Guest guest Posted October 11, 2002 Report Share Posted October 11, 2002 It is my experience that most doctors do not try to precert removal of saline implants. They assume there will be no medical necessity. You might recommend that they ask before they schedule and have the surgery, as it is much more difficult to get approval after the surgery. . -----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Thursday, October 10, 2002 9:12 AM Subject: Re: For Dr. Kolb I am under the belief that many ps' do precert the procedure. Granted, a mastopexy will never be covered by insr, but more and more companies are okaying explantation. And most doctors will automatically submit a request for precert/preauth as well as a treatment plan, and documentation of medical necessity. Now, if a woman is not having any health problems and simply wants them out, chances are insr may not pay for them. But with the work I've done with insr companies, most will pay if medically necessary, and almost all docs do get precert/preauth. And in my experience working with ps who do explant, even if it's not medically necessary, they will still try to get precert/preauth and get the insr company to pay. And I've seen this happen all over the country including the SE, NW, South, SW, and Rocky Mtn Region. e ----- Original Message ----- From: Dr. Kolb Sent: Wednesday, October 09, 2002 8:56 PM Subject: RE: For Dr. Kolb : Most of my patients have explantations covered by their insurance company so this gives them plenty of money for the supplement program. I understand that other surgeons do not precert the procedure and so no coverage is available as many plans require precertification. You did however have the $3000 for Feng's mastopexy. Mine is $2000 so that would have given you $1000 for supplements as well. . -----Original Message-----From: Heer [mailto:idagirl@...]Sent: Wednesday, October 09, 2002 11:13 AM Subject: Re: For Dr. Kolb Dear I didn't have an extra $200 a month I guess that is the point. I didn't have ANY money at all when I got explanted so I had no money to pay my house payment let alone to go on a supervised program. If it took me longer to get better than so be it I really had no other alternatives. My poor parents loaned me the money to get my implants out, after that I had nothing , I had a daughter to support and a house and bills to pay, so I had to do what I had to do, if I could buy a few groceries each month that was a good thing. I agree that if you can afford to do a supervised program that is wonderful and I never ever said your program was not good, I recomend it highly to people all the time. I guess my point which may have gotten lost in all the posts here was that if you can't do it the way you recomend you can get well doing it the way I did. Maybe it is not the best or perfect way, but it worked for me. I am not yet 2 years post explant and I am better. I also could not afford diflucan, those pills cost about what $25 a piece??? I got a script for them once and it was like 200 bucks for about 10 or less. I had to buy 4 of them with my hard earned money and that was not enough to do anything for me. THe insurance refused to pay for them. They did pay for nystatin and I took that for 2 months but that was before my explant when I was trying to keep the implants. your program is wonderful I am not and have never ever said it was not wonderful. It just was not something I could afford. I was living pay check to pay check then and I could not ask my parents to give me anymore money. It was just the way I did things. I did do yeast free diets at first but found that for the most part when I went off them I didn't feel any different. Dr Blais did analyze my implants and told me there was streptolococus,(sp?) but never mentioned yeast, I am not sure I ever had it or not to be honest. Anyhow I am better now, I guess I did the poor mans detox program. That was my point. Sorry if I didn't make it clear. So what do you recomend for people who cannot afford $200 bucks a month? to some of us that is all we have to support our families! Take care C ----- Original Message ----- From: Dr. Kolb Sent: Tuesday, October 08, 2002 10:07 PM Subject: RE: For Dr. Kolb : Most of the patients that Dr. Blais has examined their implants have fungus as a primary problem. A rheumatolgist looked at 3000 silicone patients and told me that 3000 had yeast. You had all the symptoms of a systemic fungal infection after your explant. I told you this at the time and recommended Diflucan and you disagreed with me. You would had had a much faster recovery if you had taken my advice then. The supplement program is specifically designed to correct the immune defect that causes the yeast problem so please let this be unless you do the research. When patients finish the yeast medicine and have not been on the detox and immune program long enough, they typically relapse. I agree that getting the implants out is important but so is the immune therapy and the treatment of the yeast and bacteria. The supplement program is approximately $200/ month so what is the point? . -----Original Message-----From: Heer [mailto:idagirl@...]Sent: Tuesday, October 08, 2002 9:55 AM Subject: Re: For Dr. Kolb I also crave chocolate and sweets around my period, this means it is PMS related. I just think that yes, yeast can be this problem, but also it is not wise to blame everything on yeast. I for one never get yeast infections, I just maybe have had one or two my whole life, once was when I was on all those antibiotics from the H pylori. I also know allot of the naturopathic dr's tell you that yeast can still be an issue if you don't have a yeast infection, which may be true, but lets be careful when we assume that it is yeast all the time, because they can take you for lots of $$$$ selling the supplements for yeast too. In reality I still think for most of us, getting the implants out, is the best and biggest step to take towards our healing! ----- Original Message ----- From: Bos@... Sent: Monday, October 07, 2002 11:20 AM Subject: Re: For Dr. Kolb I read once that a sweet craving means the body really wants/needs protein. . .in my experience, this is so. Yeast problems can occur without implants. . .a compromised immune system can help it grow and the immune system can be weak just due to a poor diet. . .but yeast thrives on sugar. . . when my sugar cravings became more frequent I ate more protein and the carvings subsided--I don't know if there was an overabundance of yeast or not. I think one's acid-alkaline balance (again which can be off due to diet) has a lot to do with this. Someone recently mentioned Hulda 's vitamins--Hulda used to focus on yeast about 18 years ago--it would be interesting to get her input also. I believe there are tests for yeasts and fungi (sp?) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 11, 2002 Report Share Posted October 11, 2002 Here again, , I disagree, and in my experience, most women do explant because of health problems, and therefore, medical necessity. I have worked with close to a hundred women, if not more, in getting them help to get their insurance to pay for explant. While a hundred or so women may not be a lot in the grand scheme of things, if a pt is ill and their physician(s) feel the illnesses are related to implants, it can be very successfully argued that explant is medically necessary, and therefore, covered by insurance. I have worked for United Healthcare, Cigna, and a company called Sloan's Lake. Depending on the pts plan policy and provisions, the surgery may or may not be a covered benefit. However, with an appeal, each of these companies has reversed their original decision to deny, and have covered the entire procedure minus the outpatient surgical copay. Furthermore, if there is any chance an insurance company may pay for explant, 99.9% of the time, any type of surgical procedure MUST be peauthed/precerted or else the pt pays a penalty or does not get coverage. Other than purely cosmetic type surgery done by ps' and dermatologists (dermabrasion, chemical peels, botox, etc), I have never met or encountered a physician that doesn't get precert/preauth for a procedure. I have never heard of a doctors office obtaining preauth/precert after a procedure, because, like you said, to get a retro auth is very difficult. Besides, if there's any chance insurance is going to pay for a procedure, the insurance/billing office for that doctor typically won't even allow surgery to be scheduled until they have that hot auth in their hands. And even with that auth, that is no guarantee benefits will be paid. e ----- Original Message ----- From: Dr. Kolb Sent: Thursday, October 10, 2002 7:49 PM Subject: RE: For Dr. Kolb It is my experience that most doctors do not try to precert removal of saline implants. They assume there will be no medical necessity. You might recommend that they ask before they schedule and have the surgery, as it is much more difficult to get approval after the surgery. . -----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Thursday, October 10, 2002 9:12 AM Subject: Re: For Dr. Kolb I am under the belief that many ps' do precert the procedure. Granted, a mastopexy will never be covered by insr, but more and more companies are okaying explantation. And most doctors will automatically submit a request for precert/preauth as well as a treatment plan, and documentation of medical necessity. Now, if a woman is not having any health problems and simply wants them out, chances are insr may not pay for them. But with the work I've done with insr companies, most will pay if medically necessary, and almost all docs do get precert/preauth. And in my experience working with ps who do explant, even if it's not medically necessary, they will still try to get precert/preauth and get the insr company to pay. And I've seen this happen all over the country including the SE, NW, South, SW, and Rocky Mtn Region. e ----- Original Message ----- From: Dr. Kolb Sent: Wednesday, October 09, 2002 8:56 PM Subject: RE: For Dr. Kolb : Most of my patients have explantations covered by their insurance company so this gives them plenty of money for the supplement program. I understand that other surgeons do not precert the procedure and so no coverage is available as many plans require