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Re: Oxford HMO

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Hi Everybody

I was just wondering..I may or may not switch over to Oxford. The funny thing is that in doing so I have more choices of doctors to pick from....then Dr. Ren would be on my list too. In any event, I was wondering how people have faired using Oxford insurance. I have my consul with Dr. Herron but Im getting depressed thinking about the whole situation...anyone who has used Oxford, please let me know your expriences....Thanks

Cindy

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Hi Cindy -- If you do go with Oxford, make sure it's

the Freedom Plan and not Select. There is a difference

in coverage. Oxford has been wonderful for me and I

expect to be approved next week for an 8/23 switch.

All pre-op testing has been covered in full so far

(except the psych eval which I will submit after

approval). Best of luck to you.

Sharon M in NY

--- Cinloo59@... wrote:

> Hi Everybody

>

> I was just wondering..I may or may not switch over

> to Oxford. The funny thing

> is that in doing so I have more choices of doctors

> to pick from....then Dr.

> Ren would be on my list too. In any event, I was

> wondering how people have

> faired using Oxford insurance. I have my consul with

> Dr. Herron but Im

> getting depressed thinking about the whole

> situation...anyone who has used

> Oxford, please let me know your expriences....Thanks

>

> Cindy

>

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I don't have Oxford, but back in January I had the option of choosing

an insurance provider. What I did was to get the info on the different

policies and then called the insurance people at the two hospitals I

was considering. I asked them their opinion on which was the best

option and they were quite helpful. I should know by the end of the

week if I am approved, but they don't foresee any problems. I am

scheduled for surgery Aug. 10th.

Maggie

> Hi Everybody

>

> I was just wondering..I may or may not switch over to Oxford. The

funny thing

> is that in doing so I have more choices of doctors to pick

from....then Dr.

> Ren would be on my list too. In any event, I was wondering how

people have

> faired using Oxford insurance. I have my consul with Dr. Herron but

Im

> getting depressed thinking about the whole situation...anyone who

has used

> Oxford, please let me know your expriences....Thanks

>

> Cindy

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Hello Cindy,

I have Oxford Liberty program (not a very good plan at

all) But I did have the surgery and they covered it so

I guess I shouldnt bitch to much. You will have more

options with the Freedom plan than the Liberty plan.

Just my .02.

Lisbeth

Dr. Macura

June 25, 2001

--- Cinloo59@... wrote:

> Hi Everybody

>

> I was just wondering..I may or may not switch over

> to Oxford. The funny thing

> is that in doing so I have more choices of doctors

> to pick from....then Dr.

> Ren would be on my list too. In any event, I was

> wondering how people have

> faired using Oxford insurance. I have my consul with

> Dr. Herron but Im

> getting depressed thinking about the whole

> situation...anyone who has used

> Oxford, please let me know your expriences....Thanks

>

> Cindy

>

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In a message dated 7/29/01 3:23:29 PM, duodenalswitch writes:

<< .then Dr.

Ren would be on my list too. In any event, I was wondering how people have

faired using Oxford insurance. I have my consul with Dr. Herron but Im

getting depressed thinking about the whole situation...anyone who has used

Oxford, please let me know your expriences....Thanks

>>

Hi, Cindy: I had a lap DS with Dr. Gagner/Mt. Sinai on January 25, 2001 and

had no problems at all with oxford. Of course, Dr. G was in network at that

time. But, I got a quick approval for surgery, etc. and never experienced

delays or problems with them.

I didn't realize Dr. Ren is also a participant with Oxford --- then you would

have your choice of some of the best surgeons in NYC (Ren and those at Mt.

Sinai).

I think that Oxford has a reputable track record, especially with approvals

for the DS surgery. I looked on the ObesityHelp site and read many positive

reviews. However, I really don't know if this whole issue of the ds being

'experimental', etc. has affected their review process in any way. I've read

that other insurance companies have taken a more 'conservative approach' and

use this statement as backup but I don't know if Oxford does or is planning

to.

all the best,

lap ds with gallbladder removal

January 25, 2001

six months post-op and still feelin' fabu! :)

pre-op: 307 lbs/bmi 45 (5'9 1/2 " )

now: 233

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In a message dated 7/29/01 3:23:29 PM, duodenalswitch writes:

<< Re: Oxford HMO >>

Oh, Cindy: Also, I have the Oxford PPO -- Oxford Freedom. I am not sure

about oxford Liberty (I think that's the name of it), the 'hmo'. PPO is

point of service plan and allows for out of network as well (In this case, I

would think that Dr. GAgner would be covered as 'out of network' even though

he doesn't participate in the plan anymore).

I recall some people saying they had Oxford HMO and the experiences may be

different or similar. :)

all the best,

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I had Lap BPD/DS with Dr Gagner Apr 2nd, Oxford

HMO approved without a hassle (however, our plan

does not usually need a referral to a specialist)

AND However, again, precertification with the

insurance company is required regarding surgery).

I had no problem, not a real quick answer as I

recall, but then again quick is relative.

The most significant piece of information is

that I was DENIED by Prudential PPO in November,

and approved by Oxford after switching insurance

in January (and starting the pre-certification /

approval process again, this time with Oxford).

