Re: Has anyone appealed or sued post-op?

[Guest guest]

Great advice.

Deb Hertlein

BMI 53

330 preop

waiting ins approval

[Guest guest]

Dave,

I know I would definitely hire an attorney if I am denied...I'd rather pay a

little out of pocket and have the ins. co. take care of it. Thanks!

Amy in IL

Re: Has anyone appealed or sued post-op?

>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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[Guest guest]

Dear Nan:

Yikes! Good advice. My thinking was " smooth sailing " , but I'm glad you shared

with me just what a huge financial gamble it might be if there were

complications! I can pay for a Toyota, but not a Rolls Royce! If it all

depends on luck, that is a commodity in short supply here in Oklahoma

recently. Thanks for the reality check!

Vicki Marton

Pre-Op

Oklahoma

Nan Coulter wrote:

>

>

> Good Luck, Vicki, but please be aware that you could develop complications

> and wipe yourself out financially.

>

> I had my surgery this past December, and had severe complications. As a

> result, I was in the hospital for four weeks, and all told, my medical

> expenses were well over $100,000. This doesn't include the two months I

> went unpaid while out of work and not qualifying for disability insurance.

> Thank goodness I had great coverage (United Healthcare) and they paid all

> but my $250 deductible, but it would've taken me forever to pay it all back

> if my insurance hadn't covered it.

> After being out of work for two months and having such a long recovery, I

> doubt I would've been very successful in being approved for a loan. The

> bank would probably have had doubts about my job stability, and frankly

> might think I couldn't recover sufficiently to return to work and pay back

> the loan, if I didn't eventually die from my complications (possibly the

> bank's opinion, not mine).

>

> I wish you the best of luck, and hope that you don't have any complications

> if you're paying for it all yourself. Please be careful!

>

> Nan Coulter

>

> >

> >Reply-To: MiniGastricBypassonelist

> >To: " MiniGastricBypassonelist " <MiniGastricBypassonelist>

> >Subject: Has anyone appealed or sued post-op?

> >Date: Tue, 04 May 1999 10:20:20 -0500

> >

> >

> >

> >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?

> >

> >

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[Guest guest]

The surgery is definitely a top priority for me and I too thought no matter

what my insurance company decided, I was getting the surgery. However after

careful consideration, I've decided to stick the fight out with the

insurance company. Sure, my husband and I could handle a $15,000 or $20,000

loan..that would be like buying a new vehicle. My fear, however, is that

there may be a complication and the cost of the surgery/hospitalization

could easily become $100,000. What then? That would definitely bankrupt us.

With four children, one of which begins college this year, I could not take

the risk. I wish you the best of luck and hope it works out for you.

A friend from land,

Janet

age: 35

bmi: 50

status: pre-op battling BCBS of land since 2/18/99

family: married 15 years with 4 children (2 girls & 2 boys)

[Guest guest]

Reply #2

Oooops, looks like I should have gotten completely caught up on all my list

reading before replying to your post. Apparently, others (especially Nan who

lived through my very fear) already posted the same thoughts. I'm glad

things worked out so well for you, Nan!

A friend from land,

Janet

age: 35

bmi: 50

status: pre-op battling BCBS of land since 2/18/99

family: married 15 years with 4 children (2 girls & 2 boys)

[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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[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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[Guest guest]

Thanks, Janet -- I'm tracking right along with everyone now, after my little

journey. It was the best decision I've ever made, and while there a few

times that I wondered if I'd bitten off more than I could chew, I never

regretted it for a minute. I think most of us feel that way, too.

Nan

>

>Reply-To: MiniGastricBypassonelist

>To: <MiniGastricBypassonelist>

>Subject: Re: Has anyone appealed or sued post-op?

>Date: Wed, 5 May 1999 19:09:38 -0400

>

>

>

>Reply #2

>

>Oooops, looks like I should have gotten completely caught up on all my list

>reading before replying to your post. Apparently, others (especially Nan

>who

>lived through my very fear) already posted the same thoughts. I'm glad

>things worked out so well for you, Nan!

>

>A friend from land,

>Janet

>

>age: 35

>bmi: 50

>status: pre-op battling BCBS of land since 2/18/99

>family: married 15 years with 4 children (2 girls & 2 boys)

>

>

>

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[Guest guest]

<< and while there a few times that I wondered if I'd bitten off more than I

could chew, >>

Nan,

I know that feeling. It comes around every week or so. I start thinking,

" what have I done!?!? " and then I come to my senses and realize I've done the

right thing. It's good to know that I'm not the only one thinking that way.