Re: BCBS....Good News, Bad News

[Guest guest]

In a message dated 11/05/2001 10:22:43 AM Central Standard Time,

jjamineteoj@... writes:

> The " bad news " is that they approved it at standard benefit levels,

> which leaves me with a 30% co-pay and a $500 deductible, on top of

> the $2500 that Hess asks for.

>

Did you check if the hospital will be a " preferred benefits " . It very well

may be. This would also cut your out of pocket quite a bit. If this IS the

case, I would caution against going into too much detail over being approved

for a " long limb roux en y " . You start talking ds and they might not

maintain any approval.

Just some thoughts!

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

[Guest guest]

Oh JJ I forgot to mention in my last post, I did all

this through my PCP office. Any questions please

email me direct and I'll help in any way I can.

best wishes

B

--- jjamineteoj@... wrote:

> Sorry, that last post was a bit unclear. " Standard

> Benefits " are not

> as good as " Preferred Benefits " , which in my plan,

> pay virtually

> 100%. I want to be PREFERRED dammit!

>

>

>

>

> > I know a lot of you here are interested in BCBS

> approvals....I have

> > BCBS Vermont. I applied for prior approval for

> BPD/DS with Dr.

> Hess

> > two weeks ago, and......

> >

> > It just came back approved, that's the " good

> news " .

> >

> > The " bad news " is that they approved it at

> standard benefit levels,

> > which leaves me with a 30% co-pay and a $500

> deductible, on top of

> > the $2500 that Hess asks for.

> >

> > Their reasoning was that the procedure was

> available in network.

> It

> > isn't, believe me, I've looked. I suspect it's

> going to be the old

> > RNY argument, will know more shortly.

> >

> > So now I have to convince them of the benefits of

> the " Long Limb

> RNY "

> > vs. the standard RNY.....this after I FRIGGING

> SPELLED IT OUT FOR

> > THEM, COMPLETE WITH DIAGRAMS in my original

> request.

> >

> > Ahh, if it was easy, everyone would do it....

> >

> > jj

>

>

>

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