Has Anyone Had Experience With A Phone Conference Appeal?

[happy1957 138]

Hello VSG Talk. I have been here for nearly a year now, first lurking, then excited as my journey unfolded and hanging out quite a bit. Then after my first insurance denial I slowed down on my visits. I appealed and was denied a second time and haven't stopped by at all. My surgeon has appealed yet again and this coming Tuesday the 13th I am scheduled for a second and final appeal. I have been invited or a representative to join the meeting (impossible due to distance) or via phone conference. My surgeon has no offered to join in and has wished me luck. I assume that means I'm on my own.

Has anyone here joined in on one of these appeals? What is it like? Should I be prepared with anything other than my records? The letter said NOT to be intimidated and I'm usually not, but telling me NOT to be, is like saying don't eat or want that cupcake.

Help.............

[jasleeve 440]

ive never been but i guess some good tips would be, use the bathroom prior to the call so youre not holding it while youre on the phone. take a tylenol or two before so that youre not too tensed and dont work up a headache. maybe write a little speech about how being denied has made you feel and how badly you need this and what being obese is to you physically (dont mention appearance & dont make it too long). have a glass of Water to relax you. dress comfortably so you can relax. and play out scenarios in your head. thats really the only advice i can give you since thats what i would do.

good luck to you

[Shellyac 22]

You should check out the ASMBS position paper on the sleeve (www.asmbs.org the paper is about halfway down the page) , especially if the reason you are being denied is having a lower BMI. The paper was just released at the end of October. A previous position paper is the reason that BCBS, an possibly other insurance companies, reason for requiring a 50 or higher BMI. This new paper now recommends the sleeve as a primary procedure. Even if the BMI isn't the reason the paper is good source of reasons why the sleeve is an effective procedure

[illgeturhairdid 176]

I work with insurance companies and help my patients find loop holes all the time.

Why are you being denied?

What conditions do you have that would be improved by weight loss?

What is the insurance company?

[happy1957 138]

I work with insurance companies and help my patients find loop holes all the time.

Why are you being denied?

What conditions do you have that would be improved by weight loss?

What is the insurance company?

I was denied because of a low BMI in 2009 when working with a trainer. I had started out the year at the correct BMi and my only weight reference is the on line weight chart where I started the guided diet and training and it ended abruptly when I stopped. I had lost enough weight to fall to a BMI of 32. I quickly regained the weight, but all they see is the 32 BMI. :-( AETNA) I would like to improve, high blood pressure, recent high blood sugars, high cholesterol, joint pain, strong family history of diabetes (death of dad) and stroke, death of brother and mother (who is institutionalized) . I appreciated your help...

any suggestions is great!!

[happy1957 138]

You should check out the ASMBS position paper on the sleeve (www.asmbs.org the paper is about halfway down the page) , especially if the reason you are being denied is having a lower BMI. The paper was just released at the end of October. A previous position paper is the reason that BCBS, an possibly other insurance companies, reason for requiring a 50 or higher BMI. This new paper now recommends the sleeve as a primary procedure. Even if the BMI isn't the reason the paper is good source of reasons why the sleeve is an effective procedure

Thank you for your response.. I will check this out. A low BMI in 2009 is the issue. Aetna requires a consistent 24 month BMI. I fell below their required 40 BMI in 2009 while working with a trainer. :-( yet have been heavy my entire life with a roller coaster of weight loss and regain plus.

[happy1957 138]

ive never been but i guess some good tips would be, use the bathroom prior to the call so youre not holding it while youre on the phone. take a tylenol or two before so that youre not too tensed and dont work up a headache. maybe write a little speech about how being denied has made you feel and how badly you need this and what being obese is to you physically (dont mention appearance & dont make it too long). have a glass of Water to relax you. dress comfortably so you can relax. and play out scenarios in your head. thats really the only advice i can give you since thats what i would do.

good luck to you

Thanks for your response and suggestions. I think a anti anxiety medication may be warranted. I have no idea what their expectations are of me. I am in need of this for health reasons. I am slowly slipping into the obesity multi health issues world. It needs to stop before I am totally

handicapped by my weight.

