Re: DENIED FOR THE FIRST TIME

[Guest guest]

Holly, I think you should be excited!They have given you the stipulation

and you clearly are morbidly obese,so get that wording CORRECTED and get

back on that road again.Just think you could have a borderline BMI,it's

finally good to be a fat girl(BTW my BMI 47).My insurance requires not only

morbid obesity but 100 lbs overweight,which I am.But isn't this a height

dicrimination.I have seen people post that had BMI'S very high but because

they were only around 5' weren't 100 over. Janet

>From: happygirl0925@...

>Reply-To: MiniGastricBypass (AT) egroups (DOT) com

>To: MiniGastricBypass (AT) egroups (DOT) com

>Subject: DENIED FOR THE FIRST TIME

>Date: Thu, 17 Aug 2000 11:43:58 EDT

>

>Hi guys...talked to my insurance company today they said I was denied and I

>asked her to read me out of the manual how the exclusion reads. She read

>it

>to me and it said it didn't cover treatment for obesity EXCEPT morbid

>obesity. In my insurance letter Dr. R says I am classified as being " very

>severely obese " . According to my ins co he has to classify me as Morbidly

>obese. At 5'6 and 325..I would say that is what I am right?? Should I

>email

>Dr. R or Debbie about this or what?? I am not upset because I expected to

>be

>turned down and there to be a battle so I plan to battle on. Is there a

>chart somewhere that tells us if we are catagorized as obese, severely

>obese

>or morbidly obese?? Any help you can give me is appreciated!!

>

>Holly

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[Guest guest]

You know after I posted that first email..I said wait a minute..I am calling

them back..it has to say I am morbidly obese somewhere in 13 pages!! So I

grabbed my insurance letter form Dr. R and guess what!! !st paragraph does

say severely obese but also starts to talk about morbid obesity and

classifies it as a BMI over 40..and mentions mine is 52 many times in the

letter. So I called and pointed this out to the gal on the phone. She said

that after she talked to me the first time she started looking it to it after

I told her how long the letter was and that I do qualify as morbidly obese

and she found that the letter was never even sent over to t he medical

department!! AH HA!! So she was resending it over and said to still have Dr

R send an appeal. This girl was really nice and helpful. I always try to be

really nice when I call so I don't make them mad so they won't help me!!

Anyway..I am more hopeful now than ever today..funny how a denial made me

hopeful..LOL!! Thanks for the support guys!!

Holly

doing the happy dance cause I know I will win this!!!

[Guest guest]

Hi Holly, Thank Goodness,start buying that MOM,and put a quarter in

that jukebox! Janet

>From: happygirl0925@...

>Reply-To: MiniGastricBypass (AT) egroups (DOT) com

>To: MiniGastricBypass (AT) egroups (DOT) com

>Subject: Re: DENIED FOR THE FIRST TIME

>Date: Thu, 17 Aug 2000 13:33:36 EDT

>

>You know after I posted that first email..I said wait a minute..I am

>calling

>them back..it has to say I am morbidly obese somewhere in 13 pages!! So I

>grabbed my insurance letter form Dr. R and guess what!! !st paragraph does

>say severely obese but also starts to talk about morbid obesity and

>classifies it as a BMI over 40..and mentions mine is 52 many times in the

>letter. So I called and pointed this out to the gal on the phone. She

>said

>that after she talked to me the first time she started looking it to it

>after

>I told her how long the letter was and that I do qualify as morbidly obese

>and she found that the letter was never even sent over to t he medical

>department!! AH HA!! So she was resending it over and said to still have

>Dr

>R send an appeal. This girl was really nice and helpful. I always try to

>be

>really nice when I call so I don't make them mad so they won't help me!!

>Anyway..I am more hopeful now than ever today..funny how a denial made me

>hopeful..LOL!! Thanks for the support guys!!

>

>Holly

>doing the happy dance cause I know I will win this!!!

________________________________________________________________________

Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com

[Guest guest]

Holly,

They are just stalling. You can win that appeal, no problem. It is

just a matter of getting the wording correct. Actually, they KNOW

that the two term mean the same thing, but they want to hang on to

their money as long as they can as well as hope that you might think

that the denial is final and not appeal. It won't take long to get it

straightened out. Good Luck.

Stormy

> Hi guys...talked to my insurance company today they said I was

denied and I

> asked her to read me out of the manual how the exclusion reads.

She read it

> to me and it said it didn't cover treatment for obesity EXCEPT

morbid

> obesity. In my insurance letter Dr. R says I am classified as

being " very

> severely obese " . According to my ins co he has to classify me as

Morbidly

> obese. At 5'6 and 325..I would say that is what I am right??

Should I email

> Dr. R or Debbie about this or what?? I am not upset because I

expected to be

> turned down and there to be a battle so I plan to battle on. Is

there a

> chart somewhere that tells us if we are catagorized as obese,

severely obese

> or morbidly obese?? Any help you can give me is appreciated!!

