Re: denied

July 15, 2003

I am so depressed - i just called my insurance co and they said i was

denied b/c i didn't meet criteria. i'm 38 5'3 252 lbs BMI42.9 -- high BP,

high cholesterol and high triglcycerides (over 700), joint pain, arthritis,

back pain, skin fold infections, SOB with min exertion, depression,

hypothyroid, etc etc ...WTF else do i need to meet criteria - death....

sorry...i'm upset -- i have BCBS of Illinois and i hear they have been

approving ppl but i wonder if being on COBRA and having that end in aug-sept

would have any bearing on it.....

visit our website

www.geocities.com/tanyarn96/countryside.html

-- Re: Let me know if you think this is gonna

work

Hiyas Epdi,

I went back 2 weeks to the day after my lap RNY and it was about a week to 2

weeks too soon. I wasnt having much pain, but I was so physically exhausted

that I was miserable. Ive heard of some people going back a week after

their

surgery and doing ok - they had desk jobs that were very low impact, but 5

days

sounds too risky to me. It really depends on what you do for a living. I

am

a recovery nurse and even though I dont do a lot of walking or stenuous work

I was so tired and it made me feel awful. The anesthesia sometimes takes

several weeks to get completely out of your system and that combined with

the

shock your body is thrown into with the drastic reduction of nutrition can

sure

make your functioning level drop. Have you spoken with your doctor? If so,

is

he/she willing to release you back to work so soon? Any reputable company

wont let you come back to work after a major surgery without a docs release

and

if your doc is willing to let you come back, maybe it will be ok. But Id be

willing to bet that you wont feel like it.

~ami~

LAP RNY 5-13-03

In a message dated 7/15/2003 12:02:08 PM Central Standard Time,

erigual@... writes:

> I really don't have a lot of vacation time so I am going to be in the

> hospital for four days I am having LAP RNY on Thursday August 7 will be

> in the hospital from 7,8,9,10 I have the 11th off and am gonna try to

> go back to work on that Tuesday.

>

> Has any one else gone back so quickly if you didn't could you of?

July 15, 2003

I would try resubmitting it. I too have BCBS and live in IL although my plan is

a national plan. I had no commorbities. My only problem was my bmi which was

47 I believe I was 289 and am 5 " 6. Sometimes it's just the person reviewing it.

Mel

Re: Let me know if you think this is gonna

work

Hiyas Epdi,

I went back 2 weeks to the day after my lap RNY and it was about a week to 2

weeks too soon. I wasnt having much pain, but I was so physically exhausted

that I was miserable. Ive heard of some people going back a week after

their

surgery and doing ok - they had desk jobs that were very low impact, but 5

days

sounds too risky to me. It really depends on what you do for a living. I

am

a recovery nurse and even though I dont do a lot of walking or stenuous work

I was so tired and it made me feel awful. The anesthesia sometimes takes

several weeks to get completely out of your system and that combined with

the

shock your body is thrown into with the drastic reduction of nutrition can

sure

make your functioning level drop. Have you spoken with your doctor? If so,

is

he/she willing to release you back to work so soon? Any reputable company

wont let you come back to work after a major surgery without a docs release

and

if your doc is willing to let you come back, maybe it will be ok. But Id be

willing to bet that you wont feel like it.

~ami~

LAP RNY 5-13-03

In a message dated 7/15/2003 12:02:08 PM Central Standard Time,

erigual@... writes:

> I really don't have a lot of vacation time so I am going to be in the

> hospital for four days I am having LAP RNY on Thursday August 7 will be

> in the hospital from 7,8,9,10 I have the 11th off and am gonna try to

> go back to work on that Tuesday.

>

> Has any one else gone back so quickly if you didn't could you of?

July 15, 2003

Oh, , I'm so sorry to hear that. Is it possible you might be able to

contact an attorney who could help?

Re: denied

I am so depressed - i just called my insurance co and they said i was

denied b/c i didn't meet criteria.

July 15, 2003

Im so sorry. But you need to appeal it dont give up that easy, thats

what they want. I have heard that insurance companies are hoping that

you give up but when they see that you have appealed more then once

they will approve. If for any reason to get you off their back!! So

appeal!

Pamela

11/19/02

116+ lbs gone!!

