Re: My Insurance said NO PAYMENT... HELP!

[Guest guest]

Dave, You appeal it anyway!!!! Put some pressure on them. Are you morbidly

obese?? If so, then I think you do have a leg to stand on. Do you have

other health issues that are related to your over weight? Do you have high

blood pressure?? Examine every detail. Stand firm. How medically

necessary is this??/ Is your doctor in favor of your having this surgery??

in Mo.

[Guest guest]

Dave, You appeal it anyway!!!! Put some pressure on them. Are you morbidly

obese?? If so, then I think you do have a leg to stand on. Do you have

other health issues that are related to your over weight? Do you have high

blood pressure?? Examine every detail. Stand firm. How medically

necessary is this??/ Is your doctor in favor of your having this surgery??

in Mo.

[Guest guest]

Dave, You appeal it anyway!!!! Put some pressure on them. Are you morbidly

obese?? If so, then I think you do have a leg to stand on. Do you have

other health issues that are related to your over weight? Do you have high

blood pressure?? Examine every detail. Stand firm. How medically

necessary is this??/ Is your doctor in favor of your having this surgery??

in Mo.

[Guest guest]

Dave, Don't get too discouraged about the NO's from your insurance,I was

denied twice and I just kept appealing their NO's and then finally my

employer HALLMARK CARDS INC. said that they would pay for surgery but it is

going thought the insurance as if they are paying,I feel bad that they are

paying and I really don't want my co-workers to know because they would

probley not be to happy. See it is an exclusion of benefits in my policy. It

has been a long road 8 months of just trying to be heard!!!!!!!! I told my

employer that I have a eating disorder and I need " help " I said that if I

came to them and said that I needed help for a drug problem or alcohol they

would be there for me in a minute,but since it's a food disorder it's my

problem!!!! I said that I felt totallly helpless!!! Then a couple of months

later they told me that they would approve my surgery.

See there are HAPPY ENDINGS!!!!!!

My Insurance said " NO PAYMENT " ... HELP!

>My insurance said, that the plan that I have, will not pay for these

>types of services. Now... I don't have a clue where do I go from

>here? ...I like most of you have really worked on this alot.. is this

>the end... or do I have a leg to sand on with the insurance Co.

>

>

>Thanks

>

>Dave from Kentucky

>

>

>------------------------------------------------------------------------

>Accurate impartial advice on everything from laptops to table saws.

>http://click.egroups.com/1/3020/2/_/453517/_/958607370/

>------------------------------------------------------------------------

>

>This message is from the Mini-Gastric Bypass Mailing List at Onelist.com

>Please visit our web site at http://clos.net

>Get the Patient Manual at http://clos.net/get_patient_manual.htm

>

>

[Guest guest]

Dave,

there has to be a way you can appeal, call and talk to a supervisor, and if

she dosen't give you an answer you like to to her supervisor, keep going up

til someone tells you haw to appeal.

Robynn

My Insurance said " NO PAYMENT " ... HELP!

> My insurance said, that the plan that I have, will not pay for these

> types of services. Now... I don't have a clue where do I go from

> here? ...I like most of you have really worked on this alot.. is this

> the end... or do I have a leg to sand on with the insurance Co.

>

>

> Thanks

>

> Dave from Kentucky

>

>

> ------------------------------------------------------------------------

> Accurate impartial advice on everything from laptops to table saws.

> http://click.egroups.com/1/3020/2/_/453517/_/958607389/

> ------------------------------------------------------------------------

>

> This message is from the Mini-Gastric Bypass Mailing List at Onelist.com

> Please visit our web site at http://clos.net

> Get the Patient Manual at http://clos.net/get_patient_manual.htm

>

>

>

[Guest guest]

Dave,

there has to be a way you can appeal, call and talk to a supervisor, and if

she dosen't give you an answer you like to to her supervisor, keep going up

til someone tells you haw to appeal.

Robynn

My Insurance said " NO PAYMENT " ... HELP!

> My insurance said, that the plan that I have, will not pay for these

> types of services. Now... I don't have a clue where do I go from

> here? ...I like most of you have really worked on this alot.. is this

> the end... or do I have a leg to sand on with the insurance Co.

>

>

> Thanks

>

> Dave from Kentucky

>

>

> ------------------------------------------------------------------------

> Accurate impartial advice on everything from laptops to table saws.

> http://click.egroups.com/1/3020/2/_/453517/_/958607389/

> ------------------------------------------------------------------------

>

> This message is from the Mini-Gastric Bypass Mailing List at Onelist.com

> Please visit our web site at http://clos.net

> Get the Patient Manual at http://clos.net/get_patient_manual.htm

>

>

>

[Guest guest]

Dave,

there has to be a way you can appeal, call and talk to a supervisor, and if

she dosen't give you an answer you like to to her supervisor, keep going up

til someone tells you haw to appeal.

