Yvonne
Well-Known Member
Ok @Larra and @DianaCox .
I believe I have everything you have requested. Go into this thinking this. I will NOT be using Dr. Cooper for SADI. I have already set up an appointment with Dr. Inman and that will be next Thursday. I talked to my attorney (Lindstrom) and they said they will halt any other payments (I owe $350 left of $950 and they were taking $100 a month) and put it all on hold. She didn't realize that I was having a SADI and she was SO glad that I have decided to do the DS instead. She told me that if the insurance company had found out it was not a DS, I would have had to have paid for the whole thing. I also read through Dr. Cooper's notes and I know that this is a "for-profit" business", but to see them talking about "what brings the most money" is disheartening. I also haven't heard a word from them.
The attorney sent me every single bit of my files. She actually offered to send all my files to me. She said to print the entire thing out. Print an extra copy of the psych eval and the dietetics to show her right at that first appointment, so they knew that I had already done those. Take ALL of it to the appointment I have. I also have the electronic files of it as well so I can send those if they want them instead of having to scan everything. The woman at Dr. Inman's office said their psych guy will most like read over it and decide if i need another one. That first one cost me $1500 btw.
The biggest thing is I need to get the band removal approved. I don't think she'll have trouble getting the DS approved if we can get the band out. Also I went to a "bariatric doc" from January 2013 through April 2014. Is that going to be too far away, considering my band is 10 years old, that's pretty recent to me. Then I started seeing my general doc every single month after that for my blood pressure that is still not completely controlled, and we also talked about different things to try for weight loss as well. Every month we talked about weight. Were they actual "diet" meetings? No. On the electric form they asked me every single diet I've been on. Should I list them by dates? I'm not sure I have all of the dates. But boy I've tried about all of them. Not unlike about everyone else on here. My MAIN issue is metabolic/endocrine. I diet like a champ but I need my insulin to go down in order to actually lose weight (I have PCOS).
OK, so the files attached are #1) the specific, to my husband's company, BCBS of IL RR Donnelley Bariatric Policy on covering bariatric surgery. #2)What I "think"? is the letter they submitted originally to BCBS for surgery. I'm not sure though as it's what my general practitioner filled out. #3)I can't tell heads or tails if one is the peer review denial and the other is the general denial, but it does have the reasons and codes on them.
Now remember again, I'm not going for the SADI. This is more information so that you can see what the policy is and it clear covers the DS (as long as a BMI of over 50, and I do), and I've done the psych and tried to diet. Now how much dieting do they expect? I have no idea. That's why I asked if that one diet doctor is too old? He did hormonal diet, plus he had his own program with shakes and pudding that were DISGUSTING BTW. He was working to get my estrogen down and work with the insulin problems. He cost me over $100/month cash, but we have every monthly visit for him as well in the big bundle.
I'm wanting to look for a few things. How we can get the band out. Being prepared to send an appeal letter if we need to. The attorney said they'll be right back on board if I need them. She also said to stress my time factor in that I need this before the end of the year due to my outrageous deductible ($8000). Actually at this point, my surgery will almost be all paid at 100% because I've spent so much preparing for it.
Thanks for your help.
Yvonne
I believe I have everything you have requested. Go into this thinking this. I will NOT be using Dr. Cooper for SADI. I have already set up an appointment with Dr. Inman and that will be next Thursday. I talked to my attorney (Lindstrom) and they said they will halt any other payments (I owe $350 left of $950 and they were taking $100 a month) and put it all on hold. She didn't realize that I was having a SADI and she was SO glad that I have decided to do the DS instead. She told me that if the insurance company had found out it was not a DS, I would have had to have paid for the whole thing. I also read through Dr. Cooper's notes and I know that this is a "for-profit" business", but to see them talking about "what brings the most money" is disheartening. I also haven't heard a word from them.
The attorney sent me every single bit of my files. She actually offered to send all my files to me. She said to print the entire thing out. Print an extra copy of the psych eval and the dietetics to show her right at that first appointment, so they knew that I had already done those. Take ALL of it to the appointment I have. I also have the electronic files of it as well so I can send those if they want them instead of having to scan everything. The woman at Dr. Inman's office said their psych guy will most like read over it and decide if i need another one. That first one cost me $1500 btw.
The biggest thing is I need to get the band removal approved. I don't think she'll have trouble getting the DS approved if we can get the band out. Also I went to a "bariatric doc" from January 2013 through April 2014. Is that going to be too far away, considering my band is 10 years old, that's pretty recent to me. Then I started seeing my general doc every single month after that for my blood pressure that is still not completely controlled, and we also talked about different things to try for weight loss as well. Every month we talked about weight. Were they actual "diet" meetings? No. On the electric form they asked me every single diet I've been on. Should I list them by dates? I'm not sure I have all of the dates. But boy I've tried about all of them. Not unlike about everyone else on here. My MAIN issue is metabolic/endocrine. I diet like a champ but I need my insulin to go down in order to actually lose weight (I have PCOS).
OK, so the files attached are #1) the specific, to my husband's company, BCBS of IL RR Donnelley Bariatric Policy on covering bariatric surgery. #2)What I "think"? is the letter they submitted originally to BCBS for surgery. I'm not sure though as it's what my general practitioner filled out. #3)I can't tell heads or tails if one is the peer review denial and the other is the general denial, but it does have the reasons and codes on them.
Now remember again, I'm not going for the SADI. This is more information so that you can see what the policy is and it clear covers the DS (as long as a BMI of over 50, and I do), and I've done the psych and tried to diet. Now how much dieting do they expect? I have no idea. That's why I asked if that one diet doctor is too old? He did hormonal diet, plus he had his own program with shakes and pudding that were DISGUSTING BTW. He was working to get my estrogen down and work with the insulin problems. He cost me over $100/month cash, but we have every monthly visit for him as well in the big bundle.
I'm wanting to look for a few things. How we can get the band out. Being prepared to send an appeal letter if we need to. The attorney said they'll be right back on board if I need them. She also said to stress my time factor in that I need this before the end of the year due to my outrageous deductible ($8000). Actually at this point, my surgery will almost be all paid at 100% because I've spent so much preparing for it.
Thanks for your help.
Yvonne