Miami

> I am so depressed - i just called my insurance co and they said i

was

> denied b/c i didn't meet criteria. i'm 38 5'3 252 lbs BMI42.9 --

high BP,

> high cholesterol and high triglcycerides (over 700), joint pain,

arthritis,

> back pain, skin fold infections, SOB with min exertion, depression,

> hypothyroid, etc etc ...WTF else do i need to meet criteria -

death....

> sorry...i'm upset -- i have BCBS of Illinois and i hear they have

been

> approving ppl but i wonder if being on COBRA and having that end in

aug-sept

> would have any bearing on it.....

>

> visit our website

> www.geocities.com/tanyarn96/countryside.html

> -- Re: Let me know if you think this

is gonna

> work

>

> Hiyas Epdi,

>

> I went back 2 weeks to the day after my lap RNY and it was about a

week to 2

>

> weeks too soon. I wasnt having much pain, but I was so physically

exhausted

>

> that I was miserable. Ive heard of some people going back a week

after

> their

> surgery and doing ok - they had desk jobs that were very low

impact, but 5

> days

> sounds too risky to me. It really depends on what you do for a

living. I

> am

> a recovery nurse and even though I dont do a lot of walking or

stenuous work

>

> I was so tired and it made me feel awful. The anesthesia sometimes

takes

> several weeks to get completely out of your system and that

combined with

> the

> shock your body is thrown into with the drastic reduction of

nutrition can

> sure

> make your functioning level drop. Have you spoken with your

doctor? If so,

> is

> he/she willing to release you back to work so soon? Any reputable

company

> wont let you come back to work after a major surgery without a docs

release

> and

> if your doc is willing to let you come back, maybe it will be ok.

But Id be

>

> willing to bet that you wont feel like it.

>

> ~ami~

> LAP RNY 5-13-03

>

> In a message dated 7/15/2003 12:02:08 PM Central Standard Time,

> erigual@o... writes:

>

> > I really don't have a lot of vacation time so I am going to be in

the

> > hospital for four days I am having LAP RNY on Thursday August 7

will be

> > in the hospital from 7,8,9,10 I have the 11th off and am gonna

try to

> > go back to work on that Tuesday.

> >

> > Has any one else gone back so quickly if you didn't could you of?

>

July 15, 2003

actually the nurse called back and talked to the insurance co and she said

it sounded like more information was needed and the case was not closed so

she said that is a good thing and they usually have the dr call their dr and

talk one to one and they may want some other tests done or maybe not. it

will be a week or two -- more waiting.

visit our website

www.geocities.com/tanyarn96/countryside.html

-- Re: Let me know if you think this

is gonna

> work

>

> Hiyas Epdi,

>

> I went back 2 weeks to the day after my lap RNY and it was about a

week to 2

>

> weeks too soon. I wasnt having much pain, but I was so physically

exhausted

>

> that I was miserable. Ive heard of some people going back a week

after

> their

> surgery and doing ok - they had desk jobs that were very low

impact, but 5

> days

> sounds too risky to me. It really depends on what you do for a

living. I

> am

> a recovery nurse and even though I dont do a lot of walking or

stenuous work

>

> I was so tired and it made me feel awful. The anesthesia sometimes

takes

> several weeks to get completely out of your system and that

combined with

> the

> shock your body is thrown into with the drastic reduction of

nutrition can

> sure

> make your functioning level drop. Have you spoken with your

doctor? If so,

> is

> he/she willing to release you back to work so soon? Any reputable

company

> wont let you come back to work after a major surgery without a docs

release

> and

> if your doc is willing to let you come back, maybe it will be ok.

But Id be

>

> willing to bet that you wont feel like it.

>

> ~ami~

> LAP RNY 5-13-03

>

> In a message dated 7/15/2003 12:02:08 PM Central Standard Time,

> erigual@o... writes:

>

> > I really don't have a lot of vacation time so I am going to be in

the

> > hospital for four days I am having LAP RNY on Thursday August 7

will be

> > in the hospital from 7,8,9,10 I have the 11th off and am gonna

try to

> > go back to work on that Tuesday.

> >

> > Has any one else gone back so quickly if you didn't could you of?

>

July 15, 2003

hi diana, i will definitely contact an attny if it will do any good - ive

already done all the pre-op testing and i bet they are going to want to

stick me with that too - i think i'm in shock b/c i really didn't think i

would be denied - we pay almost 1,,000 a month - denial wasn't even in my

mind.

visit our website

www.geocities.com/tanyarn96/countryside.html

-- Re: denied

Oh, , I'm so sorry to hear that. Is it possible you might be able to

contact an attorney who could help?

