Insurance

[Guest guest]

Laurie-I emailed barbara at debbies email address today; and got a response.

I have talked to pre-cert. before and just acted like I was the provider(no

one asked me) I did have all the info to pretend though. Good luck.

[Guest guest]

Hey I called my insurance and just asked for the pre authorization

nurse or physician...You do not have to talk to anyone that does not

have medical training. You can demand to talk to the nurse.

At least I did and I got right through to her but my insurance

company

is MAMSI and I hate that company....they suck out loud...sorry but

they do.

> Hi,

>

> I just called my insurance company, Aetna (locally administered),

and

> asked to see if they had received my insurance letter. She said

> nothing was in the computer (no big surprise there) and i am not

sure

> if it has been written and sent because Barb told me Friday she had

> no idea about any of that stuff. I sent my form in for the 2nd tome

> 7 days ago. And I have to admit that I am having a little troule

> watching so many people say they got there letter when they sent

> there form after me. I asked for Barb;s email so I don't have to

> bother her by phone and she can get back to me by email - I would

> still like it if any one has it.

>

> Anyway - My concern with my insurance company, and this is the 2nd

> time they have said this to me, is that they will not tLk to a

> patient about pre-certifcation. My doctor(surgeon) is suppose to

> call and talk to the nurse who pre-certs for gastric bypass. They

> would not put me through to her becasue she only talks to doctors.

> Has anyone else been told this?? Do I just demand?/ I feel like I

> can't even get started. I know they have authorized and paid for

> these before.

>

> Frustrated -

> Laurie

[Guest guest]

Hi!

I don't have any solution - but had to write because my husband and I

have Aetna, too. (Administered out of Tewksbury, MA) My husband's

letter was faxed on 7/27 but Aetna didn't show it in the system until

8/4. Like you, the precertification people wouldn't talk to us -

said this procedure was addressed in the Cost Containment Unit and

gave us a different number to call. When he called that number they

refused to talk to him - wanted to know how he got that number even!

Apparently there are some national security issues! Anyhow - we

still don't know anything, but are planning on calling twice a week

to check the progress. Would love to know how you do with them -

kindered insurance and all - if you are game. Good Luck!

Suzanne & Jeff in NC

> Hi,

>

> I just called my insurance company, Aetna (locally administered),

and

> asked to see if they had received my insurance letter. She said

> nothing was in the computer (no big surprise there) and i am not

sure

> if it has been written and sent because Barb told me Friday she had

> no idea about any of that stuff. I sent my form in for the 2nd tome

> 7 days ago. And I have to admit that I am having a little troule

> watching so many people say they got there letter when they sent

> there form after me. I asked for Barb;s email so I don't have to

> bother her by phone and she can get back to me by email - I would

> still like it if any one has it.

>

> Anyway - My concern with my insurance company, and this is the 2nd

> time they have said this to me, is that they will not tLk to a

> patient about pre-certifcation. My doctor(surgeon) is suppose to

> call and talk to the nurse who pre-certs for gastric bypass. They

> would not put me through to her becasue she only talks to doctors.

> Has anyone else been told this?? Do I just demand?/ I feel like I

> can't even get started. I know they have authorized and paid for

> these before.

>

> Frustrated -

> Laurie

[Guest guest]

Hi Suzanne and JEff -

Thanks for the update. It helps to not feel alone in the fight. I

will

keep everyone posted. This is consuming my life at the moment. I

should say for the past 6 weeks.

Are you both wanting the surgery? Best wishes -laurie

> > Hi,

> >

> > I just called my insurance company, Aetna (locally administered),

> and

> > asked to see if they had received my insurance letter. She said

> > nothing was in the computer (no big surprise there) and i am not

> sure

> > if it has been written and sent because Barb told me Friday she

had

> > no idea about any of that stuff. I sent my form in for the 2nd

tome

> > 7 days ago. And I have to admit that I am having a little troule

> > watching so many people say they got there letter when they sent

> > there form after me. I asked for Barb;s email so I don't have to

> > bother her by phone and she can get back to me by email - I would

> > still like it if any one has it.

