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RE: Good news/Bad news

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Stormy:

Thanks for your message. I've been 2x ideal weight for two years

under the NIH guidelines but not under the MET life ones (which has a

higher minimum weight) and, predictably, BC/BS was unsympathetic when

I pointed out to them -- forcefully -- that the NIH guideless

established good medical practice. I feel that if I were to fight on

and litigate I would have a very strong case (and indeed contacted

the leading plaintiff's lawyer in Alabama who agreed to represent me

if I desired).

But the sad truth is that litigation would divert my attention from

other important things I need to accomplish over the next year and I

must prioritize. (I can't " compartmentalize " as well as Slick

Willie; as a law professor I know how all-consuming a suit can be.)

That's life -- sometimes having to forego rights for the sake of the

larger picture.

I do, however, encourage those who can to fight on!!

Best,

Jon in Tuscaloosa

> > The good news: Dr. R has approved me for surgery. I'm trying to

> get

> > a date during Turkey week.

> >

> > The bad news: To my total lack of surprise, BC/BS of Alabama has

> > denied me, as they did when I tried for R-en-Y surgery, claiming

> that

> > the procedure is not medically necessary unless I'm twice my

ideal

> > weight for two years. Totally contrary to NIH guidelines, but I

> > don't have it in me to fight them again as I did (unsuccessfully)

> > over the R-en-y surgery. I think I'd win if I litigated, but

since

> > my employer (Univ. of Ala.) self-insures and uses BC/BS only as a

> > claims administrator, and I'm not yet tenured, I think it would

be

> > unwise.

> >

> > So, self-pay. But the good news trumps the bad!

> >

> > Regards to all.

> >

> > Jon in Tuscaloosa

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Congratulations Jon. And welcome from all us other self pays. The way

I figure, I'll make up the money in a year from the savings on

groceries!!!!!!

> The good news: Dr. R has approved me for surgery. I'm trying to

get

> a date during Turkey week.

>

> The bad news: To my total lack of surprise, BC/BS of Alabama has

> denied me, as they did when I tried for R-en-Y surgery, claiming

that

> the procedure is not medically necessary unless I'm twice my ideal

> weight for two years. Totally contrary to NIH guidelines, but I

> don't have it in me to fight them again as I did (unsuccessfully)

> over the R-en-y surgery. I think I'd win if I litigated, but since

> my employer (Univ. of Ala.) self-insures and uses BC/BS only as a

> claims administrator, and I'm not yet tenured, I think it would be

> unwise.

>

> So, self-pay. But the good news trumps the bad!

>

> Regards to all.

>

> Jon in Tuscaloosa

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I agree totally with , We had a lot of help from friends to self-pay.. I

have a lot of people to pay back!!

Trudy

Re: Good news/Bad news

Congratulations Jon. And welcome from all us other self pays. The way

I figure, I'll make up the money in a year from the savings on

groceries!!!!!!

> The good news: Dr. R has approved me for surgery. I'm trying to

get

> a date during Turkey week.

>

> The bad news: To my total lack of surprise, BC/BS of Alabama has

> denied me, as they did when I tried for R-en-Y surgery, claiming

that

> the procedure is not medically necessary unless I'm twice my ideal

> weight for two years. Totally contrary to NIH guidelines, but I

> don't have it in me to fight them again as I did (unsuccessfully)

> over the R-en-y surgery. I think I'd win if I litigated, but since

> my employer (Univ. of Ala.) self-insures and uses BC/BS only as a

> claims administrator, and I'm not yet tenured, I think it would be

> unwise.

>

> So, self-pay. But the good news trumps the bad!

>

> Regards to all.

>

> Jon in Tuscaloosa

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Great news ! Now you'll get it done before you're twice your ideal

weight as happens to most of us. So now about turkey week...will that be Broth

Week?

Flo in land

> ** Original Subject: RE: Good news/Bad news

> ** >

> ** Original Date: Tue, 03 Oct 2000 22:13:47 -0600

> ** Original Message follows...

>

> The good news: Dr. R has approved me for surgery. I'm trying to get

> a date during Turkey week.

>

> The bad news: To my total lack of surprise, BC/BS of Alabama has

> denied me, as they did when I tried for R-en-Y surgery, claiming that

> the procedure is not medically necessary unless I'm twice my ideal

> weight for two years. Totally contrary to NIH guidelines, but I

> don't have it in me to fight them again as I did (unsuccessfully)

> over the R-en-y surgery. I think I'd win if I litigated, but since

> my employer (Univ. of Ala.) self-insures and uses BC/BS only as a

> claims administrator, and I'm not yet tenured, I think it would be

> unwise.

>

> So, self-pay. But the good news trumps the bad!

>

> Regards to all.

>

> Jon in Tuscaloosa

>

>

>

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  • 1 year later...
Guest guest

So Lu, , Heidi, someone please put me on no mail for just a week, OK and we'll see how it goes. I have to hope the PT helps (really helps!). So, don't worry, guys, I am fine, just still stiff sore and hurting. BUT I WILL BE BACK...IN SEVEN DAYS, OK?

Love, Judy

Okay Judy, your on no mail for one week. get well, we love you!

Lu

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