Robynn

My Insurance said " NO PAYMENT " ... HELP!

> My insurance said, that the plan that I have, will not pay for these

> types of services. Now... I don't have a clue where do I go from

> here? ...I like most of you have really worked on this alot.. is this

> the end... or do I have a leg to sand on with the insurance Co.

>

>

> Thanks

>

> Dave from Kentucky

>

>

> ------------------------------------------------------------------------

> Accurate impartial advice on everything from laptops to table saws.

> http://click.egroups.com/1/3020/2/_/453517/_/958607389/

> ------------------------------------------------------------------------

>

> This message is from the Mini-Gastric Bypass Mailing List at Onelist.com

> Please visit our web site at http://clos.net

> Get the Patient Manual at http://clos.net/get_patient_manual.htm

>

>

>

[Guest guest]

Dave~

Depends alot on the wording. Some people have gotten in because the policy

excludes services for the treatment of obesity but don't mention the words

" severe obesity " or " morbid obesity " . Also, depending on your disabilities

you can hit them with the Americans with Disabilities Act, also, some states

have health insurance anti-obesity discrimination laws on the books, and of

course the insurance company isn't going to tell you THAT. My insurance

company excludes surgery or any other weight loss procedure, and if it were

just up to United Healthcare, that would have been the end of the

line---they told me so. But my employer happens to be self-insured and they

have the last say. And it states in my policy booklet that the plan

administrator (my employer) reserves the right to approve procedures that

are otherwise not normally covered under the existing policy. So, I have

tried my darndest to convince them that this is one procedure that they need

to approve. Even if it flat states exclusion, you can also read that your

policy pays for " medically necessary " procedures. While they will most

likely turn you down flat the first run, you can always appeal, stressing

the fact (by Dr R's letter, your own PCP's opinions, you own plea) that the

surgery is medically necessary, not some cosmetic surgery to make you thin.

I kind of hit my employer hard on the fact that they cover alcohol and drug

rehab, but not weight loss surgery. Get them at whatever angle you can,

because this is a fight for your life! Don't let the big dogs win--and not

only will you have a leg to stand on, but you'll have one to hike on the

insurance company's leg when the time comes!

my two cents.......

fg

At 11:49 PM 05/17/2000 -0000, you wrote:

>My insurance said, that the plan that I have, will not pay for these

>types of services. Now... I don't have a clue where do I go from

>here? ...I like most of you have really worked on this alot.. is this

>the end... or do I have a leg to sand on with the insurance Co.

>

>

>Thanks

>

>Dave from Kentucky

>

>

>------------------------------------------------------------------------

>Accurate impartial advice on everything from laptops to table saws.

>http://click.egroups.com/1/3020/2/_/453517/_/958607370/

>------------------------------------------------------------------------

>

>This message is from the Mini-Gastric Bypass Mailing List at Onelist.com

>Please visit our web site at http://clos.net

>Get the Patient Manual at http://clos.net/get_patient_manual.htm

>

>

>

[Guest guest]

I was talking about BCBS. I hope you didnt think I meant yours. I have

heard of others ways of getting it payed for.. Something about people

needing medical help and unable to pay for it... I was going to call the

local social service place tommorow. Also, the rehabilitaion place can

sometimes pay. I forget the name. It's for people with disabilities.

Morbid obesity is a disability. I will try anything.Keeley

[Guest guest]

Well let me see If I've got this correct..The insurance lady said end

of story today becuase no benefits can be paid for anything to do

with weight loss or weight controll I still have a chance.

Please tell me more.

DAVE

> >My insurance said, that the plan that I have, will not pay for

these

> >types of services. Now... I don't have a clue where do I go from

> >here? ...I like most of you have really worked on this alot.. is

this

> >the end... or do I have a leg to sand on with the insurance Co.

> >

> >

> >Thanks

> >

> >Dave from Kentucky

> >

> >

> >-------------------------------------------------------------------

-----

> >Accurate impartial advice on everything from laptops to table saws.