precertification. You did however have the $3000 for Feng's mastopexy. Mine is $2000 so that would have given you $1000 for supplements as well. . -----Original Message-----From: Heer [mailto:idagirl@...]Sent: Wednesday, October 09, 2002 11:13 AM Subject: Re: For Dr. Kolb Dear I didn't have an extra $200 a month I guess that is the point. I didn't have ANY money at all when I got explanted so I had no money to pay my house payment let alone to go on a supervised program. If it took me longer to get better than so be it I really had no other alternatives. My poor parents loaned me the money to get my implants out, after that I had nothing , I had a daughter to support and a house and bills to pay, so I had to do what I had to do, if I could buy a few groceries each month that was a good thing. I agree that if you can afford to do a supervised program that is wonderful and I never ever said your program was not good, I recomend it highly to people all the time. I guess my point which may have gotten lost in all the posts here was that if you can't do it the way you recomend you can get well doing it the way I did. Maybe it is not the best or perfect way, but it worked for me. I am not yet 2 years post explant and I am better. I also could not afford diflucan, those pills cost about what $25 a piece??? I got a script for them once and it was like 200 bucks for about 10 or less. I had to buy 4 of them with my hard earned money and that was not enough to do anything for me. THe insurance refused to pay for them. They did pay for nystatin and I took that for 2 months but that was before my explant when I was trying to keep the implants. your program is wonderful I am not and have never ever said it was not wonderful. It just was not something I could afford. I was living pay check to pay check then and I could not ask my parents to give me anymore money. It was just the way I did things. I did do yeast free diets at first but found that for the most part when I went off them I didn't feel any different. Dr Blais did analyze my implants and told me there was streptolococus,(sp?) but never mentioned yeast, I am not sure I ever had it or not to be honest. Anyhow I am better now, I guess I did the poor mans detox program. That was my point. Sorry if I didn't make it clear. So what do you recomend for people who cannot afford $200 bucks a month? to some of us that is all we have to support our families! Take care C ----- Original Message ----- From: Dr. Kolb Sent: Tuesday, October 08, 2002 10:07 PM Subject: RE: For Dr. Kolb : Most of the patients that Dr. Blais has examined their implants have fungus as a primary problem. A rheumatolgist looked at 3000 silicone patients and told me that 3000 had yeast. You had all the symptoms of a systemic fungal infection after your explant. I told you this at the time and recommended Diflucan and you disagreed with me. You would had had a much faster recovery if you had taken my advice then. The supplement program is specifically designed to correct the immune defect that causes the yeast problem so please let this be unless you do the research. When patients finish the yeast medicine and have not been on the detox and immune program long enough, they typically relapse. I agree that getting the implants out is important but so is the immune therapy and the treatment of the yeast and bacteria. The supplement program is approximately $200/ month so what is the point? . -----Original Message-----From: Heer [mailto:idagirl@...]Sent: Tuesday, October 08, 2002 9:55 AM Subject: Re: For Dr. Kolb I also crave chocolate and sweets around my period, this means it is PMS related. I just think that yes, yeast can be this problem, but also it is not wise to blame everything on yeast. I for one never get yeast infections, I just maybe have had one or two my whole life, once was when I was on all those antibiotics from the H pylori. I also know allot of the naturopathic dr's tell you that yeast can still be an issue if you don't have a yeast infection, which may be true, but lets be careful when we assume that it is yeast all the time, because they can take you for lots of $$$$ selling the supplements for yeast too. In reality I still think for most of us, getting the implants out, is the best and biggest step to take towards our healing! ----- Original Message ----- From: Bos@... Sent: Monday, October 07, 2002 11:20 AM Subject: Re: For Dr. Kolb I read once that a sweet craving means the body really wants/needs protein. . .in my experience, this is so. Yeast problems can occur without implants. . .a compromised immune system can help it grow and the immune system can be weak just due to a poor diet. . .but yeast thrives on sugar. . . when my sugar cravings became more frequent I ate more protein and the carvings subsided--I don't know if there was an overabundance of yeast or not. I think one's acid-alkaline balance (again which can be off due to diet) has a lot to do with this. Someone recently mentioned Hulda 's vitamins--Hulda used to focus on yeast about 18 years ago--it would be interesting to get her input also. I believe there are tests for yeasts and fungi (sp?) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 11, 2002 Report Share Posted October 11, 2002 e: We always try to get insurance verification if possible. I am stating that many patients tell me they are scheduled for explantation or have explantation with other surgeons without this being done. Perhaps you misunderstood my post. . -----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Friday, October 11, 2002 1:39 AM Subject: Re: For Dr. Kolb Here again, , I disagree, and in my experience, most women do explant because of health problems, and therefore, medical necessity. I have worked with close to a hundred women, if not more, in getting them help to get their insurance to pay for explant. While a hundred or so women may not be a lot in the grand scheme of things, if a pt is ill and their physician(s) feel the illnesses are related to implants, it can be very successfully argued that explant is medically necessary, and therefore, covered by insurance. I have worked for United Healthcare, Cigna, and a company called Sloan's Lake. Depending on the pts plan policy and provisions, the surgery may or may not be a covered benefit. However, with an appeal, each of these companies has reversed their original decision to deny, and have covered the entire procedure minus the outpatient surgical copay. Furthermore, if there is any chance an insurance company may pay for explant, 99.9% of the time, any type of surgical procedure MUST be peauthed/precerted or else the pt pays a penalty or does not get coverage. Other than purely cosmetic type surgery done by ps' and dermatologists (dermabrasion, chemical peels, botox, etc), I have never met or encountered a physician that doesn't get precert/preauth for a procedure. I have never heard of a doctors office obtaining preauth/precert after a procedure, because, like you said, to get a retro auth is very difficult. Besides, if there's any chance insurance is going to pay for a procedure, the insurance/billing office for that doctor typically won't even allow surgery to be scheduled until they have that hot auth in their hands. And even with that auth, that is no guarantee benefits will be paid. e ----- Original Message ----- From: Dr. Kolb Sent: Thursday, October 10, 2002 7:49 PM Subject: RE: For Dr. Kolb It is my experience that most doctors do not try to precert removal of saline implants. They assume there will be no medical necessity. You might recommend that they ask before they schedule and have the surgery, as it is much more difficult to get approval after the surgery. . -----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Thursday, October 10, 2002 9:12 AM Subject: Re: For Dr. Kolb I am under the belief that many ps' do precert the procedure. Granted, a mastopexy will never be covered by insr, but more and more companies are okaying explantation. And most doctors will automatically submit a request for precert/preauth as well as a treatment plan, and documentation of medical necessity. Now, if a woman is not having any health problems and simply wants them out, chances are insr may not pay for them. But with the work I've done with insr companies, most will pay if medically necessary, and almost all docs do get precert/preauth. And in my experience working with ps who do explant, even if it's not medically necessary, they will still try to get precert/preauth and get the insr company to pay. And I've seen this happen all over the country including the SE, NW, South, SW, and Rocky Mtn Region. e ----- Original Message ----- From: Dr. Kolb Sent: Wednesday, October 09, 2002 8:56 PM Subject: RE: For Dr. Kolb : Most of my patients have explantations covered by their insurance company so this gives them plenty of money for the supplement program. I understand that other surgeons do not precert the procedure and so no coverage is available as many plans require precertification. You did however have the $3000 for Feng's mastopexy. Mine is $2000 so that would have given you $1000 for supplements as well. . -----Original Message-----From: Heer [mailto:idagirl@...]Sent: Wednesday, October 09, 2002 11:13 AM Subject: Re: For Dr. Kolb Dear I didn't have an extra $200 a month I guess that is the point. I didn't have ANY money at all when I got explanted so I had no money to pay my house payment let alone to go on a supervised program. If it took me longer to get better than so be it I really had no other alternatives. My poor parents loaned me the money to get my implants out, after that I had nothing , I had a daughter to support and a house and bills to pay, so I had to do what I had to do, if I could buy a few groceries each month that was a good thing. I agree that if you can afford to do a supervised program that is wonderful and I never ever said your program was not good, I recomend it highly to people all the time. I guess my point which may have gotten lost in all the posts here was that if you can't do it the way you recomend you can get well doing it the way I did. Maybe it is not the best or perfect way, but it worked for me. I am not yet 2 years post explant and I am better. I also could not afford diflucan, those pills cost about what $25 a