Re: A MIRACLE!!! (long)

[Guest guest]

Congratulations, Angel!!!! Remember we met in Bowling Green last March!!! I

am so happy you get to have your surgery. It always gets to me sooo when I

hear of people having trouble with insurance. My heart goes out to them. I

have thought of you a lot over the last few months!! Now, you are on your

way!!!!

Dawn----South suburban chicago area

Dr. Hess, Bowling Green, OH

BPD/DS

4/27/00

www.duodenalswitch.com

267 to 165 5' 4 "

size 22 to size 10

have made size goal

no more high blood pressure, sore feet, or dieting!

[Guest guest]

Oh Angel, congrats to you!!!!!! I'm keeping your

letter in my KEEP files - I'm in the same boat as you

were and this is so encouraging!!!

dee

--- angelquilt1@... wrote:

> Hi Everyone, It's been a long time since I've

> posted, but I just had

> to let you know that a true miracle has happened! As

> I reported

> awhile back my insurance (Cigna Healthcare of Ohio

> HMO) denied me the

> BPD/DS (although they were willing to pay for the

> RNY). As depressing

> as that was, with the encouragement of some very

> special friends who

> are part of Dr Maguires group (in Kettering Ohio), I

> decided to

> appeal. When I called and asked for the criteria on

> which they based

> my denial on, they told me that those details would

> be in Dr M's

> denial letter. Four weeks and numerous phone calls

> later, Dr M

> received his letter and much to my frustration, it

> was the SAME

> letter they sent me, very vague. So I called Cigna

> and firmly told

> them I wanted a letter that explained exactly what

> they based their

> denial on. Then I was told they couldn't give that

> to me, it was

> " privileged " information and only the Dr. could have

> that info, boy

> was I mad! I made several calls to find out if this

> was true and

> couldn't get a straight answer from anyone. So I

> called Kim at Dr.

> M's office and asked her if she would please call

> and get the info

> for me. She called and strongly requested that the

> criteria they

> based their denial on be sent to their office right

> away. That was

> Thursday and Monday I received a call Dr Maguire's

> office, saying,

> that my case had been sent before a board of medical

> review and my

> policy had " changed " so I was APPROVED!! I was so

> shocked that I

> asked her to make sure she had the right person as I

> hadn't even sent

> in an appeal yet! But it is TRUE, I'm approved! My

> date is Oct 29th

> and I am so very excited! When I asked Kim (the

> nurse at Dr M's

> office) what she thought changed their minds she

> said she thought

> maybe they really didn't have any criteria they

> based their decision

> on and was hoping I'd just give up! So please,

> anyone out there still

> fighting, DON'T GIVE UP! Make them spell it out for

> you so you can go

> point by point and appeal it. I wish anyone still

> fighting, all the

> luck in the world! Keep close with those that will

> support you when

> you want to give up. And FIGHT! Sincerely, Angel

>

>

>

----------------------------------------------------------------------

>

[Guest guest]

Oh my goodness, Angel! That is wonderful news -- pretty soon we'll be

reading about how well you did in the hospital and then about how all

those pounds are falling right off! Congratulations!

--stella

[Guest guest]

Angel

<smiling as I read your post> I can feel the excitement, thank you

for sharing it with us!

Congratulations

Renae

>From: angelquilt1@...

>Reply-To: duodenalswitch

>To: duodenalswitch

>Subject: A MIRACLE!!! (long)

>Date: Fri, 31 Aug 2001 18:08:58 -0000

>

>Hi Everyone, It's been a long time since I've posted, but I just had

>to let you know that a true miracle has happened! As I reported

>awhile back my insurance (Cigna Healthcare of Ohio HMO) denied me the

>BPD/DS (although they were willing to pay for the RNY). As depressing

>as that was, with the encouragement of some very special friends who

>are part of Dr Maguires group (in Kettering Ohio), I decided to

>appeal. When I called and asked for the criteria on which they based

>my denial on, they told me that those details would be in Dr M's

>denial letter. Four weeks and numerous phone calls later, Dr M

>received his letter and much to my frustration, it was the SAME

>letter they sent me, very vague. So I called Cigna and firmly told

>them I wanted a letter that explained exactly what they based their

>denial on. Then I was told they couldn't give that to me, it was

> " privileged " information and only the Dr. could have that info, boy

>was I mad! I made several calls to find out if this was true and

>couldn't get a straight answer from anyone. So I called Kim at Dr.

>M's office and asked her if she would please call and get the info

>for me. She called and strongly requested that the criteria they

>based their denial on be sent to their office right away. That was

>Thursday and Monday I received a call Dr Maguire's office, saying,

>that my case had been sent before a board of medical review and my

>policy had " changed " so I was APPROVED!! I was so shocked that I

>asked her to make sure she had the right person as I hadn't even sent

>in an appeal yet! But it is TRUE, I'm approved! My date is Oct 29th

>and I am so very excited! When I asked Kim (the nurse at Dr M's

>office) what she thought changed their minds she said she thought

>maybe they really didn't have any criteria they based their decision

>on and was hoping I'd just give up! So please, anyone out there still

>fighting, DON'T GIVE UP! Make them spell it out for you so you can go

>point by point and appeal it. I wish anyone still fighting, all the

>luck in the world! Keep close with those that will support you when

>you want to give up. And FIGHT! Sincerely, Angel

>

>

>----------------------------------------------------------------------

>