Guest guest Posted May 2, 2000 Report Share Posted May 2, 2000 << Things could be worse. Dr R is within Network for me, the hospital is one of the approved ones on my list and they denied the procedure (in appeal as we speak). Fg, you are absolutely right! Things can always be worse. I have the option to have the surgery and I will do what it takes! I had my bad day yesterday and cried all day. I am now renewed by all the caring and outreaching of others in this list. It warms my heart to see people with genuine good souls. I was in a flood a few years ago and lost everything we owned. I was upset and wondered what I would do. I was feeling sorry for myself and than started to look around at everyone else in the same situation. I had to chastise myself, because I then realized that my family was young enough and strong enough to start over and rebuild. There were a lot of senior citizens that weren't that fortunate and alone in this world. I learned that year that I should thank the lord for all of his blessing and maybe that flood wasn't a tragedy but a subtle reminder that I needed to slow down and rejoice in what I really had, a family that was healthy and happy and I was truly the lucky one. Thank You for reminding me. Sometimes I forget! I hope you get your approval quickly and have DR R. God Bless JoAnn ^j^ " Friends are angels who lift us to our feet when our wings have trouble remembering how to fly. " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2000 Report Share Posted May 2, 2000 << I might request an audience with the director of human resources first, I want him to tell me to my face that I was denied and see what he does. It's too easy just to write a form letter without someone looking you right in the eye while you say, 'NO! " LOL >>fg, You go girl! Don't let them off easy. Look over your policy to see if they exclude obesity surgery. There is a difference between obesity and morbid obesity, I know several people who have gotten in under that glitch. Good luck to you. I was told by an insider (a woman on the grievance board) off the record; the higher you fight for this the more chance you have to get approved. Unfortunate for me the approval was for the surgery but not for the DR I wanted. Who knows if you fight each level they might cave on one of them. I wish you well on your endeavor. God Bless. JoAnn ^j^ " Friends are angels who lift us to our feet when our wings have trouble remembering how to fly. " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2000 Report Share Posted May 2, 2000 Well, it's natural to be disappointed when we've worked hard and things don't go the way we planned. But at least you have another option, and if you choose a good surgeon you will be well on your way to your goal. :-) I guess I will have to work out ways to self-pay if insurance denies me a second time. I might request an audience with the director of human resources first, I want him to tell me to my face that I was denied and see what he does. It's too easy just to write a form letter without someone looking you right in the eye while you say, 'NO! " LOL Good luck in finding the right surgeon, is the one in-network someone you can trust? It's hard to put trust in someone new, but if he's good, you'll be in fine hands. :-) Please let us know how you're doing and if you make the decision to have the surgery with the in-network surgeon. I do wish because of your diabetes that it would be done under laparascope, maybe you could appeal again, you never know, some other doctor might look at the case and decide in your favor. Did you insist that your case be evaluated by another bariatric surgeon? You know that is within your rights. Either way, if you have the surgery you will be so happy by this time next year! fg >Fg, you are absolutely right! Things can always be worse. I have the option >to have the surgery and I will do what it takes! I had my bad day yesterday >and cried all day. I am now renewed by all the caring and outreaching of >others in this list. It warms my heart to see people with genuine good souls. >I was in a flood a few years ago and lost everything we owned. I was upset >and wondered what I would do. I was feeling sorry for myself and than started >to look around at everyone else in the same situation. I had to chastise >myself, because I then realized that my family was young enough and strong >enough to start over and rebuild. There were a lot of senior citizens that >weren't that fortunate and alone in this world. I learned that year that I >should thank the lord for all of his blessing and maybe that flood wasn't a >tragedy but a subtle reminder that I needed to slow down and rejoice in what >I really had, a family that was healthy and happy and I was truly the lucky >one. >Thank You for reminding me. Sometimes I forget! I hope you get your approval >quickly and have DR R. >God Bless >JoAnn ^j^ > > " Friends are angels who lift us to our feet when our wings have trouble >remembering how to fly. " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2000 Report Share Posted May 2, 2000 Well, it's natural to be disappointed when we've worked hard and things