Prudential was not going to continue in health

insurance and my company was one of those

obviously " dropped " by Prudentilal as it deserted

the insurance business, that in my mind was the

real reason for denial and why I ultimately did

not appeal. I changed insurance and Darryl had

told me that Oxford had a good track record for

quick approval, so I reluctantly switched to the

HMO, with great results.

That's the story so far. For the record, I had no

co-morbidities at a weight of 341 lbs, 5'8 " age

45. That was one reason for refusal, not

medically necessary, the age old excuse. Oxford

took no such stance, approved and here I am at

least 76 lbs gone in 13 weeks, (I have to weigh

in again soon), tons of energy, easy recovery.

Many thanks to Oxford and Dr. Gagner and Assocs.

LennyB

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I had Lap BPD/DS with Dr Gagner Apr 2nd, Oxford

HMO approved without a hassle (however, our plan

does not usually need a referral to a specialist)

AND However, again, precertification with the

insurance company is required regarding surgery).

I had no problem, not a real quick answer as I

recall, but then again quick is relative.

The most significant piece of information is

that I was DENIED by Prudential PPO in November,

and approved by Oxford after switching insurance

in January (and starting the pre-certification /

approval process again, this time with Oxford).

Prudential was not going to continue in health

insurance and my company was one of those

obviously " dropped " by Prudentilal as it deserted

the insurance business, that in my mind was the

real reason for denial and why I ultimately did

not appeal. I changed insurance and Darryl had

told me that Oxford had a good track record for

quick approval, so I reluctantly switched to the

HMO, with great results.

That's the story so far. For the record, I had no

co-morbidities at a weight of 341 lbs, 5'8 " age

45. That was one reason for refusal, not

medically necessary, the age old excuse. Oxford

took no such stance, approved and here I am at

least 76 lbs gone in 13 weeks, (I have to weigh

in again soon), tons of energy, easy recovery.

Many thanks to Oxford and Dr. Gagner and Assocs.

LennyB

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Thanks Sharon

You know it's not enough that we have spent years and years dealing with weight issues, but to have to go crazy with the insurance companies when you are willing to make a life changing step is enough to make me go bonkers. Anyway, I'm going to see the doctor first on the insurance I have and spent my time praying that it clicks. I have yet to begin my fight and I'm gearing up for it...I suppose it takes the fear out of the surgery and puts it into the fear of not getting it...Everybody here are such troopers and I'm proud to read all the emails of their successes...I wish I could get online every day but that is not possible with 2 little kids and work....there is so much to know...but thank you for the good word.

Cindy

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Hi Lisbeth

I can always use a couple of extra cents (sences?) :) I have to be careful in getting the right insurance because of my kids too....you know, a hard place and a rock...

Cindy

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Wow Maggie....I wish you the best of luck....you will be in my thoughts and prayers...that is just what I'm going to do....call the doctors and hospitals and talk to them to find out what is what...Thanks again and best wishes for a safe and uneventful surgery....

Cindy

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Hi Lenny

It would be the Oxford HMO that I would be going onto. I'm on Cigna PPO now and I really like it but I think it may be a problem in getting it approved if I continue to stay on it....besides I can't do a thing until January 1 when the change to Oxford would be final....I'm gonna try to get approved on my Cigna because I do have hbp, and arthritis in my knees and a family history of diabetes and and and...:) I see Dr Herron on Aug. 16th and I'm hoping everything will go through without a hitch...keep ya fingers crossed for me. :)

Cindy

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Thanks Cindy. Best of luck to you too!

Maggie

> Wow Maggie....I wish you the best of luck....you will be in my

thoughts and

> prayers...that is just what I'm going to do....call the doctors and

hospitals

> and talk to them to find out what is what...Thanks again and best

wishes for

> a safe and uneventful surgery....

>

> Cindy

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Thanks Cindy. Best of luck to you too!

Maggie

> Wow Maggie....I wish you the best of luck....you will be in my

thoughts and

> prayers...that is just what I'm going to do....call the doctors and

hospitals

> and talk to them to find out what is what...Thanks again and best

wishes for

> a safe and uneventful surgery....

>

> Cindy

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Hi Everybody,

I would really really really appreciate if anybody has had any problem with

Oxford HMO approving DS surgery. I'm dealing with Cigna and every call is a

different story and since I have the opputunity to change coming up soon....I

just wanted to know if anyone has dealt with Oxford HMO and how it went....I

swear this stuff with the insurance is enough to throw anybody into a funk

and I would love to hear from anyone what their experiences were with Oxford

HMO. You can email me personally if you like and thanks to all of you. I'm

kinda at the point that I'm not sure what I'm doing now. I have been told by

the Cigna that I could be left with a bundle of bills if I do this or that

and that approval is done on an indiviual basis...like I don't know what that

really means :( In any case, I will have Oxford HMO by January and I would

love to start the year out and give myself a birthday present of starting a

new life...I don't have family except for my husband and kids...and his

parents are dead against this so the fight is harder. Forgive my rambling and

I'm so proud of all of you out there who are doing so well...I would just

like to be one of you too. :) I understand with Oxford I can pick either Dr

Herron or Dr Ren....I have read alot about Dr Ren and the thought is that if

you know what you want and have done your research...this is not an issue

with her....It would be foolish to think that there would be NO problem cases

with this major a surgery...Just my 2 cents worth. Again, anybody with infor

or experiences concerning Oxford HMO....please let me hear from you.

Cindy

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