Guest guest Posted May 1, 2001 Report Share Posted May 1, 2001 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2001 Report Share Posted May 4, 2001 Hi Gobo, Listen, I was wondering if I could pick your brain? You may have read my posts about being denied a consult with Dr Hess but being approved for a consult with Dr. Maguire. Well the insurance co. says they will approve the RNY but not the DS. But Tammy at the insurance co. said to go ahead (if I wanted to) and have Dr. Maguire make out a treatment plan for the DS and we'll see what happens on appeal. What do you think my chances are of an approval? I'm hoping pretty good since I got my foot in the door with a DS surgeon. Anyway, I noticed in another post to someone you mentioned you worked with insurance before (I think it was you)and if you wouldn't mind giving me some of your thoughts, I'd appreciate it greatly! Thanks bunches, Angel --- gobo yoemoe@...> wrote: > 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 > > > ---------------------------------------------------------------------- > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2001 Report Share Posted May 4, 2001 Hi Gobo, Listen, I was wondering if I could pick your brain? You may have read my posts about being denied a consult with Dr Hess but being approved for a consult with Dr. Maguire. Well the insurance co. says they will approve the RNY but not the DS. But Tammy at the insurance co. said to go ahead (if I wanted to) and have Dr. Maguire make out a treatment plan for the DS and we'll see what happens on appeal. What do you think my chances are of an approval? I'm hoping pretty good since I got my foot in the door with a DS surgeon. Anyway, I noticed in another post to someone you mentioned you worked with insurance before (I think it was you)and if you wouldn't mind giving me some of your thoughts, I'd appreciate it greatly! Thanks bunches, Angel --- gobo yoemoe@...> wrote: > 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 > > > ---------------------------------------------------------------------- > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2001 Report Share Posted May 4, 2001 Angel; An insurance company's willingness to pay for something that is outside the scope of what they normally pay is increased hugely if you can present acceptable medical evidence explaining why the teatment is medically indicated over and above the treatment they would normally agree to pay. [What a run-on sentence that was, huh?] In other words, you want to present them with evidence that shows, FOR YOU PERSONALLY, the DS is the better choice. Therefore, the reason can't be " because it's a better procedure " or, " it has a better outcome " . Those may me the reasons many of us (myself included) decided upon the DS/Switch but you need to prove to your insurance company that ONLY the DS/Swictch meets your needs. You need to prove to them that the RNY is not, in YOUR CASE a good medical decision. For instance, if your BMI is above 50, the DS really is the indicated procedure. I've also read reasons that doctors give that pertain to a person's eating habits. I am unfamiliar with what those reason would be. I worry about reasons based on eating habits sounding suspiciously like eating disorders. A doc can probably present this reason legitimately. I think that on Dr. Hess' web site, there are some lists that show the pro's and con's of each procedure. There's probably also web sites that help people to decide which procedure is best suited for them. If you check around, you'll be able to find the sort of info. I'm referring to. What I would do, is use all that info to build a case for yourself. I would advise against using the fact that DS patients lose up to 85% versus RNY patients only losing up to 65%. The reason I say this is that BC/BS is patently AGAINST covering anything that has anything to do with weight loss or obesity. The ONLY reason they cover bariatric surgery (WLS) at all, is because of all the health risks or co-morbidities. As far as they are concerned, actually losing weght is secondary to reducing one's health risks. If you want more help, please just email me. I'll jump in with you and do some research. hugs, gobo " Necessity is the mother of invention " — Wycherly: Love in a Wood, act iii. sc. 3 (1672) > > > Gobo, > > > How much does it cost monthly for Blue Cross High > > Option? > > Im thinking of switching..... > > > > > > Judie > > > > > > > ------------------------------------------------ ---------------------- > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 5, 2001 Report Share Posted May 5, 2001 Dear Gobo, How are you feeling? Hope you're feeling much better. You get all the rest you need and get back to feeling your sweet self before you even consider helping me in my fight! You have your hands full with and all the wonderful help you're giving her. I can wait until you have a little more time! I did try to approach the insurance the way you said, (I even sent in the Hess report highlighted etc. with comments in the margins why this point or that point made it the surgery that was indicated for me). However I'm not a Dr. or insurance person whose dealt with this before so maybe I just messed up my chances! 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. 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? 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.. So when you get the chance,(AND LET ME STRESS, WHEN YOU FEEL UP TO IT!) let me know what you think and what kinds of things the insurance co is looking for that would show that ONLY the DS would be indicated for me. Thanks dear. Rest and get better. I will be sending you some jokes for in the next day or two along with a note of encouragement. Thank you, thank you, thank you for being.....YOU! Angel --- gobo yoemoe@...> wrote: > Angel; > An insurance company's willingness to pay for > something that is > outside the scope of what they normally pay is > increased hugely > if you can present acceptable medical evidence > explaining why > the teatment is medically indicated over and above > the treatment > they would normally agree to pay. [What a run-on > sentence that > was, huh?] > > In other words, you want to present them with > evidence that > shows, FOR YOU PERSONALLY, the DS is the better > choice. > Therefore, the reason can't be " because it's a > better > procedure " or, " it has a better outcome " . Those may > me the > reasons many of us (myself included) decided upon > the > DS/Switch but you need to prove to your insurance > company that > ONLY the DS/Swictch meets your needs. You need to > prove to > them that the RNY is not, in YOUR CASE a good > medical > decision. > > For instance, if your BMI is above 50, the DS really > is the > indicated procedure. I've also read reasons that > doctors give that > pertain to a person's eating habits. I am unfamiliar > with what > those reason would be. I worry about reasons based > on eating > habits sounding suspiciously like eating disorders. > A doc can > probably present this reason legitimately. > > I think that on Dr. Hess' web site, there are some > lists that show > the pro's and con's of each procedure. There's > probably also > web sites that help people to decide which procedure > is best > suited for them. If you check around, you'll be able > to find the sort > of info. I'm referring to. > > What I would do, is use all that info to build a > case for yourself. I > would advise against using the fact that DS patients > lose up to > 85% versus RNY patients only losing up to 65%. The > reason I > say this is that BC/BS is patently AGAINST covering > anything that > has anything to do with weight loss or obesity. The > ONLY reason > they cover bariatric surgery (WLS) at all, is > because of all the > health risks or co-morbidities. As far as they are > concerned, > actually losing weght is secondary to reducing one's > health > risks. > > If you want more help, please just email me. I'll > jump in with you > and do some research. > > hugs, > gobo > > " Necessity is the mother of invention " — Wycherly: > Love in a > Wood, act iii. sc. 3 (1672) > __________________________________________________ Quote Link to comment Share on other sites More sharing options...
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