Re: INSURANCE PROBS

[Guest guest]

Robin L wrote:

>

> Hi Lynda

> I have heard that you are the resident expert on MGB. Please help. I

> have heard from some of the members that PHP won't cover. NO WAY, NO HOW!

> Is this true.. I have PHP.

I don't know and you don't know, either! Best thing to do is submit

your online patient form to Dr. Rutledge. He submits that to insurance

to see if they will approve. You can get an answer back pretty fast.

When you fill it out, be *especially* detailed under the " previous

diets " section, with dates and Dr. names wherever possible -- put in

*lots* of info and diets, and also on the problems you have, think of

EVERYTHING that is a problem of being fat, including:

asthma, gastric reflux, fatigue, joint pain, joint swelling,

breathlessness (dyspnea) on exertion, high blood pressure, diabetes,

high cholesteral, high triglycerides, sleep apnea, edema of the face,

hands, legs, ankles and feet, hygiene problems, fungus infections --

anything you have or might have that is related in any way to being

overweight, list it!!

> Are there any other routes I could take. I

> am very determined.

If your insurance denies you because there is an EXCLUSION in your

policy, well, then you need to go at it a different way.

If they deny you because they say it is " NOT MEDICALLY NECESSARY " or you

did not establish " MEDICAL NECESSSITY, " that's a good sign -- it means

they offer the coverage and you need to send them something to prove you

qualify. Then it is all just a matter of finding out what they need to

get you qualified.

If you have an EXCLUSION in your policy, look into:

Changing insurance companies -- with some employment-related

insurance policies, there will be an " open enrollment " period, usually

in November, where you can change to another company. Now's the time to

find out if you can do that and what the other companies may cover.

Obviously, you want one that will cover weight loss surgery.

If you work for a smaller company, there may be no other options or

any " open enrollment " period, but you may be able to talk to whoever

picked the insurance about expanding the coverage on the existing policy

and get weight loss surgery covered. Changes like this can go into

effect as soon as 30 days.

If your company is " self-insured, " you may be able to talk the

company into covering the benefits for you, believe it or not. Let me

know if this applies and I will give you some suggestions on approaching

them about it.

Last, you can self-pay. If you have a house or late-model auto

that is paid for, you may be able to borrow agains those at a good

interest rate. Kim Godfrey (fhpgunny1@...) has some info about a

company that makes low-interest-rate medical loans -- I'll post it as

soon as I get the info.

Kind regards,

> I have lived in a family of skinny people all my

> life.

Yeah, I was the short fat one in my family, too.

> My sister wears a size 1 (not a typing error). All she ever wants

> to do is get on the scales. My mother, father, brother, also all thin.

> My mother really tries to understand how I feel, but there is no way that

> she can. I have never felt like I belong with this family. When ever we

> are introduced as a group, I can see people looking them up and down, and

> then me. Oh Lynda, I am really sorry to dump this on you, but I am

> really trying to find someone that understands. Any help with the

> insurance question would be appreciated. Any suggestions on alternative

> routes would also be appreciated. Thanks!

> ________________________________________________________________

[Guest guest]

Thanks for the e-mail. 1. My insurance does read " exclusion " . There is

nothing that reads unless medically necessary anywhere near it. 2. I

work in a very small office of only 5 people who by the way are thin and

very happy with the insurance as it is. 3. I do have a home and a car

that I am currently paying for. Don't worry Lynda, I will get the money

somehow, even if I have to pay $200.00 a month for the next 10 years.

Like I said, I am very determined. I will submit my patient info first.

and see what happens. It is very nice to have people like you to talk

to. Thanks so much for the information. I know this won't be the last

time I have questions.

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