Guest guest Posted May 12, 2000 Report Share Posted May 12, 2000 Jen, I have heard of people going before the state leg. and getting approved. Ask them for the legal department. Tell them your attorney wants the info. Exactly why they turned you down.. This operation has been done for years long before DR. R..Just for different reasons. Good luck Trisha Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2000 Report Share Posted May 12, 2000 Jen, I have heard of people going before the state leg. and getting approved. Ask them for the legal department. Tell them your attorney wants the info. Exactly why they turned you down.. This operation has been done for years long before DR. R..Just for different reasons. Good luck Trisha Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2000 Report Share Posted May 12, 2000 Jen, I have heard of people going before the state leg. and getting approved. Ask them for the legal department. Tell them your attorney wants the info. Exactly why they turned you down.. This operation has been done for years long before DR. R..Just for different reasons. Good luck Trisha Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2000 Report Share Posted May 12, 2000 Dear Jen, Keep on keeping on!!! It is worth it!!! My surgery was Jan 10, 2000 and they are still denying my claim. I have an attorney now and we are sueing them and we will win. You still have a fighting chance so don't give up. I know it is very hard to do. I worked with my ins company for several months before my surgery and I did everything they asked me to do. They sent me to St Louis to a so called obesity specilist and I took that ol nasty xenical and stood on my head, patted my tummy and would have dance naked downtown to get them to cooperate, but they didn't and they won't. So by crackkie we'll just see what the judge and the jury have to say about all this. Like I have lost 70 lbs and my health has improved by 80%/ I have energy to do almost everything I want and need to do and before surgery I was on my last leg. It doesn't take a doctor to examine me and tell the world that I am about 20 years younger and happier now. So don't you give up either. You keep a stiff upper lip and push push push. This will ultimately make us more and more powerful!!!! YEAH!!!! Anne in Missouri Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2000 Report Share Posted May 12, 2000 Dear Jen, Keep on keeping on!!! It is worth it!!! My surgery was Jan 10, 2000 and they are still denying my claim. I have an attorney now and we are sueing them and we will win. You still have a fighting chance so don't give up. I know it is very hard to do. I worked with my ins company for several months before my surgery and I did everything they asked me to do. They sent me to St Louis to a so called obesity specilist and I took that ol nasty xenical and stood on my head, patted my tummy and would have dance naked downtown to get them to cooperate, but they didn't and they won't. So by crackkie we'll just see what the judge and the jury have to say about all this. Like I have lost 70 lbs and my health has improved by 80%/ I have energy to do almost everything I want and need to do and before surgery I was on my last leg. It doesn't take a doctor to examine me and tell the world that I am about 20 years younger and happier now. So don't you give up either. You keep a stiff upper lip and push push push. This will ultimately make us more and more powerful!!!! YEAH!!!! Anne in Missouri Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2000 Report Share Posted May 12, 2000 Anne, How are you doing? Getting close to the court date? Trisha Lanman praying Dr. R. will help me to the other side soon!!! Las Vegas NV bmi 40 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2000 Report Share Posted May 12, 2000 In a message dated 5/12/00 1:11:53 PM Eastern Daylight Time, croby@... writes: << Jen--one of the girls, and I'm sorry, I can't think of who it was---her insurance said the same thing---it was an investigational procedure. They finally had to go through some sort of procedure to " register " it in a way that the procedure could be covered. >> Jen, When I read this it dawned on me that you might contact Debbie (DW@...) and ask her for the actual procedure code. It's possible that if the insurance co. sees that the procedure code is a known one they will accept it as non-investigational. I'll keep praying! {{HUGS}} Claire Redhead in FL MGB 4/10/00 Dr. Rutledge (http:/clos.net) " He who began a good work in you will be faithful to complete it until the day of Christ Jesus. " - Phil. 1:6 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2000 Report Share Posted May 12, 2000 In a message dated 5/12/00 1:11:53 PM Eastern Daylight Time, croby@... writes: << Jen--one of the girls, and I'm sorry, I can't think of who it was---her insurance said the same thing---it was an investigational procedure. They finally had to go through some sort of procedure to " register " it in a way that the procedure could be covered. >> Jen, When I read this it dawned on me that you might contact Debbie (DW@...) and ask her for the actual procedure code. It's possible that if the insurance co. sees that the procedure code is a known one they will accept it as non-investigational. I'll keep praying! {{HUGS}} Claire Redhead in FL MGB 4/10/00 Dr. Rutledge (http:/clos.net) " He who began a good work in you will be faithful to complete it until the day of Christ Jesus. " - Phil. 1:6 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2000 Report Share Posted May 12, 2000 In a message dated 5/12/00 1:11:53 PM Eastern Daylight Time, croby@... writes: << Jen--one of the girls, and I'm sorry, I can't think of who it was---her insurance said the same thing---it was an investigational procedure. They finally had to go through some sort of procedure to " register " it in a way that the procedure could be covered. >> Jen, When I read this it dawned on me that you might contact Debbie (DW@...) and ask her for the actual procedure code. It's possible that if the insurance co. sees that the procedure code is a known one they will accept it as non-investigational. I'll keep praying! {{HUGS}} Claire Redhead in FL MGB 4/10/00 Dr. Rutledge (http:/clos.net) " He who began a good work in you will be faithful to complete it until the day of Christ Jesus. " - Phil. 1:6 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2000 Report Share Posted May 12, 2000 You are very brave Jen, I if I got denied, I would have chocked it up to another failure. Keep up the good work! a wrote: > > Well my appeal was denied. I hate my insurance company! > They told me they just wanted the names of the people at the two > different docs office who can distinguish that the MGB is different > from the Rny Procedure. I gave them that and so much more and > informed them that I hope they would not find another reason not to > deny me. Well now they say that the MGB is experimental and > investigational. I tried to rationalize with the rep. he was > symapathetic but he virtually has no power. He said he will try to > get their doc to phone me.(I doubt it) > I feel so down. I was trting to stay optimistic but I think this > might never happen. Has anyone any heard of getting approval with a > second appeal? My second appeal will allow me to go face to face with > them and have Dr.R on the phone(If he will do that) It is so much > work and stress. I know their trying to wear me down so I will have > the doc in nj do it. I need to gather more data to support my claim > that this surgery is not experimental. I told them over 500 should > show that, but I think I need more. Any ideas? > Thanks jen > > ------------------------------------------------------------------------ > Get paid for the stuff you know! > Get answers for the stuff you don’t. And get $10 to spend on the site! > http://click.egroups.com/1/2200/2/_/453517/_/958139534/ > ------------------------------------------------------------------------ > > 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2000 Report Share Posted May 12, 2000 As I understand it, Dr. R's procedure is not experimental. It is just a somewhat modified laparoscopic version of the Loop procedure which has been done for years. I don't know as much as all of you yet, but the main modification seems to be the longer, larger stomach pouch that is left. Also, as has been mentioned, he has done over 500. I also think I read somewhere that many (or most ) docs who do WLS modify it somewhat according to what they think will work best, and that does not qualify their surgeries as being experimental. I feel like I hate most insurance companies, too, and I haven't even started to try to get approval from mine yet! I just get so angry when I read about how they mess with so many people's lives, and how they often don't even stick to what they say they will cover. It seems like most of their energy is spent trying to deny everything possible! I'm sure I am overstating somewhat, and that some insurance companies have some compassionate people making decisions, but I just feel so badly for all of you who have been denied! You are in my prayers. Sara BMI 42 (I think) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2000 Report Share Posted May 12, 2000 Jen--one of the girls, and I'm sorry, I can't think of who it was---her insurance said the same thing---it was an investigational procedure. They finally had to go through some sort of procedure to " register " it in a way that the procedure could be covered. I'm sorry I don't know more details, but I heard about it when I first signed on in February. You might ask your insurance company what it would take to list it so it's not considered experimental, and Dr R could probably help you too. I can't believe that they would squawk at this, when they know they could save so much money by offering the MGB......good luck. Insurance companies are the pits---I totally agree! fg At 01:51 PM 05/12/2000 -0000, you wrote: >Well my appeal was denied. I hate my insurance company! >They told me they just wanted the names of the people at the two >different docs office who can distinguish that the MGB is different >from the Rny Procedure. I gave them that and so much more and >informed them that I hope they would not find another reason not to >deny me. Well now they say that the MGB is experimental and >investigational. I tried to rationalize with the rep. he was >symapathetic but he virtually has no power. He said he will try to >get their doc to phone me.