Department of Managed Health Care?? Anyone with experience

[Guest guest]

Hello all. I've been denied 3'Xs for DS surgery now. I move on to the

Department of Managed Health Care....Anyone have any experience with

them??? they will accept my request and review it. I am a little

fearfull to turn it in to them as I may leave something out, & if I

turn in too much will they even read it? Also, what I believe I need

to turn in....was already turned in to Blue Cross and heck if they

denied it.......I'm curious what have I left out that would educate

the people making the decisions?

Does anyone know the best way to proceed with the DMHC?

Steve G.

sign me worried and antagonized by B/C

[Guest guest]

Hello all. I've been denied 3'Xs for DS surgery now. I move on to the

Department of Managed Health Care....Anyone have any experience with

them??? they will accept my request and review it. I am a little

fearfull to turn it in to them as I may leave something out, & if I

turn in too much will they even read it? Also, what I believe I need

to turn in....was already turned in to Blue Cross and heck if they

denied it.......I'm curious what have I left out that would educate

the people making the decisions?

Does anyone know the best way to proceed with the DMHC?

Steve G.

sign me worried and antagonized by B/C

[Guest guest]

Steve,

Have you contacted Walter about this? Hes the attorney in San Diego who had

surgery a few yrs back and works on behalf of those who have insurance

problems, etc.

I know BC sucks. I had them for my secondary to medicare and they lied thru

their teeth thru the whole process. In the end, medicare over turned them

becuz medicare does pay for the surgery and since they do pay, BC had to pay

too! (its the law)

Wished I knew what to do to help you.....if you cant get anywhere and you

cant use Walter, can you change insurance companies?

Judie

[Guest guest]

Its interesting to me that if you have Medicare and they pay then the secondary

HAS to pay. So why dont they have to pay period? I am really rather bitter

that I'm now having to shell out 165 a month for the next 15 years (i'm a single

parent so this is hurting...and i had no other way to pay for it) and now BC/BS

is benefiting from this because I no longer exceed medical bills above the

amount of my premium.

My PCP also said to not jump on them yet for my last appeal (which I'll lose

anyway but I want to push it all the way just on principal.) because if they

dont complain about my post op blood work and stuff...then at least that is

covered. I don't know what to do now. Just sucks. I'm glad I went ahead with

the surgery but I hate they are benefiting off me.

AJ

" Judie Hensel " wrote:

>Steve,

I had them for my secondary to medicare and they lied thru

>their teeth thru the whole process. In the end, medicare over turned them

>becuz medicare does pay for the surgery and since they do pay, BC had to pay

>too! (its the law)

[Guest guest]

Steve -

hello, do you have co-morbitites? If you do do you

take perscription meds for these co-morbities? I do

and I called the pharmacy and asked for the full price

of each medication. I added them up and multiplied

x12. I then had a year price that the insurance paid

minus my co-pay. The result was 5,000.00 yearly. I

then told them that with the annual price of my

medications the proceedure would be paid for within 3

years. During this time I was also diagnosed for the

starting of neuropathy in my feet. Maybe that had

proved to the insurance company that I was telling the

truth and that it would be cheaper in the long run to

just pay for the surgery. Because I am truly falling

apart with out it.

Insurance is now paying 100%.

Tami

--- Jeffigirl@... wrote:

> Steve-

> Have you thought about contacting Walter?

>

> -Jeffi

>

> > Hello all. I've been denied 3'Xs for DS surgery

> now. I move on to the

> > Department of Managed Health Care....Anyone have

> any experience with

> > them??? they will accept my request and review

> it. I am a little

> > fearfull to turn it in to them as I may leave

> something out, & if I

> > turn in too much will they even read it? Also,

> what I believe I need

> > to turn in....was already turned in to Blue Cross

> and heck if they

> > denied it.......I'm curious what have I left out

> that would educate

> > the people making the decisions?

> >

> > Does anyone know the best way to proceed with the

> DMHC?

> >

> > Steve G.

> > sign me worried and antagonized by B/C

> >

>

>

>

>

> [Non-text portions of this message have been

> removed]

>

>

>

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

>

[Guest guest]

AJ,

When you have medicare and they pay for a procedure then by law secondary

has to pay. BC/BS balks and does all kinds of dances and tactics to keep

from paying including trying to wear you down so you give up. We lost 2

appeals with BC/BS then it went to medicare review board (which I KNEW

medicare pays for....after all, several had already gotten theirs paid for)

BC/BS said no surgeons in Washington or Idaho would perform any sort of

gastric bypass becuz it was considered too dangerous LOL

I think the question you asked " So why dont they have to pay period? " .....is

answered in this way.....it only applies to medicare, not to basic health

policies. That is the only thing I can think of.....

I know it hurts to have to pay out 165 for the next 15 yrs but you know

what? I was willing to do that in order to get the surgery and be healthy.

As much as it stinks......count your blessings! =)

Hugs, Judie

[Guest guest]

hI...Thank you for responding and no I don't have any co-morbids at

this time that cost them any money monthly. Although I did have to

surgeries in the last two years.......one knee-arthroscopic and one

torn achilles tendon.

I'm sure they'll end up paying, I just don't know how to make it

happen easily.

SG.

> > Steve-

> > Have you thought about contacting Walter?

> >

> > -Jeffi

> >

> > > Hello all. I've been denied 3'Xs for DS surgery

> > now. I move on to the

> > > Department of Managed Health Care....Anyone have

> > any experience with

> > > them??? they will accept my request and review

> > it. I am a little

> > > fearfull to turn it in to them as I may leave

> > something out, & if I

> > > turn in too much will they even read it? Also,

> > what I believe I need

> > > to turn in....was already turned in to Blue Cross

> > and heck if they

> > > denied it.......I'm curious what have I left out

> > that would educate

> > > the people making the decisions?

> > >

> > > Does anyone know the best way to proceed with the

> > DMHC?

> > >

> > > Steve G.

> > > sign me worried and antagonized by B/C

> > >

> >

> >

> >

> >

> > [Non-text portions of this message have been

> > removed]

> >

> >

> >

>

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

> >

[Guest guest]

Have you considered using Walter Lindsrom? This is his expertise.

in Seattle

> Hello all. I've been denied 3'Xs for DS surgery now. I move on to

the

> Department of Managed Health Care....Anyone have any experience

with

> them???