piece??? I got a script for them once and it was like 200 bucks for about 10 or less. I had to buy 4 of them with my hard earned money and that was not enough to do anything for me. THe insurance refused to pay for them. They did pay for nystatin and I took that for 2 months but that was before my explant when I was trying to keep the implants. your program is wonderful I am not and have never ever said it was not wonderful. It just was not something I could afford. I was living pay check to pay check then and I could not ask my parents to give me anymore money. It was just the way I did things. I did do yeast free diets at first but found that for the most part when I went off them I didn't feel any different. Dr Blais did analyze my implants and told me there was streptolococus,(sp?) but never mentioned yeast, I am not sure I ever had it or not to be honest. Anyhow I am better now, I guess I did the poor mans detox program. That was my point. Sorry if I didn't make it clear. So what do you recomend for people who cannot afford $200 bucks a month? to some of us that is all we have to support our families! Take care C ----- Original Message ----- From: Dr. Kolb Sent: Tuesday, October 08, 2002 10:07 PM Subject: RE: For Dr. Kolb : Most of the patients that Dr. Blais has examined their implants have fungus as a primary problem. A rheumatolgist looked at 3000 silicone patients and told me that 3000 had yeast. You had all the symptoms of a systemic fungal infection after your explant. I told you this at the time and recommended Diflucan and you disagreed with me. You would had had a much faster recovery if you had taken my advice then. The supplement program is specifically designed to correct the immune defect that causes the yeast problem so please let this be unless you do the research. When patients finish the yeast medicine and have not been on the detox and immune program long enough, they typically relapse. I agree that getting the implants out is important but so is the immune therapy and the treatment of the yeast and bacteria. The supplement program is approximately $200/ month so what is the point? . -----Original Message-----From: Heer [mailto:idagirl@...]Sent: Tuesday, October 08, 2002 9:55 AM Subject: Re: For Dr. Kolb I also crave chocolate and sweets around my period, this means it is PMS related. I just think that yes, yeast can be this problem, but also it is not wise to blame everything on yeast. I for one never get yeast infections, I just maybe have had one or two my whole life, once was when I was on all those antibiotics from the H pylori. I also know allot of the naturopathic dr's tell you that yeast can still be an issue if you don't have a yeast infection, which may be true, but lets be careful when we assume that it is yeast all the time, because they can take you for lots of $$$$ selling the supplements for yeast too. In reality I still think for most of us, getting the implants out, is the best and biggest step to take towards our healing! ----- Original Message ----- From: Bos@... Sent: Monday, October 07, 2002 11:20 AM Subject: Re: For Dr. Kolb I read once that a sweet craving means the body really wants/needs protein. . .in my experience, this is so. Yeast problems can occur without implants. . .a compromised immune system can help it grow and the immune system can be weak just due to a poor diet. . .but yeast thrives on sugar. . . when my sugar cravings became more frequent I ate more protein and the carvings subsided--I don't know if there was an overabundance of yeast or not. I think one's acid-alkaline balance (again which can be off due to diet) has a lot to do with this. Someone recently mentioned Hulda 's vitamins--Hulda used to focus on yeast about 18 years ago--it would be interesting to get her input also. I believe there are tests for yeasts and fungi (sp?) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 11, 2002 Report Share Posted October 11, 2002 I should also mention I had a crappy HMO that sucked! ----- Original Message ----- From: Dr. Kolb Sent: Friday, October 11, 2002 4:34 AM Subject: RE: For Dr. Kolb e: We always try to get insurance verification if possible. I am stating that many patients tell me they are scheduled for explantation or have explantation with other surgeons without this being done. Perhaps you misunderstood my post. . -----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Friday, October 11, 2002 1:39 AM Subject: Re: For Dr. Kolb Here again, , I disagree, and in my experience, most women do explant because of health problems, and therefore, medical necessity. I have worked with close to a hundred women, if not more, in getting them help to get their insurance to pay for explant. While a hundred or so women may not be a lot in the grand scheme of things, if a pt is ill and their physician(s) feel the illnesses are related to implants, it can be very successfully argued that explant is medically necessary, and therefore, covered by insurance. I have worked for United Healthcare, Cigna, and a company called Sloan's Lake. Depending on the pts plan policy and provisions, the surgery may or may not be a covered benefit. However, with an appeal, each of these companies has reversed their original decision to deny, and have covered the entire procedure minus the outpatient surgical copay. Furthermore, if there is any chance an insurance company may pay for explant, 99.9% of the time, any type of surgical procedure MUST be peauthed/precerted or else the pt pays a penalty or does not get coverage. Other than purely cosmetic type surgery done by ps' and dermatologists (dermabrasion, chemical peels, botox, etc), I have never met or encountered a physician that doesn't get precert/preauth for a procedure. I have never heard of a doctors office obtaining preauth/precert after a procedure, because, like you said, to get a retro auth is very difficult. Besides, if there's any chance insurance is going to pay for a procedure, the insurance/billing office for that doctor typically won't even allow surgery to be scheduled until they have that hot auth in their hands. And even with that auth, that is no guarantee benefits will be paid. e ----- Original Message ----- From: Dr. Kolb Sent: Thursday, October 10, 2002 7:49 PM Subject: RE: For Dr. Kolb It is my experience that most doctors do not try to precert removal of saline implants. They assume there will be no medical necessity. You might recommend that they ask before they schedule and have the surgery, as it is much more difficult to get approval after the surgery. . -----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Thursday, October 10, 2002 9:12 AM Subject: Re: For Dr. Kolb I am under the belief that many ps' do precert the procedure. Granted, a mastopexy will never be covered by insr, but more and more companies are okaying explantation. And most doctors will automatically submit a request for precert/preauth as well as a treatment plan, and documentation of medical necessity. Now, if a woman is not having any health problems and simply wants them out, chances are insr may not pay for them. But with the work I've done with insr companies, most will pay if medically necessary, and almost all docs do get precert/preauth. And in my experience working with ps who do explant, even if it's not medically necessary, they will still try to get precert/preauth and get the insr company to pay. And I've seen this happen all over the country including the SE, NW, South, SW, and Rocky Mtn Region. e ----- Original Message ----- From: Dr. Kolb Sent: Wednesday, October 09, 2002 8:56 PM Subject: RE: For Dr. Kolb : Most of my patients have explantations covered by their insurance company so this gives them plenty of money for the supplement program. I understand that other surgeons do not precert the procedure and so no coverage is available as many plans require precertification. You did however have the $3000 for Feng's mastopexy. Mine is $2000 so that would have given you $1000 for supplements as well. . -----Original Message-----From: Heer [mailto:idagirl@...]Sent: Wednesday, October 09, 2002 11:13 AM Subject: Re: For Dr. Kolb Dear I didn't have an extra $200 a month I guess that is the point. I didn't have ANY money at all when I got explanted so I had no money to pay my house payment let alone to go on a supervised program. If it took me longer to get better than so be it I really had no other alternatives. My poor parents loaned me the money to get my implants out, after that I had nothing , I had a daughter to support and a house and bills to pay, so I had to do what I had to do, if I could buy a few groceries each month that was a good thing. I agree that if you can afford to do a supervised program that is wonderful and I never ever said your program was not good, I recomend it highly to people all the time. I guess my point which may have gotten lost in all the posts here was that if you can't do it the way you recomend you can get well doing it the way I did. Maybe it is not the best or perfect way, but it worked for me. I am not yet 2 years post explant and I am better. I also could not afford diflucan, those pills cost about what $25 a piece??? I got a script for them once and it was like 200 bucks for about 10 or less. I had to buy 4 of them with my hard earned money and that was not enough to do anything for me. THe insurance refused to pay for them. They did pay for nystatin and I took that for 2 months but that was before my explant when I was trying to keep the implants. your program is wonderful I am not and have never ever said it was not wonderful. It just was not something I could afford. I was living pay check to pay check then and I could not ask my parents to give me anymore money. It was just the way I did things. I did do yeast free diets at first but found that for the most part when I went off them I didn't feel any different. Dr Blais did analyze my implants and told me there was streptolococus,(sp?) but never mentioned yeast, I am not sure I ever had it or not to be honest. Anyhow I am better now, I guess I did the poor mans detox program. That was my point. Sorry if I didn't make it clear. So what do you recomend for people who cannot afford $200 bucks a month? to some of us that is all we have to support our families! Take care C ----- Original