Re: Has anyone appealed or sued post-op?

[Guest guest]

Amy:

Thanks for agreeing with me. For one thing, I don't want to wait a year or

two for the insurance company to make up its mind. For another, if they have

proof positive that the surgery has improved things like blood pressure,

diabetes, or whatever other problems may exist.....how could they deny

paying?! And what JURY (if it went that far) could agree with a denial when

the living proof of better health was staring back at them? I hope I am

being realistic about this end of it. Even if all else fails, I look at the

cost as about the same as a mid-size car. And it will take me about the same

time to pay off the surgery as it would a car.....and my investment will last

me the rest of my life. I can assure you a CAR wouldn't.

Vicki Marton

Oklahoma (Tornado Alley)

Kribbs, Amy wrote:

> From: akribbs@... (Kribbs, Amy)

>

> Vicki,

> I'm with you one this one and looking into the possibilities myself.

> Amy in IL

> BMI 41

> age 43

> single

> 2cats

> 12 great neices and nephews!

> anxious for MGB!

> Has anyone appealed or sued post-op?

>

> >

> >

> >I have approached this surgery from the standpoint that I will get it

> >whether or not my insurance pays (no, I'm not rich. Just willing to

> >borrow the money from the bank.).

> >

> >I am submitting everything to the insurance company, but will not allow

> >it to hold up my progress at all. Have any of you gone ahead and had

> >the surgery (and paid for the surgery) after a denial or while waiting

> >for appeal and then gone after the insurance company to seek

> >reimbursement? I'm ready to give it my best shot up front, but if they

> >don't readily approve, go forward with the surgery (if allowed by Dr.

> >R), pay the expenses with a loan, and then get a lawyer and go after

> >it. The upside (hopefully) would be that your health would be steadily

> >improving. What do you think?

> >

> >

> >------------------------------------------------------------------------

> >With more than 14 million emails exchanged monthly.

> >http://www.ONElist.com

> >ONElist is truly helping connect the world!

> >------------------------------------------------------------------------

> >This message is from the Mini-Gastric Bypass List at Onelist.com

> >

>

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[Guest guest]

Amy:

Thanks for agreeing with me. For one thing, I don't want to wait a year or

two for the insurance company to make up its mind. For another, if they have

proof positive that the surgery has improved things like blood pressure,

diabetes, or whatever other problems may exist.....how could they deny

paying?! And what JURY (if it went that far) could agree with a denial when

the living proof of better health was staring back at them? I hope I am

being realistic about this end of it. Even if all else fails, I look at the

cost as about the same as a mid-size car. And it will take me about the same

time to pay off the surgery as it would a car.....and my investment will last

me the rest of my life. I can assure you a CAR wouldn't.

Vicki Marton

Oklahoma (Tornado Alley)

Kribbs, Amy wrote:

> From: akribbs@... (Kribbs, Amy)

>

> Vicki,

> I'm with you one this one and looking into the possibilities myself.

> Amy in IL

> BMI 41

> age 43

> single

> 2cats

> 12 great neices and nephews!

> anxious for MGB!

> Has anyone appealed or sued post-op?

>

> >

> >

> >I have approached this surgery from the standpoint that I will get it

> >whether or not my insurance pays (no, I'm not rich. Just willing to

> >borrow the money from the bank.).

> >

> >I am submitting everything to the insurance company, but will not allow

> >it to hold up my progress at all. Have any of you gone ahead and had

> >the surgery (and paid for the surgery) after a denial or while waiting

> >for appeal and then gone after the insurance company to seek

> >reimbursement? I'm ready to give it my best shot up front, but if they

> >don't readily approve, go forward with the surgery (if allowed by Dr.

> >R), pay the expenses with a loan, and then get a lawyer and go after

> >it. The upside (hopefully) would be that your health would be steadily

> >improving. What do you think?

> >

> >

> >------------------------------------------------------------------------

> >With more than 14 million emails exchanged monthly.

> >http://www.ONElist.com

> >ONElist is truly helping connect the world!

> >------------------------------------------------------------------------

> >This message is from the Mini-Gastric Bypass List at Onelist.com

> >

>

> ------------------------------------------------------------------------

> Get " in synch! "

> http://www.onelist.com

> With the ONElist Shared Calendar Feature. See homepage.

