Re: my worst fear come true

January 14, 2004

angela,

what kind of insurance do you have?

10-21-03

332-270-150

LapRNY

January 14, 2004

angela,

what kind of insurance do you have?

10-21-03

332-270-150

LapRNY

January 14, 2004

In a message dated 1/14/04 1:01:50 PM Eastern Standard Time,

Gastric_Bypass_Family writes:

> I am so terribly upset.....I have researched this surgery and looked

> forward to it for over 2 years. I went to the surgeon and he said I

> am a great candidate. Now, my insurance won't pay because it is a pre-

> existing condition. I have called and spoke with them and they say

> there is nothing more they can do for me. I feel awful. Has anyone

> else had to go through this? This surgery is so expensive, there is

> NO WAY i could ever have it, unless it were covered by insurance.

> I really need some encouragement....

>

Hiya ,

First of all I am very sorry that the insurance companies are doing this to

one and all! It's stupid to not give this surgery to people when the proof is

out there it does WONDERS for much things - gods, it's taken a lot off of my

records - but I'm sure hearing that didn't make you feel better...I am sorry

for your sadness...you have every right to be!

Did the insurance company KNOW about this before they denied you

pre-existing? Do you have paperwork to show this, does your doctor, does your

psychiatrist, does your PCP? If you can show they knew it and approved work for

it...I

would put that to them and say that they should reconsider...in other words

appeal. YOU CAN ALWAYS APPEAL. Many, many times! Up to the president of the

insurance company. (I used caps to emphasize not yell. ) If you have proof

in your favor I can't see how they can deny you pre existing.

Yet, to be fully honest, even though I worked with Aetna, ::shake head:: I

am not absolutely sure. Except proof of past knowledge by the insurance

company should wake them up. Because then they can't deny it saying " Oh,

well...this and that. " Try this.

I wish you the best of luck, and hunt HARD.

Take care, be well, much love - really!

You're still a winner at loosing.

Sincerely,

~*~**~ /Seta/Anneia/Ari ~**~*~

~ those who are different change the world those

who are the same keep it that way ~

Thank you to " Master Akane " for allowing me to use this quote in my

signature.

I am not aware of who the originating author is. But it's too true to pass

up.

It's how I feel as well. Enjoy it.

http://groups.yahoo.com/group/ShemsuSet

http://groups.yahoo.com/group/Ma-A-Kherw

http://www.livejournal.com/users/beloveddaughter

http://www.kemetjournals.com/users/hrhprincessseta

http://www.fanfiction.net/~HRHPrincessAri

Main E-mail:

Forthegodshonor@...

Second E-mail:

BelovedDaughterOfMaatAndSet@...

Third E-mail:

SetaTheThunderbird@...

AIM:

FutureQueenOfAll

Yahoo IM:

SetaTheThunderbird

MSN:

BelovedDaughterOfMaatAndSet

January 14, 2004

In a message dated 1/14/04 1:01:50 PM Eastern Standard Time,

Gastric_Bypass_Family writes:

> I am so terribly upset.....I have researched this surgery and looked

> forward to it for over 2 years. I went to the surgeon and he said I

> am a great candidate. Now, my insurance won't pay because it is a pre-

> existing condition. I have called and spoke with them and they say

> there is nothing more they can do for me. I feel awful. Has anyone

> else had to go through this? This surgery is so expensive, there is

> NO WAY i could ever have it, unless it were covered by insurance.

> I really need some encouragement....

>

Hiya ,

First of all I am very sorry that the insurance companies are doing this to

one and all! It's stupid to not give this surgery to people when the proof is

out there it does WONDERS for much things - gods, it's taken a lot off of my

records - but I'm sure hearing that didn't make you feel better...I am sorry

for your sadness...you have every right to be!

Did the insurance company KNOW about this before they denied you

pre-existing? Do you have paperwork to show this, does your doctor, does your

psychiatrist, does your PCP? If you can show they knew it and approved work for

it...I

would put that to them and say that they should reconsider...in other words

appeal. YOU CAN ALWAYS APPEAL. Many, many times! Up to the president of the

insurance company. (I used caps to emphasize not yell. ) If you have proof

in your favor I can't see how they can deny you pre existing.

Yet, to be fully honest, even though I worked with Aetna, ::shake head:: I

am not absolutely sure. Except proof of past knowledge by the insurance

company should wake them up. Because then they can't deny it saying " Oh,

well...this and that. " Try this.

I wish you the best of luck, and hunt HARD.

Take care, be well, much love - really!

You're still a winner at loosing.

Sincerely,

~*~**~ /Seta/Anneia/Ari ~**~*~

~ those who are different change the world those

who are the same keep it that way ~

Thank you to " Master Akane " for allowing me to use this quote in my

signature.

I am not aware of who the originating author is. But it's too true to pass

up.

It's how I feel as well. Enjoy it.

http://groups.yahoo.com/group/ShemsuSet

http://groups.yahoo.com/group/Ma-A-Kherw

http://www.livejournal.com/users/beloveddaughter

http://www.kemetjournals.com/users/hrhprincessseta

http://www.fanfiction.net/~HRHPrincessAri

Main E-mail:

Forthegodshonor@...

Second E-mail:

BelovedDaughterOfMaatAndSet@...

Third E-mail:

SetaTheThunderbird@...

AIM:

FutureQueenOfAll

Yahoo IM:

SetaTheThunderbird

MSN:

BelovedDaughterOfMaatAndSet

January 14, 2004

, I can't address the insurance problem, but do understand you being

very upset. I'm sending hugs your way. I am interested in what can be done

in this situation.

Joan

LAP RNY 11/18/03

Dr. Higa, Fresno, CA

282pre-op/275surg/235/140

jclinton@...

my worst fear come true

I am so terribly upset.....I have researched this surgery and looked

forward to it for over 2 years. I went to the surgeon and he said I

am a great candidate. Now, my insurance won't pay because it is a pre-

existing condition. I have called and spoke with them and they say

there is nothing more they can do for me. I feel awful. Has anyone

else had to go through this? This surgery is so expensive, there is

NO WAY i could ever have it, unless it were covered by insurance.

I really need some encouragement....

January 14, 2004

, I can't address the insurance problem, but do understand you being

very upset. I'm sending hugs your way. I am interested in what can be done

in this situation.

Joan

LAP RNY 11/18/03

Dr. Higa, Fresno, CA

282pre-op/275surg/235/140

jclinton@...

my worst fear come true

I am so terribly upset.....I have researched this surgery and looked

forward to it for over 2 years. I went to the surgeon and he said I

am a great candidate. Now, my insurance won't pay because it is a pre-

existing condition. I have called and spoke with them and they say

there is nothing more they can do for me. I feel awful. Has anyone

else had to go through this? This surgery is so expensive, there is

NO WAY i could ever have it, unless it were covered by insurance.

I really need some encouragement....

January 14, 2004

I am so sorry .Is this the only insurance that you can chose

from.keep your head up where there is the will there is a way.God

bless you I will keep you in my prayers. Wasia

> I am so terribly upset.....I have researched this surgery and

looked

> forward to it for over 2 years. I went to the surgeon and he said

I

> am a great candidate. Now, my insurance won't pay because it is a

pre-

> existing condition. I have called and spoke with them and they say

> there is nothing more they can do for me. I feel awful. Has anyone

> else had to go through this? This surgery is so expensive, there

is

> NO WAY i could ever have it, unless it were covered by insurance.

> I really need some encouragement....

>

January 14, 2004

I am so sorry .Is this the only insurance that you can chose

from.keep your head up where there is the will there is a way.God

bless you I will keep you in my prayers. Wasia

> I am so terribly upset.....I have researched this surgery and

looked

> forward to it for over 2 years. I went to the surgeon and he said

I

> am a great candidate. Now, my insurance won't pay because it is a

pre-

> existing condition. I have called and spoke with them and they say

> there is nothing more they can do for me. I feel awful. Has anyone

> else had to go through this? This surgery is so expensive, there

is

> NO WAY i could ever have it, unless it were covered by insurance.

