I'm Halfway There...need Suggestions?

[Gigi_Girl 77]

BCBS has approved removal of may band due to medical problems! Yeh, I am halfway there.

But...they denied the revision to a sleeve stating insurance covers on one weight loss procedure in a lifetime.

I am in the process of composing a request asking review of predetermination to pay for the sleeve. I have composed a two page letter covering all the medical issues and leaking band, etc. and have closed with the following three paragraphs. I welcome your suggestions for improvement. I plan to mail Saturday.

________________________________

The band is leaking and defective. Would a product failure through no fault of my own not be reason enough to replace the band with another restrictive method? BCBSAL states that revision of adjustable gastric restrictive devices meets BCBSAL’s medical criteria for coverage provided there is either a band erosion or slippage, or infection around the port site. Would it not also be appropriate to revise due to a device failure?

The lack of proper fill levels has impacted my weight loss. Unfortunately, with the band failure, my weight is creeping up and I have gained 25 pounds from my low weight over the last 18 months. I am compliant in knowing what things I can and cannot eat and drink and I do Zumba several times a week and I walk. But without restriction, weight will inevitable continue to reappear. If I gain much more weight, sleep Apnea will likely return and I will be put back on a CPAP.

Thank you for understanding and approving the band removal to alleviate my medical issues, but please reconsider my request that my defective band be revised to a sleeve without further delay. All I want is to repair the damage done by the failed band and to restore the gastric restriction that I was originally approved for. Please help me bring this predetermination to a quick and satisfactory conclusion.

[chitowngirl 885]

It sounds good, it's worth a try. Best of luck.

[iwannabslim 67]

It wouldn't hurt to get your doctor involved in the appeals process. Check with the coordinator at the doctor's office. I bet they could help.

[IMSKINNY 160]

Maybe getting the doctor to say that at the time, had the sleeve been a recommended procedure (as opposed to experimental), he would have recommended the sleeve rather than the band.

[GivingItMyAll 168]

Good luck.

[Gigi_Girl 77]

Thanks for everyone's comments and well wishes. Keep your fingers crossed!