Re: Insurance HELP! **Kathie**

[Guest guest]

Kathie,

Thank you for responding so quickly. I am 'too' aware of self-insured

large corporations! I have already been denied on the grounds of DS

being " investigational " . I just wonder how many have to be done or

how many years have to pass before it is accepted as a worthwhile and

successful procedure. Unfortunately, nobody will take responsibility

for saying " NO! " The insurance companies put it of on the

corporations and corporations put it off on the insurance companies!

I spoke with a representative of our union (CWA) yesterday and she

said if I know of some one with BellSouth who has been approved I

would stand a better chance of getting approval. Our contract is up

next month, so I am hoping that this WLS issue will be addressed and

it won't be a battle for us to get approval in the future.

I am not giving up! I believe we are entitled to have this coverage

and I'll fight and appeal and, and, and do whatever it takes!

Thanks again!

Echo

> Echo:

>

> A word of caution from someone who works for Verizon: Many of

these large

> corporations are self-insured and therefore the healthcare

providers are

> only administrators of the plan. The plan description is specific

to that

> large corporation and therefore may not have the same coverage as

say

> someone else with Kaiser in the same city. Call the insurance

company

> (benefit office) and ask general questions ask them if someone was

Morbidly

> Obese (treatment code 278:01) (BMI 40+) and have XYZ co-morbidities

and had

> the recommendation from their PCP and surgeon what other

requirements would

> they need and under what specific circumstances cover WLS. The CPT

codes

> for RNY= 43846, DS =43847. My cheap plan for the management staff

that is

> administered by Aetna would not cover any WLS. Fortunately, my

husband's

> plan covered me. You need to find out what the various plans will

cover.

> If you have not chosen coverage you have the right to make an

inquiry as to

> what they will cover.

>

> Good luck to you.

>

> Kathie from MD

>

>

>

>

> Insurance HELP!

>

>

> > Hey, ya'll!

> > I really need some help about my insurance! Does ANYbody know of

> > anyone who works for BellSouth who has been approved for this

> > surgery? (the DS)

> > OR anybody who has been approved by any of these insurance

companies:

> > Blue Cross/ Blue Shield of Alabama

> > Kaiser Permanente HMO

> > United HealthCare EPO

> >

> > These are our 'choices' for insurance coverage and if I can find a

> > precedence, I would have a better chance at gaining approval

myself.

> > (no pun intended)

> >

> > Thanks in advance for any and all help!

> >

> > Echo

> >

> >

> >

> > ------------------------------------------------------------------

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> >