Guest guest Posted January 14, 2004 Report Share Posted January 14, 2004 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.... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 14, 2004 Report Share Posted January 14, 2004 In a message dated 1/14/04 1:01:50 PM Eastern Standard Time, Gastric_Bypass_Family writes: > 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.... > > Hiya , First of all I am very sorry that the insurance companies are doing this to one and all! It's stupid to not give this surgery to people when the proof is out there it does WONDERS for much things - gods, it's taken a lot off of my records - but I'm sure hearing that didn't make you feel better...I am sorry for your sadness...you have every right to be! Did the insurance company KNOW about this before they denied you pre-existing? Do you have paperwork to show this, does your doctor, does your psychiatrist, does your PCP? If you can show they knew it and approved work for it...I would put that to them and say that they should reconsider...in other words appeal. YOU CAN ALWAYS APPEAL. Many, many times! Up to the president of the insurance company. (I used caps to emphasize not yell. ) If you have proof in your favor I can't see how they can deny you pre existing. Yet, to be fully honest, even though I worked with Aetna, ::shake head:: I am not absolutely sure. Except proof of past knowledge by the insurance company should wake them up. Because then they can't deny it saying " Oh, well...this and that. " Try this. I wish you the best of luck, and hunt HARD. Take care, be well, much love - really! You're still a winner at loosing. Sincerely, ~*~**~ /Seta/Anneia/Ari ~**~*~ ~ those who are different change the world those who are the same keep it that way ~ Thank you to " Master Akane " for allowing me to use this quote in my signature. I am not aware of who the originating author is. But it's too true to pass up. It's how I feel as well. Enjoy it. http://groups.yahoo.com/group/ShemsuSet http://groups.yahoo.com/group/Ma-A-Kherw http://www.livejournal.com/users/beloveddaughter http://www.kemetjournals.com/users/hrhprincessseta http://www.fanfiction.net/~HRHPrincessAri Main E-mail: Forthegodshonor@... Second E-mail: BelovedDaughterOfMaatAndSet@... Third E-mail: SetaTheThunderbird@... AIM: FutureQueenOfAll Yahoo IM: SetaTheThunderbird MSN: BelovedDaughterOfMaatAndSet Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 14, 2004 Report Share Posted January 14, 2004 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.... > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 14, 2004 Report Share Posted January 14, 2004 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!! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 14, 2004 Report Share Posted January 14, 2004 I believe in the case of Tricare it is also dependent on the PCP. Now mine....I am the only person he has EVER referred. But I spent 3 years on a supervised diet and they knew by my glucose readings and other blood test I was doing that I was doing the program as instructed. He knew I was trying to exercise (hard to do when you can't breath) and I had alot of other health problems. He has told me that he gets lots of requests for referrals but he said unless you have the co-morbidities and what he calls " the necessary state of mind to make the required changes in your life " he will not give a referral. He has given a total of 1 since I got mine and that was almost 2 years ago. Don't get me wrong he is a fabulous Dr and I would not trade him for anything but he can be kinda tough. Candi Re: my worst fear come true 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!! ---------------------------------------------------------------------------- -- Quote Link to comment Share on other sites More sharing options...
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