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Kaiser So. Sacramento frustration

Discussion in 'Insurance' started by Diana S., Jan 11, 2017.

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    Melli

    Melli Revision Gastric Bypass

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    How can I send you a message
     
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    SheenaM

    SheenaM Member

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    So I filed a complaint with member services, my pcp sent the referral stating it was medically necessary to see a bariatric surgeon. I see Dr. Y on a Wednesday. I am 10lbs over my preop wait from 2009! Thanks to meds and these crazy abdominal hunger pains which are actually physical and a crappy metabolism.

    My question, how do I specifically ask for a revision? Tell him why? Or just tell him I want it? What if he says no? What if I get told it’s in my head again? One step closer!!
     
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    southernlady

    southernlady Administrator Staff Member

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    Who are you wanting to send a message to?
     
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    Diana S.

    Diana S. Well-Known Member

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    I wrote a letter that said that I am requesting this procedure to treat my morbid obesity. I meet the National Institute of Health guidelines and my insurance's guidelines for this procedure (list them out if you like and compare your info to those guidelines, like the min BMI is 40 and I am BMI 47, or I'm between 35-40 but I have these co-morbids). I need this procedure over say the RNY because of the long term weight loss (citing sources for your facts), because of my need for NSAIDs (if you do), because of anything else you can think of to convince the reader that the DS is exactly the right surgery for you.

    If they agree with you, AWESOME. If they officially deny you, then you use that denial and get on the appeals train with @Larra and @DianaCox
     
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    SheenaM

    SheenaM Member

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    But I already had rny, I want a revision of it or to convert to a DS!
     
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    Diana S.

    Diana S. Well-Known Member

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    Ok, cool, well then I would list why the RNY failed you - if it failed to meet your weight loss goal, if it caused you physical problems, or if you needed to have surgery to correct something that went sideways... just generally how the RNY is not working for you, and how the DS would make your life so much better/more livable.

    I did the same thing, but I had the sleeve - so the next step was either the RNY or the DS for me and there's a million reasons why the RNY would simply not work for me. I think if anyone reading my NOVEL of appeals letters (other than the people who have to finance this) were to get through all my reasoning, history, citations, etc... they'd be completely educated on what I'm asking for and convinced to my side. At least that was the goal.
     
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    Melli

    Melli Revision Gastric Bypass

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    Diana S.

    Diana S. Well-Known Member

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    I did! There’s another thread around here which was my entire experience up to my surgery date... like December 1: this happened.

    I had my DS revision with Dr. Rabkin on February 8th and I’m feeling awesome :)
     
    JackieOnLine likes this.
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    Marquis Mark

    Marquis Mark Well-Known Member

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    Sorry you're going through all that. Nothing more maddening that an arrogant, under-informed douchebag doctor.
     
    JackieOnLine likes this.
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    Melli

    Melli Revision Gastric Bypass

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    No I literally gave up but I’m having so many problems I go weeks without tmi going to the bathroom an constant tummy burning I’m not sure what to do anymore
     

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