RE: I can't see through the tears ..

[Guest guest]

In a message dated 10/23/2001 11:21:08 AM Pacific Daylight Time,

joostema@... writes:

> It's strange that I come to the group at a time when I am so very

> upset; you don't know me nor love me as my family and friends do, yet

> it is the people of this group whom I've become familiar with through

> months of post reading that I need right now.

>

> I got my second denial from Cigna this afternoon. I know it

> shouldn't have surprised me so nor upset me to the extent that I can

> barely see through teary eyes to type this, but it has.

>

Many of us have been there...so we completely understand the let down and

sense of loss...the loss of hope. I hope things get straightened out. I

don't think I've ever felt as low as I did the day I got news that it wasn't

going to happen for me. I am so lucky to have a family that scrambled

together and helped me come up with the money to go to Spain...but not

everyone has the alternative available...so I hope things work for you...

Big hugs!!!

Where there is a will...there's a way...just might take a bit longer.

~*~ AJ ~*~

Age 37 5'8'' Post op 7/24/01 Open DS

self pay - Dr Baltasar -Alcoy Spain

07/24/01 BMI 64 415.1

08/24/01 BMI 58 386.5 -28.6 lbs!

09/24/01 BMI 55.8 367.1 -48.0 lbs! -37.75 inches

10/08/01 BMI 54.3 357.1 -58.0 lbs! -50.0

10/19/01 BMI 52.9 348.0 -67.1 lbs!

My profile:

http://www.obesityhelp.com/morbidobesity/profile.phtml?N=E982002956

My website:

www.wls4aj.homestead.com

[Guest guest]

Donna,

(Enters with a nice hot toddy, its almost noon here,LOL)

(((((((((((((((((((((((HUG))))))))))))))))))))))))

(((((((((((((((((((((((HUG))))))))))))))))))))))))

(((((((((((((((((((((((HUG))))))))))))))))))))))))

Kathy in Arlington

> It's strange that I come to the group at a time when I am so very

> upset; you don't know me nor love me as my family and friends do,

yet

> it is the people of this group whom I've become familiar with

through

> months of post reading that I need right now.

>

> I got my second denial from Cigna this afternoon. >>>>>>>>

>

> I need a hug ... I need a really really really big hug ... and an

> even bigger glass of whisky...

>

> I am so depressed and feel so hopeless,

> Donna

[Guest guest]

A great big ((((((((((((((((((hug))))))))))))))))) for you, Donna. here

hun......take a hankerchief and wipe those tears and lay your head on my

shoulder.......tomorrow is another day.

Hugs, Judie

[Guest guest]

Easy on the whiskey! We can handle the hugs....

((((((((((((((((((((((Hugs))))))))))))))))))))))))

Big enough???

M. in KC

I can't see through the tears ..

It's strange that I come to the group at a time when I am so very

upset; you don't know me nor love me as my family and friends do, yet

it is the people of this group whom I've become familiar with through

months of post reading that I need right now.

I got my second denial from Cigna this afternoon. I know it

shouldn't have surprised me so nor upset me to the extent that I can

barely see through teary eyes to type this, but it has.

My first denial was received upon the request for authorization to

see Dr. Hess (out of network). When that was denied, I started the

appeals process, knowing I would keep and pay for the trip to see Dr.

Hess on 10/15. I spent so much time... I typed a 14 page document

all about myself, the choice of surgeon, the surgery itself, the

pitfalls of RNY, weight loss attempts, medications, comorbids,and on

and on ... including 6 attachments to back up what I had to say.

They received my appeal package on the 25th of September, and the

bastards didn't even look at it unitl last week. They did not even

go the length to determine medical necessity. All they looked at was

that it was a request for out-of-network benefits and that as there

were in-network surgeons providing bariatric surgery, they denied.

