Guest guest Posted August 13, 2001 Report Share Posted August 13, 2001 In a message dated 8/13/01 6:25:49 PM Pacific Daylight Time, sdmm@... writes: > . Hence, I get to stay fat. > > Insurance is that way in Whatcom County also. (washington state) Never mind the policy says it can go case by case and pay without having to pay for everyone...and never mind it says if medically necessary. I ended up in Spain because my parents wanted me to live...something I wanted. I was only going downhill...and my insurance was getting 240 a month for my premium and spending about 500 to 600 on my drugs, therapy and dr visits. Isn't it nice I " m now saving them money. I wonder if I can use that to my advantage...why should they benefit from my debt that I know have of 17,000. I even came in almost 10,000 cheaper than if I'd done the surgery in my state. I think my actual surgery was 10,300...not bad! ~~* AJ *~~ Post op 7/24/01 Open DS self pay - Dr Baltasar -Alcoy Spain 07/24/01 BMI 64 - 415.1 08/06/01 BMI 59 - 390.2 -24.9 lbs!!!!!!!!!!~~~~ Check out the Bellingham Support for WLS WWW.WLSBellingham.homestead.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 13, 2001 Report Share Posted August 13, 2001 I am actually planning to do the lap band at this point, but the surgeon's office already put in for the DS. Today I got my denial letter from Aetna. Investigational. Etc. I find myself enraged. I have read the letter several times, and I cannot understand what was used to deny me, or what I would do if I wanted to appeal. This denial is not written in English. However, I am a lawyer - so I should be able to follow it along. It's deliberately bad. How insulting. They are afraid to write the letter in plain language for fear that a policyholder could understand what the hell they were talking about, get mad and demand that these companies be held accountable for their fraud on the public. Prior to today I didn't really understand why people carried on so much when they got denied. Now I get it. Aetna has no intention of paying because it will cost them some money. Irrelevant to its calculation is the fact that I will die much younger without this surgery (or another form of WLS). It doesn't matter that I'm choking every night from my sleep apnea (CPAP notwithstanding), that my chest hurts, that I have high blood pressure, that I have arthritis in my knees and feet. Aetna, as I read in the NY Times the other day, made some awful investments and is cash poor. It will be curtailing its expenses (i.e. denying claims) until next year, when it can raise premiums and make some money. Hence, I get to stay fat. Oh, I don't think so. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 13, 2001 Report Share Posted August 13, 2001 , United Healthcare did the same thing to me. They stated before the Insurance Commissioner's provider Assistance panel that they stopped approving DS in February due to the information available being insufficient to warrant further approvals. I appealed based on what my certificate of coverage says, and the following: 1. The medical industry does not approve 'for now'. They would be subject to many more lawsuits if they " willy nilly " approved 'just because'. There must be substantiating proof that it is not only safe, but effective. 2. They continued to approve patients in my area after my denial and after February 01. Historical Precendece was provided when I submitted an approval letter on their letter head for another patient. I basically showed the state of florida that united healthcare cannot be trusted, and as a group is full of shit. I made no attempts to take the higher ground when I pointed this out to the board and in this support group. I hope my words cause all prospective UHC policy holders to not take no for an answer. Read your certificate of coverages and be persistent. They thought I was some fat, lazy, slob who is too stupid to properly diet and excercise.. I say... Eat my shorts, all 3x of them! > I am actually planning to do the lap band at this point, but the surgeon's > office already put in for the DS. Today I got my denial letter from Aetna. > Investigational. Etc. > > I find myself enraged. I have read the letter several times, and I cannot > understand what was used to deny me, or what I would do if I wanted to > appeal. This denial is not written in English. However, I am a lawyer - so > I should be able to follow it along. It's deliberately bad. How insulting. > They are afraid to write the letter in plain language for fear that a > policyholder could understand what the hell they were talking about, get mad > and demand that these companies be held accountable for their fraud on the > public. > > Prior to today I didn't really understand why people carried on so much when > they got denied. Now I get it. Aetna has no intention of paying because it > will cost them some money. Irrelevant to its calculation is the fact that I > will die much younger without this surgery (or another form of WLS). It > doesn't matter that I'm choking every night from my sleep apnea (CPAP > notwithstanding), that my chest hurts, that I have high blood pressure, that > I have arthritis in my knees and feet. Aetna, as I read in the NY Times the > other day, made some awful investments and is cash poor. It will be > curtailing its expenses (i.e. denying claims) until next year, when it can > raise premiums and make some money. Hence, I get to stay fat. > > Oh, I don't think so. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 13, 2001 Report Share Posted August 13, 2001 , I understand and share your frustration. I too have Aetna insurance and have just received my second denial letter. The 1st for the orgional request for coverage and the second for my 1st appeal. I now am in the process of obtaining a lawyer to do my second and final appeal before litigation may become necessary. I too have been finding several cases of approvals for this very same procedure done this year and as late as May '01. Hull (chull1@...)has a lot of info he has collected and is more than happy to share it with you. They will cover this surgery. It is only a matter of when. If enough of us keep after them, eventually they will have to start covering this the 1st time around or they are really going to loose money over many lawsuits for bad faith(if you own your policy) and breach of contract. (By the way to the other person who mentiones their paying $200+ monthly for coverage, try my monthly rate- $454.00. that is $5448.00 a year they get from me. And what do I get from them, well not the coverage they try and convince me of in my so called policy, which come to find out is not actually the " policy " . They NEVER send the client an actually copy of the real policy. This way they can remain as vague as possible. Well keep up the fight and keep us in the loop as to your progress as will the rest of us with ours. Pre-op --------------------------------------------------------------------- > I am actually planning to do the lap band at this point, but the surgeon's > office already put in for the DS. Today I got my denial letter from Aetna. > Investigational. Etc. > > I find myself enraged. I have read the letter several times, and I cannot > understand what was used to deny me, or what I would do if I wanted to > appeal. This denial is not written in English. However, I am a lawyer - so > I should be able to follow it along. It's deliberately bad. How insulting. > They are afraid to write the letter in plain language for fear that a > policyholder could understand what the hell they were talking about, get mad > and demand that these companies be held accountable for their fraud on the > public. > > Prior to today I didn't really understand why people carried on so much when > they got denied. Now I get it. Aetna has no intention of paying because it > will cost them some money. Irrelevant to its calculation is the fact that I > will die much younger without this surgery (or another form of WLS). It > doesn't matter that I'm choking every night from my sleep apnea (CPAP > notwithstanding), that my chest hurts, that I have high blood pressure, that > I have arthritis in my knees and feet. Aetna, as I read in the NY Times the > other day, made some awful investments and is cash poor. It will be > curtailing its expenses (i.e. denying claims) until next year, when it can > raise premiums and make some money. Hence, I get to stay fat. > > Oh, I don't think so. Quote Link to comment Share on other sites More sharing options...
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