Re: any info on dealing with self insured?

[Guest guest]

Leilla~

I had the MGB on August 10. I was self-pay at the time, but I am

intending to collect from the insurance company in the future. We have

self-insured insurance, and due to a specific exclusion for any weight

loss attempts, including surgery, I have appealed directly to my

husband's employer. They are the ones that wrote the exclusion, and they

have the power to change it/approve my surgery. I informed them that it

would cost them more money in the long run to NOT cover the surgery, as

well as sending a ton of other information. They are currently

re-writing the policy, but I have yet to hear the outcome of my appeal.

Hopefully that will be soon!

In the meantime, I would suggest searching thru the archives about this

topic as it has been discussed before and I wouldn't do it justice to

try to tell it like it is.

Tricia in IL

galliel56@... wrote:

>

> hi, i'm gonna try this again. posted last night but was too wordy and

> must have bored everyone to tears as nobody responded. cathy morrow

> in lenoir...i live outside of hickory...e-mail me at

> galliel56@.... maybe we can get together for a lite lunch and

> you can share all the goods about the mgb ) i would like to have a

> copy of the appeals letter that is being shared...haven't even

> contacted my insurance co but i've been told this is not a covered

> procedure (why of course) so i'm ready for the trip. any one out

> there that who's self-insured and has not had an easy road but has

> encouraging words...please pass them along.

> thanks. leilla

>

[Guest guest]

In a message dated 8/29/2000 11:17:08 PM Eastern Daylight Time,

galliel56@... writes:

<< cathy morrow

in lenoir...i live outside of hickory.. >>

Hi Leilla,

Where outside of Hickory do you live? I'm still a pre-op. I've been here

on this site since March. Insurance has denied me and am trying to appeal it,

but if they don't come through I'll just save some and borrow some and self

pay.

I'm 45 yrs. old, am 5 feet tall and weigh probably about 218lbs. I have a BMI

of 42. I've been married to a great guy named Jim for 28 years, have 2 grown

children and 3 grandchildren.

A bunch of us from Western, NC are hoping to have a support meeting on Sat.

Sept. 9th at 11:00 am in Hickory. We'll all also do lunch. The place has not

been picked yet, but keep checking out the post or when I know something

definite I'll' email you. It's open to post and pre op's and Blair who is a

post op is trying to get it set up. Try to come, I'm sure we can learn a

lot!!!!!!

Cathy Morrow in Lenoir, NC

BMI 42

A journey of a thousand miles begins with a single step

[Guest guest]

Leilla,

Welcome to our MGB group. I am a pre-op also. Still writing my letter.

Had some setbacks this week with an abcessed tooth, root canal, crown, etc.

(Ugh) I probably am having a much worse time with this tooth that most have

having the MGB from what I have read in this group.

I live in Forest City, about 45 miles from Hickory. We have a WNC group

of both pre and Post ops meeting in Hickory on 9/9 for lunch and jabber.

The place is not nailed down yet, but sure hope you can join us. We will be

sure you know all the details thru this group. Watch for any email that has

the words WNC or Western NC in the subject line.

Good luck to you with your ins. Mine didn't require any appeal, but I

know there are many on this list that can help you.

Take care, don't give up. Betty Harrill in WNC

any info on dealing with self insured?

>

>hi, i'm gonna try this again. posted last night but was too wordy and

>must have bored everyone to tears as nobody responded. cathy morrow

>in lenoir...i live outside of hickory...e-mail me at

>galliel56@.... maybe we can get together for a lite lunch and

>you can share all the goods about the mgb ) i would like to have a

>copy of the appeals letter that is being shared...haven't even

>contacted my insurance co but i've been told this is not a covered

>procedure (why of course) so i'm ready for the trip. any one out

>there that who's self-insured and has not had an easy road but has

>encouraging words...please pass them along.

>thanks. leilla

>

>

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>

[Guest guest]

Dear Leilla,

Sorry you didn't get a response last night. I'm going through the posts

this morning. I too am in waiting. Have sent the letter to my insurance

but have not had a response. I have contacted the only other person I know

from my area (southwest Missouri) with the same insurance. She got denied,

went through the appeal process, still got denied, borrowed the money, had

the surgery, and now is in litigation with the insurance carrier. The

manual said that obesity surgery was covered with medical necessity but

somehow didn't perceive Dr. R's 13 page letter detailing medical necessity

as sufficient. She has also provided me with a wonderful appeal letter but

I don't know whether I'll need it yet or not. I told my husband last night

that I feel like my life is " ON HOLD " . (I guess that's better than before I

found this procedure - at that point I didn't even hold out any hope of any

progress.) I have three children as well! 14, 12, and 10. I don't want

them to be embarrassed to have their friends over or to do things in public

with their " fat mom " . Profoundly supportive husband who, in 19 years, has

never mentioned the fact that I'm literally twice the person he married. I

would walk to Durham to have this procedure done so the travel component

does not really stress me. I'm sorry I don't have to much in the

encouragement department but it did help me to know that others had the same

feelings that I did and were experiencing the same process of getting the

packet together and getting approval.

Tarri

waiting on insurance approval in Missouri

any info on dealing with self insured?

>

> hi, i'm gonna try this again. posted last night but was too wordy and

> must have bored everyone to tears as nobody responded. cathy morrow

> in lenoir...i live outside of hickory...e-mail me at

> galliel56@.... maybe we can get together for a lite lunch and

> you can share all the goods about the mgb ) i would like to have a

> copy of the appeals letter that is being shared...haven't even

> contacted my insurance co but i've been told this is not a covered

> procedure (why of course) so i'm ready for the trip. any one out

> there that who's self-insured and has not had an easy road but has

> encouraging words...please pass them along.

> thanks. leilla

>

>

> 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

>

>