gastric bypass complications

I had gastric bypass surgery in 97 and now my staples have come out. I went to a doctor here in TN to see if this could be repaired. He can but my insurance has turned me down twice. I am now scared I have been in pain for the past week my right side where the band is located is sore and when I touch this aread it is very tender and painful. I can fell it when I move. I don't know what to do since my insurance will not cover any of this. I can not afford to pay to have it corrected. I have Cigna PPo and I have even been through the appeal process. Please help me I am very scared. Tina:confused:

[pmanrnbflo]

Winerthawk,

You do not indicate how many levels of appeal you have gone through orif your request was denied contractually as cosmetic services or for lack of medical necessity. I am currently employed in the medical insurance industry. In my state, a person has the right to appeal to an external review board for medical services that are denied as not medically necessary, and has the right to go before the member concerns committee for contractual denials. The member concerns committee is made up of individuals from the community adn it is a forum for you to appreal to the humanity of the board. They are advised by te legal department of the ins. company, but their decision of fianl and binding. I personally have been witness to cases presented by the individual who has been denied services and seen the cases overturned. It is importantthat you follow every appeal process to the last level.

If I could offer any advise, it would be to follow your appeal process through every level. If you are unsucsessful, complain to your local politicians. That seems to get our administrators attention, and while you are at it, call your department of health and department of insurance to file a complaint. Your complaints of pain and ow this condition is affecting your ability to perform activities of daily living along with keeping you from employment, not to mention your medical well being and safety Should all be well documented.

Good Luck.