Re: denied

I am so depressed - i just called my insurance co and they said i was

denied b/c i didn't meet criteria.

July 15, 2003

,

Don't fret yet! I have BC/BS of WI and my 15 years of experience

with BCBS is that they like every T crossed and I dotted, three times

over. The nurse already did what I would have told you to do. They

need to put in writing exactly why they denied you and what criteria

you did not meet. In my case they did not call it denied but just

sent a letter requesting more information. They wanted a detailed

diet history, which they were willing to let me provide, and they

wanted all of my psychiatrist's notes for the past 3 years I have

been seeing him. I faxed them the diet info and told them to take a

flying leap about the rest. Turns out it was not the doctor who was

reviewing the case that was requesting the psych stuff but a nurse

who was assemblying the case and thought it was necessary. My

surgeon had submitted the psych eval that was done and I was not

going to give them carte blanche to my records. I told them if they

addressed in writing what they need more info on I would gladly have

my doctor submit that info. Turns out it was never needed. The case

got sent to the independent medical doctor reviewer and was approved

the next day.

You should not need to go an appeal or hire an attorney. If the

policy does not have a clear written exclusion but instead has that

in the case of morbid obesity that medical care is avaiable, then

it's just a matter of spoon feeding them what they want. All I can

tell you is they paid everything except my required deductible and co-

pay for the year and also did not pay $160 of the anesthesiologist's

bill but we are not done talking about that yet. My total, including

my 2nd surgery to resolve my incision problems, was right around

$28,000. So it's worth the hassle in the long run. They do cover

well.

However, based on my past experience with BCBS I would NEVER have had

the testing done, other than what they required for approval, as one

never knows when they are going to be a pain. They only required a

letter from the surgeon and a psych eval. Since they required them

they would have to cover all costs even if they did not approve the

surgery. I sure hope it gets approved so you are not looking at all

those bills. They can be quite substantial. Sleep study alone is

over $2000.

Also don't assume that the surgeon wrote a great letter. While there

was good information in my letter related to some co-morbs it was

missing the detailed diet history I gave him, which I knew BCBS

required, and it really only hit on some of my co-morbs. Personally I

would not have even put two of them on there as they were so minor

compared to others(high blood pressure and reflux). When I faxed my

diet history, I also faxed them a spreadsheet which details all of my

medical conditions, past surgeries and medications I was on at the

time. Many of these things were weight related. The only meds I

take anymore are for depression and my daytime sleep disorder. I'm

off about $4000 of meds a year since surgery. All I know is I had

approval very quickly after getting that info in their hands.

Let us know as you hear more!

D.

> actually the nurse called back and talked to the insurance co and

she said it sounded like more information was needed and the case was

not closed so she said that is a good thing and they usually have the

dr call their dr and talk one to one and they may want some other

tests done or maybe not. it will be a week or two -- more waiting.

>

July 15, 2003

I am so sorry to hear that news. What is the appeals process for your

insurance and can you get started on that right away? At my job here in the

city I

think in Sep or October we can switch health insurance plans. Can you switch

health insurance coverage where you are? I would contact the attorney that

everyone keeps recommending .. sorry I don't know the name but others have

posted it before.

God Bless You and keep trying

Lori Anne

July 15, 2003

thanks chris - i'm starting to feel a little better and plan to start

tomorrow getting stuff on paper - ya know i was thinking as i was going

through all this process that i was worried about like everybody else on

here like the psych eval and diet info and was thinking after it was

obviously a lot of BS b/c the NP asked what diets i was on in the past 7

years and i said all of them - you name it - so she named a few and i said

yes and we ballparked dates and weight loss b/c i have no clue and none of

the places are open anymore except WW so she made up the info and the psych

visit i was first told i had to have the MMPI and the dr said it was 150.00

and i said but you are on my BCBS plan and he said yeh but they don't cover

that so i called the office and told them and they gave me a few more names

and i called one that took my insurance and said they want me to take the

MMPI and he said he does evals for my dr and MMPI's aren't req so i called

back to double check and they agreed so that amounted to me talking to the

man for a few min and i was out the door - the only REAL test i had that had

any merit to it was the cardiac clearance.

so maybe i don't have all they want.....i'll check.

thanx again