Re: pre-surgery and bc/bs..

[Guest guest]

Lynn

I can certainly empathize with your dilemma. However, it is the

office manager that has to do the insurance, submit the paperwork, and

deal with the insurance companies on a regular basis. BC/BS may pay but

it may also take a significant amount of paperwork to get it done even if

it is an approved procedure. Maybe it is a good idea to let her do her

job. JMHO.

Lori Owen - Denton, Texas

SRVG 7/16/01

Dr. Ritter/Dr. Bryce

On Sat, 09 Aug 2003 14:19:50 -0000 " lptampa2001 "

writes:

> Hi..I'm Lynn of Florida. I read the post daily (a faithul lurker)and

>

> have learned so much for each of you. Thank you. The knowledge here

>

> is OUTSTANDING.

>

> I have been busy lately trying to see if BC/BS Federal would pay for

>

> a RNY. 17 years ago I had a VBG that, unfortunately, I was able to

> eat around, but I have lost the first 100 lbs. (My pouch is

> stretched

> out) Recently,I had an uppper GI and endoscope that showed a

> paraesphogeal hernia but that's about it. No bleeding ulcers or

> such.

> I have called BC and they say that a " Pre-surgery or a pre-existing

>

> condition " does not affect surgery. (implying that all is ok to go

> ahead with this surgery) My insurance booklet also says that a

> gastric bypass for weight reduction is a covered benefit. The

> problem is: the doctor's office manager has this IDEA that bc/bs is

>

> the WORST on paying for a " re-surgery " and has convinced the doctor

>

> that I must have all these letters from various doctors and my own

> 10

> page letter asking for this surgery. Well, I have a letter from my

>

> OB/GYN, my PCP, my psychriatrist (with 5 years of medical records),

>

> my gastroenterologist; records from my wellness center, records from

>

> the hospital and lots of comorbidities; I am 100 lbs overweight and

>

> have a BMI of at least 40.

>

> The problem is that I have NOT lost faith in this good doctor but I

>

> lost faith and am upset with his nurses/manager's attitude and the

> fact that she has me jumping through loops when all she needed to do

>

> was put in for the surgery and wait for a reaction from BC. My

> husband feels that her negative attitude will jeopardize the entire

>

> process and feels that we should change teams....help!!

> Thank you in advance.

> I am going to cross/post to protein group also. sorry

>

>

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