Guest guest Posted May 15, 1999 Report Share Posted May 15, 1999 Dee-- Don't give up. Call them back. If you get the same answer, insist on speaking to a supervisor who can explain what the criteria are that you have to meet. They want you to give up. Don't do it. Make them do their job. You have every right to know. Katy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 15, 1999 Report Share Posted May 15, 1999 Dee, please take the advice given to you. Please contact your state's insurance commissioner and the insurance company again. It's hard to get past those lovely " customer service reps " but once you do, things actually start getting easier. The true idiots high up in the insurance company don't know how to deal with direct questions or distraught clients and they will actually answer you. The reps are just little soldiers (people with bad attitudes that fail at even being telemarketers). The " high ups " expect these reps to be the fighting force to send the client running and whimpering. Usually it works. Please don't give up. You WILL win the battle. I know Dr. Rutledge will work out a payment plan with you because I asked the very same question early on in my own battle. I just got concerned that the cost could skyrocket if there were any sort of complication so I stuck it out. Best of luck to you. If you find yourself needing support, this mail list truly is a great spot. A friend from land, Janet age: 35 bmi: 50 status: pre-op Just Approved by BCBS of MD on 5/12/99; surgery date 7/19/99 family: married 15 years with 4 children (2 girls & 2 boys) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 15, 1999 Report Share Posted May 15, 1999 Dee, please take the advice given to you. Please contact your state's insurance commissioner and the insurance company again. It's hard to get past those lovely " customer service reps " but once you do, things actually start getting easier. The true idiots high up in the insurance company don't know how to deal with direct questions or distraught clients and they will actually answer you. The reps are just little soldiers (people with bad attitudes that fail at even being telemarketers). The " high ups " expect these reps to be the fighting force to send the client running and whimpering. Usually it works. Please don't give up. You WILL win the battle. I know Dr. Rutledge will work out a payment plan with you because I asked the very same question early on in my own battle. I just got concerned that the cost could skyrocket if there were any sort of complication so I stuck it out. Best of luck to you. If you find yourself needing support, this mail list truly is a great spot. A friend from land, Janet age: 35 bmi: 50 status: pre-op Just Approved by BCBS of MD on 5/12/99; surgery date 7/19/99 family: married 15 years with 4 children (2 girls & 2 boys) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 15, 1999 Report Share Posted May 15, 1999 Dee Read your EOC, very very very very carefully!!!!! Get organized!! Set up a system to keep track of all and I mean ALL phone, written, etc. types of correspondance between you and your insurance company- the kids are yelling so I will email you more details later tonight!!!!!!! Kathy Waiting..... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 17, 1999 Report Share Posted May 17, 1999 Kathy, Wait Kathy! Don't give up........Can't we all write letters or something.... Hey guys help me out here. da Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 17, 1999 Report Share Posted May 17, 1999 Kathy, Wait Kathy! Don't give up........Can't we all write letters or something.... Hey guys help me out here. da Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 17, 1999 Report Share Posted May 17, 1999 Kathy: I just wanted to reply to you (and not the others). I know you are heartbroken, and we all are for you. However, just one last thought if you can stand it. Why not call or write Walter, tell him you cannot afford to pay a lawyer, but you've done all you can alone. He says very clearly over and over at his site and in his materials that are sent to NEVER let money stand between you and your rights. He makes it very clear to contact him regardless of your ability to pay. He must mean that sincerely to put it out there for the whole world to see. And he says it in so many places. He is more concerned with your RIGHTS than your money if what he says is true. If it is any comfort, there is probably not much hope of my prevailing either. My request was denied based on " Out of Network " . Even my benefits coordinator tells me I don't have a chance. But I am going to borrow the money (including Walter's fees) and pray that nothing goes wrong that will take me over this $20,000 mark when it comes time for surgery. I do have a supplemental policy, but now my husband says that he interprets it differently