Guest guest Posted July 17, 2000 Report Share Posted July 17, 2000 Sara, God is good!!! I am so happy for you!!! Sister Trish Lanman lol Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 17, 2000 Report Share Posted July 17, 2000 In a message dated 7/17/2000 3:14:11 PM Eastern Daylight Time, vaschutz@... writes: << Thanks Trish!!! I wish I could meet you! Sara >> Someday Sara we will!!! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 17, 2000 Report Share Posted July 17, 2000 Way to go Sara! I don't know the answers to your questions, but I know my old insurance company did say that some things were over the usual and customary fees, so they wouldn't pay them and they didn't count toward my out of pocket max. I was also wondering if I will have to pay anything up front. I guess I sort of assumed that they would bill my insurance, and then send me a bill for whatever is unpaid. Anyone know about this? I am also worried that even though I received verbal approval over the phone Thursday, something might happen and I won't get that letter saying so. I would be devastated at this point if I got turned down! We just have to think positively! Good luck, hope to see you in Durham! I will be staying at Comfort Suites from July 30 - Aug. 4 or 5. Where are you planning to stay? Are you bringing your kids? Best wishes, Deb in IL MGB 7/31 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 17, 2000 Report Share Posted July 17, 2000 Thanks Sara, I sort of wanted July 31st because it is a good friend's birthday, so I thought it would be lucky for me... I know what you mean about keeping costs down.. We have 4 kids, and I'm already thinking I shouldn't be spending so much on a trip right before school starts! But, whatever the cost, it will be worth it in the long run! And, it will be a nice little vacation for us. I am not used to leaving my kids, so even the one day I was gone to Durham last week was lonely without them! I hope to see you there, and hope everything works out with both of our insurance companies. Deb in IL Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 17, 2000 Report Share Posted July 17, 2000 Thanks Sara, I sort of wanted July 31st because it is a good friend's birthday, so I thought it would be lucky for me... I know what you mean about keeping costs down.. We have 4 kids, and I'm already thinking I shouldn't be spending so much on a trip right before school starts! But, whatever the cost, it will be worth it in the long run! And, it will be a nice little vacation for us. I am not used to leaving my kids, so even the one day I was gone to Durham last week was lonely without them! I hope to see you there, and hope everything works out with both of our insurance companies. Deb in IL Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 17, 2000 Report Share Posted July 17, 2000 In a message dated 7/17/00 12:10:06 PM Pacific Daylight Time, vaschutz@... writes: << Sara BMI 43 (but not for long!) >> Sara, I am genuinely thrilled for you, sweetie! Regards, Debbie in IL Daughter MGB 8/9 Cigna (3rd appeal)--BMI 45 Counting on Cigna for Debbie (BMI 40) ins letter sent 7/14 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 17, 2000 Report Share Posted July 17, 2000 \o/ \o/ PTL, Sara!! \o/ \o/ Tricia in IL who is hoping to hear something *positive* from the insurance company this week, so maybe I'll be joining you on Aug 2!! Vaughn and Sara Schütz wrote: > > HOORAY!!! A big hurdle has just been crossed for me!!!! My insurance > company > called a little while ago and said that I have been approved to have > this > surgery because of medical necessity!! Yeah!!!! It's a > miracle!!!!!!!!!! > I am very excited, but I am trying to remain somewhat calm because we > still > have to find out how much of it they are going to cover. My book says > they > will only cover 60% of surgeries that are out of network, and we don't > know yet > if we can get them to cover this at in network percentages. The only > WLS I > know of that is done in my network is open RNY, so the comparatively > low MGB > costs should look good to the insurance company. > We have called the insurance representative at my husband's workplace, > and she > says that the per person maximum that I should have to pay per year > out of > pocket is $1,250 of which $250 is my deductible, which I have already > met this > year. So that should mean that no matter what rate they cover the > surgery at, > I should still only have to pay $1000. Does that seem correct to you > insurance > experts out there? The rep did say that they make you pay any costs > that they > feel are unreasonable out of your pocket, over and above the $1000. > For > example, if the hospital charges $10 for an aspirin, and the insurance > company > only allows $5 for an aspirin, then I would have to pay the other $5 > in > addition to the $1000. > So all this sounds all right because I can pay as much as $1000 up > front, and > could pay the rest later, but what I am worried about are the > following things: > > 1) Whether the hospital and/or Dr. R will require that I pay upfront > the > percentage that the insurance company says they won't cover. Does > anyone know > if they will require any upfront