(I doubt it) >I feel so down. I was trting to stay optimistic but I think this >might never happen. Has anyone any heard of getting approval with a >second appeal? My second appeal will allow me to go face to face with >them and have Dr.R on the phone(If he will do that) It is so much >work and stress. I know their trying to wear me down so I will have >the doc in nj do it. I need to gather more data to support my claim >that this surgery is not experimental. I told them over 500 should >show that, but I think I need more. Any ideas? >Thanks jen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2000 Report Share Posted May 12, 2000 Hi Jen Maybe if there is someone in your area that has had the MGB done could go with you and share there story as to how much better life is for them this could help. As many people as possible someone who had it done within the last few months and someone who has had it atleast a year ago. I hope this will work. I am following the steps now, my physical is coming up. Good Luck I'll be praying and don't give up. MJRN of land Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 14, 2000 Report Share Posted May 14, 2000 > Well my appeal was denied. I hate my insurance company! > I was denied a second time and am waiting for my date to go in front of the appeal board. I don't know what else I could possibly do to prepare for the meeting. I have poured out my heart and showed I have the co morbidities associated with obesity. I hope seeing is believing. I don't have much hope becuase they are advising the grievance panel that they denied me for administrative reasons not clinical. Meaning Healthsource excludes this surgery. I don't know who else is fighting with Healthsource (now Cigna) and I hope not to have to sue, but I wonder if we could get Walter to represent all of us in a class action suit. Maybe there will be more success in numbers. Also I spoke to NC insurance commisioners office, they advised me I needed to exhaust all my appeals before they get involved. They will also appeal the decision on my behalf if they agree with me. This will be my last try before I sue. Where in NJ do you live I moved from the Somerville area to NC 10 years ago. Best of luck to all of us. in Denver NC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 14, 2000 Report Share Posted May 14, 2000 > Well my appeal was denied. I hate my insurance company! > I was denied a second time and am waiting for my date to go in front of the appeal board. I don't know what else I could possibly do to prepare for the meeting. I have poured out my heart and showed I have the co morbidities associated with obesity. I hope seeing is believing. I don't have much hope becuase they are advising the grievance panel that they denied me for administrative reasons not clinical. Meaning Healthsource excludes this surgery. I don't know who else is fighting with Healthsource (now Cigna) and I hope not to have to sue, but I wonder if we could get Walter to represent all of us in a class action suit. Maybe there will be more success in numbers. Also I spoke to NC insurance commisioners office, they advised me I needed to exhaust all my appeals before they get involved. They will also appeal the decision on my behalf if they agree with me. This will be my last try before I sue. Where in NJ do you live I moved from the Somerville area to NC 10 years ago. Best of luck to all of us. in Denver NC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 14, 2000 Report Share Posted May 14, 2000 > Well my appeal was denied. I hate my insurance company! > I was denied a second time and am waiting for my date to go in front of the appeal board. I don't know what else I could possibly do to prepare for the meeting. I have poured out my heart and showed I have the co morbidities associated with obesity. I hope seeing is believing. I don't have much hope becuase they are advising the grievance panel that they denied me for administrative reasons not clinical. Meaning Healthsource excludes this surgery. I don't know who else is fighting with Healthsource (now Cigna) and I hope not to have to sue, but I wonder if we could get Walter to represent all of us in a class action suit. Maybe there will be more success in numbers. Also I spoke to NC insurance commisioners office, they advised me I needed to exhaust all my appeals before they get involved. They will also appeal the decision on my behalf if they agree with me. This will be my last try before I sue. Where in NJ do you live I moved from the Somerville area to NC 10 years ago. Best of luck to all of us. in Denver NC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 14, 2000 Report Share Posted May 14, 2000 , I live near Long Beach Island which isn't too far from Atlantic City.I just moved here from New York and gave up BC/BS and now want to kick myself for not keeping it.(it seems they approve so easlily) I was away from my computer for most of the weekend and want to thank everyone for their support and advice. I really was going to unsubscribe when I was denied I felt that devastated but I'm glad I didn't. Now that I had time to digest this and regroup, I will try to formulate a level 2 appeal. I think I will still go to the clinic to try and gain some better info and ammunition. (also it will be a nice getaway for me and my hubby lol)Dr. R was great he answered my emails quickly and will speak to their docs for my appeal. I will check out that site and try to get some info. I really need info on others who had prudential HMO and were approved for a mgb. I will ask Dr. R how to handle the response to it being investigational surgery. Thanks again guys for all the advice and for just being such a supportive group. Jen Quote Link to comment Share on other sites More sharing options...
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