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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

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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

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-- 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

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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

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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

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