doctor consult today

Discussion in 'Revisions' started by squisheez, Sep 29, 2017.

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    squisheez

    squisheez Member

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    I'm sitting in the Kaiser waiting room, waiting for my consult with the doctor. I'm so nervous. I have been waiting for 3 weeks, and I know it will be over quickly. I just want this so much, and I know I am gonna get denied. Wish me luck.
     
    Munchkin likes this.
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    Munchkin

    Munchkin Full of Fairy Dust

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    You can fight denied. Just don't give up!
     
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    squisheez

    squisheez Member

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    Dr told me there is no such thing as a revision. I asked if he put in my chart that I requested one, he said he did. What do I do from here? Do I request a formal denial from Kaiser?
     
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    Duckman

    Duckman Well-Known Member

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    slow down, help us help you. Where are you starting from and where do you want to go?
     
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    squisheez

    squisheez Member

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    I had RNY in 2010, lost about 60lbs, am currently 280, and since I found out about the possibility of a revision to ds I have been working towards it. DS was never mentioned as a possibility when I had RNY. I told the surgeon I wanted the most severe surgery, RNY was it at the time.
     
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    Munchkin

    Munchkin Full of Fairy Dust

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    The DS was available in 2010. They lied to you. Post a copy of your EOC here. That's Evidence Of Coverage from your insurance company. Should be @100 pages or so.
     
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    squisheez

    squisheez Member

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    I sent it to Larra, and she thought it was strangely worded. It didn't explain if a revision was covered, nothing about a second wls.
     
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    Larra

    Larra Well-Known Member

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    It sounds like you were told it was impossible (which you know is not the case) instead of being given a denial. It was a clever way to avoid making a denial, which you could then appeal.
    Since you have now had your consult with the bariatric surgeon, you could send him/her an email, very politely stating that you know that a revision of gastric bypass to the DS is possible, that it is done by Dr. Rabkin of Pacific Laparscopy in San Francisco, and requesting authorization for a revision to DS with him. Rest assured you will get a denial, but this puts everything in writing so you have something official in your medical record. You can then start internal appeals, which will eventually get you a final denial, and at that point you can go to external appeals.
     
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    southernlady

    southernlady Administrator Staff Member

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    @squisheez@squisheez just follow what @Larra@Larra and @DianaCox@DianaCox suggest. They are great at getting people their DS, virgin AND revision!
     
    Charris likes this.
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    DianaCox

    DianaCox Bad Cop

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    What Larra said is just what you need to do. You need a denial of your request for a revision - or a denial of a consult with a DS surgeons, since they don't have anyone in-network who even knows it exists. (The doctor FLAT OUT LIED to you - think about that for a minute or two ...)
     

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