Guest guest Posted June 9, 2001 Report Share Posted June 9, 2001 Tell me GROUP has everyone heard of the hoopla surrounding denial of the DS procedure by BC/BS? Does anyone know, if that includes Blue Cross of California? Have many people been denied that hvae Blue Cross of CA and then appealed and WON? I'm moving forward using Dr.Rabkin and I feel like as I move forward with some of the pre-op appointments I need to posture myself for a fight with them. (blue cross) Heck it seems to me BC should be held liable then for _A N Y and A L L !!!! complications surrounding MO if in fact they deny coverage for this DS procedure. They are leaving you hanging with a predisposition of a variety of complications and illnesses sure to rise up as time goes by. Maybe it's time I go back to school.....I could become an advocate for people just like us. What better reward in life than to help someone get thru a problem that makes our lives better. Steve G. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 9, 2001 Report Share Posted June 9, 2001 Heck it seems to me BC should be held liable then for _A N Y and A L L !!!! complications surrounding MO if in fact they deny coverage for this DS procedure. They are leaving you hanging with a predisposition of a variety of complications and illnesses sure to rise up as time goes by. Wow...I was just thinking this last night. I'm appealing Regence BC/BS of Wa. I've heard they do approve on a case by case and I have a copy of their policy so I wrote my appeal to match it. I also feel that they are responsible for me if get sicker and they didn't provide treatment. I wonder ....maybe this is what they mean by a class action suit. Maybe that is what the United Heathcare people need to do.... ~~* AJ *~~ BMI 58 INSURANCE: NW Washington Medical (Regence ) DR Heap, Richland WA Denied due to exclusion, submitting appeal 6/7/01 Bellingham Support for WLS WWW.lookin2bthin.homestead.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 9, 2001 Report Share Posted June 9, 2001 Steve, I have the standard Blue Cross/Blue Shield of Michigan. I was approved within 2 weeks-no problems what-so-ever! Patience paid off. Kathy Bazzi 5-15 354lbs as of 5-31 -32lbs. forever Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 9, 2001 Report Share Posted June 9, 2001 On Sat, 09 Jun 2001 15:19:18 -0000 sfgclimbhi@... writes: > Tell me GROUP has everyone heard of the hoopla surrounding denial of > > the DS procedure by BC/BS? > > Does anyone know, if that includes Blue Cross of California? Not in my case-- I was approved with absolutely no problem-- lots of co-morbidities and a BMI of 71 seem to have done the trick.-- I am Prudent Buyer ppo, which may make a difference. I will check the posts, I may have missed something, but I don't think there have been many who had trouble with BC of CA-- maybe with an hmo version and the Primary care group who were the gate keepers..... Nan E., Pre-op, USC, BMI 71 age 49 > ________________________________________________________________ GET INTERNET ACCESS FROM JUNO! Juno offers FREE or PREMIUM Internet access for less! Join Juno today! For your FREE software, visit: http://dl.www.juno.com/get/tagj. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 9, 2001 Report Share Posted June 9, 2001 Steve, I have Blue Cross Prudent Buyer in California...I was approved in less than 24 hours..my BMI was 49 with no co-morbidities (sp?). My only complaint with them, is that since the surgery, every time I have a follow up visit with either my PCP or my surgeon, and any lab work etc, get sent back as " not a covered expense " and each time I have to call them and explain that it is covered because it relates to a covered surgery...then they pay it. Brynn 5 " 7 " 9/12/00 Surgery with Dr. Keshishian weight: 299 current weight: 187 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 9, 2001 Report Share Posted June 9, 2001 is there something to why these insurance companies are dening this surgery? is there something that we should question about it? just a thought cheryl Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 9, 2001 Report Share Posted June 9, 2001 Steve, If you're serious about lobbying for this surgery for others, you may not even need to go back to school considering your experiences. I prepared myself for a fight (Pacific Care) but was pretty fortunate. It could simply be that I expected the worst, so everything that happened looked good. I'm with you, though, this red-tape business has got to stop. I'm considering it as part of my next career move. Dory Pacific Care/Sutter Gould BMI 47 Pre-op (July 2001?) Rabkin/Jossart > Tell me GROUP has everyone heard of the hoopla surrounding denial of > the DS procedure by BC/BS? > > Does anyone know, if that includes Blue Cross of California? > > Have many people been denied that hvae Blue Cross of CA and then > appealed and WON? > > I'm moving forward using Dr.Rabkin and I feel like as I move forward > with some of the pre-op appointments I need to posture myself for a > fight with them. (blue cross) > > Heck it seems to me BC should be held liable then for _A N Y and > A L L !!!! complications surrounding MO if in fact they deny coverage > for this DS procedure. They are leaving you hanging with a > predisposition of a variety of complications and illnesses sure to > rise up as time goes by. > > Maybe it's time I go back to school.....I could become an advocate for > people just like us. What better reward in life than to help someone > get thru a problem that makes our lives better. > > Steve G. