Submission round 2

[Amey]

@DianaCox. The LOMN has not been submitted yet. It was supposed to be in my fax machine when I got to work this morning..... But it's not here. She has promised me I would have it today. Evidently there is a dr leaving their office for medical reasons and it has caused some things to be delayed and moved around which is understandable. I will the LOMN as soon as I receive it. Thank you so much for checking in on me and keeping in touch.... I don't know anybody with a DS except here and the FB groups and it feels kind of scary sometimes.

 

[Amey]

@DianaCox and @Larra This is the LOMN that was faxed to me. It HAS NOT been submitted yet. I will be calling the office in the morning to let the insurance coordinator know of any changes I want made. Would you PLEASE look this over and let me know what should be changed. I feel it talks a lot about their practice and not enough of my MEDICAL NECESSITY. How should this read? I will make sure she includes the letter from my PCP. It says NOTHING about my band being removed as a life or death situation which is the only reason it was approved at Cottam's office....and it doesn't refer to the original approval stating they had already approved it or why the reasons they denied me in the first place are just plain wrong. Maybe I have it all wrong and this is the 'starting all over' letter. But I really feel that it needs to state that it is a LIFE OR DEATH situation to have my band removed and to have the revision ASAP. I have to get back to her 1st thing in the morning so hit me with all you got!!

 

[Amey]

Crap! The file is too big....I'll try to take a pic with my phone when I get home.....Give me 20 minutes to get home.

 

[Amey]

I took pictures of the letter with my phone and emailed them to myself so I could save them on my computer since I don't have a scanner at home. I'm hoping this works.

It looked like they uploaded...where did they go? UGH!!!

Fuck a duck...what am I doing wrong? These are in JPEG format. I have tried to upload them 3 times now.

 

[southernlady]

I took pictures of the letter with my phone and emailed them to myself so I could save them on my computer since I don't have a scanner at home. I'm hoping this works.

It looked like they uploaded...where did they go? UGH!!!

You may have to use something like photobucket and post them in a private folder, then copy the code and post it here in the Image button...which is next to the + button along the top of a post WHILE typing.

 

[southernlady]

Amey's LOMN:

 

[southernlady]

I figured out why they were not posting...they were HUGE. As in the smallest one was 4 MEGABYTES (MB)! This forum has a limit of 250 Kilobytes (KB)and 1 MB is 1000 KB.

 

[Amey]

You are amazing!! Thank you so so much!!

 

[DianaCox]

It is disappointing that they did not mention the life-threatening reflux, the aspiration incident and how you almost died, and that at least the band removal was already pre approved. They should also have used the words in your bariatric policy, word for word like the letter we write, and stated that you meet each requirement.

This is a sign of a lazy insurance coordinator who doesn't take his/her job seriously, nor the patient's life.

 

[Amey]

I agree.... How can I or what can I say that will not offend her yet get my point across that this is just not acceptable? And..... What exactly should it say? I know we wrote the PCP referral letter.... And that is not referenced in this letter. What would be your advice to fix this disaster that will surely be denied based on the fact that it does not show Medical Necessity?

 

[DianaCox]

Ask to speak to Dr. Simper. Tell him an attorney with bariatric insurance authorization experience reviewed the letter and deemed it inadequate in view of the language of your policy and prior interactions with the insurance company. It MUST repeat the medical necessity language and assert that you meet it.

 

[Amey]

I have never met Dr Simper so he doesn't know me from any other person on the street ....they wanted to see if I would qualify before I made an appt. Would you recommend ammending the letter and submitting it or waiting until I can get an appt and go to Utah for a face to face appt before the paperwork is submitted? I will certainly let her know, as tactfully as I can, that the verbage glorifying their clinic does help me. I need the verbage from my policy and the support that I meet those requirements. I will edit the letter myself, adding in the PCP letter verbage verbatim, if I need to. This is important... I don't want to fight a long drawn out series of appeals.

 

[Amey]

*does not help me

 

[DianaCox]

You need to have it fixed before submission. Tell them you are working with a lawyer who recommended changes to their form letter in your case.

 

[Amey]

I am rewriting it now... Quoting and supporting everything I can from the BC policy.