Message ----- From: Dr. Kolb Sent: Tuesday, October 08, 2002 10:07 PM Subject: RE: For Dr. Kolb : Most of the patients that Dr. Blais has examined their implants have fungus as a primary problem. A rheumatolgist looked at 3000 silicone patients and told me that 3000 had yeast. You had all the symptoms of a systemic fungal infection after your explant. I told you this at the time and recommended Diflucan and you disagreed with me. You would had had a much faster recovery if you had taken my advice then. The supplement program is specifically designed to correct the immune defect that causes the yeast problem so please let this be unless you do the research. When patients finish the yeast medicine and have not been on the detox and immune program long enough, they typically relapse. I agree that getting the implants out is important but so is the immune therapy and the treatment of the yeast and bacteria. The supplement program is approximately $200/ month so what is the point? . -----Original Message-----From: Heer [mailto:idagirl@...]Sent: Tuesday, October 08, 2002 9:55 AM Subject: Re: For Dr. Kolb I also crave chocolate and sweets around my period, this means it is PMS related. I just think that yes, yeast can be this problem, but also it is not wise to blame everything on yeast. I for one never get yeast infections, I just maybe have had one or two my whole life, once was when I was on all those antibiotics from the H pylori. I also know allot of the naturopathic dr's tell you that yeast can still be an issue if you don't have a yeast infection, which may be true, but lets be careful when we assume that it is yeast all the time, because they can take you for lots of $$$$ selling the supplements for yeast too. In reality I still think for most of us, getting the implants out, is the best and biggest step to take towards our healing! ----- Original Message ----- From: Bos@... Sent: Monday, October 07, 2002 11:20 AM Subject: Re: For Dr. Kolb I read once that a sweet craving means the body really wants/needs protein. . .in my experience, this is so. Yeast problems can occur without implants. . .a compromised immune system can help it grow and the immune system can be weak just due to a poor diet. . .but yeast thrives on sugar. . . when my sugar cravings became more frequent I ate more protein and the carvings subsided--I don't know if there was an overabundance of yeast or not. I think one's acid-alkaline balance (again which can be off due to diet) has a lot to do with this. Someone recently mentioned Hulda 's vitamins--Hulda used to focus on yeast about 18 years ago--it would be interesting to get her input also. I believe there are tests for yeasts and fungi (sp?) 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Guest guest Posted October 11, 2002 Report Share Posted October 11, 2002 Well they did try to get my insurance to pay, they said a big fat NO to that! ----- Original Message ----- From: Dr. Kolb Sent: Friday, October 11, 2002 4:34 AM Subject: RE: For Dr. Kolb e: We always try to get insurance verification if possible. I am stating that many patients tell me they are scheduled for explantation or have explantation with other surgeons without this being done. Perhaps you misunderstood my post. . -----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Friday, October 11, 2002 1:39 AM Subject: Re: For Dr. Kolb Here again, , I disagree, and in my experience, most women do explant because of health problems, and therefore, medical necessity. I have worked with close to a hundred women, if not more, in getting them help to get their insurance to pay for explant. While a hundred or so women may not be a lot in the grand scheme of things, if a pt is ill and their physician(s) feel the illnesses are related to implants, it can be very successfully argued that explant is medically necessary, and therefore, covered by insurance. I have worked for United Healthcare, Cigna, and a company called Sloan's Lake. Depending on the pts plan policy and provisions, the surgery may or may not be a covered benefit. However, with an appeal, each of these companies has reversed their original decision to deny, and have covered the entire procedure minus the outpatient surgical copay. Furthermore, if there is any chance an insurance company may pay for explant, 99.9% of the time, any type of surgical procedure MUST be peauthed/precerted or else the pt pays a penalty or does not get coverage. Other than purely cosmetic type surgery done by ps' and dermatologists (dermabrasion, chemical peels, botox, etc), I have never met or encountered a physician that doesn't get precert/preauth for a procedure. I have never heard of a doctors office obtaining preauth/precert after a procedure, because, like you said, to get a retro auth is very difficult. Besides, if there's any chance insurance is going to pay for a procedure, the insurance/billing office for that doctor typically won't even allow surgery to be scheduled until they have that hot auth in their hands. And even with that auth, that is no guarantee benefits will be paid. e ----- Original Message ----- From: Dr. Kolb Sent: Thursday, October 10, 2002 7:49 PM Subject: RE: For Dr. Kolb It is my experience that most doctors do not try to precert removal of saline implants. They assume there will be no medical necessity. You might recommend that they ask before they schedule and have the surgery, as it is much more difficult to get approval after the surgery. . -----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Thursday, October 10, 2002 9:12 AM Subject: Re: For Dr. Kolb I am under the belief that many ps' do precert the procedure. Granted, a mastopexy will never be covered by insr, but more and more companies are okaying explantation. And most doctors will automatically submit a request for precert/preauth as well as a treatment plan, and documentation of medical necessity. Now, if a woman is not having any health problems and simply wants them out, chances are insr may not pay for them. But with the work I've done with insr companies, most will pay if medically necessary, and almost all docs do get precert/preauth. And in my experience working with ps who do explant, even if it's not medically necessary, they will still try to get precert/preauth and get the insr company to pay. And I've seen this happen all over the country including the SE, NW, South, SW, and Rocky Mtn Region. e ----- Original Message ----- From: Dr. Kolb Sent: Wednesday, October 09, 2002 8:56 PM Subject: RE: For Dr. Kolb : Most of my patients have explantations covered by their insurance company so this gives them plenty of money for the supplement program. I understand that other surgeons do not precert the procedure and so no coverage is available as many plans require precertification. You did however have the $3000 for Feng's mastopexy. Mine is $2000 so that would have given you $1000 for supplements as well. . -----Original Message-----From: Heer [mailto:idagirl@...]Sent: Wednesday, October 09, 2002 11:13 AM Subject: Re: For Dr. Kolb Dear I didn't have an extra $200 a month I guess that is the point. I didn't have ANY money at all when I got explanted so I had no money to pay my house payment let alone to go on a supervised program. If it took me longer to get better than so be it I really had no other alternatives. My poor parents loaned me the money to get my implants out, after that I had nothing , I had a daughter to support and a house and bills to pay, so I had to do what I had to do, if I could buy a few groceries each month that was a good thing. I agree that if you can afford to do a supervised program that is wonderful and I never ever said your program was not good, I recomend it highly to people all the time. I guess my point which may have gotten lost in all the posts here was that if you can't do it the way you recomend you can get well doing it the way I did. Maybe it is not the best or perfect way, but it worked for me. I am not yet 2 years post explant and I am better. I also could not afford diflucan, those pills cost about what $25 a piece??? I got a script for them once and it was like 200 bucks for about 10 or less. I had to buy 4 of them with my hard earned money and that was not enough to do anything for me. THe insurance refused to pay for them. They did pay for nystatin and I took that for 2 months but that was before my explant when I was trying to keep the implants. your program is wonderful I am not and have never ever said it was not wonderful. It just was not something I could afford. I was living pay check to pay check then and I could not ask my parents to give me anymore money. It was just the way I did things. I did do yeast free diets at first but found that for the most part when I went off them I didn't feel any different. Dr Blais did analyze my implants and told me there was streptolococus,(sp?) but never mentioned yeast, I am not sure I ever had it or not to be honest. Anyhow I am better now, I guess I did the poor mans detox program. That was my point. Sorry if I didn't make it clear. So what do you recomend for people who cannot afford $200 bucks a month? to some of us that is all we have to support our families! Take care C ----- Original Message ----- From: Dr. Kolb Sent: Tuesday, October 08, 2002 10:07 PM Subject: RE: For Dr. Kolb : Most of the patients that Dr. Blais has examined their implants have fungus as a primary problem. A rheumatolgist looked at 3000 silicone patients and told me that 3000 had yeast. You had all the symptoms of a systemic fungal infection after your explant. I told you this at the time and recommended Diflucan and you disagreed with me. You would had had a much faster recovery if you had taken my advice then. The supplement program is specifically designed to correct the immune defect that causes the yeast problem so please let this be unless you do the research. When patients finish the yeast medicine and have not been on the detox and immune program long enough, they typically relapse. I agree that getting the implants out is important but so is the immune therapy and the treatment of the yeast and bacteria. The supplement program is approximately $200/ month so what is the point? . -----Original Message-----From: Heer [mailto:idagirl@...]Sent: Tuesday, October 08, 2002 9:55 AM Subject: Re: For Dr. Kolb I also crave chocolate and sweets around my period, this means it is PMS related. I just think that yes, yeast can be this problem, but also it is not wise to blame everything on yeast. I for one never get yeast infections, I just maybe have had one or two my whole life, once was when I was on all those antibiotics from the H pylori. I also know allot of the naturopathic dr's tell you that yeast can still be an issue if you don't have a yeast infection, which may be true, but lets be careful when we assume that it is yeast all the time, because they can take you for lots of $$$$ selling the supplements for yeast too. In reality I still think for most of us, getting the implants out, is the best and biggest step to take towards our healing! ----- Original Message ----- From: Bos@... Sent: Monday, October 07, 2002 11:20 AM Subject: Re: For Dr. Kolb I read once that a sweet craving means the body really wants/needs protein. . .in my experience, this is so. Yeast problems can occur without implants. . .a compromised immune system can help it grow and the immune system can be weak just due to a poor diet. . .but yeast thrives on sugar. . . when my sugar cravings became more frequent I ate more protein and the carvings subsided--I don't know if there was an overabundance of yeast or not. I think one's acid-alkaline balance (again which can be off due to diet) has a lot to do with this. Someone recently mentioned Hulda 's vitamins--Hulda used to focus on yeast about 18 years ago--it would be interesting to get her input also. I believe there are tests for yeasts and fungi (sp?) 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Guest guest Posted October 11, 2002 Report Share Posted October 11, 2002 , Who was/is your insurance company? LM Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 11, 2002 Report Share Posted October 11, 2002 HMO's do suck. I had Kaiser, it was a nightmare!!! LM Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 12, 2002 Report Share Posted October 12, 2002 , Insurance verification is different than insurance precert/preauth. e ----- Original Message ----- From: Dr. Kolb Sent: Friday, October 11, 2002 4:01 AM Subject: RE: For Dr. Kolb e: We always try to get insurance verification if possible. I am stating that many patients tell me they are scheduled for explantation or have explantation with other surgeons without this being done. Perhaps you misunderstood my post. . -----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Friday, October 11, 2002 1:39 AM Subject: Re: For Dr. Kolb Here again, , I disagree, and in my experience, most women do explant because of health problems, and therefore, medical necessity. I have worked with close to a hundred women, if not more, in getting them help to get their insurance to pay for explant. While a hundred or so women may not be a lot in the grand scheme of things, if a pt is ill and their physician(s) feel the illnesses are related to implants, it can be very successfully argued that explant is medically necessary, and therefore, covered by insurance. I have worked for United Healthcare, Cigna, and a company called Sloan's Lake. Depending on the pts plan policy and provisions, the surgery may or may not be a covered benefit. However, with an appeal, each of these companies has reversed their original decision to deny, and have covered the entire procedure minus the outpatient surgical copay. Furthermore, if there is any chance an insurance company may pay for explant, 99.9% of the time, any type of surgical procedure MUST be peauthed/precerted or else the pt pays a penalty or does not get coverage. Other than purely cosmetic type surgery done by ps' and dermatologists (dermabrasion, chemical peels, botox, etc), I have never met or encountered a physician that doesn't get precert/preauth for a procedure. I have never heard of a doctors office obtaining preauth/precert after a procedure, because, like you said, to get a retro auth is very difficult. Besides, if there's any chance insurance is going to pay for a procedure, the insurance/billing office for that doctor typically won't even allow surgery to be scheduled until they have that hot auth in their hands. And even with that auth, that is no guarantee benefits will be paid. e ----- Original Message ----- From: Dr. Kolb Sent: Thursday, October 10, 2002 7:49 PM Subject: RE: For Dr. Kolb It is my experience that most doctors do not try to precert removal of saline implants. They assume there will be no medical necessity. You might recommend that they ask before they schedule and have the surgery, as it is much more difficult to get approval after the surgery. . -----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Thursday, October 10, 2002 9:12 AM Subject: Re: For Dr. Kolb I am under the belief that many ps' do precert the procedure. Granted, a mastopexy will never be covered by insr, but more and more companies are okaying explantation. And most doctors will automatically submit a request for precert/preauth as well as a treatment plan, and documentation of medical necessity. Now, if a woman is not having any health problems and simply wants them out, chances are insr may not pay for them. But with the work I've done with insr companies, most will pay if medically necessary, and almost all docs do get precert/preauth. And in my experience working with ps who do explant, even if it's not medically necessary, they will still try to get precert/preauth and get the insr company to pay. And I've seen this happen all over the country including the SE, NW, South, SW, and Rocky Mtn Region. e ----- Original Message ----- From: Dr. Kolb Sent: Wednesday, October 09, 2002 8:56 PM Subject: RE: For Dr. Kolb : Most of my patients have explantations covered by their insurance company so this gives them plenty of money for the supplement program. I understand that other surgeons do not precert the procedure and so no coverage is available as many plans require precertification. You did however have the $3000 for Feng's mastopexy. Mine is $2000 so that would have given you $1000 for supplements as well. . -----Original Message-----From: Heer [mailto:idagirl@...]Sent: Wednesday, October 09, 2002 11:13 AM Subject: Re: For Dr. Kolb Dear I didn't have an extra $200 a month I guess that is the point. I didn't have ANY money at all when I got explanted so I had no money to pay my house payment let alone to go on a supervised program. If it took me longer to get better than so be it I really had no other alternatives. My poor parents loaned me the money to get my implants out, after that I had nothing , I had a daughter to support and a house and bills to pay, so I had to do what I had to do, if I could buy a few groceries each month that was a good thing. I agree that if you can afford to do a supervised program that is wonderful and I never ever said your program was not good, I recomend it highly to people all the time. I guess my point which may have gotten lost in all the posts here was that if you can't do it the way you recomend you can get well doing it the way I did. Maybe it is not the best or perfect way, but it worked for me. I am not yet 2 years post explant and I am better. I also could not afford diflucan, those pills cost about what $25 a piece??? I got a script for them once and it was like 200 bucks for about 10 or less. I had to buy 4 of them with my hard earned money and that was not enough to do anything for me. THe insurance refused to pay for them. They did pay for nystatin and I took that for 2 months but that was before my explant when I was trying to keep the implants. your program is wonderful I am not and have never ever said it was not wonderful. It just was not something I could afford. I was living pay check to pay check then and I could not ask my parents to give me anymore money. It was just the way I did things. I did do yeast free diets at first but found that for the most part when I went off them I didn't feel any different. Dr Blais did analyze my implants and told me there was streptolococus,(sp?) but never mentioned yeast, I am not sure I ever had it or not to be honest. Anyhow I am better now, I guess I did the poor mans detox program. That was my point. Sorry if I didn't make it clear. So what do you recomend for people who cannot afford $200 bucks a month? to some of us that is all we have to support our families! Take care C ----- Original Message ----- From: Dr. Kolb Sent: Tuesday, October 08, 2002 10:07 PM Subject: RE: For Dr. Kolb : Most of the patients that Dr. Blais has examined their implants have fungus as a primary problem. A rheumatolgist looked at 3000 silicone patients and told me that 3000 had yeast. You had all the symptoms of a systemic fungal infection after your explant. I told you this at the time and recommended Diflucan and you disagreed with me. You would had had a much faster recovery if you had taken my advice then. The supplement program is specifically designed to correct the immune defect that causes the yeast problem so please let this be unless you do the research. When patients finish the yeast medicine and have not been on the detox and immune program long enough, they typically relapse. I agree that getting the implants out is important but so is the immune therapy and the treatment of the yeast and bacteria. The supplement program is approximately $200/ month so what is the point? . -----Original Message-----From: Heer [mailto:idagirl@...]Sent: Tuesday, October 08, 2002 9:55 AM Subject: Re: For Dr. Kolb I also crave chocolate and sweets around my period, this means it is PMS related. I just think that yes, yeast can be this problem, but also it is not wise to blame everything on yeast. I for one never get yeast infections, I just maybe have had one or two my whole life, once was when I was on all those antibiotics from the H pylori. I also know allot of the naturopathic dr's tell you that yeast can still be an issue if you don't have a yeast infection, which may be true, but lets be careful when we assume that it is yeast all the time, because they can take you for lots of $$$$ selling the supplements for yeast too. In reality I still think for most of us, getting the implants out, is the best and biggest step to take towards our healing! ----- Original Message ----- From: Bos@... Sent: Monday, October 07, 2002 11:20 AM Subject: Re: For Dr. Kolb I read once that a sweet craving means the body really wants/needs protein. . .in my experience, this is so. Yeast problems can occur without implants. . .a compromised immune system can help it grow and the immune system can be weak just due to a poor diet. . .but yeast thrives on sugar. . . when my sugar cravings became more frequent I ate more protein and the carvings subsided--I don't know if there was an overabundance of yeast or not. I think one's acid-alkaline balance (again which can be off due to diet) has a lot to do with this. Someone recently mentioned Hulda 's vitamins--Hulda used to focus on yeast about 18 years ago--it would be interesting to get her input also. I believe there are tests for yeasts and fungi (sp?) 