I am sitting here today, nowhere further than I was when I got the

refusal to see Dr. Hess, nearly 2 months ago. I asked her why they

didn't determine medical necessity, and just deny out-of-network

benefits, and she told me that was because I requested out-of-network

benefits which didn't require establishing medical necessity in order

to be denied. I cannot believe this. She told me I can appeal

again, and I will, but I feel so emotionally beaten.

She did go on to tell me that North Carolina insurance policies can

deny wls for obese persons but that they cannot deny wls for persons

classified as MO. I told her that with a BMI of 48 and a foot long

list of comorbids THEY ARE HAVING TO PAY FOR, I certainly qualify.

She said that will have to be determined in the next level of appeals.

So .... it seems I have to appeal not only for the BPD/DS to be done

versus the RNY, but I have to appeal to have them acknowledge I am

MO ... which any idiot could've/should've gotten from my last appeals

package. I even had 5 ... yes 5 ... letters from my doctors ... 4

from surgeons and one from my PCP, all advocating this is medically

necessary.

I need a hug ... I need a really really really big hug ... and an

even bigger glass of whisky...

I am so depressed and feel so hopeless,

Donna

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

[Guest guest]

,

I've always been a 'cheap date' ... couldn't drink a bunch of whisky if I

wanted to. Yes, the hug was big enough, and I know I'll persevere once I

get un-upset.

Thank you tho ... I know that only my 'post' buddies can really understand

how a feel.

Bye,

Donna

>Easy on the whiskey! We can handle the hugs....

>((((((((((((((((((((((Hugs))))))))))))))))))))))))

>

>Big enough???

>

> M. in KC

>

_________________________________________________________________

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[Guest guest]

That's my fear, Judie ... that it'll be another day like today ... Once I

stop feeling sorry for myself, I'll get back in the battle )

But, the hug did help!!

Bye,

Donna

>

>A great big ((((((((((((((((((hug))))))))))))))))) for you, Donna. here

>hun......take a hankerchief and wipe those tears and lay your head on my

>shoulder.......tomorrow is another day.

>

>Hugs, Judie

>

_________________________________________________________________

Get your FREE download of MSN Explorer at http://explorer.msn.com/intl.asp

[Guest guest]

Donna,

*BIG HUGS* I am soo sorry this is happening to you.....I have faith that in the

end you will have your surgery. Skip the whiskey and have a nice bubble bath

instead then go curl up with a nice blankey!

*hugs*

Lisbeth

joostema@... wrote: It's strange that I come to the group at a time

when I am so very

upset; you don't know me nor love me as my family and friends do, yet

it is the people of this group whom I've become familiar with through

months of post reading that I need right now.

I got my second denial from Cigna this afternoon. I know it

shouldn't have surprised me so nor upset me to the extent that I can

barely see through teary eyes to type this, but it has.

My first denial was received upon the request for authorization to

see Dr. Hess (out of network). When that was denied, I started the

appeals process, knowing I would keep and pay for the trip to see Dr.

Hess on 10/15. I spent so much time... I typed a 14 page document

all about myself, the choice of surgeon, the surgery itself, the

pitfalls of RNY, weight loss attempts, medications, comorbids,and on

and on ... including 6 attachments to back up what I had to say.

They received my appeal package on the 25th of September, and the

bastards didn't even look at it unitl last week. They did not even

go the length to determine medical necessity. All they looked at was

that it was a request for out-of-network benefits and that as there

were in-network surgeons providing bariatric surgery, they denied.

I am sitting here today, nowhere further than I was when I got the

refusal to see Dr. Hess, nearly 2 months ago. I asked her why they

didn't determine medical necessity, and just deny out-of-network

benefits, and she told me that was because I requested out-of-network

benefits which didn't require establishing medical necessity in order

to be denied. I cannot believe this. She told me I can appeal

again, and I will, but I feel so emotionally beaten.

She did go on to tell me that North Carolina insurance policies can

deny wls for obese persons but that they cannot deny wls for persons

classified as MO. I told her that with a BMI of 48 and a foot long

list of comorbids THEY ARE HAVING TO PAY FOR, I certainly qualify.

