Insurance Problems Need Support and Prayers!!

May 11, 2000

Well, my insurance has done it again. I received a call from my HR

department and they informed me that they have researched our policy

and it does state that they will cover surgery for Morbid Obesity as

long as the doctor's can show underlying conditions that it is

medically necessary. Then they said that the nurse that had went

through all of the 14 pages could not find it medically necessary so

it had been denied. I was very upset and asked her how they could

even say that. I am 250lbs overweight and have several comorbid

conditions. The newest being PCOS. Anyway she informed me that she

was no doctor and that all she could do was tell me what Cigna had

decided. After I hung up it dawned on me that the 14 pages that she

spoke of was from the original letter sent in by Dr. R. I am waiting

on the Appeal, which is over 40 pages long. I tried to reach her

back but she had already left, so I left her a voice mail. She

called me back yesterday and said that there had been a

misunderstanding and that they didn't realize that I was in the

Appeal process and that they would get in contact with the Appeals

board and get back with me.

I AM SO SORRY THIS IS SO LONG BUT I REALLY NEED TO GET THIS OUT AND

NOBODY ELSE REALLY UNDERSTANDS THE EMOTIONS I'M GOING THROUGH RIGHT

NOW.

Later yesterday afternoon my contact from Cigna called to inform me

that he had just received a call and that the Appeal had been denied

again because it was not a covered service. I have been fighting

with this insurance company since the beginning of February. I have

been sent from person to person. I keep getting different stories

from everyone that I speak with. They never return my calls.

Needless to say I was not a bit nice yesterday as I have tried to be

through all of this. I informed him of my call from my HR department

about how it is covered if they can prove medical nesessity. He

didn't care. I informed him that I wanted a letter of denial so I

could take it to my lawyer and to the insurance commissioner. He

said I would receive one but it would only state that it had been

denied. Nothing else. I told him it needed to tell me why it was

denied and where I could find it in my policy and he informed me that

it would not state that and that they did not have to give me that

information. Needless to say after a few choice words I hung up on

him because he had me so mad I couldn't see straight.

My emotions are so bad right now. I am so tired. I know that I need

to start a letter to the insurance commissioner but I don't know

where to start. Everytime I think about all of this I start crying

again. I just need some input from some of my wonderful friends here

on the list and also ALOT of PRAYERS. Without my insurance there is

no possible way for me to have this procedure because I am a single

mom and it takes everything I have to raise my son. I want to live

to see him graduate High school and get married and have me some

grandchildren but at this rate I won't make it.

Again, I am SOOOOOOOOOOOO Sorry that this is so long.

Love you all!!

Karla Ikerd

MGB hopeful

May 11, 2000

Dear Karla,

You may need a Lawyer. I am a nurse and ask, Is your

cholesterol above 200, how about Triglycerides? Do

wake up during the night? Sleep Apnea????? Do You

have low back pain, joint pain, swollen ankles? Are you

short of breath going up stairs? All are medical

problems//////////////////////////////And If all else

fails are you depressed at being overweight with loss of

self esteem,worthlessness,fatigue,and compulsive eating

habits..............all are medical disorders and not

cosmetic as the Ins co's love put things in classes.

I have filed 1000's of claims for my pt's anbd those

that yell the loudest get the action//////////////

Love and Prayers

Judi in Fla.

Quoting Karla Ikerd KIkerd@...>:

> Well, my insurance has done it again. I received a

call from my HR

> department and they informed me that they have

researched our policy

> and it does state that they will cover surgery for

Morbid Obesity as

> long as the doctor's can show underlying conditions

that it is

> medically necessary. Then they said that the nurse

that had went

> through all of the 14 pages could not find it

medically necessary so

> it had been denied. I was very upset and asked her

how they could

> even say that. I am 250lbs overweight and have

several comorbid

> conditions. The newest being PCOS. Anyway she

informed me that she

> was no doctor and that all she could do was tell me

what Cigna had

> decided. After I hung up it dawned on me that the 14

pages that she

> spoke of was from the original letter sent in by Dr.

R. I am waiting

> on the Appeal, which is over 40 pages long. I tried

to reach her

> back but she had already left, so I left her a voice

mail. She

> called me back yesterday and said that there had been

a

> misunderstanding and that they didn't realize that I

was in the

> Appeal process and that they would get in contact

with the Appeals

> board and get back with me.

>

> I AM SO SORRY THIS IS SO LONG BUT I REALLY NEED TO

GET THIS OUT AND

> NOBODY ELSE REALLY UNDERSTANDS THE EMOTIONS I'M GOING

THROUGH RIGHT

> NOW.

>

> Later yesterday afternoon my contact from Cigna

called to inform me

> that he had just received a call and that the Appeal

had been denied

> again because it was not a covered service. I have

been fighting

> with this insurance company since the beginning of

February. I have

> been sent from person to person. I keep getting

different stories

> from everyone that I speak with. They never return

my calls.

> Needless to say I was not a bit nice yesterday as I

have tried to be

> through all of this. I informed him of my call from

my HR department

> about how it is covered if they can prove medical

nesessity. He

> didn't care. I informed him that I wanted a letter

of denial so I

> could take it to my lawyer and to the insurance

commissioner. He

> said I would receive one but it would only state that

it had been

> denied. Nothing else. I told him it needed to tell

me why it was

> denied and where I could find it in my policy and he

informed me that

> it would not state that and that they did not have to

give me that

> information. Needless to say after a few choice

words I hung up on

> him because he had me so mad I couldn't see straight.

