Guest guest Posted June 6, 2001 Report Share Posted June 6, 2001 Hi Lola, Welcome to this list and congrats on your decision to help yourself through this surgery. I am pre-op, scheduled for surgery June 25th with Dr Pomp at Mt Sinai, so I have no first hand knowledge. But I have been a member of this list since the end of January and have learned SO MUCH! I believe there have been a number of folks who have had revisions to the DS from previously failed VBGs. I thing there is another DS- Revision Yahoo group out there, but most of those members also post here, so they should be able to answer your questions for your brother. Better yet, give him the web addy to sign up for this list and ask for himself! Everyone here is always ready to help. In regards to your insurance questions, as you will soon see, there are many different experiences with the insurance process and yours is bound to be unique. If you have out-of-network coverage at 80% then, changes are, you have a PPO (preferred provider org?). Many times they do not require pre-authorization, but be sure to verify this. Please post the name of your co and plan name and state and sometimes you get lucky and folks on this list have the same plan and can give you first hand knowledge. Well, best wishes for a wonderful Journey to better health! We're glad your coming along with us! Terri Hassiak BMI 60 http://www.obesityhelp.com/morbidobesity/profile.phtml?N=H980366398 Appealed " Out-of-Network " Ins. Denial - AND WON!!! BPD/DS with Dr Pomp on 6/25/01 email(no spaces): bunsofluff @ hotmail.com > Hi Everyone, > > Thank you to all that replied to my last message. I joined this list > yesterday and have already learned so much. The more I learn about > DS surgery, the more I am convinced that it will be the best for me. > > I took the advice of some of you and researched Dr. Ren and made an > appt with her for July 11th. I contacted my insurance company > (Empire plan of NY), and was told that Dr. Ren is not covered, but I > could have the office send them the info and I would be reimbursed up > to 80% after my yearly copay ( I think?). I am under my Mom's > insurance and have never had to consider these things ( she did it > for me). She is now out of the country and the customer service > person seemed annoyed with my questions, so I let it go. Can anyone > explain this to me? Will I still have to get pre-approval? Do I pay > in full first and then get reimbursed or do I pay 20% and then get > the reimbursement and then pay that to the Dr. > > Also, my brother had his stomache stapled (I think it was VBG) about > ten years ago. He lost alot of his excess weight soon after, but is > now the same size that he was pre-surgery and can eat full meals. Is > he a candidate for DS? Seeing what happened to him kept me from even > considering WLS for so long. My brother and I are both BIG eaters > (sometimes bingers) and I want him to benefit from this surgery as > well. > > lola > BMI 57 > Consult with Dr. Ren 7/11/01 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 6, 2001 Report Share Posted June 6, 2001 Thank you to Terri for responding and best of wishes for your upcoming surgery. My insurance plan is the Empire Plan (for NY state employees and beneficiaries) I was told that hospital costs are covered by blue choice/blue shield and United Health care covers the rest. I am scheduled for a consult with Dr. Ren in NY and she is not in the network. Anyone, who has dealt with this insurance and can offer suggestions, please reply. Thank you lola BMI57 Consult w/ Dr. Ren 7/11/01 > > Hi Everyone, > > > > > > I took the advice of some of you and researched Dr. Ren and made an > > appt with her for July 11th. I contacted my insurance company > > (Empire plan of NY), and was told that Dr. Ren is not covered, but > I > > could have the office send them the info and I would be reimbursed > up > > to 80% after my yearly copay ( I think?). I am under my Mom's > > insurance and have never had to consider these things ( she did it > > for me). She is now out of the country and the customer service > > person seemed annoyed with my questions, so I let it go. Can > anyone > > explain this to me? Will I still have to get pre-approval? Do I > pay > > in full first and then get reimbursed or do I pay 20% and then get > > the reimbursement and then pay that to the Dr. > > > > > > lola > > BMI 57 > > Consult with Dr. Ren 7/11/01 Quote Link to comment Share on other sites More sharing options...
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