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Guest guest Posted October 12, 2002 Report Share Posted October 12, 2002 , Which HMO did you have (not that it matters now)? I'm just curious. So many of the insurance companies are getting better about paying. I find that initially they hem and haw and deny, then, with letters of medical necessity, and letters from the pt, they cave. I have lots of contacts in the insurance industry, and I talk to most of them about the importance of including this surgery in their benefit coverage. It's getting better, it's just not as easy as say, needing heart surgery, or repair of a fx'd bone. My hs sweetheart is an executive account manager for Cigna, and he will help out when he can when it comes to women needing the surgery and Cigna denies (Cigna doesn't deny often, though, they are one of the better companies). Anyway, I was just curious as to what HMO you had. Actually, HMO's are much better about paying than any PPO I've ever worked with. Really, HMO's are much better all around than PPO's. e ----- Original Message ----- From: Heer Sent: Friday, October 11, 2002 7:00 AM Subject: Re: For Dr. Kolb I should also mention I had a crappy HMO that sucked! ----- Original Message ----- From: Dr. Kolb Sent: Friday, October 11, 2002 4:34 AM Subject: RE: For Dr. Kolb e: We always try to get insurance verification if possible. I am stating that many patients tell me they are scheduled for explantation or have explantation with other surgeons without this being done. Perhaps you misunderstood my post. . -----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Friday, October 11, 2002 1:39 AM Subject: Re: For Dr. Kolb Here again, , I disagree, and in my experience, most women do explant because of health problems, and therefore, medical necessity. I have worked with close to a hundred women, if not more, in getting them help to get their insurance to pay for explant. While a hundred or so women may not be a lot in the grand scheme of things, if a pt is ill and their physician(s) feel the illnesses are related to implants, it can be very successfully argued that explant is medically necessary, and therefore, covered by insurance. I have worked for United Healthcare, Cigna, and a company called Sloan's Lake. Depending on the pts plan policy and provisions, the surgery may or may not be a covered benefit. However, with an appeal, each of these companies has reversed their original decision to deny, and have covered the entire procedure minus the outpatient surgical copay. Furthermore, if there is any chance an insurance company may pay for explant, 99.9% of the time, any type of surgical procedure MUST be peauthed/precerted or else the pt pays a penalty or does not get coverage. Other than purely cosmetic type surgery done by ps' and dermatologists (dermabrasion, chemical peels, botox, etc), I have never met or encountered a physician that doesn't get precert/preauth for a procedure. I have never heard of a doctors office obtaining preauth/precert after a procedure, because, like you said, to get a retro auth is very difficult. Besides, if there's any chance insurance is going to pay for a procedure, the insurance/billing office for that doctor typically won't even allow surgery to be scheduled until they have that hot auth in their hands. And even with that auth, that is no guarantee benefits will be paid. e ----- Original Message ----- From: Dr. Kolb Sent: Thursday, October 10, 2002 7:49 PM Subject: RE: For Dr. Kolb It is my experience that most doctors do not try to precert removal of saline implants. They assume there will be no medical necessity. You might recommend that they ask before they schedule and have the surgery, as it is much more difficult to get approval after the surgery. . -----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Thursday, October 10, 2002 9:12 AM Subject: Re: For Dr. Kolb I am under the belief that many ps' do precert the procedure. Granted, a mastopexy will never be covered by insr, but more and more companies are okaying explantation. And most doctors will automatically submit a request for precert/preauth as well as a treatment plan, and documentation of medical necessity. Now, if a woman is not having any health problems and simply wants them out, chances are insr may not pay for them. But with the work I've done with insr companies, most will pay if medically necessary, and almost all docs do get precert/preauth. And in my experience working with ps who do explant, even if it's not medically necessary, they will still try to get precert/preauth and get the insr company to pay. And I've seen this happen all over the country including the SE, NW, South, SW, and Rocky Mtn Region. e ----- Original Message ----- From: Dr. Kolb Sent: Wednesday, October 09, 2002 8:56 PM Subject: RE: For Dr. Kolb : Most of my patients have explantations covered by their insurance company so this gives them plenty of money for the supplement program. I understand that other surgeons do not precert the procedure and so no coverage is available as many plans require precertification. You did however have the $3000 for Feng's mastopexy. Mine is $2000 so that would have given you $1000 for supplements as well. . -----Original Message-----From: Heer [mailto:idagirl@...]Sent: Wednesday, October 09, 2002 11:13 AM Subject: Re: For Dr. Kolb Dear I didn't have an extra $200 a month I guess that is the point. I didn't have ANY money at all when I got explanted so I had no money to pay my house payment let alone to go on a supervised program. If it took me longer to get better than so be it I really had no other alternatives. My poor parents loaned me the money to get my implants out, after that I had nothing , I had a daughter to support and a house and bills to pay, so I had to do what I had to do, if I could buy a few groceries each month that was a good thing. I agree that if you can afford to do a supervised program that is wonderful and I never ever said your program was not good, I recomend it highly to people all the time. I guess my point which may have gotten lost in all the posts here was that if you can't do it the way you recomend you can get well doing it the way I did. Maybe it is not the best or perfect way, but it worked for me. I am not yet 2 years post explant and I am better. I also could not afford diflucan, those pills cost about what $25 a piece??? I got a script for them once and it was like 200 bucks for about 10 or less. I had to buy 4 of them with my hard earned money and that was not enough to do anything for me. THe insurance refused to pay for them. They did pay for nystatin and I took that for 2 months but that was before my explant when I was trying to keep the implants. your program is wonderful I am not and have never ever said it was not wonderful. It just was not something I could afford. I was living pay check to pay check then and I could not ask my parents to give me anymore money. It was just the way I did things. I did do yeast free diets at first but found that for the most part when I went off them I didn't feel any different. Dr Blais did analyze my implants and told me there was streptolococus,(sp?) but never mentioned yeast, I am not sure I ever had it or not to be honest. Anyhow I am better now, I guess I did the poor mans detox program. That was my point. Sorry if I didn't make it clear. So what do you recomend for people who cannot afford $200 bucks a month? to some of us that is all we have to support our families! Take care C ----- Original Message ----- From: Dr. Kolb Sent: Tuesday, October 08, 2002 10:07 PM Subject: RE: For Dr. Kolb : Most of the patients that Dr. Blais has examined their implants have fungus as a primary problem. A rheumatolgist looked at 3000 silicone patients and told me that 3000 had yeast. You had all the symptoms of a systemic fungal infection after your explant. I told you this at the time and recommended Diflucan and you disagreed with me. You would had had a much faster recovery if you had taken my advice then. The supplement program is specifically designed to correct the immune defect that causes the yeast problem so please let this be unless you do the research. When patients finish the yeast medicine and have not been on the detox and immune program long enough, they typically relapse. I agree that getting the implants out is important but so is the immune therapy and the treatment of the yeast and bacteria. The supplement program is approximately $200/ month so what is the point? . -----Original Message-----From: Heer [mailto:idagirl@...]Sent: Tuesday, October 08, 2002 9:55 AM Subject: Re: For Dr. Kolb I also crave chocolate and sweets around my period, this means it is PMS related. I just think that yes, yeast can be this problem, but also it is not wise to blame everything on yeast. I for one never get yeast infections, I just maybe have had one or two my whole life, once was when I was on all those antibiotics from the H pylori. I also know allot of the naturopathic dr's tell you that yeast can still be an issue if you don't have a yeast infection, which may be true, but lets be careful when we assume that it is yeast all the time, because they can take you for lots of $$$$ selling the supplements for yeast too. In reality I still think for most of us, getting the implants out, is the best and biggest step to take towards our healing! ----- Original Message ----- From: Bos@... Sent: Monday, October 07, 2002 11:20 AM Subject: Re: For Dr. Kolb I read once that a sweet craving means the body really wants/needs protein. . .in my experience, this is so. Yeast problems can occur without implants. . .a compromised immune system can help it grow and the immune system can be weak just due to a poor diet. . .but yeast thrives on sugar. . . when my sugar cravings became more frequent I ate more protein and the carvings subsided--I don't know if there was an overabundance of yeast or not. I think one's acid-alkaline balance (again which can be off due to diet) has a lot to do with this. Someone recently mentioned Hulda 's vitamins--Hulda used to focus on yeast about 18 years ago--it would be interesting to get her input also. I believe there are tests for yeasts and fungi (sp?) 