Re: Got primary insurance rejection today!

[Guest guest]

I'm crossing my fingers (toes, legs, arms...) that everything will

work out for you, Kathy. It's good that you have a positive outlook

and a proactive stance. I hope both are rewarded!

Hugs to you, and a happy, healthy new year!

Melody

>

> Yea! I know. Sounds weird, eh? But my primary insurance through

> my employer will not cover WLS. It is a listed exclusion. They

> will be adding it to the policy later this year but not until July

> 1. Appealing won't work. Our company is self-insured and

approving

> surgery based on an appeal means that the company does not get

> catastrophic insurance on the person for the procedure. In other

> words, if something goes wrong...the company is liable for all the

> hospital/doctor costs and that could amount to tons with serious

> complications. Whereas now, if someone goes for an approved

> surgery... the company is insured over a certain figure for

> catastrophic care.

>

> Anyway, now that I'm rejected by my primary insurance and it

appears

> that my secondary insurance is finally getting established - that

> we'll have the doctor send the papers to the secondary with the

> rejection from the primary. I just mailed the check to the

> insurance company to cover me from 11/22 (date of marriage) to

> today. And we mailed the first quarter fees for 2005 to them last

> week. Long story....as in the insurance company saying " our

> software cannot figure out how to prorate the fees " . Duh. What

> morons. So, this all should be fun!

>

> I do know that PHCS (secondary) requires alot of that dreaded diet

> history. I'm praying that what I wrote up...a four page history of

> my dieting life plus some computer printouts I have of dieting in

> 2003 (I did lose weight just didn't keep it of) with a week by week

> weight for 10 months of the year will suffice. Keep positive

> thoughts please!

>

> Kathy

[Guest guest]

Kathy,

I have Guardian / PHCS......... I was approved. It took about 4

weeks. PHCS did want diet history. I gave them a copy of a file from

Lindora, about 15 weeks of info and a copy of a file from my Dr's

office when I was on Phen fen 5 - 6 years ago. They approved it just

with that info. PHCS and Guardian have been great.

Good luck!!

Hugs!!

>

> Yea! I know. Sounds weird, eh? But my primary insurance through

> my employer will not cover WLS. It is a listed exclusion. They

> will be adding it to the policy later this year but not until July

> 1. Appealing won't work. Our company is self-insured and

approving

> surgery based on an appeal means that the company does not get

> catastrophic insurance on the person for the procedure. In other

> words, if something goes wrong...the company is liable for all the

> hospital/doctor costs and that could amount to tons with serious

> complications. Whereas now, if someone goes for an approved

> surgery... the company is insured over a certain figure for

> catastrophic care.

>

> Anyway, now that I'm rejected by my primary insurance and it

appears

> that my secondary insurance is finally getting established - that

> we'll have the doctor send the papers to the secondary with the

> rejection from the primary. I just mailed the check to the

> insurance company to cover me from 11/22 (date of marriage) to

> today. And we mailed the first quarter fees for 2005 to them last

> week. Long story....as in the insurance company saying " our

> software cannot figure out how to prorate the fees " . Duh. What

> morons. So, this all should be fun!

>

> I do know that PHCS (secondary) requires alot of that dreaded diet

> history. I'm praying that what I wrote up...a four page history of

> my dieting life plus some computer printouts I have of dieting in

> 2003 (I did lose weight just didn't keep it of) with a week by week

> weight for 10 months of the year will suffice. Keep positive

> thoughts please!

>

> Kathy

[Guest guest]

Kathy

Ok...step 1 is out of the way so onto step 2 and onto being a loser

right?!

You'll be getting approved in no time--happy thoughts coming to ya!!!!

>

> Yea! I know. Sounds weird, eh? But my primary insurance through

> my employer will not cover WLS. It is a listed exclusion. They

> will be adding it to the policy later this year but not until July

> 1. Appealing won't work. Our company is self-insured and approving

> surgery based on an appeal means that the company does not get

> catastrophic insurance on the person for the procedure. In other

> words, if something goes wrong...the company is liable for all the

> hospital/doctor costs and that could amount to tons with serious

> complications. Whereas now, if someone goes for an approved

> surgery... the company is insured over a certain figure for

> catastrophic care.

>

> Anyway, now that I'm rejected by my primary insurance and it appears

> that my secondary insurance is finally getting established - that

> we'll have the doctor send the papers to the secondary with the

> rejection from the primary. I just mailed the check to the

> insurance company to cover me from 11/22 (date of marriage) to

> today. And we mailed the first quarter fees for 2005 to them last

> week. Long story....as in the insurance company saying " our

> software cannot figure out how to prorate the fees " . Duh. What

> morons. So, this all should be fun!

>

> I do know that PHCS (secondary) requires alot of that dreaded diet

> history. I'm praying that what I wrote up...a four page history of

> my dieting life plus some computer printouts I have of dieting in

> 2003 (I did lose weight just didn't keep it of) with a week by week

> weight for 10 months of the year will suffice. Keep positive

> thoughts please!

>

> Kathy

[Guest guest]

Kathy......

I had to have a diet history and my insurance company wouldnt accept mine

that I had which sounds similar to yours. But my PCP took the same info, put it

on his letterhead with his signature, added a small paragraph on his medical

opinion on why I need the surgery and they took it and approved me. So maybe try

that?

Just trying to help.

Chelle