Re: Gobo/BC

[Guest guest]

Judie;

Do you mean Federal Blue Cross? If that's what you mean it's

approximately $157 per month. I don't know what it would be for

'Individual Plans' or for another group coverage. You'll have to

check your local office. Make sure and tell them whether it's

Federal or not because the Federal plan uses a different phone

number and representatives.

hugs,

gobo

> Gobo,

> How much does it cost monthly for Blue Cross High Option?

Im thinking of switching.....

>

> Judie

[Guest guest]

Hi Angel;

's sister went away for the weekend to take a much

needed break. She was stressing out really badly. I tried to see

when I was in Portland on Thursday but she was off the

unit having tests. I've called her every day since then. Friday I

tried calling 3 times but she was out of her room each time.

Saturday, when I finally reached her, her husband had just

arrived so she was distracted. Whenever I would ask how she

was doing, she would just say, " I don't know " . So, I feel stymied

in trying to support her right now. I think her spirits may be

dipping again. ;- {

Hopefully, once her sister's back in the saddle, we'll get back on

track in following the progress of our dear .

In the meantime, I'm feeling fine again, thanks for your concern. It

must have been something I ate.

Now, on to insurance concerns:

> I have Cigna HMO

> and now I have one denial, but at least they've okayed

> a consult with Dr. Maguire! Tammy (referral person? at

> Cigna) said to go to Dr. Maguire and if I want, have

> him write up a treatment plan for the DS and have him

> submit it and we'd go from there.

I'm not absolutely positive (since I've not dealt with Cigna/HMO)

but with other HMO's this would definitely be a good thing!

> Do you think his

> chances will be better at getting it approved (since

> they all ready denied the DS surgery once?) Can the

> way he " codes " it, make a difference?

ABSOLUTELY!!!!!

Dr. in Portland USED to code the DS in such a way

that ALL insurance companies were denying benefits. Patients

were desperately trying to get her to change the way she coded.

Initially, she wasn't interested in being 'told' how to run her

office

by patients until she started seeing that ALL insurance

companies were denying benefits.

Some patients took the trouble to learn how other surgeons

were sucessfully coding. She now codes in a more consistant

way.

In addition, Regence Blue Shield (part of Blue Cross) has their

acceptable CPT codes posted on their web site for WLS. I think it

would be useful to find out what Dr. 's 'new and rivised'

coding is and compare it to Regence's. Are they they same? If

so, that's the coding that would probably meet Cigna's criteria.

However, I want to warn you that surgeon's do not like being told

what to do. I would present the CPT coding issue as a problem

you are aware of with insurance companies and how others

have solved it. Dr. Maguire will be smart enough to fill in the

blanks and take it from there.

I have also been

> collecting letters from (of course), my PCP,

> cardiologist, sleep clinic and nephrologist. All are

> willing to recommend the DS specifically to the

> insurance co..

BE SURE to tell Dr. Maguire what the status currently is; that

Cigna has initially denied but has requested that you get a

treatment plan from Dr. Maguire. Also, before that, I would call

the person at Cigna who told you to go ahead and get the

treatment plan. Tell her that you need that in writing to give Dr.

Maguire. Explain that because this is a request/suggestion from

the insurance company is following a denial, the surgeon is

going to want to see that this 'treatment plan' is per Cigna.

If she balks at putting anything in writing (which she undoubtably

will) ASSURE her that you are not trying to trap her or Cigna into

anything; you just want to provide Dr. Maguire that it is legitimate

for him to do a treatment plan and not a waste of his time. At that

point, she might deny that the treatment plan is going to result in

approval. I would ask her then, what the purpose of her

suggestion was? She'll tell you whatever she's going to admit to;

such as, we need to review the procecdure, etc.

Well, whatever she says, you reply that " that's EXACTLY what I

have to provide the surgeon with. We BOTH understand what

Cigna's position is but I need to give the surgeon a reason for

doing this. Surgeon's sit up and take notice of requests made by

insurance companies more that they do patients they may never

see again. "

The point of all this is that insurance companies are notorious

for later denying anything that is not in writing. I hate to say this

but I can visualize you going through the treatment plan with Dr.

Maguire and then having some supervisor later claim that they

never suggested you do it. I've even seen situations where the

person DID get something in writing and then a manager or

supervisor later claims that the person who put it in writing had

no authority to do so, and the agreement is null and void.

Insurance companies can be totally devoid of integrity and ethics

(at their worst).

I'm not trying to depress you, because as a consumer you DO

have rights and CAN make it work for you. I'm just trying to

impress upon you the importance of being an informed

consumer and protecting yourself by having EVERYTHING in

writing. You probably want to have a separate file on 'insurance'

stuff pertaining to WLS.

What's your BMI? If it's close to or over 50 that should be a big

reason for having the DS. Also, the fact that many r-n-y's need to

be revised.