than I do. He thinks I have to come IN to the hospital in ICU, rather than go from a procedure into ICU to be covered. Risky? Yes it is, but it is a risk I have to take. Let's hope God takes care of fools like me. When you catch your breath, please consider what I've said. I don't post much, but I do read all the e-mails, and I have been following your drama with so much interest and hope. You sound too special to be down for too long, but you've earned the right to just be roll-around-on-the-ground-down-in-the-dumps for all you've been through. Those lousy suits! How dare they play with your life like that. I can understand your needing to get off the list for awhile, but I'll be looking and waiting for you to come back with your new plan of attack. And I hope you will consider letting Walter take this on.....pro bono, of course. I bet he will! I'll still be thinking about you. I'm going forward with my surgery on July 19th like I had good sense or something. Please let me (us) know how you are doing. Best wishes, Vicki Marton Stillwater, Oklahoma Kathy wrote: > From: thestewarts@... (Kathy ) > > Hey guys, > I just wanted to let everyone know that I was denied again on my second > appeal. Theure doesn't seem to be any hope left. > > They claimed that I can follow a supervised 6 month diet and exercis > program and apply again in 6 months. However, Kaiser is supposed to be > pulling out of here anytime so I don't think that will do any good. > > I know that all of you are here for me and are soo very very supportive, > but I can't deal with it now. All the talk and support in the world > will not change the reality that I am doomed to this 311 lb grossly > destesque body that will hardly work at all. > > No one seems very encouraging about being able to do anything at this > point. Maybe I'll be back on in a few months if my situation changes, > but for now it is too hurtful to be teased by this wonderful surgery, > knowing that I can't have it. I love all of you very very much - > hopefullly I will get over this initial depression on be back on in a > few days - we'll see. > > I am going to mis each and everyone of you more than you'll ever know. > Please don't anyone give up their battle. God knows that I fought a > hard one and extinguished every available option. Please do the same if > your company tries to deny you. > > I am about to type the hardest words of my life:::::::: > > Kathy STewart > DENIED ON SECOND APPEAL...... > > ------------------------------------------------------------------------ > Get involved. Share your thoughts! > http://www.onelist.com > Join the ONElist Weekly Survey. Go to homepage for details. > ------------------------------------------------------------------------ > This message is from the Mini-Gastric Bypass List at Onelist.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 17, 1999 Report Share Posted May 17, 1999 Kathy: I just wanted to reply to you (and not the others). I know you are heartbroken, and we all are for you. However, just one last thought if you can stand it. Why not call or write Walter, tell him you cannot afford to pay a lawyer, but you've done all you can alone. He says very clearly over and over at his site and in his materials that are sent to NEVER let money stand between you and your rights. He makes it very clear to contact him regardless of your ability to pay. He must mean that sincerely to put it out there for the whole world to see. And he says it in so many places. He is more concerned with your RIGHTS than your money if what he says is true. If it is any comfort, there is probably not much hope of my prevailing either. My request was denied based on " Out of Network " . Even my benefits coordinator tells me I don't have a chance. But I am going to borrow the money (including Walter's fees) and pray that nothing goes wrong that will take me over this $20,000 mark when it comes time for surgery. I do have a supplemental policy, but now my husband says that he interprets it differently than I do. He thinks I have to come IN to the hospital in ICU, rather than go from a procedure into ICU to be covered. Risky? Yes it is, but it is a risk I have to take. Let's hope God takes care of fools like me. When you catch your breath, please consider what I've said. I don't post much, but I do read all the e-mails, and I have been following your drama with so much interest and hope. You sound too special to be down for too long, but you've earned the right to just be roll-around-on-the-ground-down-in-the-dumps for all you've been through. Those lousy suits! How dare they play with your life like that. I can understand your needing to get off the list for awhile, but I'll be looking and waiting for you to come back with your new plan of attack. And I hope you will consider letting Walter take this on.....pro bono, of course. I