> >http://click.egroups.com/1/3020/2/_/453517/_/958607370/

> >-------------------------------------------------------------------

-----

> >

> >This message is from the Mini-Gastric Bypass Mailing List at

Onelist.com

> >Please visit our web site at http://clos.net

> >Get the Patient Manual at http://clos.net/get_patient_manual.htm

> >

> >

> >

[Guest guest]

You really need your own copy of your full summary plan description for your

particular policy. That's what the insurance people do, they find ways to

save the company money.....you task is to find the loophole. :-)) Read over

the entire booklet, (they legally have to give you a copy if they haven't

already.) Look for any catch phrases--there usually are several. For

instance it may say coverage for " medically necessary " treatment----your job

is to convince them that without this surgery you are going to be a bigger

liability to your insurance company now and in the future. Or if they

mention " obesity " but not morbid obesity, you need to hit them with the fact

that you aren't merely obese, but dangerously obese. Pride go out the

window here, bare your soul. Obese people have more health problems, have

more accidents, etc. Is your place of employment self-insured?? If so, you

can appeal directly to your employer, which can give you a better chance,

although not necessarily. Heck, even though NC does not yet have an anti

obesity discrimination law on the books, I still quoted the wording from

Georgia's law in my appeal letter--it just states that insurance companies

are STUPID for not covering surgery for obesity. End of story. Research,

research, research.....leave no stone unturned. Find out if anyone else at

your work has been turned down for ANYTHING and find out what they did to

resolve the situation and get the decision overturned.

fg

At 02:14 AM 05/19/2000 -0000, you wrote:

>Well let me see If I've got this correct..The insurance lady said end

>of story today becuase no benefits can be paid for anything to do

>with weight loss or weight controll I still have a chance.

>

>Please tell me more.

>

>DAVE

>

>

>> >My insurance said, that the plan that I have, will not pay for

>these

>> >types of services. Now... I don't have a clue where do I go from

>> >here? ...I like most of you have really worked on this alot.. is

>this

>> >the end... or do I have a leg to sand on with the insurance Co.

>> >

>> >

>> >Thanks

>> >

>> >Dave from Kentucky

>> >

>> >

>> >-------------------------------------------------------------------

>-----

>> >Accurate impartial advice on everything from laptops to table saws.

>> >http://click.egroups.com/1/3020/2/_/453517/_/958607370/

>> >-------------------------------------------------------------------

>-----

>> >

>> >This message is from the Mini-Gastric Bypass Mailing List at

>Onelist.com

>> >Please visit our web site at http://clos.net

>> >Get the Patient Manual at http://clos.net/get_patient_manual.htm

>> >

>> >

>> >

>

>

>------------------------------------------------------------------------

>Make new friends, find the old at Classmates.com:

>http://click.egroups.com/1/4052/2/_/453517/_/958702487/

>------------------------------------------------------------------------

>

>This message is from the Mini-Gastric Bypass Mailing List at Onelist.com

>Please visit our web site at http://clos.net

>Get the Patient Manual at http://clos.net/get_patient_manual.htm

>

>

>

[Guest guest]

You really need your own copy of your full summary plan description for your

particular policy. That's what the insurance people do, they find ways to

save the company money.....you task is to find the loophole. :-)) Read over

the entire booklet, (they legally have to give you a copy if they haven't

already.) Look for any catch phrases--there usually are several. For

instance it may say coverage for " medically necessary " treatment----your job

is to convince them that without this surgery you are going to be a bigger

liability to your insurance company now and in the future. Or if they

mention " obesity " but not morbid obesity, you need to hit them with the fact

that you aren't merely obese, but dangerously obese. Pride go out the

window here, bare your soul. Obese people have more health problems, have

more accidents, etc. Is your place of employment self-insured?? If so, you

can appeal directly to your employer, which can give you a better chance,

although not necessarily. Heck, even though NC does not yet have an anti

obesity discrimination law on the books, I still quoted the wording from

Georgia's law in my appeal letter--it just states that insurance companies

are STUPID for not covering surgery for obesity. End of story. Research,

research, research.....leave no stone unturned. Find out if anyone else at

your work has been turned down for ANYTHING and find out what they did to

resolve the situation and get the decision overturned.

fg

At 02:14 AM 05/19/2000 -0000, you wrote:

>Well let me see If I've got this correct..The insurance lady said end

>of story today becuase no benefits can be paid for anything to do

>with weight loss or weight controll I still have a chance.

>

>Please tell me more.

>

>DAVE

>

>

>> >My insurance said, that the plan that I have, will not pay for

>these

>> >types of services. Now... I don't have a clue where do I go from

>> >here? ...I like most of you have really worked on this alot.. is

>this

>> >the end... or do I have a leg to sand on with the insurance Co.

>> >

>> >

>> >Thanks

>> >

>> >Dave from Kentucky

>> >

>> >

>> >-------------------------------------------------------------------

>-----

>> >Accurate impartial advice on everything from laptops to table saws.

