- Insurance appeal

[Guest guest]

,

To add to 's good advice, also add comments along the lines of

these to your insurance appeal :

While the open RNY is effective, the MGB is a much different and far

superior procedure and is the procedure you will have performed at

some point in time. The open procedure requires a longer recovery

time, 6 weeks vs. 1 week, and also has higher risks and

complications. The MGB is easily reversible laparascopically if

required, whereas, the Open RNY is not easily reversible and requires

another major surgery. In addition, the costs of the MGB are 1/5 the

costs of Open RNY.

You could mention that without an approval of the MGB, you will be

forced to be a self-pay and with the transportation and surgery

expenses it will be some time before you have enough money to self-

pay. In the meantime, you may be forced to proceed with other

surgeries (that will cost insurance money) that would have been

avoided with the MGB, such as, surgery to alleviate knee pain, feet

pain, stress urinary incontenience, etc... Let them know they'll be

paying for future surgeries in the near future if they don't approve

the MGB.

Hope this helps, it helped me to go from " out of network " to " in

network " coverage.

Best of luck.

Sincerely,

Bernardine

TX

Another point to add to 's comments:

> Insurance is about money. Show them how their decision will cost>

them

> *more* money and how the laparscopic MGB will cost them *less.*

> > > It took a month and numerous sends to get Cigna to acknowledge

my

> > > request for pre-approval. It took only eight days to get a

> letter

> > > back stating:

> > >

> > > " We have determined that although a gastric bypass may be

> > > indicated, the laproscopic approach is not considered to be

> > essential

> > > for the necessary care and treatment of an illness or injury,

and

> > > therefore is not a covered expense. "

> > >

> > > I plan to appeal, but would like thoughts on my approach. It

> > appears

> > > to me that they are not denying me Gastric Bypass, they just

> don't

> > > want me to have it laproscopicly. Any ideas? Thoughts?

> > >

> > > Ann

> > > Wanting to cross to the other side...