I'm so mad - revision denial

[ge0rgette2 95]

Just found out that I was denied revision due to GERD, the day before pre surgical testing tomorrow!

I'm sooooo angry!! 6 weeks, I've waited and this is what they do!!?

[GotItDoneInHarlem 302]

I'm so sorry about this. Can it be appealed?

[ge0rgette2 95]

I hope so, on hold with insurance now.... pathetic, its gastro related due to sleeve and they want more clinical visits and a nutritionist again.... I think someone dropped the ball on this one

[GotItDoneInHarlem 302]

Insurance was a major hurdle when I had my sleeve, but it was approved very quickly when I needed a revision due to GERD. I had already had a motility study, a pH study, and endoscopy done by the time I applied though.

[ge0rgette2 95]

me too - had gastro endo another swallowing test, etc... they're ridiculous - they are also stating I didn't maintain loss for 2 years.... they are missing the point

[RickM 1,752]

It sounds like someone in the surgeons office coded things wrong, and they are evaluating it as a weight loss revision rather than as complication revision

[ge0rgette2 95]

Maybe you’re right.
I called my gastro and they told me diagnosis from endo is GERD.

I had them fax results to doc again.
They stated denial is I didn’t have psych and 6m of visits for the last 2 years. Which is what I did last time. And still high BMI.

This should be different I was told. so I’m sure you’re right. They aren’t coding it correctly or someone at the insurance company isn’t doing their job.

[ge0rgette2 95]

They used 43644 as cpt code

[ge0rgette2 95]

Yay!!

overturned today. I’m moving forward