> I really need some encouragement....

>

January 14, 2004

At 12:48 PM 1/14/2004, you wrote:

>....

>

>You're going at it the wrong way. No insurance will pay based strictly on

>weight. Have you pcp check you for sleep apnia...high blood

>pressure.....breathing problems....knee pain. And instead of your

>doctor's office stating they ared treating you for obesity....have them

>state they have you on a restricted eating program due to health

>issues. Have them recommend that surgery is in your best interest. Hope

>this helps

----------------------------------------

Err.. I have to disagree.

I have Great West... underwritten by One Health Plan.

They require Medical Necessity... that is it.

Medical Necessity is at the discretion of your PCP.

I had NO Comorditites.. and was in Perfect health.. except I weighed 257

lbs on a 5 foot frame.

My BMI was 49 or 50 I forget.

But.. my insurance company paid on BMI alone.

They were great.

They only required a letter from my Surgeon.. Letter from My PCP... and

Letter from a Shrink.

I didn't have to have any Pulmonary studies or tests.. Sleep apnea tests...

I did have an Upper GI which I believe is standard for most surgeons.. and

of course Cardiac Clearance.

I had an EKG and EEG done.. all of which were " beautiful " .. so sayeth the

Cardiologist.

K in Ft Lauderdale

Mommy to Noah - 10/14/02 (31 weeker)

Open RNY w/choly 12/2/03

257/227/115

30 lbs gone forever.. The scale moved 3lbs and it only took 3.5 weeks!!

January 14, 2004

At 12:48 PM 1/14/2004, you wrote:

>....

>

>You're going at it the wrong way. No insurance will pay based strictly on

>weight. Have you pcp check you for sleep apnia...high blood

>pressure.....breathing problems....knee pain. And instead of your

>doctor's office stating they ared treating you for obesity....have them

>state they have you on a restricted eating program due to health

>issues. Have them recommend that surgery is in your best interest. Hope

>this helps

----------------------------------------

Err.. I have to disagree.

I have Great West... underwritten by One Health Plan.

They require Medical Necessity... that is it.

Medical Necessity is at the discretion of your PCP.

I had NO Comorditites.. and was in Perfect health.. except I weighed 257

lbs on a 5 foot frame.

My BMI was 49 or 50 I forget.

But.. my insurance company paid on BMI alone.

They were great.

They only required a letter from my Surgeon.. Letter from My PCP... and

Letter from a Shrink.

I didn't have to have any Pulmonary studies or tests.. Sleep apnea tests...

I did have an Upper GI which I believe is standard for most surgeons.. and

of course Cardiac Clearance.

I had an EKG and EEG done.. all of which were " beautiful " .. so sayeth the

Cardiologist.

K in Ft Lauderdale

Mommy to Noah - 10/14/02 (31 weeker)

Open RNY w/choly 12/2/03

257/227/115

30 lbs gone forever.. The scale moved 3lbs and it only took 3.5 weeks!!

January 14, 2004

I have insurance with BlueCross BlueShield of Louisiana. There is an

exclusion and limitation that states that I do not have benefits of

weight loss sugery for morbid obesity " REGARDLESS OF MEDICAL

CONDITION OR MEDICAL NECESSITY " . The people at NeWeigh here in Baton

Rouge, which is a medical facilitator and consultant to insurance

companies, will not make an effort to contact my insurance company.

They said that I do not have any benefits because of the exclusion

BCBS wrote. They say it would not do any good to submit a letter. I

spoke with our Human Resources at my employment about BlueCross

BlueShield of LA and they said that BCBS has never authorized this

type of surgery.

I have decided to go to Mexico to self pay, which will create a

financial hardship for me, but my quality of life is way more

important to me than the insurance game.

I was lucky enough to have found ObesityHelp.com Patients of

Aguirre Wallace, M.D. Bariatrics and other's profiles

telling about Dr Aguirre in Ensenada, Mexico, and what a wonderful

surgeon he is. I am happy to say that I am scheduled for surgery with

Dr Aguirre on March 16, 2004, and I can't wait!!

January 14, 2004