>

> My emotions are so bad right now. I am so tired. I

know that I need

> to start a letter to the insurance commissioner but I

don't know

> where to start. Everytime I think about all of this

I start crying

> again. I just need some input from some of my

wonderful friends here

> on the list and also ALOT of PRAYERS. Without my

insurance there is

> no possible way for me to have this procedure because

I am a single

> mom and it takes everything I have to raise my son.

I want to live

> to see him graduate High school and get married and

have me some

> grandchildren but at this rate I won't make it.

>

> Again, I am SOOOOOOOOOOOO Sorry that this is so long.

>

> Love you all!!

> Karla Ikerd

> MGB hopeful

>

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

------------------

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> Click Here:

>

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List at Onelist.com

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May 11, 2000

I wish I had words of wisdom, but I am in appeals myself. So sorry they

have done this to you. Unfortunately, when I called my insurance company at

the start of this process, they didn't blink an eye when I asked them about

bypass surgery. However, when I got the complete packet with non-covered

items from my employer, it stated that it didn't cover it even for morbid

obesity. When I called the insurance company back and told them this, their

whole attitude changed......not a covered benefit? Oh well, then we'll

never pay for surgery. Then I realize that my employer is a self insured

corporation and that appeals do not go through the insurance company at all

but strictly through my employer. So now I am in appeal through my

employer, but they haven't been that gracious in sharing their thoughts.LOL

When I asked for appeal, my HR contact said they usually don't approve

things if it is non-covered. I said, " You said, 'not USUALLY! " ' lol

Anyway, I sent in a several page personal appeal as well as the info that Dr

R includes in his appeal letter. We'll see what they say.

All I'm saying, is that when you first made contact with your insurance

company, they might not have known exactly what policy your employer had

purchased, or it might be like where I work, the company is just a

front......manages the accounts, etc, the institution actually runs the

inner workings of the plan. I do know that they are not allowed to withhold

complete policy information from you........what they will and will not

cover. My company sends one out to us every year, or whenever the policy

changes. States exclusions in black and white. I would be very intent on

getting a copy of the insurance manual if I were you, and if the words are

simply obesity and not morbid obesity, I would fight them for it. Even if I

had to get a lawyer I would do it. You can look up the name of your state

insurance commissioner on the net. You don't perchance live in one of the

states with a passed obesity law, do you? Good luck in your fight.

fg

At 02:27 PM 05/11/2000 -0000, you wrote:

>Well, my insurance has done it again. I received a call from my HR

>department and they informed me that they have researched our policy

>and it does state that they will cover surgery for Morbid Obesity as

>long as the doctor's can show underlying conditions that it is

>medically necessary. Then they said that the nurse that had went

>through all of the 14 pages could not find it medically necessary so

>it had been denied. I was very upset and asked her how they could

>even say that. I am 250lbs overweight and have several comorbid

>conditions. The newest being PCOS. Anyway she informed me that she

>was no doctor and that all she could do was tell me what Cigna had

>decided. After I hung up it dawned on me that the 14 pages that she

>spoke of was from the original letter sent in by Dr. R. I am waiting

>on the Appeal, which is over 40 pages long. I tried to reach her

>back but she had already left, so I left her a voice mail. She

>called me back yesterday and said that there had been a

>misunderstanding and that they didn't realize that I was in the

>Appeal process and that they would get in contact with the Appeals

>board and get back with me.

>

>I AM SO SORRY THIS IS SO LONG BUT I REALLY NEED TO GET THIS OUT AND

>NOBODY ELSE REALLY UNDERSTANDS THE EMOTIONS I'M GOING THROUGH RIGHT

>NOW.

>

>Later yesterday afternoon my contact from Cigna called to inform me

>that he had just received a call and that the Appeal had been denied

>again because it was not a covered service. I have been fighting

>with this insurance company since the beginning of February. I have

>been sent from person to person. I keep getting different stories

>from everyone that I speak with. They never return my calls.

>Needless to say I was not a bit nice yesterday as I have tried to be

>through all of this. I informed him of my call from my HR department

>about how it is covered if they can prove medical nesessity. He

>didn't care. I informed him that I wanted a letter of denial so I

>could take it to my lawyer and to the insurance commissioner. He

>said I would receive one but it would only state that it had been

>denied. Nothing else. I told him it needed to tell me why it was

>denied and where I could find it in my policy and he informed me that

>it would not state that and that they did not have to give me that

>information. Needless to say after a few choice words I hung up on

>him because he had me so mad I couldn't see straight.

>

>My emotions are so bad right now. I am so tired. I know that I need

>to start a letter to the insurance commissioner but I don't know

>where to start. Everytime I think about all of this I start crying

>again. I just need some input from some of my wonderful friends here

>on the list and also ALOT of PRAYERS. Without my insurance there is

>no possible way for me to have this procedure because I am a single

>mom and it takes everything I have to raise my son. I want to live

>to see him graduate High school and get married and have me some

>grandchildren but at this rate I won't make it.

>

>Again, I am SOOOOOOOOOOOO Sorry that this is so long.

>

>Love you all!!

>Karla Ikerd

>MGB hopeful

>

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

>Win $500 at freewarranty.com!

>Click Here:

>http://click.egroups.com/1/4031/2/_/453517/_/958055249/

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

>

>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

>

May 11, 2000