WLS and Insurance

[Guest guest]

INSURANCE

Walter from the Obesity Law & Advocacy Center has written a great

paper called Maximizing your Chances of Getting an Insurance

Approval the First Time. He has put it out on Internet at

http://www.obesitylaw.com. Read through it and take a copy to your

Dr.

As far as the ins. company requirements, everyone of course is

different- if you can find a doctor on your insurance " network " that

does the surgery then get a referral from your primary doc. If you

can't find one (which was my case) then you choose your

doctor/clinic and go to them- they will fill out all necessary forms-

which is asking about your past and present health, what diets you

have tried in the past, and the problems (shortness of breath, sleep

apnea, diabetes, etc) as a result of your weight. From there the

forms are sent to your insurance company who then will tell you if

they require more info, or may just approve you (as mine did). It

seems very overwhelming at first, go here go there do this etc. but

it is really not. You will be surprised how easy it is to get things

going.

It was really simple. Almost scary it is so simple.

Procedure number

Insurance ID number

Height

Weight

Frame size

Ideal Weight

Medical Conditions (i.e. diabetes, joint problems, reflux,

hypertension, sleep apnea....)

Diet history (include all doctor supervised and stress these)

That is it. As my surgeon is a preferred provider and the hospital

is one of the " approved " facilities, I am fairly confident that it

will be pretty painless to get the ok.

My primary care physician and my psychiatrist wrote letters to my

insurance company first. After I got approval, then he referred me

to a surgeon

Thursday I had a little scare. I called the doctor's office and

they told me my insurance company was now (after all this time)

concerned about this being " pre-existing " . I called them and told

them I have been fat since I was 13 - how were they going to

determine if this was pre-existing? She said my insurance went into

effect on Jan. 1 so they are determining if I was treated in the

three months prior to that. The only time I went to the doctor three

months prior was when I slipped on the ice and hurt my ankle. I told

her I could have done that if I weighed 120 pounds. She asked me a

bunch of questions and said she was submitting it to a medical

review board.

I got to thinking more about it and my employer changed insurance

providers - it was not our choice. I called and asked them about it

and they said there was no " pre-existing " clause for us. When they

changed they made sure of that. There are people at work being

treated for serious cancer and their benefits continued as though

there was no change. Sooo.... I called the insurance company back

and got some one else on the line and explained that to her. She

looked up the files and was soooo apologetic about the mistake. She

was going to mark my records, and I asked her to go tell the other

dufus before she caused me more problems. I swear - you have to stay

on top of this stuff all the time!!!!

I am calling upon each of you to get involved with something very

important. This may be one of the best ways you can support

yourselves and others.

There is some legislation which is being introduced in Washington,

D.C. called the Patient Access to Responsible Care Act (PARCA) by

Congressman Norwood in Georgia. Without boring you as to the

details, a lot of the reasons that we all have trouble getting

insurance approvals is that group health plans are generally

governed by a nasty huge federal statute called ERISA (Employee

Retirement Income Security Act of 1974). This statute takes away all

state law remedies for " bad faith " claims handling and is what

allows HMO's and insurance companies to torture us and deny proper

claims.

This PARCA act gives back our rights and remedies...it can only help

us get more approvals. The big problem is getting the bill out of

committee and passed. I need EVERYONE'S HELP TO DO THIS. Please

email or write your congressional representatives and senators

asking for them to support this important bill. Let them know you

want your rights back under the law to force health insurers to pay

claims fairly. If you don't know who your representative is, go to

my web site (www.obesitylaw.com) and you can link to him or her from

there.

This is really really important. Please take a couple minutes away

from the list and the emails you read and send to do this.

Thanks.