Guest guest Posted August 18, 2000 Report Share Posted August 18, 2000 KathyM I know exactlly what your going thru. I too have Anthem Blue Cross Blue Shield Option 2000. It makes me sick to think of all the other companies paying and even people where my husband works are getting approved but they will not approve me. What state are you in? I am in Kentucky. I keep thinking why me??? KEELEY Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2000 Report Share Posted August 18, 2000 well, I have been absessed with this surgery/web site/ email for weeks now. I have asked questions, talked my husband into it, had him talk to my PCP about it, figured it into my plans for the month of december. If I was able to get it all done by then ofcourse. So today all excited about the decision being basically made, I call Anthem and ask what there policy is regarding WLS and the MGB. They said we don't pay for any WLS or MGB for any reason. GREAT. That really pisses me off. I pay alot for this friggn' policy and I know of many people that abuse the hell out of it. we have a special rider for durable medical equipment for 1 employee basically that got sick and needs unlimited funds, a 1 million dollar rider, But god forbid your just FAT and looking for help. I basically got the brush off. Well so much for me unless we change insurance companies next year. Self-pay is not an option for me. Aggravated in CT. - Kathy _______________________________________________________ Say Bye to Slow Internet! http://www.home.com/xinbox/signup.html Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2000 Report Share Posted August 18, 2000 -- In MiniGastricBypass (AT) egroups (DOT) com, keeleyrodkey@a... wrote: > KathyM > It makes me sick to think of all the other companies > paying and even people where my husband works are getting approved but they > will not approve me. What state are you in? I am in Kentucky. I keep > thinking why me??? KEELEY I know how you both feel, for the life of me I cannot understand how some people can be approved by Cigna and others cannot. I realize there are different plans, but how do insurance companies get away with treating people with the same disease differently. I don't get it. Cigna approves some, but they certainly have denied me. , MGB hopeful since 2/19 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2000 Report Share Posted August 18, 2000 Kathy-- The person from Anthem lied to you. I too live in CT (in Rocky Hill), have Anthem " Blue Care " (which is the " low end " HMO-type policy) AND....I had the surgery on 7/20. It cost me absolutely nothing except for a $10 co-pay at Dr. R's clinic. Now, here's the thing--they denied me at first (because of the " out of network " thing--they recommended me to another surgeon here in CT that does the RNY--so once again, they lied--they do indeed cover WLS, and are known within CT as being the best insurance co. to deal with for WLS). I requested reconsideration, wrote a " kick ass " letter, and was approved within 5 days of when I faxed the letter. In fact, I submitted my reconsideration request on June 30, and was approved July 5--that's five days over a holiday weekend! I am an attorney, so I know what to write--take a deep breath, and then give me a call next week [, leave a message if we don't answer, and I will definitely call you back], and we'll get you approved. I guarantee it. I'll be out of town until through Wednesday, so call Thurs. or Fri. In the meantime, if you have a copy of your policy, locate it, and see what it says re:WLS. That's the best source of information, not what someone will tell you over the phone. My policy (which, once again, is a " low end " one) excludes WLS except (and this is a big EXCEPT) when medically necessary. Anthem didn't even try to exclude me on that basis--their " medical necessity " standard is the same as Dr. R's--i.e. a BMI>40 or >35 with co-morbs). Hang in there sister--you'll be doing the dance by Christmas! --a in CT > well, I have been absessed with this surgery/web site/ email for weeks now. > I have asked questions, talked my husband into it, had him talk to my PCP > about it, figured it into my plans for the month of december. If I was able > to get it all done by then ofcourse. So today all excited about the decision > being basically made, I call Anthem and ask what there policy is regarding > WLS and the MGB. They said we don't pay for any WLS or MGB for any reason. > GREAT. That really pisses me off. I pay alot for this friggn' policy and I > know of many people that abuse the hell out of it. we have a special rider > for durable medical equipment for 1 employee basically that got sick and > needs unlimited funds, a 1 million dollar rider, But god forbid your just > FAT and looking for help. I basically got the brush off. Well so much for > me unless we change insurance companies next year. Self-pay is not an option > for me. Aggravated in CT. - Kathy > > > > > > _______________________________________________________ > Say Bye to Slow Internet! > http://www.home.com/xinbox/signup.html Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 19, 2000 Report Share Posted August 19, 2000 When companies contract with insurance companies, to keep price low they pick a certain package based on what they feel they can afford to pay for employees and what as employers they can pay out for coverage. Understand I am not trying to justify how these plans are set up by the same insurance companies, only giving you insight as to why one Cigna may pay and another may not. Also know that in some cases because of the overwhelming medical problems of one subscriber an ins. company waying their odds of what will happen if drastic measures are not taken to correct it, some people have been approved for different types of surgeries. I am not well versed in this type of surgery so I am not sure if this may be one of them. I am doing my homework. If I find out any information, I will be sure to pass it along. Good luck to all of you having problems and if you have a particular question, please feel free to contact me. > > KathyM > > > It makes me sick to think of all the other companies > > paying and even people where my husband works are getting approved > but they > > will not approve me. What state are you in? I am in Kentucky. I > keep > > thinking why me??? KEELEY > > I know how you both feel, for the life of me I cannot understand how > some people can be approved by Cigna and others cannot. I realize > there are different plans, but how do insurance companies get away > with treating people with the same disease differently. I don't get > it. Cigna approves some, but they certainly have denied me. , > MGB hopeful since 2/19 Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.