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 9, 2001 Report Share Posted June 9, 2001 is there something to why these insurance companies are dening this surgery? is there something that we should question about it? just a thought I think its called money and prejudice. Personally I think they don't find it necessary because its not like a heart attack in their eyes...even though it is...we just run up more bills over more years first. I get so tired of hearing people say they can be a drug addict, alcohol addict, smoker and can get help with insurance but we can't. We aren't even doing anything illegal as some of them are but they will pay for rehab even though the success rates are very low probably lower than the success stories of weight loss. Its just okay to discriminate against big people....and its really sad. ~~* AJ *~~ BMI 58 INSURANCE: NW Washington Medical (Regence ) DR Heap, Richland WA Denied due to exclusion, submitting appeal 6/7/01 Bellingham Support for WLS WWW.lookin2bthin.homestead.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 9, 2001 Report Share Posted June 9, 2001 >No hoopla going on with Blue Cross. They just paid for my DS. Blue Cross of California is now denying DS requests, according to two California surgeons. There apparently was a patient of Dr. Rabkin's who was approved and BC called to rescind it the day before her surgery, shortly before Memorial Day. Those of us who are approved but not yet up to our surgery dates are holding our breath. Those BCers who haven't been approved are probably looking at a battle. L. Dr. K 6/26 no matter what Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 9, 2001 Report Share Posted June 9, 2001 I have BC/BS of Hawaii, however, I can use in all 50 states and this is the truth. For example, I work in Hawaii, I live in Ga., had surgery in New York 15 days:BPD w/ DS, had endoscopy and psych. eval in New York and filled prescriptions in Ga. If I come to Calif., then I would go thru BC/BS of Calif. Good luck. I was preapproval in 2 days and I was told that WLS was exclusion. Switched on 5/25/01 Started @ 285 lbs. > Tell me GROUP has everyone heard of the hoopla surrounding denial of > the DS procedure by BC/BS? > > Does anyone know, if that includes Blue Cross of California? > > Have many people been denied that hvae Blue Cross of CA and then > appealed and WON? > > I'm moving forward using Dr.Rabkin and I feel like as I move forward > with some of the pre-op appointments I need to posture myself for a > fight with them. (blue cross) > > Heck it seems to me BC should be held liable then for _A N Y and > A L L !!!! complications surrounding MO if in fact they deny coverage > for this DS procedure. They are leaving you hanging with a > predisposition of a variety of complications and illnesses sure to > rise up as time goes by. > > Maybe it's time I go back to school.....I could become an advocate for > people just like us. What better reward in life than to help someone > get thru a problem that makes our lives better. > > Steve G. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 9, 2001 Report Share Posted June 9, 2001 Contracted docs like Dr Ren (NYUMC charged $24,000 for my surgery and they paid the contracted amount of $7000) do not even need pre-approval. Only the hospital needs pre-approval from BCBS. OMG the dr charges $24000??? Mine is only just a little over $4000 and has been doing this for years....WOW NY is expensive!! The drs here are lucky to get $2000. ~~* AJ *~~ BMI 58 INSURANCE: NW Washington Medical (Regence ) DR Heap, Richland WA Denied due to exclusion, submitting appeal 6/7/01 Bellingham Support for WLS WWW.lookin2bthin.homestead.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 9, 2001 Report Share Posted June 9, 2001 Steve G. No hoopla going on with Blue Cross. They just paid for my DS. One doc Dr Aslam (?) has told one of his patients that Blue Cross was doing this. My thinking is he is not a contracted doc for Blue Cross and therefore they do not want to pay his price. Contracted docs like Dr Ren (NYUMC charged $24,000 for my surgery and they paid the contracted amount of $7000) do not even need pre-approval. Only the hospital needs pre-approval from BCBS. Viau http://www.angelfire.com/on/wannabemagic/WLS.html 3/29/01: 3166/4/01: 265 (-51 lbs)Dr Ren, NYUMC http://www.thinforlife.orgTo join the new group for Dr Ren click on the link belowhttp://groups.yahoo.com/group/NYUMC-thinforlife Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2001 Report Share Posted June 11, 2001 Tell me more, In