[jasleeve 440]

my next suggestion would be to wait until the new year. then 2009 shouldnt matter. only 2010-2011 will matter as you will now be in 2012!

I was denied because of a low BMI in 2009 when working with a trainer. I had started out the year at the correct BMi and my only weight reference is the on line weight chart where I started the guided diet and training and it ended abruptly when I stopped. I had lost enough weight to fall to a BMI of 32. I quickly regained the weight, but all they see is the 32 BMI. :-( AETNA) I would like to improve, high blood pressure, recent high blood sugars, high cholesterol, joint pain, strong family history of diabetes (death of dad) and stroke, death of brother and mother (who is institutionalized) . I appreciated your help...

any suggestions is great!!

[happy1957 138]

Just a update.... I had the phone conference. It was really quite easy. There were 5 people present, one Dr. 2 nurses, the narrator and myself. They just asked why I thought they should overturn their decision and and I started with that I understood their ONLY reason for my denial was the low BMI in 2009 which was caused by but another attempt at diet and exercise, although I had started 2009 with the correct BMI. Then I just opened up like faucet. I had no problem telling my story which was easy because it was the truth. I will admit, I did get emotional at one time because it's difficult pouring your heart and soul out to strangers when you can't even pour it out to the people you love without feeling condemned in some way. It was a humbling experience. I know these people have a job to do and if things don't work out, it's not one individuals fault. It's a majority vote and I suspect God's will. It was my second level and last appeal. I meet all the requirements, have all the records around that date. They had very few questions, thanked me for representing myself, said I did a great job and that after hanging up they would continue the decision making process and let me know in a few days. My letter said they had to let me know within 5 days. I'll keep you informed. Thanks for listening,.

[illgeturhairdid 176]

Just a update.... I had the phone conference. It was really quite easy. There were 5 people present, one Dr. 2 nurses, the narrator and myself. They just asked why I thought they should overturn their decision and and I started with that I understood their ONLY reason for my denial was the low BMI in 2009 which was caused by but another attempt at diet and exercise, although I had started 2009 with the correct BMI. Then I just opened up like faucet. I had no problem telling my story which was easy because it was the truth. I will admit, I did get emotional at one time because it's difficult pouring your heart and soul out to strangers when you can't even pour it out to the people you love without feeling condemned in some way. It was a humbling experience. I know these people have a job to do and if things don't work out, it's not one individuals fault. It's a majority vote and I suspect God's will. It was my second level and last appeal. I meet all the requirements, have all the records around that date. They had very few questions, thanked me for representing myself, said I did a great job and that after hanging up they would continue the decision making process and let me know in a few days. My letter said they had to let me know within 5 days. I'll keep you informed. Thanks for listening,.

I'm keeping my fingers crossed for you!

[jasleeve 440]

youre in my prayers!!!

[happy1957 138]

OMG!!!!!!!!!!!!!!!!!!!!!!!! Thank you everyone for your prayers.... I was officially approved today! I am so overwhelmed and shocked to tell you the truth. This was my final appeal. To all of those of you that have been denied. Please don't give up!!!!

The surgeons office is making arrangements as I write this to set a date for this year!!!! This is the best Christmas present ever. Thank you for listening!!! Thank you God for helping me save my life!!

[jasleeve 440]

CONGRATS MY LOVE!!!! im so happy for you!!! <3

OMG!!!!!!!!!!!!!!!!!!!!!!!! Thank you everyone for your prayers.... I was officially approved today! I am so overwhelmed and shocked to tell you the truth. This was my final appeal. To all of those of you that have been denied. Please don't give up!!!!

The surgeons office is making arrangements as I write this to set a date for this year!!!! This is the best Christmas present ever. Thank you for listening!!! Thank you God for helping me save my life!!

[Swimmer 199]

Congrats!

[happy1957 138]

Date set Dec 28th at 7:00 am.... Happy, Happy, Happy!!! labs done last night, liquid diet starts tomorrow. This is a whirlwind of good things to come. :-)

Merry Christmas everyone!