>> >http://click.egroups.com/1/3020/2/_/453517/_/958607370/

>> >-------------------------------------------------------------------

>-----

>> >

>> >This message is from the Mini-Gastric Bypass Mailing List at

>Onelist.com

>> >Please visit our web site at http://clos.net

>> >Get the Patient Manual at http://clos.net/get_patient_manual.htm

>> >

>> >

>> >

>

>

>------------------------------------------------------------------------

>Make new friends, find the old at Classmates.com:

>http://click.egroups.com/1/4052/2/_/453517/_/958702487/

>------------------------------------------------------------------------

>

>This message is from the Mini-Gastric Bypass Mailing List at Onelist.com

>Please visit our web site at http://clos.net

>Get the Patient Manual at http://clos.net/get_patient_manual.htm

>

>

>

[Guest guest]

You really need your own copy of your full summary plan description for your

particular policy. That's what the insurance people do, they find ways to

save the company money.....you task is to find the loophole. :-)) Read over

the entire booklet, (they legally have to give you a copy if they haven't

already.) Look for any catch phrases--there usually are several. For

instance it may say coverage for " medically necessary " treatment----your job

is to convince them that without this surgery you are going to be a bigger

liability to your insurance company now and in the future. Or if they

mention " obesity " but not morbid obesity, you need to hit them with the fact

that you aren't merely obese, but dangerously obese. Pride go out the

window here, bare your soul. Obese people have more health problems, have

more accidents, etc. Is your place of employment self-insured?? If so, you

can appeal directly to your employer, which can give you a better chance,

although not necessarily. Heck, even though NC does not yet have an anti

obesity discrimination law on the books, I still quoted the wording from

Georgia's law in my appeal letter--it just states that insurance companies

are STUPID for not covering surgery for obesity. End of story. Research,

research, research.....leave no stone unturned. Find out if anyone else at

your work has been turned down for ANYTHING and find out what they did to

resolve the situation and get the decision overturned.

fg

At 02:14 AM 05/19/2000 -0000, you wrote:

>Well let me see If I've got this correct..The insurance lady said end

>of story today becuase no benefits can be paid for anything to do

>with weight loss or weight controll I still have a chance.

>

>Please tell me more.

>

>DAVE

>

>

>> >My insurance said, that the plan that I have, will not pay for

>these

>> >types of services. Now... I don't have a clue where do I go from

>> >here? ...I like most of you have really worked on this alot.. is

>this

>> >the end... or do I have a leg to sand on with the insurance Co.

>> >

>> >

>> >Thanks

>> >

>> >Dave from Kentucky

>> >

>> >

>> >-------------------------------------------------------------------

>-----

>> >Accurate impartial advice on everything from laptops to table saws.

>> >http://click.egroups.com/1/3020/2/_/453517/_/958607370/

>> >-------------------------------------------------------------------

>-----

>> >

>> >This message is from the Mini-Gastric Bypass Mailing List at

>Onelist.com

>> >Please visit our web site at http://clos.net

>> >Get the Patient Manual at http://clos.net/get_patient_manual.htm

>> >

>> >

>> >

>

>

>------------------------------------------------------------------------

>Make new friends, find the old at Classmates.com:

>http://click.egroups.com/1/4052/2/_/453517/_/958702487/

>------------------------------------------------------------------------

>

>This message is from the Mini-Gastric Bypass Mailing List at Onelist.com

>Please visit our web site at http://clos.net

>Get the Patient Manual at http://clos.net/get_patient_manual.htm

>

>

>

[Guest guest]

Thanks soooooooooooooooo much I'm going to worry them to death until

I get what I want...

Dave

> >> >My insurance said, that the plan that I have, will not pay for

> >these

> >> >types of services. Now... I don't have a clue where do I go

from

> >> >here? ...I like most of you have really worked on this alot..

is

> >this

> >> >the end... or do I have a leg to sand on with the insurance Co.

> >> >

> >> >

> >> >Thanks

> >> >

> >> >Dave from Kentucky

> >> >

> >> >

> >>

>-------------------------------------------------------------------

> >-----

> >> >Accurate impartial advice on everything from laptops to table

saws.