> >

> > Anyway - My concern with my insurance company, and this is the

2nd

> > time they have said this to me, is that they will not tLk to a

> > patient about pre-certifcation. My doctor(surgeon) is suppose to

> > call and talk to the nurse who pre-certs for gastric bypass.

They

> > would not put me through to her becasue she only talks to

doctors.

> > Has anyone else been told this?? Do I just demand?/ I feel like

I

> > can't even get started. I know they have authorized and paid for

> > these before.

> >

> > Frustrated -

> > Laurie

[Guest guest]

Melody, I was told up to a year. I have Aetna Hmo with an out of network

plan. I am using the out of net work option. Good luck. EKG and Lap work

needs to be less than one month old.

[Guest guest]

Hi Melody,

Your Pap and Mammogram (only needed if your doctor says you need it, usually if

you

are over 40) have to be within the year before surgery. The EKG and blood work

(CBC

and basic chem, I think) need to be within 30 days of the surgery. Take two

copies

of the EKG and blood work with you when you go for surgery - one for Dr. R and

one to

give them at the hospital.

Good luck to you!

Sara

MGB 8/2

Candle wrote:

> I was wondering if anyone has Aetna. I sent the letter from Dr. R

> to them today and have been riding my Doc here to make sure he gets his

> in. I know they have approved the Rou-en-y for a few people in the ofc

> that have had it done. I dont want that done and want to go to Dr. R

> instead of the guy here. Let me know any info abt Aetna if you can. Thank

> you ahead of time.

>

> I have an appt next week with him and am taking the pkt info with

> me so we start checking things off. I have a pap set in two weeks. Does

> anyone know how old the info can be for Dr. R to accept it. If I start

> getting all this now but then dont have the surgery till OCT will that be

> ok? I printed the manual and family letter stuff today and gave it to

> everyone so they can get the letters ready asap. I told everyone They have

> till Sept 1st or sooner.

>

> Melody

> Pre_op

>

>

[Guest guest]

hey all, guess what I got to talk to a great girl at the human resourses

today and I can send my appeal directly to them. I have of course already

sent it to Cigna and they say it is excluded benefit and only Agfa can do

something about it. Any how so at least I am getting some where and maybe

they will at least help pay some of it. I really want Dr. R to do my surgery,

I think that he is best and knows more than any other surgeon out there.

hugs marg keep u fingers crossed someone up there likes me. lol

[Guest guest]

Blanche,

I have noticed form your post that you are having the same problems as I

am with insurance. I have decided to self-pay somehow, someway. My job

is stressful enough. I don't need the added stress of insurance. I hope

you work things out so that you can have the surgery too. It is a

miracle. I have seen the results up close. A girl that works in my

office had the surgery in December and she looks amazing. And she seems

to feel just fine. She claims that the surgery has changed her life, and

I believe her. I do live in Greenville, SC. I think you asked that in

an earlier e-mail. Sorry I didn't respond sooner. Good Luck!!!!!

Robin in Greenville

________________________________________________________________

YOU'RE PAYING TOO MUCH FOR THE INTERNET!

Juno now offers FREE Internet Access!

Try it today - there's no risk! For your FREE software, visit:

http://dl.www.juno.com/get/tagj.

[Guest guest]

I have not had any problem but I assure you this could be a problem. It all

depends on the coverage, insurance company, employer, etc.

Best wishes, Poncho - GA

[Guest guest]

Hi Everyone:

I have noticed some individuals mention they changed insurance companies

since having cp, and I was wondering if anyone ran into the situation that

the new insurance company would not cover them for cp under the

" pre-existing condition " clause? I have thought many times about leaving my

current job, which is a very long story, but what makes me stay is the fear

that if I leave I won't be able to get insured for anything to do with my

pancreatitis. Any thoughts? Thanks for your help, as always!

