Guest guest Posted August 3, 2000 Report Share Posted August 3, 2000 In a message dated 8/3/2000 1:20:04 PM Eastern Daylight Time, steague99@... writes: << Any suggestions from any of you guys who are or have already fought this battle? Thanks, >> I'm sorry , That woman needs her butt kicked!!!! I'd at least call back, demand to speak to her supervision and give them an earful over how you were treated by her!!!!!!! Cathy Morrow in Lenoir, NC 5' 0 " 216.5 Lbs. BMI 42 A journey of a thousand miles begins with a single step Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 3, 2000 Report Share Posted August 3, 2000 In a message dated 8/3/00 10:20:28 AM Pacific Daylight Time, steague99@... writes: << Hey guys...Well somehow I wish the insurance company had told me they lost my letter for approval...instead when I called what I got was a rude lady who was in no way, shape or form interested in talking to me about the latter...However what I got was a nasty attitude and a good day mam...She basically told me that since my policy plainly stated they did not cover any weight loss treatment that my request would not that day nor ever go anyfurther than her desk so I could appeal if I liked but It wouldn't do me anygood.....Any suggestions from any of you guys who are or have already fought this battle? Thanks, >> T could probably answer better, but I would call and ask for any of these people: Appeals Director, Medical Director or Assistant MD (and yes, they are doctors), Grievance Director, or Authorization Nurse. Believe it or not, it was the latter who was most helpful, and I believe instrumental in getting both and I approved. The higher up the ladder you go, the nicer the people. Those at the bottom are trained to deal with you so that you do not get any further, although I really did not encounter anyone downright rude. Another hint, talk really slowly, confidently, and be sickeningly sweet. They know how to deal with difficult people--it's the very sweet ones that trip them up! Don't back down! You will be added to my prayers, sweetie! Hang tough! Regards, Debbie in IL MGB 8/10 Cigna (1st appeal)--BMI 40 Daughter (age 16) MGB 8/9 Cigna (3rd appeal)--BMI 45 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 3, 2000 Report Share Posted August 3, 2000 That is SO common for an insurance company. And they now think that they have heard the last from you! NOT!!! This is NOT weight loss treatment. It is probably not excluded in your policy. Here's what my policy(I'm approved)says for example: Exclusions...Services or expenses primarily to lose weight due to excess fat, heart disease, or diabetes. This exclusion does not apply to surgery for morbid obesity if medically necessary and meets the guidelines and limitations set by Blue Cross. Most exclusions are even more vauge than that, but most are worded to include morbid obesity. Even if you do have a concrete exclusion, says that there are ways around them sometimes. My advice to you would be to get a copy of your policy an read. If you like, post the wording of the exclusion and maybe someone here can help you. Don't give up. I was denied twice before was able to get me an approval. Best Wishes. Stormy > Hey guys...Well somehow I wish the insurance company had told me they > lost my letter for approval...instead when I called what I got was a > rude lady who was in no way, shape or form interested in talking to > me > about the latter...However what I got was a nasty attitude and a good > day mam...She basically told me that since my policy plainly stated > they did not cover any weight loss treatment that my request would > not > that day nor ever go anyfurther than her desk so I could appeal if I > liked but It wouldn't do me anygood.....Any suggestions from any of > you guys who are or have already fought this battle? > > Thanks, > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2001 Report Share Posted June 14, 2001 Keep the faith....so many people have fought the fight.... Cindy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 4, 2005 Report Share Posted September 4, 2005 I've been denied BMI was 39 I have sinced gained the 4lbs need to hit 40. I really didn'y have a Doctor who was supportive. I only saw him one time and talked to him about the gastric bypass and he did the referral right than. I wish I would of had another slepp apnea test, the last one was 40 lbs ago. Also the arthritis in my back is not being considered. I do have a urologist who would say I'm have issues with leakage due to my weight. Lost and don't know where to go from here! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 4, 2005 Report Share Posted September 4, 2005 Maybe change your PCP and then ask the new one? __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 4, 2005 Report Share Posted September 4, 2005 If you know of a PCP, in the area of Fairfield or the pleasant hill area I'd be grateful. Thank you! Delaina wrote: Maybe change your PCP and then ask the new one?__________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 6, 2005 Report Share Posted September 6, 2005 (and anyone else who has been denied surgery by Kaiser because you don't " weigh enough " ), Sorry it has taken me so long to see this. I read in " digest " form so get things later than some others. Don't forget that you can appeal through the DMHC (Department of Managed Healthcare). Their web address is www.hmohelp.com . I know an attorney who works there and he says the DMHC just LOVES to overturn Kaiser's denials for WLS. He said they overturn them 99.9% of the time. If you meet the NIH (National Institute of Health) guidelines for WLS, which are far less stringent than Kaiser's, you qualify for WLS. I think it is a BMI of 30 or 35 to meet the NIH guidelines, with NO cormorbidities required. The appeal process through the DMHC is very easy -- all you have to have to appeal is a written denial from Kaiser. The instructions are right there on their web site. Be proactive! Laurie W. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 6, 2005 Report Share Posted September 6, 2005 Thank you!! Soooooo much I will get on it right away! Laurie W wrote: (and anyone else who has been denied surgery by Kaiser because you don't "weigh enough"),Sorry it has taken me so long to see this. I read in "digest" form so get things later than some others.Don't forget that you can appeal through the DMHC (Department of Managed Healthcare). Their web address is www.hmohelp.com . I know an attorney who works there and he says the DMHC just LOVES to overturn Kaiser's denials for WLS. He said they overturn them 99.9% of the time. If you meet the NIH (National Institute of Health) guidelines for WLS, which are far less stringent than Kaiser's, you qualify for WLS. I think it is a BMI of 30 or 35 to meet the NIH guidelines, with NO cormorbidities required.The appeal process through the DMHC is very easy -- all you have to have to appeal is a written denial from Kaiser. The instructions are right there on their web site.Be proactive!Laurie W. Quote Link to comment Share on other sites More sharing options...
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