> >> >http://click.egroups.com/1/3020/2/_/453517/_/958607370/

> >>

>-------------------------------------------------------------------

> >-----

> >> >

> >> >This message is from the Mini-Gastric Bypass Mailing List at

> >Onelist.com

> >> >Please visit our web site at http://clos.net

> >> >Get the Patient Manual at http://clos.net/get_patient_manual.htm

> >> >

> >> >

> >> >

> >

> >

>

>---------------------------------------------------------------------

---

> >Make new friends, find the old at Classmates.com:

> >http://click.egroups.com/1/4052/2/_/453517/_/958702487/

>

>---------------------------------------------------------------------

---

> >

> >This message is from the Mini-Gastric Bypass Mailing List at

Onelist.com

> >Please visit our web site at http://clos.net

> >Get the Patient Manual at http://clos.net/get_patient_manual.htm

> >

> >

> >

[Guest guest]

Ok I got that copy of the plan today and under EXCLUSIONS is

says...Services or procedures for the primary purpose of weight

control or reduction. it sounds firm to me and I only have 60 days

to appeal.and in the appeal section is says the decision of the plan

administrator and claims administrator is final. see anything in

here that can help.

DAVE

> >> >My insurance said, that the plan that I have, will not pay for

> >these

> >> >types of services. Now... I don't have a clue where do I go

from

> >> >here? ...I like most of you have really worked on this alot..

is

> >this

> >> >the end... or do I have a leg to sand on with the insurance Co.

> >> >

> >> >

> >> >Thanks

> >> >

> >> >Dave from Kentucky

> >> >

> >> >

> >> >----------------------------------------------------------------

---

> >-----

> >> >Accurate impartial advice on everything from laptops to table

saws.

> >> >http://click.egroups.com/1/3020/2/_/453517/_/958607370/

> >> >----------------------------------------------------------------

---

> >-----

> >> >

> >> >This message is from the Mini-Gastric Bypass Mailing List at

> >Onelist.com

> >> >Please visit our web site at http://clos.net

> >> >Get the Patient Manual at http://clos.net/get_patient_manual.htm

> >> >

> >> >

> >> >

> >

> >

> >-------------------------------------------------------------------

-----

> >Make new friends, find the old at Classmates.com:

> >http://click.egroups.com/1/4052/2/_/453517/_/958702487/

> >-------------------------------------------------------------------

-----

> >

> >This message is from the Mini-Gastric Bypass Mailing List at

Onelist.com

> >Please visit our web site at http://clos.net

> >Get the Patient Manual at http://clos.net/get_patient_manual.htm

> >

> >

> >

[Guest guest]

Ok I got that copy of the plan today and under EXCLUSIONS is

says...Services or procedures for the primary purpose of weight

control or reduction. it sounds firm to me and I only have 60 days

to appeal.and in the appeal section is says the decision of the plan

administrator and claims administrator is final. see anything in

here that can help.

DAVE

> >> >My insurance said, that the plan that I have, will not pay for

> >these

> >> >types of services. Now... I don't have a clue where do I go

from

> >> >here? ...I like most of you have really worked on this alot..

is

> >this

> >> >the end... or do I have a leg to sand on with the insurance Co.

> >> >

> >> >

> >> >Thanks

> >> >

> >> >Dave from Kentucky

> >> >

> >> >

> >> >----------------------------------------------------------------

---

> >-----

> >> >Accurate impartial advice on everything from laptops to table

saws.

> >> >http://click.egroups.com/1/3020/2/_/453517/_/958607370/

> >> >----------------------------------------------------------------

---

> >-----

> >> >

> >> >This message is from the Mini-Gastric Bypass Mailing List at

> >Onelist.com

> >> >Please visit our web site at http://clos.net

> >> >Get the Patient Manual at http://clos.net/get_patient_manual.htm

> >> >

> >> >

> >> >

> >

> >

> >-------------------------------------------------------------------

-----

> >Make new friends, find the old at Classmates.com:

> >http://click.egroups.com/1/4052/2/_/453517/_/958702487/

> >-------------------------------------------------------------------

-----

> >

> >This message is from the Mini-Gastric Bypass Mailing List at

Onelist.com

> >Please visit our web site at http://clos.net

> >Get the Patient Manual at http://clos.net/get_patient_manual.htm

> >

> >

> >

[Guest guest]

Ok I got that copy of the plan today and under EXCLUSIONS is

says...Services or procedures for the primary purpose of weight

control or reduction. it sounds firm to me and I only have 60 days

to appeal.and in the appeal section is says the decision of the plan

administrator and claims administrator is final. see anything in

here that can help.

DAVE

> >> >My insurance said, that the plan that I have, will not pay for

> >these

> >> >types of services. Now... I don't have a clue where do I go

from

> >> >here? ...I like most of you have really worked on this alot..

is

> >this

> >> >the end... or do I have a leg to sand on with the insurance Co.

> >> >

> >> >

> >> >Thanks

> >> >

> >> >Dave from Kentucky

> >> >

> >> >

> >> >----------------------------------------------------------------

---

> >-----

> >> >Accurate impartial advice on everything from laptops to table

saws.

