Guest guest Posted July 24, 2000 Report Share Posted July 24, 2000 Dear List: It appears that my assistance is not welcome and, unknown to me, claims to or does represent the entirety of this list. It was my understanding this was a public forum. Since it would be inappropriate for me to correspond with people represented by counsel, I suggest you all defer to her in all matters with respect to the MGB. Walter Lindstrom, Esquire Obesity Law & Advocacy Center www.obesitylaw.com 2939 Alta View Drive - Suite O-360 San Diego, CA 92139 Tel: Fax: INSURANCE EXLUSIONS - Dreamscape and > > Cathy in > > Lenoir > > > > > I'm working on posting an insurance primer tonight or tomorrow. > > Hope > > > that will help. > > > > > > When " weight loss surgery is exluded " in your policy, there are a > > couple > > > of things to do: > > > > > > (1) Make them prove it. Send a certified letter to them, asking > > them > > > to send you exactly the part that says weight loss surgery is > > excluded, > > > why, and under what conditions. Pick up the forms for the certified > > > letter at the post office ahead of time and at the top of the > > letter, > > > prominently write: " BY CERTIFIED U.S. MAIL #___________________ " > > (put > > > the number from the receipt in the letter). This will cost you > > about > > > $2.55 to mail, but it puts them on notice that you want proof and it > > > proves they got it (insurance companies like to claim they " didn't > > get " > > > things.) > > > > > > It is possible that weight loss surgery is exluded *EXCEPT FOR* > > certain > > > cases and usually, the certain cases are " morbid obesity " and > > obesity > > > with life-threatening complications. Most everybody on here > > qualifies > > > under those " except for " conditions. > > > > > > So don't take their word for it. It is just some insurance clerk > > > probably fresh out of high school sending you that letter and she > > may > > > not know any better. > > > > > > (2) See if the hospital bill and anaesthesia are covered anyway. > > > Sometimes, even though the surgery itself ( " weight loss surgery " ) is > > > exluded, when you have to be hospitalized, your insurance policy > > will > > > cover the hospital bill and maybe even the anesthesia bill. This is > > the > > > *major* part of the expense. The surgery bill is $4,000 (and you > > get a > > > discount if you pay cash, so I think it is $3,200 in that case), but > > the > > > hospital bill is about $9,000 and the anesthesia is another $1,000. > > If > > > your policy pays the hospitalization, alone, that would be $9,000 > > you > > > don't have to pay. Again, find out if your policy will cover the > > > hospital bills. Just like they will pay for your physical before > > > surgery and medicines that you need after the surgery, they may very > > > well pay the hospital bill and even the anesthesia bill, even when > > > " weight loss surgery " is excluded in your policy. > > > > > > > > > Kind regards, > > > > > > > > > > > > P.S. Since some of the newer folks may not know this, I'm an > > attorney > > > and I've had the MGB. There are seven attorneys that I know of who > > have > > > had the MGB. > > > > > > > > > CMo6331945@... wrote: > > > > > > > > In a message dated 7/22/2000 2:27:21 PM Eastern Daylight Time, > > > > dreamscape3@... writes: > > > > > > > > << " The CIGNA HealthCare of North Carolina, Inc., Health Services > > > > Department, has received a reques on you behalf for Gastric Bypass > > > > Surgery. > > > > After careful review of the information submitted, it has been > > > > determined > > > > that this request is denied because this is not covered under your > > > > group > > > > health benefit plan (see Member Certificate page 18, Item " KK " ). >> > > > > > > > > Hi Irene, > > > > You must be my twin!!! I'm also 5 feet tall, weigh 216 > > lbs., > > > > have BMI > > > > of 42. My Insurance, United Healthcare of NC also denied me as > > saying > > > > there > > > > is an exclusion for " weight loss surgery " . The difference is my > > letter > > > > told > > > > me I can't appeal it which I don't understand. I thought all > > Insurance > > > > co. > > > > had an appeal process, so I am now at a loss at what I'm supposed > > to > > > > do. I > > > > guess try and save up the money to self pay, unless there is > > someone > > > > out here > > > > who can advise me on a different recourse. I wish you luck on > > fighting > > > > > > > > them!!!!!!!!! > > > > > > > > ------------------------------------------------------------------------ > > > Missing old school friends? Find them here: > > > http://click.egroups.com/1/7079/3/_/453517/_/964305456/ > > > > > ------------------------------------------------------------------------ > > > > > > 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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