Re: Fighting the Insurance Battle

[Guest guest]

I read your comments on your 100% insurance approval with Dr. Rabkin

and am curious how you are going to work out the $12,000 pre-surgery

Dr. fees with Dr. Rabkin.

I am investigating all my options now and this is a struggling point

for me.

Thanks for your help.

steve

>

> In response to your question, I have Pacific Care.

> Which is an HMO. After 4 months of fighting I am happy

> to say that my insurance is covering 100% !!!!

>

> In the final month of deliberation I decided " Money

> Talks " , so I called the pharmacy I go to and asked for

> the price of each and every medication I am on. I then

> subtracted my co-pay. Then I multiplied by 12. That

> gave me the full price the insurance company paid for

> my medications. I informed the insurance company that

> within 3-4 years what they pay in my medications would

> pay off my surgical proceedure. And that I would very

> possibly be off medications right now if I had the

> surgery instead of arguing with them. Thus saving them

> MONEY!

>

> Shortly after this revelation, I was approved. And the

> coverage is 100%. I don't know if this revelation to

> the insurance company was the clincher, but it sure

> did seem that way!!!!

>

> My surgery is with Dr Rabkin on October 2nd, 2001. My

> pre op is on Sept 27th.

>

> Tami

>

> __________________________________________________

>

[Guest guest]

What a great idea of adding up your prescription costs! I fought for 18

months and I never thought to do that. At least I did get my surgery paid

for in the end.

Good luck!

Kathy M.

================================================================================\

===============================

Kathy,

I would go stark raving mad if I had to

sit on pins and needles for 18 months (not

that I may not have to!!) But I'm so glad

you had your surgery and were covered.

My document, to date, is now 12-1/2 pages,

single-spaced, typewritten. Maybe seeing

that much stuff up front will make them

approve me just to get rid of me !! )

This doesn't even take into account all of

the 'attachments' I've stuck on the end ...

I'll take an approval any way I can get it!!

Donna

[Guest guest]

Hi Tami,

Thanks for your interesting reply. What was the policy of your HMO

regarding WLS before you started your " battle? " Did they provide

any coverage at all? My problem is that my company offers coverage,

but only $5000. I had thought about doing something along the lines

of what you did: I don't have a lot of expense each month for drugs

related to my obesity - I only take high blood pressure medication -

but I had thought of telling them that I will probably be facing

surgery to correct my sleep apnea and knee and foot surgery for my

poor joints, plus treatment for potential diabetes and heart disease,

and see what they say. WLS surgery would be less expensive than all

those combined, don't you think? Anyway, I am trying to get my ducks

in a row to fight this in the most effective way. Any further input

would be greatly appreciated.

Blessings,

Sue

[Guest guest]

Yes Donna-

I really believe that is the only way insurances

companies understand. You are going the right

direction. Go ahead and play the " Money Game " .

Tami

__________________________________________________

[Guest guest]

Steve-

My insurance is paying 100% of that also.

Tami

--- steve.ellis@... wrote:

> I read your comments on your 100% insurance approval

> with Dr. Rabkin

> and am curious how you are going to work out the

> $12,000 pre-surgery

> Dr. fees with Dr. Rabkin.

>

> I am investigating all my options now and this is a

> struggling point

> for me.

>

> Thanks for your help.

> steve

__________________________________________________

[Guest guest]

Dee-

The State of California. In other words Cal Pers. This

is a retirement benefit.

But that should not matter. I believe they are the

same.

Tami

--- Dee wrote:

> Congrats to you, Tami! I have Pacificare through

> the

> Marin IPA. Who is your Pacificare through?

>

> dee

>

>

> --- Tami Kopp wrote:

> >

> > In response to your question, I have Pacific Care.

> > Which is an HMO. After 4 months of fighting I am

> > happy

> > to say that my insurance is covering 100% !!!!

> >

> > In the final month of deliberation I decided

> " Money

> > Talks " , so I called the pharmacy I go to and asked

> > for

> > the price of each and every medication I am on. I

> > then

> > subtracted my co-pay. Then I multiplied by 12.

> That

> > gave me the full price the insurance company paid

> > for

> > my medications. I informed the insurance company

> > that

> > within 3-4 years what they pay in my medications

> > would

> > pay off my surgical proceedure. And that I would

> > very

> > possibly be off medications right now if I had the

> > surgery instead of arguing with them. Thus saving

> > them

> > MONEY!

> >

> > Shortly after this revelation, I was approved. And

> > the

> > coverage is 100%. I don't know if this revelation

> > to

> > the insurance company was the clincher, but it

> sure

> > did seem that way!!!!

> >

> > My surgery is with Dr Rabkin on October 2nd, 2001.

> > My

> > pre op is on Sept 27th.

> >

> > Tami

> >

> > __________________________________________________

> >