payment even if I can show them that > I have a > personal yearly maximum of $1000? Because I can't afford to pay 40% > of this > surgery upfront, even if I am going to be reimbursed later, because I > just > don't have access to that kind of money all at once. > > 2) I also worry (hopefully unreasonably) that they will change their > minds and > not cover me (or decide not to cover the MGB) because I have to wait > for a > letter to come from some other office in another state saying that I > am > approved, according to the insurance caseworker who called me. > > 3) I will be devastated if, after all of this, something happens and I > can't > have the surgery. > > The insurance company said they will call Dr. R's office this > afternoon and set > a surgery date for me, so I called Debbie and told her that they will > be > calling, and she said I can have surgery on August 2nd. I am so > glad!!! > > If anyone can give me any advice or reassurance about the insurance > questions > above, I would really appreciate it. If all goes well, I will be at > clinic on > August 1st, and have surgery on August 2nd!!!!! Anyone else on those > dates? > > Sara > BMI 43 (but not for long!) > > ---------------------------------------------------------------------- > > ---------------------------------------------------------------------- > 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 > > To Unsubscribe Send and Email to: > MiniGastricBypass-unsubscribe (AT) egroups (DOT) com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 17, 2000 Report Share Posted July 17, 2000 Thanks Trish!!! I wish I could meet you! Sara metrishal@... wrote: > Sara, God is good!!! > I am so happy for you!!! > Sister Trish Lanman lol > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 17, 2000 Report Share Posted July 17, 2000 Tricia Bardell wrote: > \o/ \o/ PTL, Sara!! \o/ \o/ > > Tricia in IL > who is hoping to hear something *positive* from the insurance company > this week, > so maybe I'll be joining you on Aug 2!! > I hope so, Tricia!!! Sara Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 17, 2000 Report Share Posted July 17, 2000 Hi Deb, We will probably be staying in Rocky Mount, NC with some friends. We used to live there. It is about an hour east of Durham. We will be bringing our children, all six of them!!! Our older children are looking forward to seeing old friends in Rocky Mount. We have to keep expenses down as much as possible (our oldest is starting college this fall), so it will really help us to stay with friends who don't charge us! Although, after having all 8 of us there for several days, they may decide to make us pay somehow! LOL You're having your surgery on my husband's birthday. That's a good day. Sara Hadjab@... wrote: > Way to go Sara! I don't know the answers to your questions, but I know my > old insurance company did say that some things were over the usual and > customary fees, so they wouldn't pay them and they didn't count toward my out > of pocket max. I was also wondering if I will have to pay anything up front. > I guess I sort of assumed that they would bill my insurance, and then send > me a bill for whatever is unpaid. Anyone know about this? > I am also worried that even though I received verbal approval over the > phone Thursday, something might happen and I won't get that letter saying so. > I would be devastated at this point if I got turned down! We just have to > think positively! > > Good luck, hope to see you in Durham! I will be staying at Comfort Suites > from July 30 - Aug. 4 or 5. Where are you planning to stay? Are you > bringing your kids? > > Best wishes, > > Deb in IL > MGB 7/31 > > ------------------------------------------------------------------------ > Get great brand name shoes with just the click of a mouse. Check out > the huge selection at Zappos.com, the Web's Most Popular Store! > http://click.egroups.com/1/6994/3/_/453517/_/963863154/ > ------------------------------------------------------------------------ > > 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 > > To Unsubscribe Send and Email to: MiniGastricBypass-unsubscribe (AT) egroups (DOT) com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 17, 2000 Report Share Posted July 17, 2000 Sara, I am sssooooooo happy for you! Today is a big day for both of us, I also received my insurance approval today!!! Mine is a long story but I am going to TRY to have my surgery next week...if not, maybe we will be " littermates " !!! That would be great since we also live so close. I am sssooooo excited but I am like you too, afraid something will go wrong! I guess thats why I haven't posted on line yet. I am waiting for a date. Keep in touch. Winstead sburg, TN > HOORAY!!! A big hurdle has just been crossed for me!!!! My insurance company > called a little while ago and said that I have been approved to have this > surgery because of medical necessity!! Yeah!!!! It's a miracle!!!!!!!!!! > I am very excited, but I am trying to remain somewhat calm because we still > have to find out how much of it they are going to cover. My book says they > will only cover 60% of surgeries that are out of network, and we don't know yet > if we can get them to cover