> >> >http://click.egroups.com/1/3020/2/_/453517/_/958607370/

> >> >----------------------------------------------------------------

---

> >-----

> >> >

> >> >This message is from the Mini-Gastric Bypass Mailing List at

> >Onelist.com

> >> >Please visit our web site at http://clos.net

> >> >Get the Patient Manual at http://clos.net/get_patient_manual.htm

> >> >

> >> >

> >> >

> >

> >

> >-------------------------------------------------------------------

-----

> >Make new friends, find the old at Classmates.com:

> >http://click.egroups.com/1/4052/2/_/453517/_/958702487/

> >-------------------------------------------------------------------

-----

> >

> >This message is from the Mini-Gastric Bypass Mailing List at

Onelist.com

> >Please visit our web site at http://clos.net

> >Get the Patient Manual at http://clos.net/get_patient_manual.htm

> >

> >

> >

[Guest guest]

Dave,

Could it be that the primary purpose of the surgery is to save your

life and to improve the quality of your life? I don't know about you but I

have a 179% greater chance of dying than a normal weighted person. Just a

thought.

Genz

PS, I used to go to school with a Glenn Pemberton, do you know him?

dtpemberton@... wrote:

> Ok I got that copy of the plan today and under EXCLUSIONS is

> says...Services or procedures for the primary purpose of weight

> control or reduction. it sounds firm to me and I only have 60 days

> to appeal.and in the appeal section is says the decision of the plan

> administrator and claims administrator is final. see anything in

> here that can help.

>

> DAVE

>

>

> > >> >My insurance said, that the plan that I have, will not pay for

> > >these

> > >> >types of services. Now... I don't have a clue where do I go

> from

> > >> >here? ...I like most of you have really worked on this alot..

> is

> > >this

> > >> >the end... or do I have a leg to sand on with the insurance Co.

> > >> >

> > >> >

> > >> >Thanks

> > >> >

> > >> >Dave from Kentucky

> > >> >

> > >> >

> > >> >----------------------------------------------------------------

> ---

> > >-----

> > >> >Accurate impartial advice on everything from laptops to table

> saws.

> > >> >http://click.egroups.com/1/3020/2/_/453517/_/958607370/

> > >> >----------------------------------------------------------------

> ---

> > >-----

> > >> >

> > >> >This message is from the Mini-Gastric Bypass Mailing List at

> > >Onelist.com

> > >> >Please visit our web site at http://clos.net

> > >> >Get the Patient Manual at http://clos.net/get_patient_manual.htm

> > >> >

> > >> >

> > >> >

> > >

> > >

> > >-------------------------------------------------------------------

> -----

> > >Make new friends, find the old at Classmates.com:

> > >http://click.egroups.com/1/4052/2/_/453517/_/958702487/

> > >-------------------------------------------------------------------

> -----

> > >

> > >This message is from the Mini-Gastric Bypass Mailing List at

> Onelist.com

> > >Please visit our web site at http://clos.net

> > >Get the Patient Manual at http://clos.net/get_patient_manual.htm

> > >

> > >

> > >

>

> ------------------------------------------------------------------------

> High rates giving you headaches? The 0% APR Introductory Rate from

> Capital One. 9.9% Fixed thereafter!

> http://click.egroups.com/1/3010/2/_/453517/_/958791989/

> ------------------------------------------------------------------------

>

> This message is from the Mini-Gastric Bypass Mailing List at Onelist.com

> Please visit our web site at http://clos.net

> Get the Patient Manual at http://clos.net/get_patient_manual.htm

[Guest guest]

But morbid obesity is a serious disease. You (like me) are not merely fat

and in need of losing a few pounds, but your health is seriously at risk

here. That's the difference. If you read on Dr R's website (and in his

appeal letter that he writes) that it is unanimous that the only truly

successful method for us to reach a HEALTHY weight (and this might not be

thin) is by surgery. List your comorbidities and then have a chart showing

which ones would be managed with less medication or eradicated by surgery.

Morbid obesity is in a completely different class than " regular " obesity.

I would suggest that you request an appeal letter from Debbie (have you

filled out the on-line form in third person??) That is what Dr R uses to

create the appeal letter. If you have not initially filled out the form and

sent it in to insurance you prolly need to do so, they need to deny you

first (which will take mere moments, dear) before you can file an official

appeal. In the meantime start typing your own plea to your employer. Go on

the net and research other cases if you have to, or other state's obesity

laws. Turn over every rock you come to, and send it in the info ASAP, as

they usually can take up to 90 days to review an appeal.