don't go the way we planned. But at least you have another option, and if you choose a good surgeon you will be well on your way to your goal. :-) I guess I will have to work out ways to self-pay if insurance denies me a second time. I might request an audience with the director of human resources first, I want him to tell me to my face that I was denied and see what he does. It's too easy just to write a form letter without someone looking you right in the eye while you say, 'NO! " LOL Good luck in finding the right surgeon, is the one in-network someone you can trust? It's hard to put trust in someone new, but if he's good, you'll be in fine hands. :-) Please let us know how you're doing and if you make the decision to have the surgery with the in-network surgeon. I do wish because of your diabetes that it would be done under laparascope, maybe you could appeal again, you never know, some other doctor might look at the case and decide in your favor. Did you insist that your case be evaluated by another bariatric surgeon? You know that is within your rights. Either way, if you have the surgery you will be so happy by this time next year! fg >Fg, you are absolutely right! Things can always be worse. I have the option >to have the surgery and I will do what it takes! I had my bad day yesterday >and cried all day. I am now renewed by all the caring and outreaching of >others in this list. It warms my heart to see people with genuine good souls. >I was in a flood a few years ago and lost everything we owned. I was upset >and wondered what I would do. I was feeling sorry for myself and than started >to look around at everyone else in the same situation. I had to chastise >myself, because I then realized that my family was young enough and strong >enough to start over and rebuild. There were a lot of senior citizens that >weren't that fortunate and alone in this world. I learned that year that I >should thank the lord for all of his blessing and maybe that flood wasn't a >tragedy but a subtle reminder that I needed to slow down and rejoice in what >I really had, a family that was healthy and happy and I was truly the lucky >one. >Thank You for reminding me. Sometimes I forget! I hope you get your approval >quickly and have DR R. >God Bless >JoAnn ^j^ > > " Friends are angels who lift us to our feet when our wings have trouble >remembering how to fly. " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2000 Report Share Posted May 2, 2000 Well, it's natural to be disappointed when we've worked hard and things don't go the way we planned. But at least you have another option, and if you choose a good surgeon you will be well on your way to your goal. :-) I guess I will have to work out ways to self-pay if insurance denies me a second time. I might request an audience with the director of human resources first, I want him to tell me to my face that I was denied and see what he does. It's too easy just to write a form letter without someone looking you right in the eye while you say, 'NO! " LOL Good luck in finding the right surgeon, is the one in-network someone you can trust? It's hard to put trust in someone new, but if he's good, you'll be in fine hands. :-) Please let us know how you're doing and if you make the decision to have the surgery with the in-network surgeon. I do wish because of your diabetes that it would be done under laparascope, maybe you could appeal again, you never know, some other doctor might look at the case and decide in your favor. Did you insist that your case be evaluated by another bariatric surgeon? You know that is within your rights. Either way, if you have the surgery you will be so happy by this time next year! fg >Fg, you are absolutely right! Things can always be worse. I have the option >to have the surgery and I will do what it takes! I had my bad day yesterday >and cried all day. I am now renewed by all the caring and outreaching of >others in this list. It warms my heart to see people with genuine good souls. >I was in a flood a few years ago and lost everything we owned. I was upset >and wondered what I would do. I was feeling sorry for myself and than started >to look around at everyone else in the same situation. I had to chastise >myself, because I then realized that my family was young enough and strong >enough to start over and rebuild. There were a lot of senior citizens that >weren't that fortunate and alone in this world. I learned that year that I >should thank the lord for all of his blessing and maybe that flood wasn't a >tragedy but a subtle reminder that I needed to slow down and rejoice in what >I really had, a family that was healthy and happy and I was truly the lucky >one. >Thank You for reminding me. Sometimes I forget! I hope you get your approval >quickly and have DR R. >God Bless >JoAnn ^j^ > > " Friends are angels who lift us to our feet when our wings have trouble >remembering how to fly. " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2000 Report Share Posted May 3, 2000 Yes, my policy excludes any sort of weight loss treatments/surgeries even for morbid obesity. BUT---my employer is a self-insured entity, and it says right