Re: Need input....regarding what to do!!!

[Guest guest]

If you are going to a Dr. in LA, I recommend Cedars Sinai, tho UCLA is

really good too. I did an intake with Dr Edy Soffer 310-423-6143 and the

surgeon was Dr. who was one of the innovators of Laparascopic surgery.

This was April 2009. They were quite wonderful, although I have had some

problems since, I think due to my original GI in Santa Barbara who did every

study in the book and didn't know what was wrong with me and refused to

consult with another GI in his office. He admitted he didn't know. This put a

year and a half lag, hence a distended esophagus. The problems I have are

air swallowing that buoys up the food so there is no room for more food. So,

I eat less....that isnt bad. My saliva/foamy also wont let the food go

down easily. I blame the original GI. I dont believe that they dont consult

with other doctors. That is real stupidity.

did a laparoscopic Hellers Monotomy and a Dors Fundiplication. I

have not had a moment of GERD/heartburn, which plagued me for over 40 years.

Cedars is very patient conscious.

Please go ahead with something that will resolve this. These GI departments

are really savvy! Follow thru and dont lag. It is driving you nuts.

8

05.565.1332/881.2181

In a message dated 7/31/2010 5:08:53 P.M. Pacific Daylight Time,

medhelpinfo@... writes:

I figured that because I was diagnosised finally with achalasia, the

insurance would forward me to a qualifed surgeon. No, they have allowed a GI

visit to UCLA (Los Angeles). Is this how it works?? I get to start all over

again??

Any suggestions? I'm frustrated.

Julee So Calif.

[Guest guest]

Hi Julee,

Don't " figure. "   You took 22 years to get diagnosed with achalasia.  How long

do

you think it will take an insurance company to figure out the best way to deal

with the disease?  The policy of insurance companies, whether it is for health

or casualty, is to collect all the premiums and deny most of the benefits. That

is how they profit in the real world. There are those of us on this Board (and I

don't include myself amongst them) who know how to " play the system. " They will

speak up to help you if need be. For my part, I have helped several people here

who were getting screwed by life insurance companies who wanted to sell the most

expensive (rated)plans to achalasia sufferers, while my agent succeeded in

selling me a preferred policy.

________________________________

From: anna <medhelpinfo@...>

achalasia

Sent: Sat, July 31, 2010 8:08:28 PM

Subject: Need input....regarding what to do!!!

 

I figured that because I was diagnosised finally with achalasia, the insurance

would forward me to a qualifed surgeon. No, they have allowed a GI visit to UCLA

(Los Angeles). Is this how it works?? I get to start all over again??

Any suggestions? I'm frustrated.

Julee So Calif.

[Guest guest]

You are right!  Okay, then I am playing recon!!!  I found out the name of top

surgeon, did some research and sent her an email to introduce myself.  Maybe by

speaking to them, it will help me gain some ground.  If anyone knows how to

play

this system, PLEASE let me know!!!! 

Thanks, Julee So Calif.

________________________________

From: RICHARD FRIEDMAN <cynmark24@...>

achalasia

Sent: Sat, July 31, 2010 6:04:37 PM

Subject: Re: Need input....regarding what to do!!!

 

Hi Julee,

Don't " figure. "   You took 22 years to get diagnosed with achalasia.  How long

do

you think it will take an insurance company to figure out the best way to deal

with the disease?  The policy of insurance companies, whether it is for health

or casualty, is to collect all the premiums and deny most of the benefits. That

is how they profit in the real world. There are those of us on this Board (and I

don't include myself amongst them) who know how to " play the system. " They will

speak up to help you if need be. For my part, I have helped several people here

who were getting screwed by life insurance companies who wanted to sell the most

expensive (rated)plans to achalasia sufferers, while my agent succeeded in

selling me a preferred policy.

________________________________

From: anna <medhelpinfo@...>

achalasia

Sent: Sat, July 31, 2010 8:08:28 PM

Subject: Need input....regarding what to do!!!

 

I figured that because I was diagnosised finally with achalasia, the insurance

would forward me to a qualifed surgeon. No, they have allowed a GI visit to UCLA

(Los Angeles). Is this how it works?? I get to start all over again??

Any suggestions? I'm frustrated.

Julee So Calif.

[Guest guest]

Julee - 'recon' is a good term and is your way to go. Find the best surgeon you

can and then their insurance people can help you.

I'll use my personal example - it's kind of a twisty story but illustrates well

the power of good insurance staff.

I was in Pittsburgh for my ectomy which had been approved by BC/BS. I was

waiting to have a CT scan done (routine) the day before my surgery was scheduled

and the insurance company called me to tell me I was not approved because my

company had missed the payment, the insurance had cancelled and my company had

made up the payment and had it paid retroactive but because BCBS had not had 3

full weeks since the retroactive status was restored - they were denying because

they are entitled to 3 weeks to review records on elective surgeries.

I flipped out!! I had made all of these massive arrangements for work, my kids,

my mom was at my house for a month (she had to take off work), my husband had to

take off work - you get the picture.

I spoke with the insurance person at Dr. L's office and within an hour - she had

me approved - for a $100,000 plus procedure.

They know how to do these kind of work-arounds, especially if you are going to

UCLA or someplace really big - they have the pull you are going to need.

Hope that helps!

~ in NC

>

> You are right!  Okay, then I am playing recon!!!  I found out the name of

top

> surgeon, did some research and sent her an email to introduce myself.  Maybe

by

> speaking to them, it will help me gain some ground.  If anyone knows how to

play

> this system, PLEASE let me know!!!! 

