Denial

Denied! "Not Medically Necessary"-- that's what my insurance -SH- says about the turbinate and septoplasty part of the surgery. The MMA/jaw and genioglossus/tongue part is covered and medically necessary but not the nose part. This was the original decision of the authorization proposal but I got the review committee decision today after the appeal letter was sent in by me and Dr S. Basically, the reasoning... I'm fat. Yep. My insurance company called me fat. I'm hurt, I admit it. I also admit I'm fat, however that doesn't change anything. According to the appeal review because I didn't got out and loose half my body weight like 2 different physicians said to I cannot have the nose part of the surgery. Because I haven't tried "alternate, less invasive methods". Gah! Wow?! Where ever do I begin with that, I think to myself... Maybe if they would have gotten records from say oh, my PCP that I've seen for 10+ years and knows the constant struggle with weight is not so easy with a few medical conditions? But no, they have the two pages of office notes from a first time visit to an ENT the week before Dr S's initial consult for an ear infection and then Dr S's notes from my initial consult which includes the referral from my sleep doc. Oh well... It's ok. I'm conflicted though. I would know for sure we'd tried everything and done it all in one surgical stay and time off work. That this drastic MMA surgery has the best capability to reach its full potential of curing OSA 95% of the time. But, on the other hand... I'm so very claustrophobic that having my nose done too and all stuffed up at the same time of my jaw and tongue all swollen and banded shut I'm pretty sure that'd kill me! And by kill me I mean both literally and mentally! It'd be in my head the whole time that I was suffocating if I had no breathing capabilities. So, I'm going to try to not be annoyed that I didn't win my appeal and try again with the actual valid medical records from my PCP-the one who knows- and try to forget they called me fat and just let it go. Its a good thing. They don't think its medically necessary as well- that my septum isn't deviated enough (or at all?) so maybe I'll just hold on to that hope that my nose is fine- even if it is small and always infected... but at least it'll be an open passage to which I will breath while banded shut! Denial... I can live with that. :)