bet he will! I'll still be thinking about you. I'm going forward with my surgery on July 19th like I had good sense or something. Please let me (us) know how you are doing. Best wishes, Vicki Marton Stillwater, Oklahoma Kathy wrote: > From: thestewarts@... (Kathy ) > > Hey guys, > I just wanted to let everyone know that I was denied again on my second > appeal. Theure doesn't seem to be any hope left. > > They claimed that I can follow a supervised 6 month diet and exercis > program and apply again in 6 months. However, Kaiser is supposed to be > pulling out of here anytime so I don't think that will do any good. > > I know that all of you are here for me and are soo very very supportive, > but I can't deal with it now. All the talk and support in the world > will not change the reality that I am doomed to this 311 lb grossly > destesque body that will hardly work at all. > > No one seems very encouraging about being able to do anything at this > point. Maybe I'll be back on in a few months if my situation changes, > but for now it is too hurtful to be teased by this wonderful surgery, > knowing that I can't have it. I love all of you very very much - > hopefullly I will get over this initial depression on be back on in a > few days - we'll see. > > I am going to mis each and everyone of you more than you'll ever know. > Please don't anyone give up their battle. God knows that I fought a > hard one and extinguished every available option. Please do the same if > your company tries to deny you. > > I am about to type the hardest words of my life:::::::: > > Kathy STewart > DENIED ON SECOND APPEAL...... > > ------------------------------------------------------------------------ > Get involved. Share your thoughts! > http://www.onelist.com > Join the ONElist Weekly Survey. Go to homepage for details. > ------------------------------------------------------------------------ > This message is from the Mini-Gastric Bypass List at Onelist.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 17, 1999 Report Share Posted May 17, 1999 Hi Kathy, I understand your reluctance to stay on the list, but after you grieve for awhile, please come back and join the family. We all suffer your pain. I too, am still battling and have been since Dec. I'll do whatever I can to help you. Only you and your family can decide if it is worth pursuing further (ie)Walter, changing insurances, etc.... Whatever you decide, you will always be a part of this list and the tight knit family we have become. I'll miss just reading your posts and all the good advice you give. You don't have to have the surgery or be waiting to have the surgery to become the friend you have become to us all! My prayers and tears are for you dear lady! Tina Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 17, 1999 Report Share Posted May 17, 1999 Hi Kathy, I understand your reluctance to stay on the list, but after you grieve for awhile, please come back and join the family. We all suffer your pain. I too, am still battling and have been since Dec. I'll do whatever I can to help you. Only you and your family can decide if it is worth pursuing further (ie)Walter, changing insurances, etc.... Whatever you decide, you will always be a part of this list and the tight knit family we have become. I'll miss just reading your posts and all the good advice you give. You don't have to have the surgery or be waiting to have the surgery to become the friend you have become to us all! My prayers and tears are for you dear lady! Tina Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 17, 1999 Report Share Posted May 17, 1999 Kathy, The suggestion about going to a local TV station might not be a bad idea.....Do ya'll have some kind of " Consumer Reporter " or Trouble Resolution contact person at a local station. I know that Channel 9 in Charlotte, and maybe Channel 3 have those people.....It might be worth a shot! Re: DENIED >From: JBSETM@... > >kathy, >One more thing to consider. It would mean bearing you soul but, it may work. >I know a girl who needed surgery and the ins. co. said no, and that it was >for cosmetic reasons. The family (it was a child, so the mom and dad did >this) went to the tv. station and newspaper and told their side of the story >and made it clear that ins. was refusing to pay. With in a few days, , wow , >it's a miracle, the ins. co. changed their minds and coughed up the >money----- 75,000 dallars worth. >bonnie > >--------------------------------------------------------------------- --- >ONElist: bringing the world together. >http://www.onelist.com >Join a new list today! >--------------------------------------------------------------------- --- >This message is from the Mini-Gastric Bypass List at Onelist.com Quote Link to comment Share on other sites More sharing options...
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