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Guest guest Posted October 12, 2002 Report Share Posted October 12, 2002 It was Healthnet, now I have Intercare, part of the CCN preffered provider network, it is good but sometimes slow to pay! ----- Original Message ----- From: perlesetlacet@... Sent: Friday, October 11, 2002 2:29 PM Subject: Re: For Dr. Kolb ,Who was/is your insurance company?LM Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 12, 2002 Report Share Posted October 12, 2002 We get insurance precertification in writing prior to surgery. . -----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Friday, October 11, 2002 7:37 PM Subject: Re: For Dr. Kolb , Insurance verification is different than insurance precert/preauth. e ----- Original Message ----- From: Dr. Kolb Sent: Friday, October 11, 2002 4:01 AM Subject: RE: For Dr. Kolb e: We always try to get insurance verification if possible. I am stating that many patients tell me they are scheduled for explantation or have explantation with other surgeons without this being done. Perhaps you misunderstood my post. . -----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Friday, October 11, 2002 1:39 AM Subject: Re: For Dr. Kolb Here again, , I disagree, and in my experience, most women do explant because of health problems, and therefore, medical necessity. I have worked with close to a hundred women, if not more, in getting them help to get their insurance to pay for explant. While a hundred or so women may not be a lot in the grand scheme of things, if a pt is ill and their physician(s) feel the illnesses are related to implants, it can be very successfully argued that explant is medically necessary, and therefore, covered by insurance. I have worked for United Healthcare, Cigna, and a company called Sloan's Lake. Depending on the pts plan policy and provisions, the surgery may or may not be a covered benefit. However, with an appeal, each of these companies has reversed their original decision to deny, and have covered the entire procedure minus the outpatient surgical copay. Furthermore, if there is any chance an insurance company may pay for explant, 99.9% of the time, any type of surgical procedure MUST be peauthed/precerted or else the pt pays a penalty or does not get coverage. Other than purely cosmetic type surgery done by ps' and dermatologists (dermabrasion, chemical peels, botox, etc), I have never met or encountered a physician that doesn't get precert/preauth for a procedure. I have never heard of a doctors office obtaining preauth/precert after a procedure, because, like you said, to get a retro auth is very difficult. Besides, if there's any chance insurance is going to pay for a procedure, the insurance/billing office for that doctor typically won't even allow surgery to be scheduled until they have that hot auth in their hands. And even with that auth, that is no guarantee benefits will be paid. e ----- Original Message ----- From: Dr. Kolb Sent: Thursday, October 10, 2002 7:49 PM Subject: RE: For Dr. Kolb It is my experience that most doctors do not try to precert removal of saline implants. They assume there will be no medical necessity. You might recommend that they ask before they schedule and have the surgery, as it is much more difficult to get approval after the surgery. . -----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Thursday, October 10, 2002 9:12 AM Subject: Re: For Dr. Kolb I am under the belief that many ps' do precert the procedure. Granted, a mastopexy will never be covered by insr, but more and more companies are okaying explantation. And most doctors will automatically submit a request for precert/preauth as well as a treatment plan, and documentation of medical necessity. Now, if a woman is not having any health problems and simply wants them out, chances are insr may not pay for them. But with the work I've done with insr companies, most will pay if medically necessary, and almost all docs do get precert/preauth. And in my experience working with ps who do explant, even if it's not medically necessary, they will still try to get precert/preauth and get the insr company to pay. And I've seen this happen all over the country including the SE, NW, South, SW, and Rocky Mtn Region. e ----- Original Message ----- From: Dr. Kolb Sent: Wednesday, October 09, 2002 8:56 PM Subject: RE: For Dr. Kolb : Most of my patients have explantations covered by their insurance company so this gives them plenty of money for the supplement program. I understand that other surgeons do not precert the procedure and so no coverage is available as many plans require precertification. You did however have the $3000 for Feng's mastopexy. Mine is $2000 so that would have given you $1000 for supplements as well. . -----Original Message-----From: Heer [mailto:idagirl@...]Sent: Wednesday, October 09, 2002 11:13 AM Subject: Re: For Dr. Kolb Dear I didn't have an extra $200 a month I guess that is the point. I didn't have ANY money at all when I got explanted so I had no money to pay my house payment let alone to go on a supervised program. If it took me longer to get better than so be it I really had no other alternatives. My poor parents loaned me the money to get my implants out, after that I had nothing , I had a daughter to support and a house and bills to pay, so I had to do what I had to do, if I could buy a few groceries each month that was a good thing. I agree that if you can afford to do a supervised program that is wonderful and I never ever said your program was not good, I recomend it highly to people all the time. I guess my point which may have gotten lost in all the posts here was that if you can't do it the way you recomend you can get well doing it the way I did. Maybe it is not the best or perfect way, but it worked for me. I am not yet 2 years post explant and I am better. I also could not afford diflucan, those pills cost about what $25 a piece??? I got a script for them once and it was like 200 bucks for about 10 or less. I had to buy 4 of them with my hard earned money and that was not enough to do anything for me. THe insurance refused to pay for them. They did pay for nystatin and I took that for 2 months but that was before my explant when I was trying to keep the implants. your program is wonderful I am not and have never ever said it was not wonderful. It just was not something I could afford. I was living pay check to pay check then and I could not ask my parents to give me anymore money. It was just the way I did things. I did do yeast free diets at first but found that for the most part when I went off them I didn't feel any different. Dr Blais did analyze my implants and told me there was streptolococus,(sp?) but never mentioned yeast, I am not sure I ever had it or not to be honest. Anyhow I am better now, I guess I did the poor mans detox program. That was my point. Sorry if I didn't make it clear. So what do you recomend for people who cannot afford $200 bucks a month? to some of us that is all we have to support our families! Take care C ----- Original Message ----- From: Dr. Kolb Sent: Tuesday, October 08, 2002 10:07 PM Subject: RE: For Dr. Kolb : Most of the patients that Dr. Blais has examined their implants have fungus as a primary problem. A rheumatolgist looked at 3000 silicone patients and told me that 3000 had yeast. You had all the symptoms of a systemic fungal infection after your explant. I told you this at the time and recommended Diflucan and you disagreed with me. You would had had a much faster recovery if you had taken my advice then. The supplement program is specifically designed to correct the immune defect that causes the yeast problem so please let this be unless you do the research. When patients finish the yeast medicine and have not been on the detox and immune program long enough, they typically relapse. I agree that getting the implants out is important but so is the immune therapy and the treatment of the yeast and bacteria. The supplement program is approximately $200/ month so what is the point? . -----Original Message-----From: Heer [mailto:idagirl@...]Sent: Tuesday, October 08, 2002 9:55 AM Subject: Re: For Dr. Kolb I also crave chocolate and sweets around my period, this means it is PMS related. I just think that yes, yeast can be this problem, but also it is not wise to blame everything on yeast. I for one never get yeast infections, I just maybe have had one or two my whole life, once was when I was on all those antibiotics from the H pylori. I also know allot of the naturopathic dr's tell you that yeast can still be an issue if you don't have a yeast infection, which may be true, but lets be careful when we assume that it is yeast all the time, because they can take you for lots of $$$$ selling the supplements for yeast too. In reality I still think for most of us, getting the implants out, is the best and biggest step to take towards our healing! ----- Original Message ----- From: Bos@... Sent: Monday, October 07, 2002 11:20 AM Subject: Re: For Dr. Kolb I read once that a sweet craving means the body really wants/needs protein. . .in my experience, this is so. Yeast problems can occur without implants. . .a compromised immune system can help it grow and the immune system can be weak just due to a poor diet. . .but yeast thrives on sugar. . . when my sugar cravings became more frequent I ate more protein and the carvings subsided--I don't know if there was an overabundance of yeast or not. I think one's acid-alkaline balance (again which can be off due to diet) has a lot to do with this. Someone recently mentioned Hulda 's vitamins--Hulda used to focus on yeast about 18 years ago--it would be interesting to get her input also. I believe there are tests for yeasts and fungi (sp?) 