I hope this doesn't discourage you. Fighting an insurance

company CAN be a downer. But! it CAN be done with

perserverance and conviction. The encouraging thing about

HMO's is that they really do treat each patient on a case-by-case

basis. I've sucessfully appealed many denials. The one thing

they won't budge on is approving 'out of network'.

Let me know if I can offer any more assistance.

Hugs,

gobo

[Guest guest]

Hi Angel;

's sister went away for the weekend to take a much

needed break. She was stressing out really badly. I tried to see

when I was in Portland on Thursday but she was off the

unit having tests. I've called her every day since then. Friday I

tried calling 3 times but she was out of her room each time.

Saturday, when I finally reached her, her husband had just

arrived so she was distracted. Whenever I would ask how she

was doing, she would just say, " I don't know " . So, I feel stymied

in trying to support her right now. I think her spirits may be

dipping again. ;- {

Hopefully, once her sister's back in the saddle, we'll get back on

track in following the progress of our dear .

In the meantime, I'm feeling fine again, thanks for your concern. It

must have been something I ate.

Now, on to insurance concerns:

> I have Cigna HMO

> and now I have one denial, but at least they've okayed

> a consult with Dr. Maguire! Tammy (referral person? at

> Cigna) said to go to Dr. Maguire and if I want, have

> him write up a treatment plan for the DS and have him

> submit it and we'd go from there.

I'm not absolutely positive (since I've not dealt with Cigna/HMO)

but with other HMO's this would definitely be a good thing!

> Do you think his

> chances will be better at getting it approved (since

> they all ready denied the DS surgery once?) Can the

> way he " codes " it, make a difference?

ABSOLUTELY!!!!!

Dr. in Portland USED to code the DS in such a way

that ALL insurance companies were denying benefits. Patients

were desperately trying to get her to change the way she coded.

Initially, she wasn't interested in being 'told' how to run her

office

by patients until she started seeing that ALL insurance

companies were denying benefits.

Some patients took the trouble to learn how other surgeons

were sucessfully coding. She now codes in a more consistant

way.

In addition, Regence Blue Shield (part of Blue Cross) has their

acceptable CPT codes posted on their web site for WLS. I think it

would be useful to find out what Dr. 's 'new and rivised'

coding is and compare it to Regence's. Are they they same? If

so, that's the coding that would probably meet Cigna's criteria.

However, I want to warn you that surgeon's do not like being told

what to do. I would present the CPT coding issue as a problem

you are aware of with insurance companies and how others

have solved it. Dr. Maguire will be smart enough to fill in the

blanks and take it from there.

I have also been

> collecting letters from (of course), my PCP,

> cardiologist, sleep clinic and nephrologist. All are

> willing to recommend the DS specifically to the

> insurance co..

BE SURE to tell Dr. Maguire what the status currently is; that

Cigna has initially denied but has requested that you get a

treatment plan from Dr. Maguire. Also, before that, I would call

the person at Cigna who told you to go ahead and get the

treatment plan. Tell her that you need that in writing to give Dr.

Maguire. Explain that because this is a request/suggestion from

the insurance company is following a denial, the surgeon is

going to want to see that this 'treatment plan' is per Cigna.

If she balks at putting anything in writing (which she undoubtably

will) ASSURE her that you are not trying to trap her or Cigna into

anything; you just want to provide Dr. Maguire that it is legitimate

for him to do a treatment plan and not a waste of his time. At that

point, she might deny that the treatment plan is going to result in

approval. I would ask her then, what the purpose of her

suggestion was? She'll tell you whatever she's going to admit to;

such as, we need to review the procecdure, etc.

Well, whatever she says, you reply that " that's EXACTLY what I

have to provide the surgeon with. We BOTH understand what

Cigna's position is but I need to give the surgeon a reason for

doing this. Surgeon's sit up and take notice of requests made by

insurance companies more that they do patients they may never

see again. "

The point of all this is that insurance companies are notorious

for later denying anything that is not in writing. I hate to say this

but I can visualize you going through the treatment plan with Dr.

Maguire and then having some supervisor later claim that they

never suggested you do it. I've even seen situations where the

person DID get something in writing and then a manager or

supervisor later claims that the person who put it in writing had

no authority to do so, and the agreement is null and void.

Insurance companies can be totally devoid of integrity and ethics

(at their worst).

I'm not trying to depress you, because as a consumer you DO

have rights and CAN make it work for you. I'm just trying to

impress upon you the importance of being an informed

consumer and protecting yourself by having EVERYTHING in

writing. You probably want to have a separate file on 'insurance'

stuff pertaining to WLS.

What's your BMI? If it's close to or over 50 that should be a big

reason for having the DS. Also, the fact that many r-n-y's need to

be revised.

I hope this doesn't discourage you. Fighting an insurance

company CAN be a downer. But! it CAN be done with

perserverance and conviction. The encouraging thing about

HMO's is that they really do treat each patient on a case-by-case

basis. I've sucessfully appealed many denials. The one thing

they won't budge on is approving 'out of network'.