> ------------------------------------------------------------------------

> This message is from the Mini-Gastric Bypass List at Onelist.com

[Guest guest]

Amy:

Thanks for agreeing with me. For one thing, I don't want to wait a year or

two for the insurance company to make up its mind. For another, if they have

proof positive that the surgery has improved things like blood pressure,

diabetes, or whatever other problems may exist.....how could they deny

paying?! And what JURY (if it went that far) could agree with a denial when

the living proof of better health was staring back at them? I hope I am

being realistic about this end of it. Even if all else fails, I look at the

cost as about the same as a mid-size car. And it will take me about the same

time to pay off the surgery as it would a car.....and my investment will last

me the rest of my life. I can assure you a CAR wouldn't.

Vicki Marton

Oklahoma (Tornado Alley)

Kribbs, Amy wrote:

> From: akribbs@... (Kribbs, Amy)

>

> Vicki,

> I'm with you one this one and looking into the possibilities myself.

> Amy in IL

> BMI 41

> age 43

> single

> 2cats

> 12 great neices and nephews!

> anxious for MGB!

> Has anyone appealed or sued post-op?

>

> >

> >

> >I have approached this surgery from the standpoint that I will get it

> >whether or not my insurance pays (no, I'm not rich. Just willing to

> >borrow the money from the bank.).

> >

> >I am submitting everything to the insurance company, but will not allow

> >it to hold up my progress at all. Have any of you gone ahead and had

> >the surgery (and paid for the surgery) after a denial or while waiting

> >for appeal and then gone after the insurance company to seek

> >reimbursement? I'm ready to give it my best shot up front, but if they

> >don't readily approve, go forward with the surgery (if allowed by Dr.

> >R), pay the expenses with a loan, and then get a lawyer and go after

> >it. The upside (hopefully) would be that your health would be steadily

> >improving. What do you think?

> >

> >

> >------------------------------------------------------------------------

> >With more than 14 million emails exchanged monthly.

> >http://www.ONElist.com

> >ONElist is truly helping connect the world!

> >------------------------------------------------------------------------

> >This message is from the Mini-Gastric Bypass List at Onelist.com

> >

>

> ------------------------------------------------------------------------

> Get " in synch! "

> http://www.onelist.com

> With the ONElist Shared Calendar Feature. See homepage.

> ------------------------------------------------------------------------

> This message is from the Mini-Gastric Bypass List at Onelist.com

[Guest guest]

Vicki,

I'm with you one this one and looking into the possibilities myself.

Amy in IL

BMI 41

age 43

single

2cats

12 great neices and nephews!

anxious for MGB!

Has anyone appealed or sued post-op?

>

>

>I have approached this surgery from the standpoint that I will get it

>whether or not my insurance pays (no, I'm not rich. Just willing to

>borrow the money from the bank.).

>

>I am submitting everything to the insurance company, but will not allow

>it to hold up my progress at all. Have any of you gone ahead and had

>the surgery (and paid for the surgery) after a denial or while waiting

>for appeal and then gone after the insurance company to seek

>reimbursement? I'm ready to give it my best shot up front, but if they

>don't readily approve, go forward with the surgery (if allowed by Dr.

>R), pay the expenses with a loan, and then get a lawyer and go after

>it. The upside (hopefully) would be that your health would be steadily

>improving. What do you think?

>

>

>------------------------------------------------------------------------

>With more than 14 million emails exchanged monthly.

>http://www.ONElist.com

>ONElist is truly helping connect the world!

>------------------------------------------------------------------------

>This message is from the Mini-Gastric Bypass List at Onelist.com

>

[Guest guest]

Vicki,

I'm with you one this one and looking into the possibilities myself.

Amy in IL

BMI 41

age 43

single

2cats

12 great neices and nephews!

anxious for MGB!

Has anyone appealed or sued post-op?

>

>

>I have approached this surgery from the standpoint that I will get it

>whether or not my insurance pays (no, I'm not rich. Just willing to

>borrow the money from the bank.).

>

>I am submitting everything to the insurance company, but will not allow

>it to hold up my progress at all. Have any of you gone ahead and had

>the surgery (and paid for the surgery) after a denial or while waiting

>for appeal and then gone after the insurance company to seek

>reimbursement? I'm ready to give it my best shot up front, but if they

>don't readily approve, go forward with the surgery (if allowed by Dr.

>R), pay the expenses with a loan, and then get a lawyer and go after

>it. The upside (hopefully) would be that your health would be steadily

>improving. What do you think?

>

>

>------------------------------------------------------------------------

>With more than 14 million emails exchanged monthly.

>http://www.ONElist.com

>ONElist is truly helping connect the world!

