Grrrr.. denied

[Christine_California 0]

I don't fully understand my "denial" paperwork, but it looks like my physician didn't properly document my BMI, my weight and my co-morbidities.

I saw my primary care doctor and she said she put through a request for referral to the bariatric surgeon.

I got a letter today on letterhead from my physician's medical group, saying I was denied because they didn't have info on my BMI, my height and weight, my co-morbidities, my psychological fitness for surgery, and documentation that I've been on physician supervised diets. So essentially none of the health history we spent an hour discussing was passed on.

But in the letter I was given instructions on how to file a grievance, and the grievance letter is to be directed to my insurance company. So I'm not really sure who denied me.

At this point I'll write the grievance letter pointing out all the ways I am appropriate for WLS, and if it turns out it was actually the doctor who wasn't cooperating, I'll switch doctors. I have two coworkers who were referred to WLS through another primary care physician.

[aubrie 6]

It took me 11 months and TWO appeals to get approved. Don't give up!! Have ALL your doctors write letters on your behalf. That's what I ended up doing. I elisted the help of my cardiologist, my rhuemetologist, my OB/GYN, a psychiatrist for my psych eval., a sleep study doctor and my family doctor. All wrote letters for me on how the loss of weight would benefit me. Who could argue with all that?

[Christine_California 0]

It took me 11 months and TWO appeals to get approved. Don't give up!! Have ALL your doctors write letters on your behalf. That's what I ended up doing. I elisted the help of my cardiologist, my rhuemetologist, my OB/GYN, a psychiatrist for my psych eval., a sleep study doctor and my family doctor. All wrote letters for me on how the loss of weight would benefit me. Who could argue with all that?

Thanks for taking the time to respond. I guess my problem for now is that my family doctor takes care of all my weight-related

complications and since she isn't a supporter of WLS, I don't really have anyone on my side at this point. Maybe I'll contact the pulmonologist who prescribed the CPAP for apnea, and my former psychiatrist is well aware of how much my weight impacts my life, so she'd probably be supportive and write a letter as well.

Its very easy to give up and just say I've done this to myself, its just a matter of controlling what I put in my mouth, blah blah blah, so why should I expect health professionals and insurance companies to support me? :cursing:

[RestlessMonkey 7]

I guess my problem for now is that my family doctor takes care of all my weight-related complications and since she isn't a supporter of WLS, I don't really have anyone on my side at this point. :cursing:

Your primary doesn't need to "support" WLS....those medical records are on YOU and YOU have a right to that information. Start out asking nicely but if she won't provide what you need, demand it. You PAID her for her services and it is your info to do with as you please.