How Does the Process Work

[Guest guest]

Hi again Dee--

Wow--it sounds like you've been through the wringer with your insurance. Those

problems could very well lay ahead for me too--I have Anthem Blue Cross/Blue

Shield (in Connecticut), who I've heard is pretty good about approving these

surgeries, but (fortunately, I suppose) I don't have co-morbidities, so I know

that makes my insurance approval more tenuous.

I'm 31, 5'5, 270, and growing weekly, even though I'm always on a diet. Ironic,

isn't it? I know that health problems are out there waiting for me, and it

seems like, with the availability of this procedure, that I shouldn't have to

wait for serious health problems to happen before I can do something about it.

I have two children, ages 5 & 7, and I want to be able to take them to the park,

to the pool, teach them to play tennis, without feeling like I'd rather lay at

home on the couch rather than face those annoying skinny moms on the playground

with their kids. I'd also like to have another baby someday, which at my

current weight, is just plain outright not a good idea. When my son, Hunter,

was born (by c-section at 38 weeks--2 weeks early!) he weighed 10 lbs. 11 oz.

Undoubtedly a result of my weight and borderline gestational diabetes.

I hope you'll have time to answer a few other questions for me: is this the

order that things happened for you: (1) sent your packet, (2) Dr. R submitted

to insurance, and they declined, and (3) now you're battling with insurance? If

this is how it happened, had you already had blood testing and stuff before you

submitted your packet, and if so, now will you have to get that stuff done again

when your insurance finally comes through (which I PRAY for you that it will!)?

Also, we are about the same age...did you need to get a mammogram? I see alot

of women on here refer to that, was wondering if that's for patients over 40.

Thanks for your continuing help, and don't let these insurance companies ruin

your day! Fight the good fight and have faith that it will work out however

it's supposed to, and regardless of the outcome, you'll be a far stronger

person! Remember, only you can determine whether you have a good day or not, so

resolve not to let it get to you, to let it make you stronger! (Of course, I

can't always live by this philosophy myself, we all have bad days--but sometimes

it helps me to stop, remember that I have control over how I respond to things,

and resolve to start my day over! Believe me, there's been days where I've

started the day over more that a dozen times! LOL)

I'll look forward to hearing from you again soon!

a

alexa mease-white, esq.

business director

diva web solutions

*********** REPLY SEPARATOR ***********

Dear a,

I am so very sorry for my post to you...I had a rough morning and I've been

working with my insurance company for months trying to get approved...I took it

out on you and I am very sorry !

I did misunderstand your post and I should know better, I am just soooo

frustrated with the whole process. I am 30 years old and have been heavy all my

life, and to finally find a miracle surgery, and then have an insurance company

that you've been paying high premiums to forever, decline you, it gets so

frustrating !! Again, please accept my apologies, I have no excuse, we are all

in this together, and even if you were approved the very second you asked, I

should have been right there jumping for joy with you...

Thank you for not flaming me :0) that alone shows what an understanding person

you are !

PS...GOOD LUCK WITH YOUR PCP ! I'll have my fingers crossed !

PSS...No I have not yet had the surgery, my PCP recommended this surgery with

Dr.R and he sent a letter to Cigna for my pre-approval, Cigna declined, based on

it being not medically necessary, (I am 5'1, 297 lbs, 55% BMI with co-morbities)

but they feel its not medically necessary. I have appealed this decision, and

sent a 124 page appeal letter (more like a manual) to Cigna's appeal board. If

I am again denied, I will try a level II appeal, and if that is denied I will

contact an attorney. The whole process is so frustrating, and I got upset at

the wrong person. Again I am sorry.

Sincerely,

Re:

Hi Dee--

You may have misunderstood my posting--I didn't get approved for the surgery, so

I have nothing to " gloat " about. I haven't even talked to my personal physician

about the MGB yet (although I have an appointment with her this week--crossing

my fingers!)

My posting (asking whether everyone gets approved that quickly) was in response

to a posting from someone who had mailed their packet and then got approved for

the surgery a week later. I'm just now in the process of getting my packet

together, and I am simply curious about how long it takes to get approved once

the packet is completed, assuming no roadblocks.

So please don't take offense at me--if your beef is with anyone, it should be

with the original author of the posting, although I don't think she intended

hers to be offensive either.

Have you had the surgery? Have you had problems with your insurance? I was

under the impression that Dr. R's office handles the insurance end...is that

assuming no problems with insurance (i.e. if your insurance declines, then you

have to deal directly with them)???

Just wondering, I still have alot of unanswered questions. Your help would be

much appreciated!

Thanks--

alexa mease-white, esq.

business director

diva web solutions

*********** REPLY SEPARATOR ***********

>>I have a question: does EVERYONE get approved that quickly? I<<<

Although everyone is very happy to hear when our " sisters " are approved, it is

probably not a good idea to alert everyone by saying the above .....NO ,

EVERYONE does NOT get approved that quickly ! Some of us have been fighting

for months with our insurance companies, some folks will never have the surgery

until they have it covered by insurance. So please, as happy as everyone is to

see our sister close to the other side, try not to be " gloating " about it ok?

Maybe a different choice of words like.....HEYYYYYY I'VE BEEN APPROVED !! FIRST

TIME AROUND !! might be just as effective.

I dont mean to flame you...but your post just really got to me.

Sincerely,

Dee