>------------------------------------------------------------------------

>This message is from the Mini-Gastric Bypass List at Onelist.com

>

[Guest guest]

Vicki,

I'm with you one this one and looking into the possibilities myself.

Amy in IL

BMI 41

age 43

single

2cats

12 great neices and nephews!

anxious for MGB!

Has anyone appealed or sued post-op?

>

>

>I have approached this surgery from the standpoint that I will get it

>whether or not my insurance pays (no, I'm not rich. Just willing to

>borrow the money from the bank.).

>

>I am submitting everything to the insurance company, but will not allow

>it to hold up my progress at all. Have any of you gone ahead and had

>the surgery (and paid for the surgery) after a denial or while waiting

>for appeal and then gone after the insurance company to seek

>reimbursement? I'm ready to give it my best shot up front, but if they

>don't readily approve, go forward with the surgery (if allowed by Dr.

>R), pay the expenses with a loan, and then get a lawyer and go after

>it. The upside (hopefully) would be that your health would be steadily

>improving. What do you think?

>

>

>------------------------------------------------------------------------

>With more than 14 million emails exchanged monthly.

>http://www.ONElist.com

>ONElist is truly helping connect the world!

>------------------------------------------------------------------------

>This message is from the Mini-Gastric Bypass List at Onelist.com

>

[Guest guest]

Vicki,

I was thinking along the same lines as you!

Another idea...write it off as an uncovered medical expense on taxes. I need

to write our accountant and ask him if this is possible. I'll update you

when I find out.

Felicia

Pre-op

5'8.5 " 245 lbs.

Northern VA

[Guest guest]

Vicki,

I was thinking along the same lines as you!

Another idea...write it off as an uncovered medical expense on taxes. I need

to write our accountant and ask him if this is possible. I'll update you

when I find out.

Felicia

Pre-op

5'8.5 " 245 lbs.

Northern VA

[Guest guest]

Vicki,

I was thinking along the same lines as you!

Another idea...write it off as an uncovered medical expense on taxes. I need

to write our accountant and ask him if this is possible. I'll update you

when I find out.

Felicia

Pre-op

5'8.5 " 245 lbs.

Northern VA

[Guest guest]

Felicia -

I am a pre-op CPA and the surgery would be tax deductible along with any

associated expenses, i.e., travel, hotel, etc....

However, you can only deduct the portion over 7.5% of your adjusted gross

income, and the deduction is an itemized deduction.

Check with your accountant or tax preparer to see if your individual

situation would benefit!

Let me know if anyone has questions.

[Guest guest]

Felicia -

I am a pre-op CPA and the surgery would be tax deductible along with any

associated expenses, i.e., travel, hotel, etc....

However, you can only deduct the portion over 7.5% of your adjusted gross

income, and the deduction is an itemized deduction.

Check with your accountant or tax preparer to see if your individual

situation would benefit!

Let me know if anyone has questions.

[Guest guest]

Felicia -

I am a pre-op CPA and the surgery would be tax deductible along with any

associated expenses, i.e., travel, hotel, etc....

However, you can only deduct the portion over 7.5% of your adjusted gross

income, and the deduction is an itemized deduction.

Check with your accountant or tax preparer to see if your individual

situation would benefit!

Let me know if anyone has questions.

[Guest guest]

,

Thanks for the help! I think I would benefit, as long as my husband and I

file jointly. I am praying that our insurance will cover it, but if not, at

least I could get reimbursed for some of it!

Felicia

Pre-op

5'8.5 " 245 lbs.

Northern VA

[Guest guest]

,

Thanks for the help! I think I would benefit, as long as my husband and I

file jointly. I am praying that our insurance will cover it, but if not, at

least I could get reimbursed for some of it!

Felicia

Pre-op

5'8.5 " 245 lbs.

Northern VA

[Guest guest]

,

Thanks for the help! I think I would benefit, as long as my husband and I

file jointly. I am praying that our insurance will cover it, but if not, at

least I could get reimbursed for some of it!

Felicia

Pre-op

5'8.5 " 245 lbs.

Northern VA

[Guest guest]

My advice would be to consult the lawyer before you pay for the surgery

yourself. Depending on the language of your policy/plan and the caselaw of

your state, paying for the surgery yourself without first getting a final

denial might-might- preclude you from suing. Getting the right legal advise

now could prove a whole lot less expensive than hiring a lawyer later to try

and put the rabbit back in the hat.

Good Luck.

