Who do I trust with my appeal?

Exhorter · 05-17-2007, 03:23 PM

Ok so now most know they have said no to me about my surgery. I know that I need to appeal no doubt about that!!! But now here is my question do I put my trust in the doctors "STAFF" or what do I do?
I know that in one of Doc's post she stated I had to speak their language and I know there is a book that I can get that will help, but it won't help them if they are the ones who are doing the appeal. What if they don't know their language? I would think they should as that is the surgery they do. When I ask her today how often they get patients who are turned down she said "oh all the time" this is normal. WEll I want to make sure I have everything done right before the appeal goes to them again. How many times do I get to appeal this decision?

MsVickie · 05-17-2007, 07:07 PM

You should only need one appeal. Two is the max I think. When they appeal it the letter will come from your surgeon to there medical director. The nurses at your health insurance company wont have anything to do with the decision this time. You have had such a problem with the office staff at that office to begin with. I will say I don't like the fact they picked though your medical records and sent just 15 pages. OK think of it this way. If you were ever diagnosed with hypertension, diabetes, sleep apena, ect.......these are weight related. Edema, skin rashes, numbness, joint pain, those are related to. I know you feel the Dr's office staff should be trained on what to send......but as you stated this Dr. is famous, and he is very busy. If you feel your still not trusting the staff... call and speak with the office manager. You tell her what is going on and Im sure she or he will look into it for you. Keep fighting Donna. I just wish you didn't have to fight as hard as you are but your gonna have to. Craig The guy that runs this site had to fight to. I would look into purchasing his book on line and giving it a good look. If your denied again.,......... I wont know what else I can suggest to help you. All I can do is suggest and lead you on what I know. The Drs letter will be the key to your puzzle in your situation.

Kenyar · 05-19-2007, 06:24 AM

I think you should trust in yourself. WHile the dr's office will be the ones writing letters and speaking with the ins companies, KEEP COPIES OF EVERYTHING. follow up ON EVERYTHING. make yourself seen and known by all parties. If you have to call weekly or daily to follow up do so, also it might not hurt to write a personal cover letter type of document when you re-submit your documentation for your appeal. Dont just leave it in the dr's office's hands. Please please please dollow up and dont give up.

05-17-2007, 03:23 PM	#1 (permalink)
Exhorter Big Loser Join Date: Jun 2006 Posts: 196 Please Enter Height:	Who do I trust with my appeal? Ok so now most know they have said no to me about my surgery. I know that I need to appeal no doubt about that!!! But now here is my question do I put my trust in the doctors "STAFF" or what do I do? I know that in one of Doc's post she stated I had to speak their language and I know there is a book that I can get that will help, but it won't help them if they are the ones who are doing the appeal. What if they don't know their language? I would think they should as that is the surgery they do. When I ask her today how often they get patients who are turned down she said "oh all the time" this is normal. WEll I want to make sure I have everything done right before the appeal goes to them again. How many times do I get to appeal this decision?

05-17-2007, 07:07 PM	#2 (permalink)
MsVickie Seasoned Veteran Join Date: Mar 2007 Location: Floyd County Virginia Posts: 3,609 Blog Entries: 1 Weight Statistics September 19th 2007 Start Date: September 19th 2007 Surgery Date: 5' 10" Height: 363 lb Start Weight: 211 lb Current Weight: 165 lb Goal Weight: 152 lb Weight Loss: 46 lb Lb Left to Lose: 41.8732782369 % % Lost: 12/31/09 Goal Date: Body Mass Index 52.0793877551 BMI Start: 30.2720408163 BMI Current: 23.6724489796 BMI Goal: Weight Loss Method Roux en Y Gastric Bypass	You should only need one appeal. Two is the max I think. When they appeal it the letter will come from your surgeon to there medical director. The nurses at your health insurance company wont have anything to do with the decision this time. You have had such a problem with the office staff at that office to begin with. I will say I don't like the fact they picked though your medical records and sent just 15 pages. OK think of it this way. If you were ever diagnosed with hypertension, diabetes, sleep apena, ect.......these are weight related. Edema, skin rashes, numbness, joint pain, those are related to. I know you feel the Dr's office staff should be trained on what to send......but as you stated this Dr. is famous, and he is very busy. If you feel your still not trusting the staff... call and speak with the office manager. You tell her what is going on and Im sure she or he will look into it for you. Keep fighting Donna. I just wish you didn't have to fight as hard as you are but your gonna have to. Craig The guy that runs this site had to fight to. I would look into purchasing his book on line and giving it a good look. If your denied again.,......... I wont know what else I can suggest to help you. All I can do is suggest and lead you on what I know. The Drs letter will be the key to your puzzle in your situation. __________________ REMEMBER.. Tough times never last Tough people do. This ribbon is for our Lady Lisa and all the beautiful women that fight this ugly disease. Last edited by MsVickie : 05-17-2007 at 07:11 PM. Reason: spelling

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05-19-2007, 06:24 AM	#3 (permalink)
Kenyar Seasoned Veteran Join Date: Apr 2007 Location: Mount Vernon, NY Posts: 7,520 Weight Statistics 4/1/07 Start Date: 4/19/07 Surgery Date: 5' 9" Height: 258 lb Start Weight: 165 lb Current Weight: 165 lb Goal Weight: 93 lb Weight Loss: 36.0465116279 % % Lost: 04/19/2008 Goal Date: Body Mass Index 38.0957781979 BMI Start: 24.36357908 BMI Current: 24.36357908 BMI Goal: Weight Loss Method Roux en Y Gastric Bypass	I think you should trust in yourself. WHile the dr's office will be the ones writing letters and speaking with the ins companies, KEEP COPIES OF EVERYTHING. follow up ON EVERYTHING. make yourself seen and known by all parties. If you have to call weekly or daily to follow up do so, also it might not hurt to write a personal cover letter type of document when you re-submit your documentation for your appeal. Dont just leave it in the dr's office's hands. Please please please dollow up and dont give up.