in my packet that I can appeal directly to the administrator, and they have the power to approve procedures that are excluded in the policy. If it had not said that, I would have realized that I didn't have a leg to stand on. But I chose my words carefully (I didn't want to p*** them off) but made my point. So that, along with Dr R's very indepth appeal letter, I pray that they approve me! I'll even keep very quiet about it at work if necessary, nobody will EVER know!! LOL Hopefully I should know something within the next couple of weeks. Gives me a chance to get all my other stuff ready. fg MGB wannabe > >>fg, You go girl! Don't let them off easy. Look over your policy to see if >they exclude obesity surgery. There is a difference between obesity and >morbid obesity, I know several people who have gotten in under that glitch. >Good luck to you. I was told by an insider (a woman on the grievance board) >off the record; the higher you fight for this the more chance you have to get >approved. Unfortunate for me the approval was for the surgery but not for the >DR I wanted. Who knows if you fight each level they might cave on one of >them. I wish you well on your endeavor. God Bless. > > >JoAnn ^j^ > > " Friends are angels who lift us to our feet when our wings have trouble >remembering how to fly. " > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2000 Report Share Posted May 3, 2000 Yes, my policy excludes any sort of weight loss treatments/surgeries even for morbid obesity. BUT---my employer is a self-insured entity, and it says right in my packet that I can appeal directly to the administrator, and they have the power to approve procedures that are excluded in the policy. If it had not said that, I would have realized that I didn't have a leg to stand on. But I chose my words carefully (I didn't want to p*** them off) but made my point. So that, along with Dr R's very indepth appeal letter, I pray that they approve me! I'll even keep very quiet about it at work if necessary, nobody will EVER know!! LOL Hopefully I should know something within the next couple of weeks. Gives me a chance to get all my other stuff ready. fg MGB wannabe > >>fg, You go girl! Don't let them off easy. Look over your policy to see if >they exclude obesity surgery. There is a difference between obesity and >morbid obesity, I know several people who have gotten in under that glitch. >Good luck to you. I was told by an insider (a woman on the grievance board) >off the record; the higher you fight for this the more chance you have to get >approved. Unfortunate for me the approval was for the surgery but not for the >DR I wanted. Who knows if you fight each level they might cave on one of >them. I wish you well on your endeavor. God Bless. > > >JoAnn ^j^ > > " Friends are angels who lift us to our feet when our wings have trouble >remembering how to fly. " > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2000 Report Share Posted May 3, 2000 Yes, my policy excludes any sort of weight loss treatments/surgeries even for morbid obesity. BUT---my employer is a self-insured entity, and it says right in my packet that I can appeal directly to the administrator, and they have the power to approve procedures that are excluded in the policy. If it had not said that, I would have realized that I didn't have a leg to stand on. But I chose my words carefully (I didn't want to p*** them off) but made my point. So that, along with Dr R's very indepth appeal letter, I pray that they approve me! I'll even keep very quiet about it at work if necessary, nobody will EVER know!! LOL Hopefully I should know something within the next couple of weeks. Gives me a chance to get all my other stuff ready. fg MGB wannabe > >>fg, You go girl! Don't let them off easy. Look over your policy to see if >they exclude obesity surgery. There is a difference between obesity and >morbid obesity, I know several people who have gotten in under that glitch. >Good luck to you. I was told by an insider (a woman on the grievance board) >off the record; the higher you fight for this the more chance you have to get >approved. Unfortunate for me the approval was for the surgery but not for the >DR I wanted. Who knows if you fight each level they might cave on one of >them. I wish you well on your endeavor. God Bless. > > >JoAnn ^j^ > > " Friends are angels who lift us to our feet when our wings have trouble >remembering how to fly. " > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2000 Report Share Posted May 3, 2000 So that, along with Dr R's very indepth appeal letter, I pray that they approve me! I'll even keep very quiet about it at work if necessary, nobody will EVER know!! LOL Hopefully I should know something within the next couple of weeks. Gives me a chance to get all my other stuff ready. fg >> I wish you all the luck in the world fg. I'll be praying for you to win your case. Sounds like you have a good chance. JoAnn ^j^ " Friends are angels who lift us to our feet when our wings have trouble remembering how to fly. " Quote Link to comment Share on other sites More sharing options...
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