Guest guest Posted May 7, 2003 Report Share Posted May 7, 2003 Has anyone had the surgery after fighting with Blue Cross? How did you do it? Need help. Hi ???! I am six months post op with Blue Cross first denying then resending everything with a new Dr. (Dr. K). They DO cover it, but it isn't easy -- and even easier if your BMI is over 55. The best of luck to you! Hugs and blessings, Ann Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 7, 2003 Report Share Posted May 7, 2003 , I won after my second appeal. I had to hire Walter Lindstrom from Obesitiy Law and Advocacy. He and his wife were so great to work with. And without his help and guidance I would still have fought, but I am not sure I could have won. He is very savvy on what is and is not a good fight. I won based on a swallowing disorder I have. I must drink with meals and the RNY (which BC/BS of AK approves) does not give one that leeway. So after going to an ENT and having a diagnosis was what won my DS approval. Basically the dianosis was I had swallowing difficulty, maybe due to my thyroid problem (hypothyroid), and that his treatment would be to drink with meals (this is a very basic summary of wht he said). Good luck. BC/BS of Alaska have caused me many moments of sadness, stress and frustration. My first appeal was well over 100 pages long. Quantity did not win my appeal but I am positive it got my foot in the door. Debi, Juneau, AK Post-op 2/13/03 Dr. K > Has anyone had the surgery after fighting with Blue Cross? How did > you do it? Need help. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2003 Report Share Posted May 8, 2003 >Hi Ann, Thanks for answering my inquiry. I really appreciate it. I read your message the other day! You have done so great! I don't know you but am still proud of you! I am still fighting BC, on my third denial, but my BMI is only 51.3. (Can't believe I said " only " ) Anyway, I will keep at them. They want me to try the Roux-N-Y. Boy they haven't done their homework! Thanks again! and Good Luck karen > Has anyone had the surgery after fighting with Blue Cross? How did > you do it? Need help. > > Hi ???! > > I am six months post op with Blue Cross first denying then resending > everything with a new Dr. (Dr. K). They DO cover it, but it isn't easy -- > and even easier if your BMI is over 55. The best of luck to you! > > Hugs and blessings, Ann > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2003 Report Share Posted May 8, 2003 > > Has anyone had the surgery after fighting with Blue Cross? How did > > you do it? Need help. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2003 Report Share Posted May 8, 2003 Hi , Sorry to stick my nose in here but I wanted to tell you that when I consulted with Obesity Law, it was around $700 or $800 for him to go the entire round for you. I think that's pretty reasonable since most lawyers charge a couple hundred dollars per hour. I used the less expensive service of just a written letter to the insurance company for, I think, $250. (It wasn't enough, I wound up self paying.) You have a few options with Walter. He's a very nice man and really cares. Tracey > --- In , " clownfireak " > Hi > Thanks for answering my inquiry. I really appreciate it. I haven't > checked into the Obesity Law and Advocacy yet. Is it expensive? I > also don't have many complications, so don't know if it would work. > Just Type II diabetes and some minor heart problems. Blue Cross wants > me to try Roux-N-Y ! I can't believe they don't know better. They > say Dr. K's method is " investigative " . They just haven't done their > homework. I keep trying to educate them. > > Anyway, I will keep at it and see if I can afford to get legal help. > > Thanks again. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2003 Report Share Posted May 8, 2003 > > --- In , " clownfireak " > > Hi > > Thanks for answering my inquiry. I really appreciate it. I haven't > > checked into the Obesity Law and Advocacy yet. Is it expensive? I > > also don't have many complications, so don't know if it would work. > > Just Type II diabetes and some minor heart problems. Blue Cross > wants > > me to try Roux-N-Y ! I can't believe they don't know better. They > > say Dr. K's method is " investigative " . They just haven't done their > > homework. I keep trying to educate them. > > > > Anyway, I will keep at it and see if I can afford to get legal help. > > > > Thanks again. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2003 Report Share Posted May 8, 2003 > > --- In , " clownfireak " > > Hi > > Thanks for answering my inquiry. I really appreciate it. I haven't > > checked into the Obesity Law and Advocacy yet. Is it expensive? I > > also don't have many complications, so don't know if it would work. > > Just Type II diabetes and some minor heart problems. Blue Cross > wants > > me to try Roux-N-Y ! I can't believe they don't know better. They > > say Dr. K's method is " investigative " . They just haven't done their > > homework. I keep trying to educate them. > > > > Anyway, I will keep at it and see if I can afford to get legal help. > > > > Thanks again. