External Review Advice

[Kelly S]

@DianaCox and @Larra

Appealing denial for Revision-Seeking interpretation of policy.

Please see attached documents for in depth information regarding my case.

Summary

Surgery 1 - 11/13/2002- RNY - Dr. T. Scott

• 242 down to 192 & stalled due to staple line failure

Surgery 2 - 2/23/2006-Dr. K. Warnock

• Laparotonomy with lysis of adhesions, partial gastrectomy, reversal of previous gastric bypass RNY w/ conversion to new RNY (transected stomach from pouch)
• Lowest weight 149 (through 2009)
• Maintained 160-165 (2009-2013)

Current status: Stretched stoma and pouch. Weight 192-5'8

• 
  
  
  • Pre Auth-Denied
  • Appeal #1 - Denied
  • Preparing external review titled rebuttle

Insurance - United Healthcare - through (former employer who is self insured L'Oreal USA-On Cobra)

Thank you!