Good luck~~

fg

At 03:06 AM 05/20/2000 -0000, you wrote:

>Ok I got that copy of the plan today and under EXCLUSIONS is

>says...Services or procedures for the primary purpose of weight

>control or reduction. it sounds firm to me and I only have 60 days

>to appeal.and in the appeal section is says the decision of the plan

>administrator and claims administrator is final. see anything in

>here that can help.

>

>DAVE

>

[Guest guest]

Thanks for the reply...I don't think I know Glenn Pemberton. we could

be related but out family tree stops at my grandfather, because of

him being adopted.

Thanks again

DAVEfrom Kentucky

> > > >> >My insurance said, that the plan that I have, will not pay

for

> > > >these

> > > >> >types of services. Now... I don't have a clue where do I go

> > from

> > > >> >here? ...I like most of you have really worked on this

alot..

> > is

> > > >this

> > > >> >the end... or do I have a leg to sand on with the insurance

Co.

> > > >> >

> > > >> >

> > > >> >Thanks

> > > >> >

> > > >> >Dave from Kentucky

> > > >> >

> > > >> >

> > > >> >------------------------------------------------------------

----

> > ---

> > > >-----

> > > >> >Accurate impartial advice on everything from laptops to

table

> > saws.

> > > >> >http://click.egroups.com/1/3020/2/_/453517/_/958607370/

> > > >> >------------------------------------------------------------

----

> > ---

> > > >-----

> > > >> >

> > > >> >This message is from the Mini-Gastric Bypass Mailing List at

> > > >Onelist.com

> > > >> >Please visit our web site at http://clos.net

> > > >> >Get the Patient Manual at

http://clos.net/get_patient_manual.htm

> > > >> >

> > > >> >

> > > >> >

> > > >

> > > >

> > > >---------------------------------------------------------------

----

> > -----

> > > >Make new friends, find the old at Classmates.com:

> > > >http://click.egroups.com/1/4052/2/_/453517/_/958702487/

> > > >---------------------------------------------------------------

----

> > -----

> > > >

> > > >This message is from the Mini-Gastric Bypass Mailing List at

> > Onelist.com

> > > >Please visit our web site at http://clos.net

> > > >Get the Patient Manual at

http://clos.net/get_patient_manual.htm

> > > >

> > > >

> > > >

> >

> > ------------------------------------------------------------------

------

> > High rates giving you headaches? The 0% APR Introductory Rate from

> > Capital One. 9.9% Fixed thereafter!

> > http://click.egroups.com/1/3010/2/_/453517/_/958791989/

> > ------------------------------------------------------------------

------

> >

> > This message is from the Mini-Gastric Bypass Mailing List at

Onelist.com

> > Please visit our web site at http://clos.net

> > Get the Patient Manual at http://clos.net/get_patient_manual.htm

[Guest guest]

Dave,

I was thinking the same thing that Genz says - the PRIMARY purpose really is

to reduce any co-morbidities that exist now, and to prevent any that will

surely arise in the future. The PRIMARY purpose is to lengthen your life and

give you a more healthy life. Of course, it will also probably save the

insurance company money in the long run, but all insurance companies seem to

be so stupid that they never take that fact into consideration.

Good Luck, Dave. We're all pulling for you. Hang in there.

Sara

BMI 42 (I think)

smootgen@... wrote:

> Dave,

> Could it be that the primary purpose of the surgery is to save your

> life and to improve the quality of your life? I don't know about you but I

> have a 179% greater chance of dying than a normal weighted person. Just a

> thought.

> Genz

> PS, I used to go to school with a Glenn Pemberton, do you know him?

>

> dtpemberton@... wrote:

>

> > Ok I got that copy of the plan today and under EXCLUSIONS is

> > says...Services or procedures for the primary purpose of weight

> > control or reduction. it sounds firm to me and I only have 60 days

> > to appeal.and in the appeal section is says the decision of the plan

> > administrator and claims administrator is final. see anything in

> > here that can help.

> >

> > DAVE

> >

> >

> > > >> >My insurance said, that the plan that I have, will not pay for

> > > >these

> > > >> >types of services. Now... I don't have a clue where do I go

> > from

> > > >> >here? ...I like most of you have really worked on this alot..

> > is

> > > >this

> > > >> >the end... or do I have a leg to sand on with the insurance Co.

> > > >> >

> > > >> >

> > > >> >Thanks

> > > >> >

> > > >> >Dave from Kentucky

> > > >> >

> > > >> >

> > > >> >----------------------------------------------------------------

> > ---

> > > >-----

> > > >> >Accurate impartial advice on everything from laptops to table

> > saws.

