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

[Guest guest]

Im so sorry, Donna.. {{{HUGS, HUGS, HUGS!!!}}}} but please dont give

up.. do all you have to, to get approved.. I'll pray for you..

Love, Sue

> 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]

AJ,

Yup ... that's how I feel ). I have a backup plan (to switch ins.

companies) and then a backup to the backup plan (go to Dr. Baltasar), so it

took a while for me to realize why I was/am soooo upset. I think that when

I realized they had basically discounted the work I put into the appeals, it

just made me feel that I wasn't even worth this surgery or the right to live

without pain. So ... I got really pissed off, then I cried, then I called

the ins. company back and got some good advice, then I cried again, and now

I'm better )

I think my nerves are a little to taut over this and I need to learn to

relax a little ... I pick up my prescription for xanax in just a little bit

)

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.

Bye,

Donna

>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]

Thanks, Judie ... you guys already do make it better. That's why I came

here to you all before I even told my husband. I need you all and

appreciate you all more than words can say. I'm not a big time poster, but

I read all the posts every day and feel as tho I know a great many of you,

and your words mean a lot to me.

Bye,

Donna

>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]

Thank you, Sue. I'm not going to give up and make it that easy on them ...

but pray for me anyway ... every little bit helps !!

Bye,

Donna

>

>Im so sorry, Donna.. {{{HUGS, HUGS, HUGS!!!}}}} but please dont give

>up.. do all you have to, to get approved.. I'll pray for you..

>Love, Sue

>

>

> > 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'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

>

>

>

>

>

>

>

>

>

>

>

>

>

>

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>