Guest guest Posted September 4, 2000 Report Share Posted September 4, 2000 Hi everyone, I am just curious ... were any of you approved by your insurance for an open RNY before you got approved for a MGB? I would think that any insurance company that would approve an open RNY would approve a MGB. I am nervous that things have went so smooth so far and now because I changed my mind on which procedure to have ... my insurance won't approve me. I am going to call them tomorrow just to see what they say. I know I am probably jumping the gun but I waited for a whole year for approval for the Open RNY. I don't want anything to stand in the way of this surgery. I am trying so hard to stay positive. Terri Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 4, 2000 Report Share Posted September 4, 2000 In a message dated 9/4/2000 9:40:00 PM Eastern Daylight Time, TKirrie@... writes: << were any of you approved by your insurance for an open RNY before you got approved for a MGB? >> Well, I'm really no help, but thought I'd say that I was approved for an open RNY a couple years ago.. had Principal PPO then.... I have BC/BS of Florida now, the HMO plan, and haven't submitted anything to them yet... I would think if it's a covered procedure and is shown to be 'medically necessary', under whatever plan, it would be approved. But, we all know that this is not always true... so.... Good luck! <---to me, too! <g> Robin Wife to Doug Mommy to Tyler, 4 yrs., and Brennan, 1 yr. Singer, wife, mom, secretary.. and not in that particular order. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 4, 2000 Report Share Posted September 4, 2000 TKirrie@... wrote: > > Hi everyone, > > I am just curious ... were any of you approved by your insurance for an open > RNY before you got approved for a MGB? I would think that any insurance > company that would approve an open RNY would approve a MGB. I am nervous that > things have went so smooth so far and now because I changed my mind on which > procedure to have ... my insurance won't approve me. There are two primary reasons insurance companies turn you down: (1) You have an exclusion in your policy; (2) You haven't proved that surgery is medically necessary to treat your obesity. Obviously, #1 does not apply to you or you could not be approved at all. You *have* to have proved surgery was medically necessary, or you would have been denied based on #2. With one memorable exception, generally insurance companies are not concerned with which variation of a gastric bypass you get, what they are concerned about is whether or not you need *any* gastric bypass -- an you've already established that. That is why you were approved for the open RNY. You should be fine. The MGB costs about 1/4 of what the open RNY costs, so they should be doing a tap dance when they find out you are having the MGB instead of the open RNY. Kind regards, I am going to call them > tomorrow just to see what they say. I know I am probably jumping the gun but > I waited for a whole year for approval for the Open RNY. I don't want > anything to stand in the way of this surgery. I am trying so hard to stay > positive. > > Terri > > This message is from the Mini-Gastric Bypass Mailing List at Onelist.com > Please visit our web site at http://clos.net > Get the Patient Manual at http://clos.net/get_patient_manual.htm > > and for more on the MGB,Don't miss : > http://www.fourlane.com/mgb > > To Unsubscribe Send and Email to: MiniGastricBypass-unsubscribe (AT) egroups (DOT) com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 5, 2000 Report Share Posted September 5, 2000 Thank you - I am feeling very positive on this issue- I will let you know what they say when I call them later today. Terri Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 5, 2000 Report Share Posted September 5, 2000 my hmo approved me for open rny with a local doctor. when i decided i wanted mgb, i first had to convince my primary care physician to do new referral, then my hmo turned me down, saying dr. r wasn't in network (their theory being that there was a perfectly good dr. in network doing substantially the same thing. since i am on an hmo, they do not have out of network rates, out of network just isn't covered if there is an alternative in network). anyway, i appealed and overwhelmed them with multiple copies of dr. r's paper, the manual, long letters from me, etc., and, i think, just wore them down, so they approved me for mgb. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 5, 2000 Report Share Posted September 5, 2000 HMO's are a different breed than PPO's and traditional insurance. They literally can write their own rules. America wrote: > > my hmo approved me for open rny with a local doctor. when i decided i > wanted mgb, i first had to convince my primary care physician to do > new referral, then my hmo turned me down, saying dr. r wasn't in > network (their theory being that there was a perfectly good dr. in > network doing substantially the same thing. since i am on an hmo, > they do not have out of network rates, out of network just isn't > covered if there is an alternative in network). anyway, i appealed > and overwhelmed them with multiple copies of dr. r's paper, the > manual, long letters from me, etc., and, i think, just wore them > down, so they approved me for mgb. > > This message is from the Mini-Gastric Bypass Mailing List at Onelist.com > Please visit our web site at http://clos.net > Get the Patient Manual at http://clos.net/get_patient_manual.htm > > and for