Re: Fighting the Insurance Battle

[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.

DS 7/19/01 Dr. Hares

213 pre-op

173 today

[Guest guest]

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

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[Guest guest]

>> 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

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Tami,

That's great to know !!! I've got this elaborate document I've been

working on for about

a month now. I plan on giving it to Dr. Hess to submit along with his

letter to Cigna. In my

document, I did something very similar ... I went to Cigna themselves and

told them I wanted

a copy of everything they've paid over the last 2-1/2 years, and they are

going to mail

that to me. I've also gone to my pharmacist to get a list of all of my

meds over this

timeframe (I know ... this should also be on Cigna's list, but some were

not actually due

to the comorbidities, so I needed to subtract them). My meds alone are

over $9,000.00.

I planned on using the very same approach as you ... forcing them to SEE

what it is

costing them to NOT approve the surgery so that they'll be able to view

this as a cost

savings since they are driven by profit.

It's very comforting to hear that this approach has worked, albeit with a

different company.

The concept is the same, tho, and I am so happy for you that you have a

date. Pray that

I get to join you in a triumph with my insurance company next month.

Wishing you the very best,

Donna

[Guest guest]

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

>

> __________________________________________________

>

[Guest guest]

Oh Tami, unfortunately it does matter. Pacificare,

through the Marin IPA, does not want to pay for the

DS, only the RNY.

dee

--- Tami Kopp wrote:

> 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.

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