talk to our CEO about this, rather than appealing the exclusion. He was very supportive. He stated that he was unaware that this was an uncovered procedure on our insurance, and that he will contact the insurance broker to see if he can either A - get a special exception for me or B - add on this rider. If so, he would need documentation from my doctor that states a revision would alleviate, if not "cure", the GERD.
I called my provider and left a message, explaining the situation. I also sent him a copy of the appeal that I was going to originally do. He called back, first congratulating me on such a detailed and wonderful appeal letter. He was very impressed with my letter, which included a history of my symptoms, research supporting my theory, and possible outcomes if I did not get the surgery. He stated that I would have to file a release of records in order to obtain my doctor's notes. The release was received today. It can take up to 30 days to process... So now I have to wait. Once I receive my records, I can send the relevant notes to my CEO along with my original revision letter. I have hope again.
I will keep you guys updated