Robin R.

Sr. Production Planning Specialist

* (ext. 102)

* (fax)

robin.cox@...

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

This e-mail and any files transmitted with it are confidential and intended

solely for the use of the

individual or entity to whom they are addressed.

If you have received this e-mail in error please notify the system manager:

postmaster@...

This e-mail and its attachments have been scanned for the presence of computer

viruses, however

it is always advisable to run a virus check on e-mails and attachments before

opening them.

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

[Guest guest]

Robin,

My husband has changed jobs and ins several times since I've had

CP. I have never had a problem with them putting limitations for a

pre-existind cond. I'm not sure but I think group plans don't have

any pre-exiting condition clauses, I've even swithced ins when I was

8 mos pregnant.

- In pancreatitis , " , Robin " <robin.cox@m...>

wrote:

> Hi Everyone:

>

> I have noticed some individuals mention they changed insurance

companies

> since having cp, and I was wondering if anyone ran into the

situation that

> the new insurance company would not cover them for cp under the

> " pre-existing condition " clause? I have thought many times about

leaving my

> current job, which is a very long story, but what makes me stay is

the fear

> that if I leave I won't be able to get insured for anything to do

with my

> pancreatitis. Any thoughts? Thanks for your help, as always!

>

> Robin R.

> Sr. Production Planning Specialist

> * (ext. 102)

> * (fax)

> robin.cox@m...

>

>

>

>

> --------------------------------------------------------

> This e-mail and any files transmitted with it are confidential and

intended solely for the use of the

> individual or entity to whom they are addressed.

> If you have received this e-mail in error please notify the system

manager:

> postmaster@m...

> This e-mail and its attachments have been scanned for the presence

of computer viruses, however

> it is always advisable to run a virus check on e-mails and

attachments before opening them.

> --------------------------------------------------------

>

>

>

[Guest guest]

Robin,

I believe is correct that if it's a group plan it doesn't have

pre-existing clauses. My husband's employer is a major US

airline, and each change of insurance companies that we have

undergone has been initiated by his employer, not personally. I

was surprised, though, that 's husband has been able to

change jobs and insurance companies on his own initiative,

without the fear of limitation for pre-existing conditions.

That's when I thought the insurance companies COULD enforce

limitations on pre-existing medical problems. Obviously, I don't

know much about this at all. We have always been covered

under a group plan, and although he pays dearly for our

coverage, I don't know what we would have done without it during

these last few years of my illnesses.

On the other hand, my daughter has a thyroid condition that she

has intentionally NOT had treated. The insurance provided by

her employer is only marginal as it is a small, private company

with only 10 employees. She's engaged now, and her fiance

has excellent insurance coverage through the company he

works for, which will pick her up as soon as they marry. She has

told me that she's avoided treatment for her thyroid condition

until she's married and on the new insurance, as she doesn't

want the thyroid condition to be disqualified as pre-existing.

So now I'm totally confused. Perhaps someone else in the

group has some insurance experience and more knowledge of

how this really works. I can certainly understand why you would

be very hesitant to change your working situation until you knew

for sure that your CP would still be covered by a new insurance

company. The hospital bills alone are daunting, and

can tell you how ridiculously expensive home care can be, too! I

had a couple days of home care, which was a nurse coming to

the house for 15 minutes for two days. All she did was watch me

do a blood check with my glucometer, and then watch me inject

my insulin. The bill was $800!

I hope you can get a straight answer on this.

With hope and prayers,

Heidi

Heidi H. Griffeth

South Carolina

SC & SE Regional Rep.

PAI, Intl.

Note: All comments or advice are personal opinion only, and

should not be substituted for consultation with a medical

professional.

wrote:

>My husband has changed jobs and ins several times since I've

had CP. I have never had a problem with them putting

limitations for a pre-existind cond. I'm not sure but I think group

plans don't have any pre-exiting condition clauses, I've even

swithced ins when I was 8 mos pregnant.