Guest guest Posted February 21, 2000 Report Share Posted February 21, 2000 I have a question about something I read here. Someone mentioned Dr. Rutledge being " out of the network. " Is that some kind of Preferred Provider for insurance, or do some insurance companies just not want to cover his surgery because it's different from the other procedures? Anne Hi, I can only speak for my situation. I am with United HealthCare of Florida. I have both the HMO and the Select Plus plans. Under the HMO they will cover a laparoscopic gastric bypass, but they want me to go to an " In Network " doctor. They have doctors in Florida who they are under contract with them that are part of their network. Interestingly, under the plan that allows me to choose my doctor of choice, meet a deductible and pay 30% of the cost, weight loss surgery is specifically excluded. My argument with United was that the " In Network/Florida doctors that they wanted me to use did not provide the specific surgical procedure that my doctor and I thought was best for me. Under United's HMO policy, if you can demonstrate that there is not a doctor in their network that can provide the specific procedure that you need, then you have a very strong case for them approving to pay the costs for you to go to a doctor that is " out of network " . It's all about contracts! If you want further information, please feel free to E-mail me direct at Buildart@... Have a great day! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2000 Report Share Posted February 21, 2000 In a message dated 2/21/00 3:09:36 PM Eastern Standard Time, keech@... writes: << I have a question about something I read here. Someone mentioned Dr. Rutledge being " out of the network. " Is that some kind of Preferred Provider for insurance, or do some insurance companies just not want to cover his surgery because it's different from the other procedures? >> I have BC/BS PPO and for me a Dr. is " in " network if he/she contracts with the BC/BS in someway to be considered a " preferred provider " . A Dr. is " out " of network if they don't do this. An in-network provider is covered at a higher rate through my insurance than is an out-of-network provider. Hope that helps! {{HUGS}} " He who began a good work in you will be faithful to complete it even unto the day of Christ Jesus. " - Phil. 1:6 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 28, 2000 Report Share Posted February 28, 2000 You can fax them as many copies as you wish....say, every couple of days??? LOL Also it is a good idea to call and get a contact name. Dr R told me to snail mail a copy by registered mail specifically to the person, that way she can't claim that the fax machine was out of paper. :-)) Good luck, and go get 'em!! fg At 08:24 PM 02/28/2000 -0600, you wrote: > > >I know have a copy of the letter that Dr. R will send to my insurance. Should I send it to them also? Or should I just get my next letter ready for when the denial comes through. They had not officially denied me so I want to keep hitting them with all I can. Maybe they will get tired of me and just give ME THE SURGERY!!!!! > > Ann > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 1, 2000 Report Share Posted March 1, 2000 At 01:49 PM 3/1/00 PST, you wrote: > Your primary care physician would have to place a >request to our office with supporting documentation. Hi Jackie, My insurance company requested more info before approval. I called and talked to the pre-approval nurse, and was told to send letters. In addition to letters from the doctors that had been seeing me for weight related problems, the chiropractor for back problems, and the podiatrist for ankle and foot problems, I also sent along a letter from me laying out the day to day problems I had with dealing with being so overweight. As much as I could think of, and as objectively as I could (insurance companies do not deal with emotions, they need just the facts, ma'am, just the fact). I put in stuff like how it affected being able to clip my toenails, and wash my feet, cleaning my house ( can't get down to do the low stuff, or climb up to do high stuff), can't sit comfortably or sometimes at all in seats at the movies or other places. If you sit and start listing you will be amazed at how many places and things obesity impacts in our daily lives, and we stop being conscious of it after awhile. A letter like this might help, and certainly wouldn't hurt. Not being able to read the minds at the insurance office, I do not know how much my letter influenced their decision to approve, but if it helped at all it was worth it. Hope this helps. Jo Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 1, 2000 Report Share Posted March 1, 2000 Jo, I totally agree with you! I did not realize how bad I WAS affected til I lost and reagained about 60 lbs. WOW The things skinnies take for granted! PAige > >Reply-To: MiniGastricBypassonelist >To: MiniGastricBypassonelist >Subject: Re: INSURANCE >Date: Wed, 01 Mar 2000 21:03:29 -0500 > >At 01:49 PM 3/1/00 PST, you wrote: > > > > Your primary care physician would have to place a > >request to our office with supporting documentation. > >Hi Jackie, My insurance company requested more info before approval. I >called and talked to the pre-approval nurse, and was told to send letters. >In addition to letters from the doctors that had been seeing me for weight >related problems, the chiropractor for back problems, and the podiatrist >for >ankle and foot problems, I also sent along a letter from me laying out the >day to day problems I had with dealing with being so overweight. As much >as >I could think of, and as objectively as I could (insurance companies do not >deal with emotions, they need just the facts, ma'am, just the fact). I put >in stuff like how it affected being able to clip my toenails, and wash my >feet, cleaning my house ( can't get down to do the low stuff, or climb up >to >do high stuff), can't sit comfortably or sometimes at all in seats at the >movies or other places. If you sit and start listing you will be amazed at >how many places and things obesity impacts in our daily lives, and we stop >being conscious of it after awhile. A letter like this might help, and >certainly wouldn't hurt. Not being able to read the minds at the insurance >office, I do not know how much my letter influenced their decision to >approve, but if it helped at all it was worth it. Hope this helps. > > Jo > ______________________________________________________ Get Your Private, Free Email at http://www.hotmail.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2000 Report Share Posted March 2, 2000 At 02:15 AM 3/2/00 PST, you wrote: > .. WOW The things skinnies take for granted! > PAige Paige, Ain't it the truth!! BTW, Congratulations on your approval and upcomming trip to this side. Jo Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 6, 2000 Report Share Posted March 6, 2000 In a message dated 3/5/00 10:07:53 PM Eastern Standard Time, cathee@... writes: << Well, to me if your doctor and surgeon deem you as " medically necessary " why do we still have to get prior approval? >> To protect you from your insurance company coming back after the surgery and telling you that the " fine print " doesn't cover your particular surgery, etc. {{HUGS}} in FL MGB Hopeful BMI 51 " He who began a good work in you will be faithful to complete it until the day of Christ Jesus. " - Phil. 1:6 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 9, 2003 Report Share Posted March 9, 2003 Hello Everyone, Regarding insurance coverage this is just in U.S.A. right? Here in Canada we are fully covered as far as I know right? GiJo _________________________________________________________________ MSN 8 with e-mail virus protection service: 2 months FREE* http://join.msn.com/?page=features/virus Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 10, 2003 Report Share Posted March 10, 2003 Hi GiJo. I think it depends what province you are in. I'm in Alberta, and our provincial health care only covers the hospital costs. I am responsible for my surgeon's fees (plus braces, of course). I don't know if this is the same in all provinces, but it's definitely worth checking out. Best not to assume it's all covered, then get a nasty surprise. Good luck! K. > > Hello Everyone, > Regarding insurance coverage this is just in U.S.A. right? Here in Canada > we are fully covered as far as I know right? > GiJo > > > > > _________________________________________________________________ > MSN 8 with e-mail virus protection service: 2 months FREE* > http://join.msn.com/?page=features/virus Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 11, 2003 Report Share Posted March 11, 2003 In bc the actual operation is cover but not his work up fees or after surery care. I paid about 750 for surgery. I checked with my extended health(blue cross) and they cover nothing. My braces are not covered either but my ortho did them pro bono for me. I guess i am pretty lucky. Quote Link to comment Share on other sites More sharing options...
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