band to rny -- appeal rants!

[bartoe 0]

So I've started the grievence process and have a "hearing" date on 11/3 to explain to them why i want MY doctor to perform the revisional surgery because the doctor they want me to see is a complete idiot (i mean who mistakes a 60-year-old women for a 26-year-old patient and then lies to the insurance company about what the patient says?)

anyways i'm FREAKING out at the moment because I am going in front of a committee and the thought of it makes me want to be sick to my stomach. I have no idea what to expect and I'm not sure if there is anyone who'd even be able to give me information on what to expect.

I'm just really frustrated that they won't listen to me. they even had the balls to use my words of "imposition on her caregivers" what they didn't bother to read was my sister was involved in a near fatal head on collision and survived with a shattered left hip, left arm and fractured ankle...so she's an "imposition" to them.

sorry i just needed to rant to someone who doesn't know me lol. if anyone has any helpful advice i'd appreciate it greatly!

[Poodles 0]

They are just people. Don't be afraid of them.

If you have all your documention and have met their criteria it does not matter what is going on personally in your life. Just state the facts.

Now, because I don't know the specifics, if you are trying to get them to do a revision without meeting the policy procedures, I recommend you have some research stating how this would be a good thing to your health.

If they paid for the band, they should pay to convert. In my case, I had to show effort (lap band fill history), complications (egd report) and then I had to fight for a DS over an RNY. But there are 10-15 year studies out there about how the DS is better than the RNY... so I just printed them out and sent it in.

First and formost remember they are people. No better than you. Don't let them intimidate you. It is your health and they are your health insurance carrier... so they are going to pay for it one way or another. I was sure to point out how much they were spending on doctors visits, meds, surgeries, er visits etc... cost to benefit ratio there. They put in X amount of dollars now to avoid XX amount of dollars later.

Good luck!