She said that will have to be determined in the next level of appeals.

So .... it seems I have to appeal not only for the BPD/DS to be done

versus the RNY, but I have to appeal to have them acknowledge I am

MO ... which any idiot could've/should've gotten from my last appeals

package. I even had 5 ... yes 5 ... letters from my doctors ... 4

from surgeons and one from my PCP, all advocating this is medically

necessary.

I need a hug ... I need a really really really big hug ... and an

even bigger glass of whisky...

I am so depressed and feel so hopeless,

Donna

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

[Guest guest]

Donna,

You do realize that once you finally get approved and have your surgery, you

will be a really, really cheap date!

I am 10 weeks post-op and when my family goes out to eat, I either just take

a little from my hubby's and kids' plates or order a child's meal and take

2/3 of it home. I have become a professional at taking leftovers to work

for lunch!

Keep on the insurance company and eventually you will get the approval you

need. We will all be rooting for you!

M. in KC

RE: I can't see through the tears ..

,

I've always been a 'cheap date' ... couldn't drink a bunch of whisky if I

wanted to. Yes, the hug was big enough, and I know I'll persevere once I

get un-upset.

Thank you tho ... I know that only my 'post' buddies can really understand

how a feel.

Bye,

Donna

>Easy on the whiskey! We can handle the hugs....

>((((((((((((((((((((((Hugs))))))))))))))))))))))))

>

>Big enough???

>

> M. in KC

>

_________________________________________________________________

Get your FREE download of MSN Explorer at http://explorer.msn.com/intl.asp

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

[Guest guest]

No Donna, another day with bright sunshine. Its not the end of the world

hun.....lve been there!! Now is the time to gear up with a fight with all

you have to muster!

You have the support and backing and help from all of us here on the list,.

you are NOT alone girlfriend! Never forget that!!

This is one time I wish I was a rich lady......if I was, you would have your

surgery with the surgeon of your choice!

(maybe some day I will get that dream and be able to help others........)

Lotsa hugs, Judie

[Guest guest]

Gosh, Judie ... I'm going to start crying again )

But you're absolutely right ... I will continue to fight until I get what I

deserve, and I thank you for your posts.

Bye,

Donna

>No Donna, another day with bright sunshine. Its not the end of the world

>hun.....lve been there!! Now is the time to gear up with a fight with all

>you have to muster!

>You have the support and backing and help from all of us here on the list,.

>you are NOT alone girlfriend! Never forget that!!

>This is one time I wish I was a rich lady......if I was, you would have

>your

>surgery with the surgeon of your choice!

>(maybe some day I will get that dream and be able to help others........)

>

>Lotsa hugs, Judie

>

>

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

>

[Guest guest]

Donna,

If you need some help or a lift along the way, just holler! We are all here

for you. We will do everything we can to make your burden lighter! =)

Hugs, Judie

[Guest guest]

Thanks, Dee!! I'm feeling better now )

Bye,

Donna

>

>I'm adding my hugs to you too, Donna. Heck, us Donnas

>have to stick together!

>

>(((((((((((((((((((((((HUGS)))))))))))))))))))))))

>

>dee

>

>

>--- Manero wrote:

> > Easy on the whiskey! We can handle the hugs....

> > ((((((((((((((((((((((Hugs))))))))))))))))))))))))

> >

> > Big enough???

> >

> > M. in KC

> >

> > I can't see through the

> > tears ..

> >

> >

> > It's strange that I come to the group at a time when

> > I am so very

> > upset; you don't know me nor love me as my family

> > and friends do, yet

> > it is the people of this group whom I've become

> > familiar with through

> > months of post reading that I need right now.

> >

> > I got my second denial from Cigna this afternoon. I

> > know it

> > shouldn't have surprised me so nor upset me to the

> > extent that I can

> > barely see through teary eyes to type this, but it

> > has.