this at in network percentages. The only WLS I > know of that is done in my network is open RNY, so the comparatively low MGB > costs should look good to the insurance company. > We have called the insurance representative at my husband's workplace, and she > says that the per person maximum that I should have to pay per year out of > pocket is $1,250 of which $250 is my deductible, which I have already met this > year. So that should mean that no matter what rate they cover the surgery at, > I should still only have to pay $1000. Does that seem correct to you insurance > experts out there? The rep did say that they make you pay any costs that they > feel are unreasonable out of your pocket, over and above the $1000. For > example, if the hospital charges $10 for an aspirin, and the insurance company > only allows $5 for an aspirin, then I would have to pay the other $5 in > addition to the $1000. > So all this sounds all right because I can pay as much as $1000 up front, and > could pay the rest later, but what I am worried about are the following things: > > 1) Whether the hospital and/or Dr. R will require that I pay upfront the > percentage that the insurance company says they won't cover. Does anyone know > if they will require any upfront payment even if I can show them that I have a > personal yearly maximum of $1000? Because I can't afford to pay 40% of this > surgery upfront, even if I am going to be reimbursed later, because I just > don't have access to that kind of money all at once. > > 2) I also worry (hopefully unreasonably) that they will change their minds and > not cover me (or decide not to cover the MGB) because I have to wait for a > letter to come from some other office in another state saying that I am > approved, according to the insurance caseworker who called me. > > 3) I will be devastated if, after all of this, something happens and I can't > have the surgery. > > The insurance company said they will call Dr. R's office this afternoon and set > a surgery date for me, so I called Debbie and told her that they will be > calling, and she said I can have surgery on August 2nd. I am so glad!!! > > If anyone can give me any advice or reassurance about the insurance questions > above, I would really appreciate it. If all goes well, I will be at clinic on > August 1st, and have surgery on August 2nd!!!!! Anyone else on those dates? > > Sara > BMI 43 (but not for long!) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 17, 2000 Report Share Posted July 17, 2000 Sara, I am sssooooooo happy for you! Today is a big day for both of us, I also received my insurance approval today!!! Mine is a long story but I am going to TRY to have my surgery next week...if not, maybe we will be " littermates " !!! That would be great since we also live so close. I am sssooooo excited but I am like you too, afraid something will go wrong! I guess thats why I haven't posted on line yet. I am waiting for a date. Keep in touch. Winstead sburg, TN > HOORAY!!! A big hurdle has just been crossed for me!!!! My insurance company > called a little while ago and said that I have been approved to have this > surgery because of medical necessity!! Yeah!!!! It's a miracle!!!!!!!!!! > I am very excited, but I am trying to remain somewhat calm because we still > have to find out how much of it they are going to cover. My book says they > will only cover 60% of surgeries that are out of network, and we don't know yet > if we can get them to cover this at in network percentages. The only WLS I > know of that is done in my network is open RNY, so the comparatively low MGB > costs should look good to the insurance company. > We have called the insurance representative at my husband's workplace, and she > says that the per person maximum that I should have to pay per year out of > pocket is $1,250 of which $250 is my deductible, which I have already met this > year. So that should mean that no matter what rate they cover the surgery at, > I should still only have to pay $1000. Does that seem correct to you insurance > experts out there? The rep did say that they make you pay any costs that they > feel are unreasonable out of your pocket, over and above the $1000. For > example, if the hospital charges $10 for an aspirin, and the insurance company > only allows $5 for an aspirin, then I would have to pay the other $5 in > addition to the $1000. > So all this sounds all right because I can pay as much as $1000 up front, and > could pay the rest later, but what I am worried about are the following things: > > 1) Whether the hospital and/or Dr. R will require that I pay upfront the > percentage that the insurance company says they won't cover. Does anyone know > if they will require any upfront payment even if I can show them that I have a > personal yearly maximum of $1000? Because I can't afford to pay 40% of this > surgery upfront, even if I am going to be reimbursed later, because I just > don't have access to that kind of money all at once. > > 2) I also worry (hopefully unreasonably) that they will change their minds and > not cover me (or decide not to cover the MGB) because I have to wait for a > letter to come from some other office in another state saying that I am > approved, according to the insurance caseworker who called me. > > 3) I will be devastated if, after all of this, something happens and I can't > have the surgery. > > The insurance company said they will call Dr. R's office this afternoon and set > a surgery date for me, so I called Debbie and told her that they will be > calling, and she said I can have surgery on August 2nd. I am so glad!!! > > If anyone can give me any advice or reassurance about the insurance questions > above, I would really appreciate it. If all goes well, I will be at clinic on > August 1st, and have surgery on August 2nd!!!!! Anyone else on those dates? > > Sara > BMI 43 (but not for long!) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 17, 2000 Report Share Posted July 17, 2000 In a message dated 7/17/00 6:59:31 PM Pacific Daylight Time, vaschutz@... writes: << Thank you, Debbie. Is getting excited? When do you expect to hear about your own approval? Sara >> Hi Sara, Thanks for asking. is still at camp in Mass. but is coming home next Sunday (after 4 weeks). I talked to her when I got back from my trip on Friday and she seemed to be excited (and a bit nervous). I will be glad when I can take her in my arms and give her a hug! As for me, I had hoped to be a lot further along but am sort of back at the beginning since the letter from Dr R's office to Cigna was just sent out last Friday, due to some kind of glitch. I do have all my appeal letters in envelopes ready to go, though, and of course my dialing finger is ready to call the nice lady in charge of appeals! LOL I guess I know the drill! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 17, 2000 Report Share Posted July 17, 2000 Congrats Sara! I hope to say that same thing one day soon! Maybe before Aug 1 and I can meet you in NC. Dinah in Alabama > > > > HOORAY!!! A big hurdle has just been crossed for me!!!! My insurance > > company > > called a little while ago and said that I have been approved to have > > this > > surgery because of medical necessity!! Yeah!!!! It's a > > miracle!!!!!!!!!! > > I am very excited, but I am trying to remain somewhat calm because we > > still > > have to find out how much of it they are going to cover. My book says > > they > > will only cover 60% of surgeries that are out of network, and we don't > > know yet > > if we can get them to cover this at in network percentages. The only > > WLS I > > know of that is done in my network is open RNY, so the comparatively > > low MGB > > costs should look good to the insurance company. > > We have called the insurance representative at my husband's workplace, > > and she > > says that the per person maximum that I should have to pay per year > > out of > > pocket is $1,250 of which $250 is my deductible, which I have already > > met this > > year. So that should mean that no matter what rate they cover the > > surgery at, > > I should still only have to pay $1000. Does that seem correct to you > > insurance > > experts out there? The rep did say that they make you pay any costs > > that they > > feel are unreasonable out of your pocket, over and above the $1000. > > For > > example, if the hospital charges $10 for an aspirin, and the insurance > > company > > only allows $5 for an aspirin, then I would have to pay the other $5 > > in > > addition to the $1000. > > So all this sounds all right because I can pay as much as $1000 up > > front, and > > could pay the rest later, but what I am worried about are the > > following things: > > > > 1) Whether the hospital and/or Dr. R will require that I pay upfront > > the > > percentage that the insurance company says they won't cover. Does > > anyone know > > if they will require any upfront payment even if I can show them that > > I have a > > personal yearly maximum of $1000? Because I can't afford to pay 40% > > of this > > surgery upfront, even if I am going to be reimbursed later, because I > > just > > don't have access to that kind of money all at once. > > > > 2) I also worry (hopefully unreasonably) that they will change their > > minds and > > not cover me (or decide not to cover the MGB) because I have to wait > > for a > > letter to come from some other office in another state saying that I > > am > > approved, according to the insurance caseworker who called me. > > > > 3) I will be devastated if, after all of this, something happens and I > > can't > > have the surgery. > > > > The insurance company said they will call Dr. R's office this > > afternoon and set > > a surgery date for me, so I called Debbie and told her that they will > > be > > calling, and she said I can have surgery on August 2nd. I am so > > glad!!! > > > > If anyone can give me any advice or reassurance about the insurance > > questions > > above, I would really appreciate it. If all goes well, I will be at > > clinic on > > August 1st, and have surgery on August 2nd!!!!! Anyone else on those > > dates? > > > > Sara > > BMI 43 (but not for long!) > > > > ------------------------------------------------------------------ ---- > > > > ------------------------------------------------------------------ ---- > > 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 > > > > To Unsubscribe Send