my book from BC Dr. Aslam is listed,as a contract Dr. Beyound that I don't know exactly how it works. I t is BC/BS Anthem, and it is HMO, but I was under the impression that if a Dr. was in my book and I had referral from my PCP,[which I do] that they would pay. The Dr. office told me that they are now saying it is too experimental. I know that they have approved people in Maine for surgery, but now they are not. The people that were approved were not given a hard time or anything. If you know of something I can do, something I can tell them,? I am hoping to find out more soon. Darlene from Maine Darlene Pre-op BMI 49 waiting ????? No hoopla going on with Blue Cross. They just paid for my DS. One doc Dr Aslam (?) has told one of his patients that Blue Cross was doing this. My thinking is he is not a contracted doc for Blue Cross and therefore they do not want to pay his price. Contracted docs like Dr Ren (NYUMC charged $24,000 for my surgery and they paid the contracted amount of $7000) do not even need pre-approval. Only the hospital needs pre-approval from BCBS. Viau Tell me more, In my book from BC Dr. Aslam is listed,as a contract Dr. Beyound that I don't know exactly how it works. I t is BC/BS Anthem, and it is HMO, but I was under the impression that if a Dr. was in my book and I had referral from my PCP,[which I do] that they would pay. The office told me that they are now saying it is too experimental. I know that they have approved people in Maine for surgery, but now they are not. The people that were approved were not given a hard time or anything. If you know of something I can do, something I can tell them,? I don't know which thing to do next. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2001 Report Share Posted June 11, 2001 Hi Steve, I'm actually waiting to hear back from BC/BS of Massachusetts with Dr. Rabkin's office. I have heard that they were at one time approving the DS but that they now are NOT. As far as appeals are concerned, I don't know that yet as I haven't had to tackle that situation so far. If you happen to hear anything, please forward any information that you may have and I'll do the same. We're in this together! > Blue Cross > > Tell me GROUP has everyone heard of the hoopla surrounding denial of > the DS procedure by BC/BS? > > Does anyone know, if that includes Blue Cross of California? > > Have many people been denied that hvae Blue Cross of CA and then > appealed and WON? > > I'm moving forward using Dr.Rabkin and I feel like as I move forward > with some of the pre-op appointments I need to posture myself for a > fight with them. (blue cross) > > Heck it seems to me BC should be held liable then for _A N Y and > A L L !!!! complications surrounding MO if in fact they deny coverage > for this DS procedure. They are leaving you hanging with a > predisposition of a variety of complications and illnesses sure to > rise up as time goes by. > > Maybe it's time I go back to school.....I could become an advocate for > people just like us. What better reward in life than to help someone > get thru a problem that makes our lives better. > > Steve G. > > > ---------------------------------------------------------------------- > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2001 Report Share Posted June 11, 2001 I had BCBS of CA for my surgery & had no problems. I was approved without a hitch! It worked out well for me. My sister had it done with them too, just 3 weeks after me. Let your dr. fill out all the info. My dr's office dealt with the insur. company. I never had to. Good luck, Cheri DS-2/6/01 Dr. Warden Ocean Springs, MS > Tell me GROUP has everyone heard of the hoopla surrounding denial of > the DS procedure by BC/BS? > > Does anyone know, if that includes Blue Cross of California? > > Have many people been denied that hvae Blue Cross of CA and then > appealed and WON? > > I'm moving forward using Dr.Rabkin and I feel like as I move forward > with some of the pre-op appointments I need to posture myself for a > fight with them. (blue cross) > > Heck it seems to me BC should be held liable then for _A N Y and > A L L !!!! complications surrounding MO if in fact they deny coverage > for this DS procedure. They are leaving you hanging with a > predisposition of a variety of complications and illnesses sure to > rise up as time goes by. > > Maybe it's time I go back to school.....I could become an advocate for > people just like us. What better reward in life than to help someone > get thru a problem that makes our lives better. > > Steve G. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 5, 2001 Report Share Posted July 5, 2001 Hi. I have BC/BS Personal Choice and I received my approval last week. Good luck to you. --- PugMaggie@... wrote: > Anyone get approved recently? Just wondering if there is any news or > changes in Blue Cross denials. > > > ---------------------------------------------------------------------- > Quote Link to comment Share on other sites More sharing options...
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