> > > >> >http://click.egroups.com/1/3020/2/_/453517/_/958607370/

> > > >> >----------------------------------------------------------------

> > ---

> > > >-----

> > > >> >

> > > >> >This message is from the Mini-Gastric Bypass Mailing List at

> > > >Onelist.com

> > > >> >Please visit our web site at http://clos.net

> > > >> >Get the Patient Manual at http://clos.net/get_patient_manual.htm

> > > >> >

> > > >> >

> > > >> >

> > > >

> > > >

> > > >-------------------------------------------------------------------

> > -----

> > > >Make new friends, find the old at Classmates.com:

> > > >http://click.egroups.com/1/4052/2/_/453517/_/958702487/

> > > >-------------------------------------------------------------------

> > -----

> > > >

> > > >This message is from the Mini-Gastric Bypass Mailing List at

> > Onelist.com

> > > >Please visit our web site at http://clos.net

> > > >Get the Patient Manual at http://clos.net/get_patient_manual.htm

> > > >

> > > >

> > > >

> >

> > ------------------------------------------------------------------------

> > High rates giving you headaches? The 0% APR Introductory Rate from

> > Capital One. 9.9% Fixed thereafter!

> > http://click.egroups.com/1/3010/2/_/453517/_/958791989/

> > ------------------------------------------------------------------------

> >

> > This message is from the Mini-Gastric Bypass Mailing List at Onelist.com

> > Please visit our web site at http://clos.net

> > Get the Patient Manual at http://clos.net/get_patient_manual.htm

>

> ------------------------------------------------------------------------

> Failed tests, classes skipped, forgotten locker combinations.

> Remember the good 'ol days

> http://click.egroups.com/1/4053/2/_/453517/_/958800359/

> ------------------------------------------------------------------------

>

> This message is from the Mini-Gastric Bypass Mailing List at Onelist.com

> Please visit our web site at http://clos.net

> Get the Patient Manual at http://clos.net/get_patient_manual.htm

[Guest guest]

The email I got from Barbara the other day says that WE have to file the

appeal letter...they do not.

elaine

Re: My Insurance said " NO PAYMENT " ... HELP!

> But morbid obesity is a serious disease. You (like me) are not merely fat

> and in need of losing a few pounds, but your health is seriously at risk

> here. That's the difference. If you read on Dr R's website (and in his

> appeal letter that he writes) that it is unanimous that the only truly

> successful method for us to reach a HEALTHY weight (and this might not be

> thin) is by surgery. List your comorbidities and then have a chart

showing

> which ones would be managed with less medication or eradicated by surgery.

> Morbid obesity is in a completely different class than " regular " obesity.

>

> I would suggest that you request an appeal letter from Debbie (have you

> filled out the on-line form in third person??) That is what Dr R uses to

> create the appeal letter. If you have not initially filled out the form

and

> sent it in to insurance you prolly need to do so, they need to deny you

> first (which will take mere moments, dear) before you can file an official

> appeal. In the meantime start typing your own plea to your employer. Go

on

> the net and research other cases if you have to, or other state's obesity

> laws. Turn over every rock you come to, and send it in the info ASAP, as

> they usually can take up to 90 days to review an appeal.

>

> Good luck~~

>

> fg

>

> At 03:06 AM 05/20/2000 -0000, you wrote:

> >Ok I got that copy of the plan today and under EXCLUSIONS is

> >says...Services or procedures for the primary purpose of weight

> >control or reduction. it sounds firm to me and I only have 60 days

> >to appeal.and in the appeal section is says the decision of the plan

> >administrator and claims administrator is final. see anything in

> >here that can help.

> >

> >DAVE

> >

>

>

> ------------------------------------------------------------------------

> High rates giving you headaches? The 0% APR Introductory Rate from

> Capital One. 9.9% Fixed thereafter!

> http://click.egroups.com/1/3010/2/_/453517/_/958801527/

> ------------------------------------------------------------------------

>

> This message is from the Mini-Gastric Bypass Mailing List at Onelist.com

> Please visit our web site at http://clos.net

> Get the Patient Manual at http://clos.net/get_patient_manual.htm

>

>

>

[Guest guest]

Yes, but Debbie will mail Dr R's portion to you.

fg

At 12:21 PM 05/21/2000 -0500, you wrote:

>The email I got from Barbara the other day says that WE have to file the

>appeal letter...they do not.

>elaine

> Re: My Insurance said " NO PAYMENT " ... HELP!

>

>

>> But morbid obesity is a serious disease. You (like me) are not merely fat

>> and in need of losing a few pounds, but your health is seriously at risk