Guest guest Posted October 3, 2000 Report Share Posted October 3, 2000 Hi Jon, I first want to say how sorry I am that you have been denied the medical care that you need. I am also in Alabama, and was denied twice before getting approval on the third appeal. I felt, as you do, that the " being twice your weight for the last two years " requirement was wrong, but found out that they will NOT approve you if you do not meet this requirement. I don't know your weight and height, but I would like to suggest that you go to the Metropolitan Insurance Weight charts (you can find them with an online search) and see what the lowest weight for your height is, and see if it is anywhere close to twice your ideal body weight. You may have already done this, but I was suprised to see how low the charts put my ideal weight. I was a few pounds shy of twice my weight at one time in the last two years, but was approved anyway. I was denied twice because I was not twice my body weight before getting an approval. I was denied twice for the open RNY before I was able to get approval for the MGB. I don't think that it really matters to the insurance company which surgery you decide to have, but they sure like to try to run you off with denials. If you decide to self-pay, please do yourself a favor and continue to fight Blue Cross. You have a good chance of winning eventually. If I can help you at all, please email me at talachee @ hotmail.com. Stormy in Monroeville > 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 Jon, Congratulations on your GOOD news! So sorry to hear about your bad news. I also have BC/BS of Alabama and I am awaiting their decision. Doesn't look good now! My husband is from Northport and we are heading up there this weekend. Roll Tide! Of course, no ballgame so that's no fun! haha Do you teach at the University? Larry has 2 degrees from there (Biology and Chemical Engineering). Best Wishes, Rebekah mother of 9 yr old twins Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 4, 2000 Report Share Posted October 4, 2000 In a message dated 10/4/2000 8:23:49 AM Central Daylight Time, jsb@... writes: << Are you pre or post? >> Jon, I am pre-op. Rebekah Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 4, 2000 Report Share Posted October 4, 2000 Have fun this weekend! Are you pre or post? > Jon, > > Congratulations on your GOOD news! So sorry to hear about your bad news. I > also have BC/BS of Alabama and I am awaiting their decision. Doesn't look > good now! > > My husband is from Northport and we are heading up there this weekend. Roll > Tide! Of course, no ballgame so that's no fun! haha Do you teach at the > University? Larry has 2 degrees from there (Biology and Chemical > Engineering). > > Best Wishes, > > Rebekah > mother of 9 yr old twins Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 4, 2000 Report Share Posted October 4, 2000 When do you " dance " ? I just got my date: Nov. 22. Also, I forgot to answer your question: I'm a professor at UA School of Law. Have fun this weekend! > In a message dated 10/4/2000 8:23:49 AM Central Daylight Time, > jsb@j... writes: > > << Are you pre or post? > >> > > > Jon, > > I am pre-op. > > Rebekah Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 25, 2002 Report Share Posted April 25, 2002 Well, good news first! The brace is finally off my knee! AND I took my first shower in 10 days! Ohhhhhhh, the joy, it felt so good! Bad news, I still can't bend it. So I am still supposed to keep it elevated and iced. Physical therapy starts on Monday (14 visits - to start), so I'm still stuck here with my leg in the air and ice packs on it. Are we having fun yet? There are also about 600 + messages that I can't get to, so, as leery as I am to do it, can someone please put me on "no mail" for a week? One week only!, OK? This makes me nervous, since last time I was on no mail, we couldn't get it straightened out for months, but I just can't sit here and try to do this. Besides, to tell the truth, it really hurts. I don't know why I was expecting to just have it done and go my merry way, probably because each of the approximately six times I've had this done, I did just walk away and that was it, but this time, it really hurts, doesn't bend, is still really swollen, and in general is a real pain in the ass! Other than that....! 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 Quote Link to comment Share on other sites More sharing options...
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