>

> Holly

[Guest guest]

In a message dated 8/17/00 9:16:40 AM Pacific Daylight Time, lsnow@...

writes:

<<

She read it to me and it said it didn't cover treatment for obesity

EXCEPT morbid

obesity. In my insurance letter Dr. R says I am classified as being " very

severely obese " . According to my ins co he has to classify me as Morbidly

obese. Is there a chart somewhere that tells us if we are catagorized as

obese, severely obese or morbidly obese?? Any help you can give me is

appreciated

>>

Hi Holly,

You definitely qualify for this surgery. Get ready to fight, girl!

Regards,

Debbie in IL

MGB 8/10 Cigna approved as " in network "

[Guest guest]

She read it to me and it said it didn't cover treatment for obesity EXCEPT

morbid

obesity. In my insurance letter Dr. R says I am classified as being " very

severely obese " . According to my ins co he has to classify me as Morbidly

obese. Is there a chart somewhere that tells us if we are catagorized as obese,

severely obese or morbidly obese?? Any help you can give me is appreciated

That just makes no sense to me!! Why do insurance companies give us a hard time

about this??

Your BMI is 52.5 which is Obese Class 3 which is the same as Secerely obese. Go

to:

http://www.freeweightloss.com/calculator2.html

, Ms

5'3 "

240 Lbs

BMI 41.6

www.clos.net

www.obesityhelp.com

[Guest guest]

She read it to me and it said it didn't cover treatment for obesity EXCEPT

morbid

obesity. In my insurance letter Dr. R says I am classified as being " very

severely obese " . According to my ins co he has to classify me as Morbidly

obese. Is there a chart somewhere that tells us if we are catagorized as

obese, severely obese or morbidly obese?? Any help you can give me is

appreciated

That just makes no sense to me!! Why do insurance companies give us a hard

time about this??

Your BMI is 52.5 which is Obese Class 3 which is the same as Severely obese.

Go to:

http://www.freeweightloss.com/calculator2.html

, Ms

5'3 "

240 Lbs

BMI 41.6

www.clos.net

www.obesityhelp.com

[Guest guest]

Hi Holly,

Sorry about your denial, but I feel sure if Dr. R says it, it is so!

By the way, did you think them for the flattery!!!!! ) Oh, not to be

morbid obese!!!!! (sigh)

Rosemary

DENIED FOR THE FIRST TIME

Hi guys...talked to my insurance company today they said I was denied and I

asked her to read me out of the manual how the exclusion reads. She read it

to me and it said it didn't cover treatment for obesity EXCEPT morbid

obesity. In my insurance letter Dr. R says I am classified as being " very

severely obese " . According to my ins co he has to classify me as Morbidly

obese. At 5'6 and 325..I would say that is what I am right?? Should I

email

Dr. R or Debbie about this or what?? I am not upset because I expected to

be

turned down and there to be a battle so I plan to battle on. Is there a

chart somewhere that tells us if we are catagorized as obese, severely obese

or morbidly obese?? Any help you can give me is appreciated!!

Holly

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[Guest guest]

Hi Holly,

My exclusion was worded exactly the same way, and I was approved after I gave

them

all the information they requested. On this page of the web site:

http://clos.net/obesity1.htm it says that morbid obesity is a BMI of 35 or

above. I

think generally a BMI of 40 or above is always considered morbid obesity. Your

insurance company is being ridiculous to make Dr. R use the exact words they

want

when they can clearly see that you qualify as morbidly obese. Insurance

companies

really make me mad! But I do think with the way your exclusion is worded that

if

they see the right words in writing, and if you give them the information they

need,

then you have a good chance of being approved. I was.

Good luck to you!!

Sara

MGB 8/2

> Hi guys...talked to my insurance company today they said I was denied and I

> asked her to read me out of the manual how the exclusion reads. She read it

> to me and it said it didn't cover treatment for obesity EXCEPT morbid

> obesity. In my insurance letter Dr. R says I am classified as being " very

> severely obese " . According to my ins co he has to classify me as Morbidly

> obese. At 5'6 and 325..I would say that is what I am right?? Should I email

> Dr. R or Debbie about this or what?? I am not upset because I expected to be

> turned down and there to be a battle so I plan to battle on. Is there a

> chart somewhere that tells us if we are catagorized as obese, severely obese

> or morbidly obese?? Any help you can give me is appreciated!!

>

> Holly

>

>

>

> This message is from the Mini-Gastric Bypass Mailing List at Onelist.com

> Please visit our web site at http://clos.net

> Get the Patient Manual at http://clos.net/get_patient_manual.htm

>

> To Unsubscribe Send and Email to: MiniGastricBypass-unsubscribe (AT) egroups (DOT) com

[Guest guest]

happygirl0925@... wrote:

> Holly

> doing the happy dance cause I know I will win this!!!

YES! you will, Holly!!!

Looking forward to hearing you holler the good news,

Tricia in IL