Thank You

[MaryL 0]

Hi, my name is Mary and I've just registered with the site. Despite that, I'm very familiar with Vertical Sleeve Talk, because it has been my "go-to" place for help and advice these past several months.

I began the journey toward weight loss surgery in April of this year and, thoroughly researching my options, knew from the start that I wanted the vertical sleeve. But my insurance is Anthem Blue Cross (in Southern California), and I felt pretty dismal about my chances of being approved. My surgeon, (Quilici) requested the sleeve, but, sure enough, Anthem denied the procedure on the basis that it is "always" experimental. They approved me instead for the gastric bypass. If it hadn't been for everyone on this forum, I never would have had the knowledge or courage to file an appeal.

I want to thank all of you so very much. Because of you, I knew to file the appeal directly with the DMHC in California, rather than with Anthem, and I knew exactly the information to send and what I should include in my letter.

And I won my appeal! I'm scheduled to be sleeved on September 24th, and am looking forward to a new, healthy life. I'm even excited about starting my two-week pre-surgery liquid diet tomorrow. (Although I imagine the thrill of liquids may wear off in about three days. <G>)

So thank you all very much. I'm so glad to be getting the sleeve instead of the bypass, and never would have been able to get that accomplished without the amazing help and advice you all have shared.

-- Mary

[mp8btpc 33]

Mary that is so wonderful to hear. Way to stick to your guns and use the information to make it happen. Congrats on your upcoming surgery and keep us posted.

[Mary Gordon 3]

good for you....you will definitely love your sleeve plus your new journey to weight loss.....please keep us posted.....best of luck!!!:biggrin0:

[FitatFifty 11]

Congratulatoins Mary! It feels so good to win your appeal. I did too and my surgery date is Sept. 16--next Thursday.

Fit

[SandiKay 0]

I have Anthem in CA also...so how or what did you put in your appeal letter? I do appreciate it.

[goodlife 3]

Congratulations!

Best wishes on your surgery!

[MaryL 0]

Thank you all so much for your good wishes. This has definitely been one of the most interesting journeys of my life!

Sandi, I got your private e-mail and will send you a copy of my appeal letter. I would try to post information here but I'm not sure how to upload documents.

Basically I spent a great deal of time researching what the most successful appeals seemed to be, and these focused on why the sleeve is better for that particular individual. In my case, for instance, I have had a lifelong struggle with anemia, which the bypass might have made much worse, (because of malabsorption), and I have mild arthritis which may one day require NSAIDs, another big problem with the bypass. I listed my various medical and future concerns in my appeal and then provided documentation (there are tons of great articles and papers on the web) to support my arguments. (I think I had 14 attachments.)

From what I've read, and from my own experience, focusing on specifics like medical issues rather than on general feelings, such as saying that you just like the idea of the sleeve more, appears to make the difference in winning your appeal.

Hope this is helpful. (Sandi, keep an eye out for an e-mail from me.)

-- Mary