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2003 Report Share Posted May 8, 2003 In a message dated 5/8/2003 10:38:03 AM Pacific Daylight Time, kblansett@... writes: > am still fighting BC, on my > third denial, but my BMI is only 51.3. (Can't believe I said " only " ) > Anyway, I will keep at them. They want me to try the Roux-N-Y. Boy > they haven't done their homework! Hi ! I am so sick of them saying " You can have the Roux-en-Y *first* then if it doesn't work out we will consider the DS! " How can they possibly WANT us to have to have two surgeries in the place of one? I wish that some doctors would stop doing the Roux-en-Y and do just the DS. As long as there are DS doctors that do BOTH surgeries, they are doing a disservice to the general obese community in making it harder to get approvals for the DS. Far too many people have to have a Roux-en-Y because *it is better than nothing!* Of course it is, but they are being set up for future surgery and higher complications! I wish there were a way to get the doctors to change and to get insurance companies to change. One tack you might want to take during an appeal would be to use the fact that Medi-cal and Medicare both cover it -- who makes BC a higher authority than Medicare? Are they in the business to help people to get well or what? In the end it is far cheaper for them to fund the surgery than to take on the complications possible from having diabetes or other obesity related conditions! This really is a no brainer (but they have no collective brain)! LOL I guess as a last resort you could always gain weight (I did, because of the stress from the denials)! I wish you all the best, , and I hope you soon get your approval! Hugs and blessings, Ann Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 13, 2009 Report Share Posted January 13, 2009 ,My assistant says yes to all this . Plus sometimes they want a modifier and sometimes they don't and if they don't want it they just won't pay.Usually, if we re-bill a denial because they have lumped the itemizations in the billing they will pay, but it depends on the policy. Overall, my assistant is earning her salary.AnnetteOn Jan 13, 2009, at 9:37 AM, johncc48 wrote:Has anyone had problems with Blue Cross recently? They have been lumping some of the therapies into the manipulation fee on some even though the therapies are covered services. They will sometimes pay when confronted about this but it seems that they are hoping we won't notice. Colwell, DC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 13, 2009 Report Share Posted January 13, 2009 We've been noticing this for about the last year ... sometimes we win and sometimes we don't ... no rhyme or reason that I can see. Sunny Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7C Eugene, Oregon, 97401 541- 344- 0509; Fx; 541- 344- 0955 From: johncc48@...Date: Tue, 13 Jan 2009 09:37:36 -0800Subject: Blue cross Has anyone had problems with Blue Cross recently? They have been lumping some of the therapies into the manipulation fee on some even though the therapies are covered services. They will sometimes pay when confronted about this but it seems that they are hoping we won't notice. Colwell, DC Windows Live™ Hotmail®: Chat. Store. Share. Do more with mail. See how it works. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 13, 2009 Report Share Posted January 13, 2009 They are simply banking on a high percentage of docs just saying " Whatever " and accepting their cost-cutting skulduggery. Lyndon McGill, D.C. Salem, Oregon Sunny Kierstyn wrote: > > We've been noticing this for about the last year ... sometimes we win > and sometimes we don't ... no rhyme or reason that I can see. > > Sunny > > > Sunny Kierstyn, RN DC > Fibromyalgia Care Center of Oregon > 2677 Willakenzie Road, 7C > Eugene, Oregon, 97401 > 541- 344- 0509; Fx; 541- 344- 0955 > > > > > ------------------------------------------------------------------------ > > From: johncc48@... > Date: Tue, 13 Jan 2009 09:37:36 -0800 > Subject: Blue cross > > Has anyone had problems with Blue Cross recently? They have been > lumping some of the therapies into the manipulation fee on some even > though the therapies are covered services. They will sometimes pay when > confronted about this but it seems that they are hoping we won't notice. > > Colwell, DC > > > ------------------------------------------------------------------------ > Windows Live™ Hotmail®: Chat. Store. Share. Do more with mail. See how > it works. > <http://windowslive.com/howitworks?ocid=TXT_TAGLM_WL_t1_hm_justgotbetter_howitwo\ rks_012009> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 15, 2009 Report Share Posted January 15, 2009 I'll second that. Twila is outstanding. Also, BC has short two hour seminars in and about the state and they are worth going to. Neil R. Cohen, D.C. -------------- Original message ---------------------- From: " A. Simpson " <csimpson@...