Guest guest Posted October 3, 2000 Report Share Posted October 3, 2000 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 4, 2000 Report Share Posted October 4, 2000 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 4, 2000 Report Share Posted October 4, 2000 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 4, 2000 Report Share Posted October 4, 2000 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 > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 25, 2002 Report Share Posted April 25, 2002 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 Quote Link to comment Share on other sites More sharing options...
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