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Guest guest Posted October 12, 2002 Report Share Posted October 12, 2002 Hi Ladies, Please remind me to explain, in the next couple of days; 'how, when, & why' an insurer legally HAS to pay for BI explantation. However, so many health plan insurers may have to be pushed really hard, to finally get them to pay for explant surgery. I'm sorry I don't have time to 'get into this' tonight ..... I have to get to bed so I can get up to go watch my precious little 9-year-old red-head win his Little League Homecoming Football Game at noon Saturday! His 10-year-old sister is the 'Head Cheerleader' for his team! "GO - Maraudars - GO"! MM PS - ... and "Hook-em Horns"!!! (TX vs OK) Martha Murdock, DirectorNational Silicone Implant Foundation | Dallas Headquarters"Supporting Survivors of Medical Implant Devices"4416 Willow LaneDallas, TX 75244-7537 ----- Original Message ----- From: Heer Sent: Friday, October 11, 2002 8:51 AM Subject: Re: For Dr. Kolb Well they did try to get my insurance to pay, they said a big fat NO to that! ----- Original Message ----- From: Dr. Kolb Sent: Friday, October 11, 2002 4:34 AM Subject: RE: For Dr. Kolb e: We always try to get insurance verification if possible. I am stating that many patients tell me they are scheduled for explantation or have explantation with other surgeons without this being done. Perhaps you misunderstood my post. . -----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Friday, October 11, 2002 1:39 AM Subject: Re: For Dr. Kolb Here again, , I disagree, and in my experience, most women do explant because of health problems, and therefore, medical necessity. I have worked with close to a hundred women, if not more, in getting them help to get their insurance to pay for explant. While a hundred or so women may not be a lot in the grand scheme of things, if a pt is ill and their physician(s) feel the illnesses are related to implants, it can be very successfully argued that explant is medically necessary, and therefore, covered by insurance. I have worked for United Healthcare, Cigna, and a company called Sloan's Lake. Depending on the pts plan policy and provisions, the surgery may or may not be a covered benefit. However, with an appeal, each of these companies has reversed their original decision to deny, and have covered the entire procedure minus the outpatient surgical copay. Furthermore, if there is any chance an insurance company may pay for explant, 99.9% of the time, any type of surgical procedure MUST be peauthed/precerted or else the pt pays a penalty or does not get coverage. Other than purely cosmetic type surgery done by ps' and dermatologists (dermabrasion, chemical peels, botox, etc), I have never met or encountered a physician that doesn't get precert/preauth for a procedure. I have never heard of a doctors office obtaining preauth/precert after a procedure, because, like you said, to get a retro auth is very difficult. Besides, if there's any chance insurance is going to pay for a procedure, the insurance/billing office for that doctor typically won't even allow surgery to be scheduled until they have that hot auth in their hands. And even with that auth, that is no guarantee benefits will be paid. e ----- Original Message ----- From: Dr. Kolb Sent: Thursday, October 10, 2002 7:49 PM Subject: RE: For Dr. Kolb It is my experience that most doctors do not try to precert removal of saline implants. They assume there will be no medical necessity. You might recommend that they ask before they schedule and have the surgery, as it is much more difficult to get approval after the surgery. . -----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Thursday, October 10, 2002 9:12 AM Subject: Re: For Dr. Kolb I am under the belief that many ps' do precert the procedure. Granted, a mastopexy will never be covered by insr, but more and more companies are okaying explantation. And most doctors will automatically submit a request for precert/preauth as well as a treatment plan, and documentation of medical necessity. Now, if a woman is not having any health problems and simply wants them out, chances are insr may not pay for them. But with the work I've done with insr companies, most will pay if medically necessary, and almost all docs do get precert/preauth. And in my experience working with ps who do explant, even if it's not medically necessary, they will still try to get precert/preauth and get the insr company to pay. And I've seen this happen all over the country including the SE, NW, South, SW, and Rocky Mtn Region. e ----- Original Message ----- From: Dr. Kolb Sent: Wednesday, October 09, 2002 8:56 PM Subject: RE: For Dr. Kolb : Most of my patients have explantations covered by their insurance company so this gives them plenty of money for the supplement program. I understand that other surgeons do not precert the procedure and so no coverage is available as many plans require precertification. You did however have the $3000 for Feng's mastopexy. Mine is $2000 so that would have given you $1000 for supplements as well. . -----Original Message-----From: Heer [mailto:idagirl@...]Sent: Wednesday, October 09, 2002 11:13 AM Subject: Re: For Dr. Kolb Dear I didn't have an extra $200 a month I guess that is the point. I didn't have ANY money at all when I got explanted so I had no money to pay my house payment let alone to go on a supervised program. If it took me longer to get better than so be it I really had no other alternatives. My poor parents loaned me the money to get my implants out, after that I had nothing , I had a daughter to support and a house and bills to pay, so I had to do what I had to do, if I could buy a few groceries each month that was a good thing. I agree that if you can afford to do a supervised program that is wonderful and I never ever said your program was not good, I recomend it highly to people all the time. I guess my point which may have gotten lost in all the posts here was that if you can't do it the way you recomend you can get well doing it the way I did. Maybe it is not the best or perfect way, but it worked for me. I am not yet 2 years post explant and I am better. I also could not afford diflucan, those pills cost about what $25 a piece??? I got a script for them once and it was like 200 bucks for about 10 or less. I had to buy 4 of them with my hard earned money and that was not enough to do anything for me. THe insurance refused to pay for them. They did pay for nystatin and I took that for 2 months but that was before my explant when I was trying to keep the implants. your program is wonderful I am not and have never ever said it was not wonderful. It just was not something I could afford. I was living pay check to pay check then and I could not ask my parents to give me anymore money. It was just the way I did things. I did do yeast free diets at first but found that for the most part when I went off them I didn't feel any different. Dr Blais did analyze my implants and told me there was streptolococus,(sp?) but never mentioned yeast, I am not sure I ever had it or not to be honest. Anyhow I am better now, I guess I did the poor mans detox program. That was my point. Sorry if I didn't make it clear. So what do you recomend for people who cannot afford $200 bucks a month? to some of us that is all we have to support our families! Take care C ----- Original Message ----- From: Dr. Kolb Sent: Tuesday, October 08, 2002 10:07 PM Subject: RE: For Dr. Kolb : Most of the patients that Dr. Blais has examined their implants have fungus as a primary problem. A rheumatolgist looked at 3000 silicone patients and told me that 3000 had yeast. You had all the symptoms of a systemic fungal infection after your explant. I told you this at the time and recommended Diflucan and you disagreed with me. You would had had a much faster recovery if you had taken my advice then. The supplement program is specifically designed to correct the immune defect that causes the yeast problem so please let this be unless you do the research. When patients finish the yeast medicine and have not been on the detox and immune program long enough, they typically relapse. I agree that getting the implants out is important but so is the immune therapy and the treatment of the yeast and bacteria. The supplement program is approximately $200/ month so what is the point? . -----Original Message-----From: Heer [mailto:idagirl@...]Sent: Tuesday, October 08, 2002 9:55 AM Subject: Re: For Dr. Kolb I also crave chocolate and sweets around my period, this means it is PMS related. I just think that yes, yeast can be this problem, but also it is not wise to blame everything on yeast. I for one never get yeast infections, I just maybe have had one or two my whole life, once was when I was on all those antibiotics from the H pylori. I also know allot of the naturopathic dr's tell you that yeast can still be an issue if you don't have a yeast infection, which may be true, but lets be careful when we assume that it is yeast all the time, because they can take you for lots of $$$$ selling the supplements for yeast too. In reality I still think for most of us, getting the implants out, is the best and biggest step to take towards our healing! ----- Original Message ----- From: Bos@... Sent: Monday, October 07, 2002 11:20 AM Subject: Re: For Dr. Kolb I read once that a sweet craving means the body really wants/needs protein. . .in my experience, this is so. Yeast problems can occur without implants. . .a compromised immune system can help it grow and the immune system can be weak just due to a poor diet. . .but yeast thrives on sugar. . . when my sugar cravings became more frequent I ate more protein and the carvings subsided--I don't know if there was an overabundance of yeast or not. I think one's acid-alkaline balance (again which can be off due to diet) has a lot to do with this. Someone recently mentioned Hulda 's vitamins--Hulda used to focus on yeast about 18 years ago--it would be interesting to get her input also. I believe there are tests for yeasts and fungi (sp?) 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