Let me know if I can offer any more assistance.

Hugs,

gobo

[Guest guest]

Hi Angel;

's sister went away for the weekend to take a much

needed break. She was stressing out really badly. I tried to see

when I was in Portland on Thursday but she was off the

unit having tests. I've called her every day since then. Friday I

tried calling 3 times but she was out of her room each time.

Saturday, when I finally reached her, her husband had just

arrived so she was distracted. Whenever I would ask how she

was doing, she would just say, " I don't know " . So, I feel stymied

in trying to support her right now. I think her spirits may be

dipping again. ;- {

Hopefully, once her sister's back in the saddle, we'll get back on

track in following the progress of our dear .

In the meantime, I'm feeling fine again, thanks for your concern. It

must have been something I ate.

Now, on to insurance concerns:

> I have Cigna HMO

> and now I have one denial, but at least they've okayed

> a consult with Dr. Maguire! Tammy (referral person? at

> Cigna) said to go to Dr. Maguire and if I want, have

> him write up a treatment plan for the DS and have him

> submit it and we'd go from there.

I'm not absolutely positive (since I've not dealt with Cigna/HMO)

but with other HMO's this would definitely be a good thing!

> Do you think his

> chances will be better at getting it approved (since

> they all ready denied the DS surgery once?) Can the

> way he " codes " it, make a difference?

ABSOLUTELY!!!!!

Dr. in Portland USED to code the DS in such a way

that ALL insurance companies were denying benefits. Patients

were desperately trying to get her to change the way she coded.

Initially, she wasn't interested in being 'told' how to run her

office

by patients until she started seeing that ALL insurance

companies were denying benefits.

Some patients took the trouble to learn how other surgeons

were sucessfully coding. She now codes in a more consistant

way.

In addition, Regence Blue Shield (part of Blue Cross) has their

acceptable CPT codes posted on their web site for WLS. I think it

would be useful to find out what Dr. 's 'new and rivised'

coding is and compare it to Regence's. Are they they same? If

so, that's the coding that would probably meet Cigna's criteria.

However, I want to warn you that surgeon's do not like being told

what to do. I would present the CPT coding issue as a problem

you are aware of with insurance companies and how others

have solved it. Dr. Maguire will be smart enough to fill in the

blanks and take it from there.

I have also been

> collecting letters from (of course), my PCP,

> cardiologist, sleep clinic and nephrologist. All are

> willing to recommend the DS specifically to the

> insurance co..

BE SURE to tell Dr. Maguire what the status currently is; that

Cigna has initially denied but has requested that you get a

treatment plan from Dr. Maguire. Also, before that, I would call

the person at Cigna who told you to go ahead and get the

treatment plan. Tell her that you need that in writing to give Dr.

Maguire. Explain that because this is a request/suggestion from

the insurance company is following a denial, the surgeon is

going to want to see that this 'treatment plan' is per Cigna.

If she balks at putting anything in writing (which she undoubtably

will) ASSURE her that you are not trying to trap her or Cigna into

anything; you just want to provide Dr. Maguire that it is legitimate

for him to do a treatment plan and not a waste of his time. At that

point, she might deny that the treatment plan is going to result in

approval. I would ask her then, what the purpose of her

suggestion was? She'll tell you whatever she's going to admit to;

such as, we need to review the procecdure, etc.

Well, whatever she says, you reply that " that's EXACTLY what I

have to provide the surgeon with. We BOTH understand what

Cigna's position is but I need to give the surgeon a reason for

doing this. Surgeon's sit up and take notice of requests made by

insurance companies more that they do patients they may never

see again. "

The point of all this is that insurance companies are notorious

for later denying anything that is not in writing. I hate to say this

but I can visualize you going through the treatment plan with Dr.

Maguire and then having some supervisor later claim that they

never suggested you do it. I've even seen situations where the

person DID get something in writing and then a manager or

supervisor later claims that the person who put it in writing had

no authority to do so, and the agreement is null and void.

Insurance companies can be totally devoid of integrity and ethics

(at their worst).

I'm not trying to depress you, because as a consumer you DO

have rights and CAN make it work for you. I'm just trying to

impress upon you the importance of being an informed

consumer and protecting yourself by having EVERYTHING in

writing. You probably want to have a separate file on 'insurance'

stuff pertaining to WLS.

What's your BMI? If it's close to or over 50 that should be a big

reason for having the DS. Also, the fact that many r-n-y's need to

be revised.

I hope this doesn't discourage you. Fighting an insurance

company CAN be a downer. But! it CAN be done with

perserverance and conviction. The encouraging thing about

HMO's is that they really do treat each patient on a case-by-case

basis. I've sucessfully appealed many denials. The one thing

they won't budge on is approving 'out of network'.

Let me know if I can offer any more assistance.

Hugs,

gobo