Guest guest Posted June 7, 2000 Report Share Posted June 7, 2000 Well, , that STINKS! How can they do that to you?? I would think as long as you precertified, then they will have to end up paying it. I live in IL, and I have BCBS of Minnesota. This is a new policy for me since my hubby just changed jobs, so I'm not sure how well they will pay. We had BCBS of IL at his last job, and they paid very well. That policy had major medical, so we paid nothing at all for hospital bills and other things that were big. This policy doesn't say anything about major medical, so we will have to pay 10% if Durham hospital is in network. I'm not sure about that. My handbook does not say that obesity surgery is excluded, but it does say that it needs to be precertified. I am hoping Dr. R's office has sent a request for approval to them, if not, it should be going to them soon. I guess there is no way of knowing if they will pay even if they do approve it... Good luck, let me know what happens, ok? Deb in IL Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2000 Report Share Posted June 7, 2000 Well, , that STINKS! How can they do that to you?? I would think as long as you precertified, then they will have to end up paying it. I live in IL, and I have BCBS of Minnesota. This is a new policy for me since my hubby just changed jobs, so I'm not sure how well they will pay. We had BCBS of IL at his last job, and they paid very well. That policy had major medical, so we paid nothing at all for hospital bills and other things that were big. This policy doesn't say anything about major medical, so we will have to pay 10% if Durham hospital is in network. I'm not sure about that. My handbook does not say that obesity surgery is excluded, but it does say that it needs to be precertified. I am hoping Dr. R's office has sent a request for approval to them, if not, it should be going to them soon. I guess there is no way of knowing if they will pay even if they do approve it... Good luck, let me know what happens, ok? Deb in IL Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2000 Report Share Posted June 7, 2000 i will certainly keep you posted. good luck to you. k Re: insurance warning > Well, , that STINKS! How can they do that to you?? I would think as > long as you precertified, then they will have to end up paying it. I live in > IL, and I have BCBS of Minnesota. This is a new policy for me since my hubby > just changed jobs, so I'm not sure how well they will pay. We had BCBS of IL > at his last job, and they paid very well. That policy had major medical, so > we paid nothing at all for hospital bills and other things that were big. > This policy doesn't say anything about major medical, so we will have to pay > 10% if Durham hospital is in network. I'm not sure about that. My handbook > does not say that obesity surgery is excluded, but it does say that it needs > to be precertified. I am hoping Dr. R's office has sent a request for > approval to them, if not, it should be going to them soon. I guess there is > no way of knowing if they will pay even if they do approve it... Good luck, > let me know what happens, ok? > > Deb in IL > > ------------------------------------------------------------------------ > Old school buds here: > http://click.egroups.com/1/4057/2/_/453517/_/960434181/ > ------------------------------------------------------------------------ > > 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 June 7, 2000 Report Share Posted June 7, 2000 i will certainly keep you posted. good luck to you. k Re: insurance warning > Well, , that STINKS! How can they do that to you?? I would think as > long as you precertified, then they will have to end up paying it. I live in > IL, and I have BCBS of Minnesota. This is a new policy for me since my hubby > just changed jobs, so I'm not sure how well they will pay. We had BCBS of IL > at his last job, and they paid very well. That policy had major medical, so > we paid nothing at all for hospital bills and other things that were big. > This policy doesn't say anything about major medical, so we will have to pay > 10% if Durham hospital is in network. I'm not sure about that. My handbook > does not say that obesity surgery is excluded, but it does say that it needs > to be precertified. I am hoping Dr. R's office has sent a request for > approval to them, if not, it should be going to them soon. I guess there is > no way of knowing if they will pay even if they do approve it... Good luck, > let me know what happens, ok? > > Deb in IL > > ------------------------------------------------------------------------ > Old school buds here: > http://click.egroups.com/1/4057/2/_/453517/_/960434181/ > ------------------------------------------------------------------------ > > 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 June 8, 2000 Report Share Posted June 8, 2000 In a message dated 6/7/00 10:44:04 PM Eastern Daylight Time, bergin@... writes: << but it was not in my handbook. bcbs said they would fax me their statement from the policy BUT LATER CHANGED THEIR MIND and will not provide it to me. my human resources dept will neither confirm nor deny the exclusion and will not provide me any additional documentation beyond my employee benefits booklet which does not list the exclusion. they suggest i appeal with blue cross. >> , Since you have it in writing that there is no exclusion and both BCBS and your HR dept have refused to supply you with written documentation otherwise, I would contact an attorney and have them write a letter demanding proof that it is excluded or payment. Depending on how much you will be out of pocket otherwise, it might be worth you while. {{HUGS}} Claire MGB 4/10/00 300/264 15.25 inches lost forever!! 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 June 8, 2000 Report Share Posted June 8, 2000 claire, i intend to pursue all avenues, if for no other reason the point of the matter. thanks,k Re: insurance warning > In a message dated 6/7/00 10:44:04 PM Eastern Daylight Time, bergin@... > writes: > > << but it was not in my handbook. bcbs said they would fax me their > statement from the policy BUT LATER CHANGED THEIR MIND and will not provide > it to me. my human resources dept will neither confirm nor deny the exclusion > and will not provide me any additional documentation beyond my employee > benefits booklet which does not list the exclusion. they suggest i appeal > with blue cross. >> > > , > > Since you have it in writing that there is no exclusion and both BCBS and > your HR dept have refused to supply you with written documentation otherwise, > I would contact an attorney and have them write a letter demanding proof that > it is excluded or payment. Depending on how much you will be out of pocket > otherwise, it might be worth you while. > > {{HUGS}} > > Claire > MGB 4/10/00 > 300/264 > 15.25 inches lost forever!! > 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 > > ------------------------------------------------------------------------ > Old school buds here: > http://click.egroups.com/1/4057/2/_/453517/_/960480473/ > ------------------------------------------------------------------------ > > 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...
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