> > , Annette, Sunny, Lyndon et al, > > If you are having issues with Regence Blue Cross Blue Sheild of Oregon (aka > " Blue Cross " or " Regence " ) I would suggest contacting the provider > representative there, Twila Baker. Ms. Baker is a great resource to help > you and your office staff understand the ins and outs of " Blue Cross " and > an advocate for DCs in resolving problems. > > There are lots of different plans that may seem to fall under the BC lable > and understanding which plan is which can untangle what often seems like > contradictory and capricious stuff. > > With her permission, her phone is 503-225-6891. Give her a try. > > C Simpson, DC > Beaverton OR , Annette, Sunny, Lyndon et al, If you are having issues with Regence Blue Cross Blue Sheild of Oregon (aka " Blue Cross " or " Regence " ) I would suggest contacting the provider representative there, Twila Baker. Ms. Baker is a great resource to help you and your office staff understand the ins and outs of " Blue Cross " and an advocate for DCs in resolving problems. There are lots of different plans that may seem to fall under the BC lable and understanding which plan is which can untangle what often seems like contradictory and capricious stuff. With her permission, her phone is 503-225-6891. Give her a try. C Simpson, DC Beaverton OR Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 15, 2009 Report Share Posted January 15, 2009 I'll second that. Twila is outstanding. Also, BC has short two hour seminars in and about the state and they are worth going to. Neil R. Cohen, D.C. -------------- Original message ---------------------- From: " A. Simpson " <csimpson@...> > , Annette, Sunny, Lyndon et al, > > If you are having issues with Regence Blue Cross Blue Sheild of Oregon (aka > " Blue Cross " or " Regence " ) I would suggest contacting the provider > representative there, Twila Baker. Ms. Baker is a great resource to help > you and your office staff understand the ins and outs of " Blue Cross " and > an advocate for DCs in resolving problems. > > There are lots of different plans that may seem to fall under the BC lable > and understanding which plan is which can untangle what often seems like > contradictory and capricious stuff. > > With her permission, her phone is 503-225-6891. Give her a try. > > C Simpson, DC > Beaverton OR , Annette, Sunny, Lyndon et al, If you are having issues with Regence Blue Cross Blue Sheild of Oregon (aka " Blue Cross " or " Regence " ) I would suggest contacting the provider representative there, Twila Baker. Ms. Baker is a great resource to help you and your office staff understand the ins and outs of " Blue Cross " and an advocate for DCs in resolving problems. There are lots of different plans that may seem to fall under the BC lable and understanding which plan is which can untangle what often seems like contradictory and capricious stuff. With her permission, her phone is 503-225-6891. Give her a try. C Simpson, DC Beaverton OR Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 15, 2009 Report Share Posted January 15, 2009 I don't think that is the correct phone number for Twyla Baker at Regence BCBS! I think that's Don Giles number...(I could be wrong!). We have Twyla's number as: 503-226-8740. Does anyone else have a different number for her? (:-) Bob s Re: Blue Cross I'll second that.Twila is outstanding.Also, BC has short two hour seminars in and about the state and they are worth going to.Neil R. Cohen, D.C.-------------- Original message ----------------------From: " A. Simpson" <csimpsoneasystreet (DOT) net>> , Annette, Sunny, Lyndon et al,> > If you are having issues with Regence Blue Cross Blue Sheild of Oregon (aka> "Blue Cross" or "Regence") I would suggest contacting the provider> representative there, Twila Baker. Ms. Baker is a great resource to help> you and your office staff understand the ins and outs of "Blue Cross" and> an advocate for DCs in resolving problems.> > There are lots of different plans that may seem to fall under the BC lable> and understanding which plan is which can untangle what often seems like> contradictory and capricious stuff.> > With her permission, her phone is 503-225-6891. Give her a try.> > C Simpson, DC> Beaverton OR Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 15, 2009 Report Share Posted January 15, 2009 I don't think that is the correct phone number for Twyla Baker at Regence BCBS! I think that's Don Giles number...(I could be wrong!). We have Twyla's number as: 503-226-8740. Does anyone else have a different number for her? (:-) Bob s Re: Blue Cross I'll second that.Twila is outstanding.Also, BC has short two hour seminars in and about the state and they are worth going to.Neil R. Cohen, D.C.-------------- Original message ----------------------From: " A. Simpson" <csimpsoneasystreet (DOT) net>> , Annette, Sunny, Lyndon et al,> > If you are having issues with Regence Blue Cross Blue Sheild of Oregon (aka> "Blue Cross" or "Regence") I would suggest contacting the provider> representative there, Twila Baker. Ms. Baker is a great resource to help> you and your office staff understand the ins and outs of "Blue Cross" and> an advocate for DCs in resolving problems.> > There are lots of different plans that may seem to fall under the BC lable> and understanding which plan is which can untangle what often seems like> contradictory and capricious stuff.> > With her permission, her phone is 503-225-6891. Give her a try.> > C Simpson, DC> Beaverton OR Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 15, 2009 Report Share Posted January 15, 2009 OD DCs, Oy veh! My mistake. Dr s is correct on both counts...althought Don Giles is a nice guy, he cant' help as much as Twila Baker can. Sheesh. sorry. C Simpson, DC BeavertonOR Quote Link to comment Share on other sites More sharing options...
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