Guest guest Posted October 17, 2000 Report Share Posted October 17, 2000 Dear , I just thought I'd share with you my thoughts. After finding the web site I was consumed with having this surgery. In my spare time I researched. In the middle of the night I prowled around with excess energy about insurance, the procedure, travel arrangements. I never felt so fat as the time between reading Dr. R's letter to the insurance company and the time I actually had the procedure. This message board put me in contact with the only other person who has the same insurance I do who had had the MGB. I knew from her experience (thank you from Springfield) that the insurance battle was not going to be pretty. She has been fighting since January and still no coverage. The thing that motivated me was that has lost 100 pounds during the fight. I made up my mind that I refuse to be held hostage by the insurance company. I scheduled all the preop stuff, had the surgery, all the while fighting with the insurance company. I got a home equity loan with the understanding that I may never see a penny from the insurance company. Friday I received the first appeal denial. Get this. On the 8th I sent a release of my medical records to them so they could make and informed decision. ( I guess their original denial was uninformed since they didn't consider my records before.) The denial letter was dated the 11th. They never even requested my records ( I work at the hospital - I checked) but still the denial letter stated " after thorough and careful consideration " they still denied the procedure. (My policy says its covered only if medically necessary). I asked for the criteria they use to determine medical necessity and , of course, they blew that off. I spoke with the Missouri Insurance Commission yesterday and they are filing a level two appeal on my behalf. The rep at the MO Ins Commission said " if this isn't medical necessity I don't know what is. " My point is, fight the fight, but you may have to go around the insurance company and be getting healthier in the meantime. As of this morning, I have lost 24 pounds. I'm exercising for the first time in my life. I'm not so sluggish that I barely navigate through the day to collapse on the couch when I get home. I have optimism about wearing something that doesn't have an XX in the label. I refuse to let an insurance company take away those milestones. Yes I may be poor. Yes this battle may go on for who knows how long. But, I will be one shrinking, motivated, energetic person during the fight. I'll be thinking of you. Tarri in Missouri MGB 09-29-00 329/305 Yea! > I am sooo happy for you guys who just got approved! > > WHOOOO!!! YEA!! WAY TO GO!!! CLAPPING AND EXCITED FOR YOU IN OHIO! > > I wish it were me. I am still waiting ont the #$)%^*%* insurance > company!!!!! By the way, I choose to just SPIT! No lady like > business for me!! I've earned it. I might even %#(). (you know... > pass gas) FART! If I feel like it. HE HE LOL > > I'm still plaining on that belly ring. > > Tired of Being Obese in Ohio > BMI 42 > ANGELA > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2000 Report Share Posted October 17, 2000 Tarri: Thanks so much for sharing! It means alot to me. Sometimes I forget that I am not the only one and all of you have been through the same thing. I have thrown down the glove and I am ready to fight! > Dear , > I just thought I'd share with you my thoughts. After finding the web site I > was consumed with having this surgery. In my spare time I researched. In > the middle of the night I prowled around with excess energy about insurance, > the procedure, travel arrangements. I never felt so fat as the time between > reading Dr. R's letter to the insurance company and the time I actually had > the procedure. This message board put me in contact with the only other > person who has the same insurance I do who had had the MGB. I knew from her > experience (thank you from Springfield) that the insurance battle > was not going to be pretty. She has been fighting since January and still > no coverage. The thing that motivated me was that has lost 100 > pounds during the fight. I made up my mind that I refuse to be held hostage > by the insurance company. I scheduled all the preop stuff, had the surgery, > all the while fighting with the insurance company. I got a home equity loan > with the understanding that I may never see a penny from the insurance > company. Friday I received the first appeal denial. Get this. On the 8th > I sent a release of my medical records to them so they could make and > informed decision. ( I guess their original denial was uninformed since > they didn't consider my records before.) The denial letter was dated the > 11th. They never even requested my records ( I work at the hospital - I > checked) but still the denial letter stated " after thorough and careful > consideration " they still denied the procedure. (My policy says its covered > only if medically necessary). I asked for the criteria they use to > determine medical necessity and , of course, they blew that off. I spoke > with the Missouri Insurance Commission yesterday and they are filing a level > two appeal on my behalf. The rep at the MO Ins Commission said " if this > isn't medical necessity I don't know what is. " My point is, fight the > fight, but you may have to go around the insurance company and be getting > healthier in the meantime. As of this morning, I have lost 24 pounds. I'm > exercising for the first time in my life. I'm not so sluggish that I barely > navigate through the day to collapse on the couch when I get home. I have > optimism about wearing something that doesn't have an XX in the label. I > refuse to let an insurance company take away those milestones. Yes I may be > poor. Yes this battle may go on for who knows how long. But, I will be one > shrinking, motivated, energetic person during the fight. > I'll be thinking of you. > Tarri in Missouri > MGB 09-29-00 > 329/305 > Yea! > > > > I am sooo happy for you guys who just got approved! > > > > WHOOOO!!! YEA!! WAY TO GO!!! CLAPPING AND EXCITED FOR YOU IN OHIO! > > > > I wish it were me. I am still waiting ont the #$)%^*%* insurance > > company!!!!! By the way, I choose to just SPIT! No lady like > > business for me!! I've earned it. I might even %#(). (you know... > > pass gas) FART! If I feel like it. HE HE LOL > > > > I'm still plaining on that belly ring. > > > > Tired of Being Obese in Ohio > > BMI 42 > > ANGELA > > > > > > Quote Link to comment Share on other sites More sharing options...
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