>

>

> Thanks, Julee So Calif.

>

>

>

>

> ________________________________

> From: RICHARD FRIEDMAN <cynmark24@...>

> achalasia

> Sent: Sat, July 31, 2010 6:04:37 PM

> Subject: Re: Need input....regarding what to do!!!

>

>  

> Hi Julee,

>

> Don't " figure. "   You took 22 years to get diagnosed with achalasia.  How

long do

>

> you think it will take an insurance company to figure out the best way to deal

> with the disease?  The policy of insurance companies, whether it is for

health

> or casualty, is to collect all the premiums and deny most of the benefits.

That

> is how they profit in the real world. There are those of us on this Board (and

I

>

> don't include myself amongst them) who know how to " play the system. " They

will

> speak up to help you if need be. For my part, I have helped several people

here

> who were getting screwed by life insurance companies who wanted to sell the

most

>

> expensive (rated)plans to achalasia sufferers, while my agent succeeded in

> selling me a preferred policy.

>

>

>

> ________________________________

> From: anna <medhelpinfo@...>

> achalasia

> Sent: Sat, July 31, 2010 8:08:28 PM

> Subject: Need input....regarding what to do!!!

>

>  

> I figured that because I was diagnosised finally with achalasia, the insurance

> would forward me to a qualifed surgeon. No, they have allowed a GI visit to

UCLA

>

> (Los Angeles). Is this how it works?? I get to start all over again??

>

> Any suggestions? I'm frustrated.

>

> Julee So Calif.

>

>

[Guest guest]

,

You have just described insurance nightmare!!  This is the kinds of crappy

stuff

we have to deal with in the middle of a health crisis no less!  Thanks for your

story, so glad that it worked out and just proves the point.  I am trying to

get

to the doctor and explain my situation before I even get there so that they can

get the insurance monster at bay.  At least I hope this will work.  I emailed

a

surgeon already at UCLA and we shall see if they reply to me.  I have only a GI

approval, which seems like I am starting all over again, but maybe with the

extra effort, it will work out.  For now, I just pray and wait to here from

someone. 

My husband and I are paying for our own insurance, the rates are " high " and work

is slow, I am self employed, he is also sick and had to retire 4 years ago, it's

a tight situation.  Thanks again so much, you are always there with a good word

for me! 

Julee, So Calif.

________________________________

From: zlmmom1 <mcnairmichelle@...>

achalasia

Sent: Sun, August 1, 2010 6:38:18 AM

Subject: Re: Need input....regarding what to do!!!

 

Julee - 'recon' is a good term and is your way to go. Find the best surgeon you

can and then their insurance people can help you.

I'll use my personal example - it's kind of a twisty story but illustrates well

the power of good insurance staff.

I was in Pittsburgh for my ectomy which had been approved by BC/BS. I was

waiting to have a CT scan done (routine) the day before my surgery was scheduled

and the insurance company called me to tell me I was not approved because my

company had missed the payment, the insurance had cancelled and my company had

made up the payment and had it paid retroactive but because BCBS had not had 3

full weeks since the retroactive status was restored - they were denying because

they are entitled to 3 weeks to review records on elective surgeries.

I flipped out!! I had made all of these massive arrangements for work, my kids,

my mom was at my house for a month (she had to take off work), my husband had to

take off work - you get the picture.

I spoke with the insurance person at Dr. L's office and within an hour - she had

me approved - for a $100,000 plus procedure.

They know how to do these kind of work-arounds, especially if you are going to

UCLA or someplace really big - they have the pull you are going to need.

Hope that helps!

~ in NC

>

> You are right!  Okay, then I am playing recon!!!  I found out the name

of top

>

> surgeon, did some research and sent her an email to introduce myself. 

Maybe

>by

>

> speaking to them, it will help me gain some ground.  If anyone knows how to

>play

>

> this system, PLEASE let me know!!!! 

>

>

> Thanks, Julee So Calif.

>

>

>

>

> ________________________________

> From: RICHARD FRIEDMAN <cynmark24@...>

> achalasia

> Sent: Sat, July 31, 2010 6:04:37 PM

> Subject: Re: Need input....regarding what to do!!!

>

>  

> Hi Julee,

>

> Don't " figure. "   You took 22 years to get diagnosed with achalasia.  How

long

>do

>

>

> you think it will take an insurance company to figure out the best way to deal

> with the disease?  The policy of insurance companies, whether it is for

health

>

> or casualty, is to collect all the premiums and deny most of the benefits.

That

>

> is how they profit in the real world. There are those of us on this Board (and

>I

>

>

> don't include myself amongst them) who know how to " play the system. " They

will

>

> speak up to help you if need be. For my part, I have helped several people

here

>

> who were getting screwed by life insurance companies who wanted to sell the

>most

>

>

> expensive (rated)plans to achalasia sufferers, while my agent succeeded in

> selling me a preferred policy.

>

>

>

> ________________________________

> From: anna <medhelpinfo@...>

> achalasia

> Sent: Sat, July 31, 2010 8:08:28 PM

> Subject: Need input....regarding what to do!!!

>

>  

> I figured that because I was diagnosised finally with achalasia, the insurance

> would forward me to a qualifed surgeon. No, they have allowed a GI visit to

>UCLA

>

>

> (Los Angeles). Is this how it works?? I get to start all over again??

>

> Any suggestions? I'm frustrated.

>

> Julee So Calif.

>

>