Kinda denied, but!!!!!!
I appealed my initial denial when my insurance company said I had not complied with ANYTHING AT ALL on their criteria. I am also very stubborn and don't like to be told the word no.
For about five months (on and off) I have crafted an appeal, much of which I borrowed heavily from Diane S. and Rose. I wrote a detailed, concise, matter of fact letter. I also attached 10 exhibits to point out why the VSG is better for me and why it should not be considered investigational.
I received a letter that my appeal had been reviewed by 3 doctors and 3 nurses in various high up position. They all agreed that I WAS a candidate for bariatric surgery if I just lost about 22 pounds.
They also agreed that they still considered the VSG investigational, HOWEVER, were going to start researching it as an alternative to other surgeries, and that they would be developing a criteria for it if it was approved.
I SOOO don't see this as a no! I feel like this is just a "wait'. Plus, I am going to find out who the people are to research this so I can point them in certain directions to get a faster start. Number one on that list will be Dr. Cirangle.
If anyone has any other suggestions, I would appreciate it!
Thank you from the bottom of my heart to everyone who has answered questions, and to Rose (Sublimate) and Diane S. who have disseminated such valuable information that I was able to use.
Not yet is waaay better than no!!
For about five months (on and off) I have crafted an appeal, much of which I borrowed heavily from Diane S. and Rose. I wrote a detailed, concise, matter of fact letter. I also attached 10 exhibits to point out why the VSG is better for me and why it should not be considered investigational.
I received a letter that my appeal had been reviewed by 3 doctors and 3 nurses in various high up position. They all agreed that I WAS a candidate for bariatric surgery if I just lost about 22 pounds.
They also agreed that they still considered the VSG investigational, HOWEVER, were going to start researching it as an alternative to other surgeries, and that they would be developing a criteria for it if it was approved.
I SOOO don't see this as a no! I feel like this is just a "wait'. Plus, I am going to find out who the people are to research this so I can point them in certain directions to get a faster start. Number one on that list will be Dr. Cirangle.
If anyone has any other suggestions, I would appreciate it!
Thank you from the bottom of my heart to everyone who has answered questions, and to Rose (Sublimate) and Diane S. who have disseminated such valuable information that I was able to use.
Not yet is waaay better than no!!
No heaven will not ever Heaven be
Unless my cats are there to welcome me.
~Author Unknown
Good luck! I too am working to get approval for VSG. I would be VERY interested in your letter and references if you wouldn't mind sharing. I just found out on Thursday of last week that I was approved for the RNY and Lap Band, but not VSG...but in no way shape or form want the Lap Band, and use anti inflammatories, have a history of IBD type stuff and have had a history of ulcers, so shouldn't even consider the RNY...insurance companies :-(
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