Dave from Michigan

[Guest guest]

My advice would be to consult the lawyer before you pay for the surgery

yourself. Depending on the language of your policy/plan and the caselaw of

your state, paying for the surgery yourself without first getting a final

denial might-might- preclude you from suing. Getting the right legal advise

now could prove a whole lot less expensive than hiring a lawyer later to try

and put the rabbit back in the hat.

Good Luck.

Dave from Michigan

[Guest guest]

My advice would be to consult the lawyer before you pay for the surgery

yourself. Depending on the language of your policy/plan and the caselaw of

your state, paying for the surgery yourself without first getting a final

denial might-might- preclude you from suing. Getting the right legal advise

now could prove a whole lot less expensive than hiring a lawyer later to try

and put the rabbit back in the hat.

Good Luck.

Dave from Michigan

[Guest guest]

Lawyers, cars, hats, rabbits -- I've darn near forgotten the subject. Thanks

for the good advice, Dave from Michigan. I am curious, though. Is this coming

from the Southern Baptist half or the Orthodox Jewish half? It's a lovely

combination, Dave, with so many food issues its making my eyes twitch just

thinking about it. I've had vast experience with both cultures, so I say that

with kindness. Back to the subject of paying for the surgery myself, great food

for thought (which also causes me to gain). Thanks so much. I may contact an

attorney this week to seek counsel.

Vicki

Oklahoma

Kaleva@... wrote:

> From: Kaleva@...

>

> My advice would be to consult the lawyer before you pay for the surgery

> yourself. Depending on the language of your policy/plan and the caselaw of

> your state, paying for the surgery yourself without first getting a final

> denial might-might- preclude you from suing. Getting the right legal advise

> now could prove a whole lot less expensive than hiring a lawyer later to try

> and put the rabbit back in the hat.

>

> Good Luck.

>

> Dave from Michigan

>

> ------------------------------------------------------------------------

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> http://www.onelist.com

> It's a new incentive program at ONElist. See homepage for details.

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[Guest guest]

Nan,

The advice you gave to Vicki (see below) is excellent. If someone didn't

say it, I was going to. As much as we all wish that we could 'by-pass "

the insurance companies, I'm afraid that to do so is extremely risky

financially. I would strongly caution against it. Don't take no for an

answer from your insurance and if you have to get help, hire Walter

Lindstrom to represent you, but don't go into surgery without proper

insurance in place. There are just too many unknowns for that, I'm afraid.

My .02 cents worthl.

Merritt

down 80 pounds in 4 months.

[Guest guest]

Vicki, in this great country of ours it doesn't matter whether it's my

Southern Baptist side or my orthodox side. Everbody can sue!! Isn't it

glorious?

Dave from Michigan

[Guest guest]

Vicki, in this great country of ours it doesn't matter whether it's my

Southern Baptist side or my orthodox side. Everbody can sue!! Isn't it

glorious?

Dave from Michigan

[Guest guest]

Vicki, in this great country of ours it doesn't matter whether it's my

Southern Baptist side or my orthodox side. Everbody can sue!! Isn't it

glorious?

Dave from Michigan

[Guest guest]

You are right, Dave! Oh, the one-liners that are spinning around my

head......but as Norm said last night on TV, " Carpe Diem! Seize the

Fish! " :-)

I'm keeping Walter's number handy!

Vicki

Oklahoma

Kaleva@... wrote:

> From: Kaleva@...

>

> Vicki, in this great country of ours it doesn't matter whether it's my

> Southern Baptist side or my orthodox side. Everbody can sue!! Isn't it

> glorious?

>

> Dave from Michigan

>

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> http://www.onelist.com

> Join today.

> ------------------------------------------------------------------------

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[Guest guest]

To Vicki & anyone else fighting the insurance companies - yes, Call

Walter! He's the

one who got my approval & I HIGHLY recommend him! Beth Sorensen

On Thu, 06 May 1999 08:48:59 -0500 vmart@... (Vicki Marton)

wrote:

>

>

>You are right, Dave! Oh, the one-liners that are spinning around my

>head......but as Norm said last night on TV, " Carpe Diem! Seize the

>Fish! " :-)

>

>I'm keeping Walter's number handy!

>

>Vicki

>Oklahoma

>

>Kaleva@... wrote:

>

>> From: Kaleva@...

>>

>> Vicki, in this great country of ours it doesn't matter whether it's

>my

>> Southern Baptist side or my orthodox side. Everbody can sue!! Isn't

>it

>> glorious?

>>

>> Dave from Michigan

>>

>>

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