Guest guest Posted July 16, 2000 Report Share Posted July 16, 2000 Dear Deb in IL I got out my Blue Shield book and found under maximum calender year copayment responsibility. For services rendered by Blue Shield Select Providers $4,000. per person. Services rendered by Preferred Physicians $5,000. Non prefered providers $15,000. So I think I have to find out what they really consider Dr R. Everyones policy is different of course, so check your policy. Hope you have a better policy than I do. I know my employer pays almost $400 a month for my husband and my insurance. What a rip! The post today have been so fascinating. I love the open forum of this group, like my husband always says KNOWLEDGE IS POWER! I found myself LOL because I understood a post that said ROFLMAOAPMP! Just a couple of months ago I didn't even know LOL!For all the other newbies it means rolling on the floor laughing my ass off as I pee my pants!( or thats what I think it said) I still need to write my letter but I am so well informed that it should be a piece of cake. Question please, I have read the sample letter and would like to know if Dr R wants you to express your personal feelings about your obesity or does he want you to stick to the facts more? Since I am coming from CA I am so happy to have a support group like this because I know I will need it. I have been lurking on the post-op group but have never posted and won't untill I am a post-op, but it has helped me also. Thanks all you post-ops that post here as well, it is very helpful as we can respond to you and get all your insights. As they say on NYPD Blue I'll keep a good thought for Ya! Marjory in Ca Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 16, 2000 Report Share Posted July 16, 2000 Hi Marjory, Wow, I'm sorry about your insurance. That really stinks. My out of pocket max for in network providers is $1,000 per person, and for out of network providers it is $2,000. I was wishing our new policy had major medical. My husband's old policy had a major medical policy included, all major things (such as surgeon's fees, and hospital fees) were paid at 100%. But, I'm not sure that they paid for WLS, so I am happy with what I have. Also, Debbie said at clinic last week that Dr. R. wants all of the topics that are in the sample letter to be in our letters, with all of the headings. You can write your own feelings about this surgery at the beginning or the end of the letter. Hope this helps! Good luck! Deb in IL Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 16, 2000 Report Share Posted July 16, 2000 In a message dated 7/15/00 11:34:58 PM Pacific Daylight Time, sumlinsr@... writes: << I have read the sample letter and would like to know if Dr R wants you to express your personal feelings about your obesity or does he want you to stick to the facts more? >> Hi Marjory! It's not so much what Dr R wants, but will work in your appeal. I started out with mostly " the facts, " but got increasingly personal as I snaked my way up the appeal chain. My final letter was VERY personal. 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 16, 2000 Report Share Posted July 16, 2000 In a message dated 7/16/00 7:51:05 AM Pacific Daylight Time, Hadjab@... writes: << Debbie said at clinic last week that Dr. R. wants all of the topics that are in the sample letter to be in our letters, with all of the headings. You can write your own feelings about this surgery at the beginning or the end of the letter. Hope this helps! Good luck! Deb in IL >> Hi Marjorie, Sorry, I thought you were still talking about the ins appeal letter. Pay no attention to my prior post! 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 16, 2000 Report Share Posted July 16, 2000 Will someone please explain to me what the pocket max is. I have never had insurance before this and am not aware of that. Please help me and tell me how to find out what the pocket max is for me insurance. Dr. Rutledge is out of network and my part would be $2800.00 if the surgery runs $14,000. I have to pay 20% Lara Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 16, 2000 Report Share Posted July 16, 2000 Lara, Your insurance booklet should have a section where it tells you what your percentage is, and somewhere it should say something like " $1,000 out of pocket maximum per person, $2,000 per family, per calender year " It could be $5,000, or more, depending on what kind insurance you have. I've had several different insurance companies, and most of mine have been $1,000 or $2,000 per person, and double that per family. The out of pocket max means that is the most you will be responsible for paying in a calender year. The worst part of that is that they can sometimes get you by saying different things aren't covered. When I had my first baby, they considered ultrasounds unnecessary, so I had to pay the total cost of the 2 I had myself, plus my $1,000 out of pocket. Still better than no insurance at all, and a small price to pay for this surgery. Hope this helps.. I always seem to make a short story long.... they will be giving me the sleepy drugs as soon as I get into that quiet holding area just to shut me up! LOL Deb in IL Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 16, 2000 Report Share Posted July 16, 2000 Thanks for the info...I do not have a booklet. I was added to my husbands insurance when we got married and he does not have one. I will call them first thing on Monday and have them send me a book. Lara Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 16, 2000 Report Share Posted July 16, 2000 LOL... aren't husbands excellent with all that paper work? Mine never had a book before we got married, either... maybe they just ask at work if anyone wants one? He had never used his insurance in about 5 years that he had it before we got married... then came me...LOL I had an asthma attack on our honeymoon.. they were probably not thrilled to have me added.... It will help to have a book. Actually, you could even ask the customer service rep to look at your policy when you call to ask for a booklet and they could tell you what your out-of-pocket maximums are, if you don't want to wait for the book to get there. Good luck, Lara!! Deb Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 16, 2000 Report Share Posted July 16, 2000 Hey Debbie, Thanks for responding. I can identify with you. My husband has been with this company for 10 1/2 years and has only been to the doctor once. I could not imagine not having to go to the doctor. Shucks I see mine on a regular bases at least 12-15 times a year. I mean he and I are on a first name bases now. LOL. Sounds like your husband is just like mine...HE NEVER GETS SICK.. Yikes!!!! I wish that was me. I will call them and have them send a book because we need that and have them tell me what the out of packet max is. Lara Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 17, 2000 Report Share Posted July 17, 2000 Lara, It would be in your insurance booklet. For instance, my booklet has a plan summary which lists the annual individual, annual family deductible and the annual Out-of-Pocket Maximum for both individual and family. If you don't have a booklet/pamphlet or something to refer to, I would call and talk to your insurance company and ask them to give you those figures. Tricia in IL LaraAkin033100@... wrote: > > Will someone please explain to me what the pocket max is. I have > never had > insurance before this and am not aware of that. Please help me and > tell me > how to find out what the pocket max is for me insurance. Dr. Rutledge > is out > of network and my part would be $2800.00 if the surgery runs $14,000. > I have > to pay 20% > Lara > ---------------------------------------------------------------------- > > ---------------------------------------------------------------------- > 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...
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