more on the MGB,Don't miss : > http://www.fourlane.com/mgb > > To Unsubscribe Send and Email to: MiniGastricBypass-unsubscribe (AT) egroups (DOT) com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 5, 2000 Report Share Posted September 5, 2000 Thank you for your reply, . I hope that I don't get denied. I had to wait a year for approval with the open. I really just wish this one will be a lot easier. I just talked to my PCP about being my referral today and he agreed. I don't know how much more anticipation I can handle. My stomach has been in knots for months not knowing what is going to happen next. I just have to put all of my faith into God and pray that everything will work itself out. I talked to my insurance people today. They said they didn't think there would be a problem but they had to wait to get the info submitted from Dr. R's office before they could commit to anything. It will probably take a while considering I just sent in my Patient information form via the website tonight (only because I needed to make sure my PCP was supportive). Now I have to wait for approval from Dr. R. I know I am jumping the gun but I already have my patient letter written. I am so anxious and I want this soooooooo bad. I nearly lost all self control over my emotions in my PCP's office today. Everything is going so smooth for the open RNY - I am terrified I am going to run into a brick wall because I know want the MGB. Anyway-thanks for putting up with my ramble and I apologize to anyone who is still reading. Hope I am not driving you all crazy, yet. Thanks for listening.... Terri In a message dated 9/5/00 2:46:15 PM !!!First Boot!!!, annaamerica@... writes: > my hmo approved me for open rny with a local doctor. when i decided i > wanted mgb, i first had to convince my primary care physician to do > new referral, then my hmo turned me down, saying dr. r wasn't in > network (their theory being that there was a perfectly good dr. in > network doing substantially the same thing. since i am on an hmo, > they do not have out of network rates, out of network just isn't > covered if there is an alternative in network). anyway, i appealed > and overwhelmed them with multiple copies of dr. r's paper, the > manual, long letters from me, etc., and, i think, just wore them > down, so they approved me for mgb. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 6, 2000 Report Share Posted September 6, 2000 Terri: Yes, waiting is excruciating, but we all have to do it, and you're doing just fine. Judith in Seattle Re: Re: insurance approval... > Thank you for your reply, . I hope that I don't get denied. I had to wait > a year for approval with the open. I really just wish this one will be a lot > easier. I just talked to my PCP about being my referral today and he agreed. > I don't know how much more anticipation I can handle. My stomach has been in > knots for months not knowing what is going to happen next. I just have to put > all of my faith into God and pray that everything will work itself out. I > talked to my insurance people today. They said they didn't think there would > be a problem but they had to wait to get the info submitted from Dr. R's > office before they could commit to anything. It will probably take a while > considering I just sent in my Patient information form via the website > tonight (only because I needed to make sure my PCP was supportive). Now I > have to wait for approval from Dr. R. I know I am jumping the gun but I > already have my patient letter written. I am so anxious and I want this > soooooooo bad. I nearly lost all self control over my emotions in my PCP's > office today. Everything is going so smooth for the open RNY - I am terrified > I am going to run into a brick wall because I know want the MGB. > Anyway-thanks for putting up with my ramble and I apologize to anyone who is > still reading. Hope I am not driving you all crazy, yet. Thanks for > listening.... > > Terri > > In a message dated 9/5/00 2:46:15 PM !!!First Boot!!!, annaamerica@... > writes: > > > my hmo approved me for open rny with a local doctor. when i decided i > > wanted mgb, i first had to convince my primary care physician to do > > new referral, then my hmo turned me down, saying dr. r wasn't in > > network (their theory being that there was a perfectly good dr. in > > network doing substantially the same thing. since i am on an hmo, > > they do not have out of network rates, out of network just isn't > > covered if there is an alternative in network). anyway, i appealed > > and overwhelmed them with multiple copies of dr. r's paper, the > > manual, long letters from me, etc., and, i think, just wore them > > down, so they approved me for mgb. > > > > > > This message is from the Mini-Gastric Bypass Mailing List at Onelist.com > Please visit our web site at http://clos.net > Get the Patient Manual at http://clos.net/get_patient_manual.htm > > and for more on the MGB,Don't miss : > http://www.fourlane.com/mgb > > To Unsubscribe Send and Email to: MiniGastricBypass-unsubscribe (AT) egroups (DOT) com > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 6, 2000 Report Share Posted September 6, 2000 Thanks Judith for your words of encouragement! Terri In a message dated 9/6/00 7:23:57 AM !!!First Boot!!!, judith98101@... writes: > Terri: > Yes, waiting is excruciating, but we all have to do it, and you're doing > just fine. > Judith in Seattle Quote Link to comment Share on other sites More sharing options...
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