Guest guest Posted January 20, 2000 Report Share Posted January 20, 2000 Thanks Jo That is just the kind of information I am looking for, Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 20, 2000 Report Share Posted January 20, 2000 Thanks Jo That is just the kind of information I am looking for, Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 20, 2000 Report Share Posted January 20, 2000 Jane, If I am not being too nosy what is your particular case??? I have something called PTC and so my insurance basically said the same thing yours did. But I tell you what ,I swear that Dr R's letter put the fear of God in them! They took almost 5 months to review it and then were calling their lawyers and such! I swear the reason my insurance was changed was due to THAT letter. I am in a fairly low population area and trully believe that the appeal letter Dr R sent out may have very well changed my insurance for the better! I sent in over 200 pages in appeal and they said BOO about that but they sure told me that my insurance had an exclusion for obesity even though my neurologist said that this would be a cure for my PTC. * SIGH* I feel like I am swimming upstream to spawn every time I talk to any one in the insurance office!!!!LOL:)They can frustrate you but hang in there!!! By the way that goes for all of you chasing the insurance wagon! It is difficult to keep up with, and when you feel bad it is worse like who felt so bad, you just want to have the surgery! I have spent close to a year on the initial pre-approval and the appeal and the response to the appeal .................ect ect I guess in the last months I have gotten quieter on the list due to just wanting this to be done!!! But now my insurance has changed for the better and I sure hope that I am approved soon and that I can get on with my life!!!!!!! Please gimmee a holler if you need any help! Paige >From: McJaneygrl@... >Reply-To: MiniGastricBypassonelist >To: MiniGastricBypassonelist >Subject: Insurnce Appeal >Date: 21 Jan 2000 01:35:36 -0000 > >Hi... >I want to file an appeal with my insurance company but am wondering if I >can do that myself or do I have to have the doctor do it. While I think >the appeal letter that is on Dr. R site is extremely informative, I get >from the insurance company that they feel his letters give more info about >obesity than my particular case. > >Has anyone filed an appeal by themselves? If so, did you just submit a >letter or did you send copies of your medical records too? > >Any appeal information would be greatly appreciated. > >Thanks >Jane > >PS.. love hearing how well everyone is doing... ______________________________________________________ Get Your Private, Free Email at http://www.hotmail.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 20, 2000 Report Share Posted January 20, 2000 At 01:35 AM 1/21/00 -0000, you wrote: >From: McJaneygrl@... > > >Has anyone filed an appeal by themselves? If so, did you just submit a letter or did you send copies of your medical records too? > >Any appeal information would be greatly appreciated. > Jane I didn't have to file an appeal, but before my insurance (BCBS of NC) would approve they did ask for more info. I had to supply medical records from previous doctors within the last 5 years showing what problems morbid obesity was causing me specifically. So I sent medical records, and letters from both my chiropractor, and podiatrist showing the joint and mobility problems I had been treated for, and their opinion that weight was a contributing factor, and that loss of weight would make a big difference in my conditions. I also wrote and sent a letter myself that was as non-emotional as I could make it (insurance does not care about hurt feelings) stating how being as overweight as I was affected my daily life, everything I could think of, from difficulty bending over to wash my feet or other body parts when i showered, not being able to use a tub because I couldn't get out of it, Not being able to shop because of the back, leg, and foot pains it caused. Not being able to exercise due to same. The seatbelt of my car not being safe because it didn't fit properly. Anyway, you get the idea. The more you can, without emotion or sentiment, lay out the facts of how your weight affects your ability to get through your day, the difficulty it causes you just doing normal activity related to normal daily events and job related events, the more the insurance company has to work with to objectively see the difference weight loss would make in YOUR life. This is kind of long, but basically this is what the person at my insurance co. explained to me when I called asking them what additional info they were looking for. Hope it helps. Jo Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 20, 2000 Report Share Posted January 20, 2000 At 01:35 AM 1/21/00 -0000, you wrote: >From: McJaneygrl@... > > >Has anyone filed an appeal by themselves? If so, did you just submit a letter or did you send copies of your medical records too? > >Any appeal information would be greatly appreciated. > Jane I didn't have to file an appeal, but before my insurance (BCBS of NC) would approve they did ask for more info. I had to supply medical records from previous doctors within the last 5 years showing what problems morbid obesity was causing me specifically. So I sent medical records, and letters from both my chiropractor, and podiatrist showing the joint and mobility problems I had been treated for, and their opinion that weight was a contributing factor, and that loss of weight would make a big difference in my conditions. I also wrote and sent a letter myself that was as non-emotional as I could make it (insurance does not care about hurt feelings) stating how being as overweight as I was affected my daily life, everything I could think of, from difficulty bending over to wash my feet or other body parts when i showered, not being able to use a tub because I couldn't get out of it, Not being able to shop because of the back, leg, and foot pains it caused. Not being able to exercise due to same. The seatbelt of my car not being safe because it didn't fit properly. Anyway, you get the idea. The more you can, without emotion or sentiment, lay out the facts of how your weight affects your ability to get through your day, the difficulty it causes you just doing normal activity related to normal daily events and job related events, the more the insurance company has to work with to objectively see the difference weight loss would make in YOUR life. This is kind of long, but basically this is what the person at my insurance co. explained to me when I called asking them what additional info they were looking for. Hope it helps. Jo Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 20, 2000 Report Share Posted January 20, 2000 Hi Paige... You're right... insurance companies definately can frustrate. I think they make everyone take a class in how to string people along and talk in circles before they put them on the job. My insurance is self-funded by the company I work for and administered by General American. The self-funded part is the piece that concerns me. I have a long history with the company and they definately have been good to me and therefore, I find it hard to take any legal action against them. In fact, the president of our division has even gone to bat for me with the human resource department with no success. I was sure it would be approved because of the specific wording my policy. It is really ironic because they sent me the same page in our benefits booklet saying why they weren't paying as I sent to them saying why they SHOULD cover it. " Treatment for obesity is excluded except of underlying medical conditions " I said I wasn't going to file a suit against the company but I just realized that I never did file an official appeal and I am going to talk to my boss tomorrow and give him a heads up that I am going to do that. Thanks for your concern Jane Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 20, 2000 Report Share Posted January 20, 2000 What is PTC? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 23, 2000 Report Share Posted January 23, 2000 I am fairly new in the appeal's process, I have insurance with an HMO. My original request was for an physician which was recommended to me by another person who had the surgery performed in Monterrey, Mexico. She has been extremely successful with her surgery. I was denied on the basis that it was an " out of network provider " . I then sent an modified appeal I found on the internet and they have denied one surgeon to perform the procedure, and has referred it to another " network provider " . When I reviewed the letter, I never paid attention to the type of surgery they were trying to get approved. It was Roux-en-Y procedure. I sent a letter requesting the request to reflect " laparoscopic " procedure. I still have a long way to go and probably more appeals to file also. If any one has any more sources for additional appeals, please e-mail me so I can download them. Thanks a lot !!! One day trying to stay alive and get help from our insurance companies won't be so hard. In the field of work I'm in, it's sad to say, but all laws are written in blood, which means someone has to die or something drastic has to happen before a law is written or action is taken. I wish the best of luck to all who are struggling for approval and help with their problems. Quote Link to comment Share on other sites More sharing options...
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