Guest guest Posted November 7, 2001 Report Share Posted November 7, 2001 Have you looked into the surgery being treatment for the other co-morbidities not for " weight loss " . Just a thought 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 7, 2001 Report Share Posted November 7, 2001 Hey Judie, Yep, that's the deal - my insurance company will only pay a total of $5k for the surgery and complications. Wait! Make that less than five grand, because I took phen/phen a few years ago and have to deduct for that, since the policy only pays $5k lifetime for ALL weight loss programs including surgery. Nice, huh? Actually they have been a pretty good company to have, until now, that is. I don't qualify for disability and I am too young for Medicare. My husband and I are both retired so switching insurance companies is out of the question. I am just recently retired, and have thought of looking into insurance just for myself through some organization so I could get group coverage. I also sent a letter to the plan administrator of my insurance company telling him my story and including some documentation. I even sent a copy of a tape I have showing a news program feature about DS surgery with Dr. Rabkin and his patients. I am hoping this might make them reconsider their policy. I know it is a long shot, but how do policies get changed if no one speaks out? I am also trying to start something at the state level (California) and have been in touch with two gals working in their own states to get new laws regarding WLS surgery. I appreciate your kind words and look forward to more of your witty and informative posts. And if you can think of anything else for me to try, let me know. Blessings, Sue > Hiya Sue! > > Nice to meet another " oldie " who no doubt is young in spirit and will be > even younger once you get the surgery! I was amazed at how smooth the > surgery went for me with the DS compared to other surgeries Ive had in the > past.....like gallbladder removal, etc. That one was horrific but the DS > was a piece of cake. > Are you saying your insurance company will only pay $5,000 of the total bill > of maybe 30 grand? > Do you by any chance, qualify for medicare disability? If you do, that > would be one way to go. The other option would be to find another insurance > company, yes?? I sure hope things change for you and really soon. Let me > know if there is anything I can do for you. And I mean that! > > Hugs, Judie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 7, 2001 Report Share Posted November 7, 2001 Hi Dawn, Thanks for the suggestion. I will certainly give it lots of thought. Actually, I have begun to suspect that I am heading toward gall bladder problems, and have thought that perhaps I could have gall bladder surgery done by Dr. K and while he is in there, he could do the DS and I could self-pay for that portion of the surgery. Of course, I have to go to a tummy doctor and find out if my suspicions are correct, but it might be worth a try. I am so grateful to the folks on this list, like yourself, who are helpful and supporting. I am determined to be switched no matter what! Blessings, Sue Sue Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 7, 2001 Report Share Posted November 7, 2001 Sue, My company would only pay up to $3000 per lifetime for weight loss related medical treatment. When I requested pre approval for the bpd/ds I was approved in about 3 weeks. I was under the impression that the components of the surgery considered " wls " would be capped at $3000 and the rest of the surgery and hospital bills would be paid in full. When I started getting my claims back from the insurance co. they were all paid up til that $3000 then they started denying them stating it exceeded the amt...etc... I requested a letter from Dr. Hess stating that all components were not WLS and in about 2 weeks I got a letter from my ins co stating that they had paid my $22,000. hospital bill. I was soooooo happy. I guess it was the fact that I was being treated for a diseased gall bladder and they paid for that surgery. The wls part was just " Icing on the cake " . The insurance gal I talked to over the phone said the whole reason the hospital bill wasnt being paid was something to do with the codes. To them the whole procedure looked like WLS, but in the end it all worked out for me. I hope things work out for you. a Gossman -- In duodenalswitch@y..., countrygal@t... wrote: > Hey Judie, > Yep, that's the deal - my insurance company will only pay a total of > $5k for the surgery and complications. Wait! Make that less than > five grand, because I took phen/phen a few years ago and have to > deduct for that, since the policy only pays $5k lifetime for ALL > weight loss programs including surgery. Nice, huh? Actually they > have been a pretty good company to have, until now, that is. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 8, 2001 Report Share Posted November 8, 2001 Hi a, Thanks for telling me your story. I am hoping I can work it out like you did to find a way around this. Stories like yours keep me inspired and prod me to keep going forward. Thanks again. Blessings, Sue > > Hey Judie, > > Yep, that's the deal - my insurance company will only pay a total > of > > $5k for the surgery and complications. Wait! Make that less than > > five grand, because I took phen/phen a few years ago and have to > > deduct for that, since the policy only pays $5k lifetime for ALL > > weight loss programs including surgery. Nice, huh? Actually they > > have been a pretty good company to have, until now, that is. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 8, 2001 Report Share Posted November 8, 2001 I am also trying to start something at the state level (California) and have been in touch with two gals working in their own states to get new laws regarding WLS surgery. >>>> That is great, Sue! Obviously, something has to be done on state levels to get insurance approvals for more people. I think it totally sucks when an insurance company puts a cap on the amount. $5 grand hardly covers anything! Getting in the news and getting your voice heard is so important.......I wish you loads of success in doing this and paving the way not only for yourself but for others to follow...... Hugs, Judie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 8, 2001 Report Share Posted November 8, 2001 Hey Judie, If I ever get to the point where they have WLS hearings at the state capitol, how about joining me so we can both " give 'em hell?! " See you in Sacramento! Blessings, Sue > I > am also trying to start something at the state level (California) and > have been in touch with two gals working in their own states to get > new laws regarding WLS surgery. >>>> > > That is great, Sue! Obviously, something has to be done on state levels to > get insurance approvals for more people. I think it totally sucks when an > insurance company puts a cap on the amount. $5 grand hardly covers > anything! > Getting in the news and getting your voice heard is so important.......I > wish you loads of success in doing this and paving the way not only for > yourself but for others to follow...... > > Hugs, Judie Quote Link to comment Share on other sites More sharing options...
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