and Email to: > > MiniGastricBypass-unsubscribe (AT) egroups (DOT) com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 17, 2000 Report Share Posted July 17, 2000 Thank you, Dinah! Good luck to you! Sara dinah@... wrote: > Congrats Sara! I hope to say that same thing one day soon! Maybe > before Aug 1 and I can meet you in NC. > > Dinah in Alabama Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 17, 2000 Report Share Posted July 17, 2000 Thank you, Debbie. Is getting excited? When do you expect to hear about your own approval? Sara DebLaMan@... wrote: > In a message dated 7/17/00 12:10:06 PM Pacific Daylight Time, > vaschutz@... writes: > > << > Sara > BMI 43 (but not for long!) > > >> > Sara, > I am genuinely thrilled for you, sweetie! > > Regards, > Debbie in IL > Daughter MGB 8/9 Cigna (3rd appeal)--BMI 45 > Counting on Cigna for Debbie (BMI 40) ins letter sent 7/14 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 17, 2000 Report Share Posted July 17, 2000 Hi , Congratulations!! I hope you can have your surgery next week like you want, but if not, it would be great if we could be littermates. Sara W wrote: > Sara, > > I am sssooooooo happy for you! Today is a big day for both of us, I > also received my insurance approval today!!! Mine is a long story > but I am going to TRY to have my surgery next week...if not, maybe we > will be " littermates " !!! That would be great since we also live so > close. I am sssooooo excited but I am like you too, afraid something > will go wrong! I guess thats why I haven't posted on line yet. I am > waiting for a date. > > Keep in touch. > > Winstead > sburg, TN > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2001 Report Share Posted August 26, 2001 In a message dated 8/26/01 11:37:37 AM Pacific Daylight Time, Beauby1022050943@... writes: > I fit into a size 14 jeans. I am a happy person.Ellen(Pam > > Woo hoo!! I'm sure that is a great feeling!! I hope I get there !!! ~~* AJ *~~ Age 37 5'8'' Post op 7/24/01 Open BPD/DS self pay - Dr Baltasar -Alcoy Spain 07/24/01 BMI 64 415.1 08/06/01 BMI 59 390.2 -24.9 lbs! -10.75 inches 08/16/01 BMI 58 387.0 -27.9 lbs! -11.25 inches 08/24/01 BMI 58 386.5 -28.7 lbs! -15.5 inches My personal website: www.WLS4AJ@... Check out the Bellingham Support Group at WWW.WLSBellingham.homestead.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2001 Report Share Posted August 26, 2001 In a message dated 08/26/2001 1:37:57 PM Central Daylight Time, Beauby1022050943@... writes: > I fit into a size 14 jeans. I am a happy person.Ellen(Pam > Yahhooo! Isn't this surgery a wonder!!! Dawn----South suburban chicago area Dr. Hess, Bowling Green, OH BPD/DS 4/27/00 www.duodenalswitch.com 267 to 165 5' 4 " size 22 to size 10 have made size goal no more high blood pressure, sore feet, or dieting! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2001 Report Share Posted August 26, 2001 In a message dated 08/26/2001 1:37:57 PM Central Daylight Time, Beauby1022050943@... writes: > I fit into a size 14 jeans. I am a happy person.Ellen(Pam > Yahhooo! Isn't this surgery a wonder!!! Dawn----South suburban chicago area Dr. Hess, Bowling Green, OH BPD/DS 4/27/00 www.duodenalswitch.com 267 to 165 5' 4 " size 22 to size 10 have made size goal no more high blood pressure, sore feet, or dieting! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2001 Report Share Posted August 26, 2001 Good News > I fit into a size 14 jeans. I am a happy person.Ellen(Pam > > I fit into 14 jeans too, easily and 12's in Wal Mart shorts what have elastic waist whoooooooohoooooooo! Judie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2001 Report Share Posted August 26, 2001 Good News > I fit into a size 14 jeans. I am a happy person.Ellen(Pam > > I fit into 14 jeans too, easily and 12's in Wal Mart shorts what have elastic waist whoooooooohoooooooo! Judie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2001 Report Share Posted August 26, 2001 I'm sure that is a great feeling!! I hope I get there !!! ~~* AJ *~~ You dont " Hope " to get there, Aj.....you WILL get there!!! <g> Right now it seems to take forever but trust me......time has a way of going pretty fast now! Just keep busy and keep in touch here and before you know it, you will be a 14 too! Hey.....tell ya what.......Ill save my size 14 jeans for you when you reach that size....just tell me when you are an 18 so you can have something to look forward to.... ok?? Judie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2001 Report Share Posted August 26, 2001 Yay!!!! I can't tell you what *year* it was the last time I fit into a size 14 jeans. ) alyssa Good News > I fit into a size 14 jeans. I am a happy person.Ellen(Pam > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2001 Report Share Posted August 26, 2001 Yahhooo! Isn't this surgery a wonder!!!>>>> You bet it is, Dawn! Remember my concern that you got into size 10 at 165 and I couldnt do it? Well, now I can get into size 12 shorts with elastic waist! Im not far behind the 10 now and Im 162! Maybe when I hit 155 I will get into the 10? Ill get there!! Hugs, Judie Quote Link to comment Share on other sites More sharing options...
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