> >

> > My first denial was received upon the request for

> > authorization to

> > see Dr. Hess (out of network). When that was

> > denied, I started the

> > appeals process, knowing I would keep and pay for

> > the trip to see Dr.

> > Hess on 10/15. I spent so much time... I typed a 14

> > page document

> > all about myself, the choice of surgeon, the surgery

> > itself, the

> > pitfalls of RNY, weight loss attempts, medications,

> > comorbids,and on

> > and on ... including 6 attachments to back up what I

> > had to say.

> > They received my appeal package on the 25th of

> > September, and the

> > bastards didn't even look at it unitl last week.

> > They did not even

> > go the length to determine medical necessity. All

> > they looked at was

> > that it was a request for out-of-network benefits

> > and that as there

> > were in-network surgeons providing bariatric

> > surgery, they denied.

> >

> > I am sitting here today, nowhere further than I was

> > when I got the

> > refusal to see Dr. Hess, nearly 2 months ago. I

> > asked her why they

> > didn't determine medical necessity, and just deny

> > out-of-network

> > benefits, and she told me that was because I

> > requested out-of-network

> > benefits which didn't require establishing medical

> > necessity in order

> > to be denied. I cannot believe this. She told me I

> > can appeal

> > again, and I will, but I feel so emotionally beaten.

> >

> > She did go on to tell me that North Carolina

> > insurance policies can

> > deny wls for obese persons but that they cannot deny

> > wls for persons

> > classified as MO. I told her that with a BMI of 48

> > and a foot long

> > list of comorbids THEY ARE HAVING TO PAY FOR, I

> > certainly qualify.

> > She said that will have to be determined in the next

> > level of appeals.

> >

> > So .... it seems I have to appeal not only for the

> > BPD/DS to be done

> > versus the RNY, but I have to appeal to have them

> > acknowledge I am

> > MO ... which any idiot could've/should've gotten

> > from my last appeals

> > package. I even had 5 ... yes 5 ... letters from my

> > doctors ... 4

> > from surgeons and one from my PCP, all advocating

> > this is medically

> > necessary.

> >

> > I need a hug ... I need a really really really big

> > hug ... and an

> > even bigger glass of whisky...

> >

> > I am so depressed and feel so hopeless,

> > Donna

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

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

> >

[Guest guest]

In a message dated 10/23/01 2:20:54 PM Pacific Daylight Time,

joostema@... writes:

> I may be coming to you for advice soon if things to take a more positive

> turn with insurance. I think you're doing GREAT ... better than great,

> actually, and am very happy for you ... jealous as hell, but very happy

> deep

> down where it counts.

>

>

Donna...you're such a sweetie! Believe me...I was jealous of everyone when I

was waiting...thats okay...its normal...and I KNOW your day is going to be

here soon and I'll be the first one rooting for you! You're doing great and

you've worked hard...take satisfaction in that and no matter what..you're one

better than anyone you've had to deal with at the insurance company...they

can't possibly appreciate the heart, soul and emotion that goes into those

appeals..the stress and uncertainy waiting for a response or what it does

when its not going to be approved. This is so much more than just a health

thing! So take pride in the fact that you are way better off than those

people because you know what it means to want something so bad, and you will

appreciate your surgery more than any of them will ever understand.

hugs!

Hugs!

~*~ AJ ~*~

Bellingham, WA

Age 37 5'8'' Open DS

self pay - Dr Baltasar -Alcoy Spain

07/24/01 BMI 64 415.1

08/24/01 BMI 58 386.5 -28.6 lbs!

09/24/01 BMI 55.8 367.1 -48.0 lbs! -37.75 inches

10/23/01 BMI 52.6 346.0 -69.1 lbs! -50.0 inches

My profile:

http://www.obesityhelp.com/morbidobesity/profile.phtml?N=E982002956

My website:

www.wls4aj.homestead.com

[Guest guest]

(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((DONNA))))

)))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))