Re: my worst fear come true

[Guest guest]

, I can't address the insurance problem, but do understand you being

very upset. I'm sending hugs your way. I am interested in what can be done

in this situation.

Joan

LAP RNY 11/18/03

Dr. Higa, Fresno, CA

282pre-op/275surg/235/140

jclinton@...

my worst fear come true

I am so terribly upset.....I have researched this surgery and looked

forward to it for over 2 years. I went to the surgeon and he said I

am a great candidate. Now, my insurance won't pay because it is a pre-

existing condition. I have called and spoke with them and they say

there is nothing more they can do for me. I feel awful. Has anyone

else had to go through this? This surgery is so expensive, there is

NO WAY i could ever have it, unless it were covered by insurance.

I really need some encouragement....

[Guest guest]

I am so sorry .Is this the only insurance that you can chose

from.keep your head up where there is the will there is a way.God

bless you I will keep you in my prayers. Wasia

> I am so terribly upset.....I have researched this surgery and

looked

> forward to it for over 2 years. I went to the surgeon and he said

I

> am a great candidate. Now, my insurance won't pay because it is a

pre-

> existing condition. I have called and spoke with them and they say

> there is nothing more they can do for me. I feel awful. Has anyone

> else had to go through this? This surgery is so expensive, there

is

> NO WAY i could ever have it, unless it were covered by insurance.

> I really need some encouragement....

>

[Guest guest]

At 12:48 PM 1/14/2004, you wrote:

>....

>

>You're going at it the wrong way. No insurance will pay based strictly on

>weight. Have you pcp check you for sleep apnia...high blood

>pressure.....breathing problems....knee pain. And instead of your

>doctor's office stating they ared treating you for obesity....have them

>state they have you on a restricted eating program due to health

>issues. Have them recommend that surgery is in your best interest. Hope

>this helps

----------------------------------------

Err.. I have to disagree.

I have Great West... underwritten by One Health Plan.

They require Medical Necessity... that is it.

Medical Necessity is at the discretion of your PCP.

I had NO Comorditites.. and was in Perfect health.. except I weighed 257

lbs on a 5 foot frame.

My BMI was 49 or 50 I forget.

But.. my insurance company paid on BMI alone.

They were great.

They only required a letter from my Surgeon.. Letter from My PCP... and

Letter from a Shrink.

I didn't have to have any Pulmonary studies or tests.. Sleep apnea tests...

I did have an Upper GI which I believe is standard for most surgeons.. and

of course Cardiac Clearance.

I had an EKG and EEG done.. all of which were " beautiful " .. so sayeth the

Cardiologist.

K in Ft Lauderdale

Mommy to Noah - 10/14/02 (31 weeker)

Open RNY w/choly 12/2/03

257/227/115

30 lbs gone forever.. The scale moved 3lbs and it only took 3.5 weeks!!