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Hi Donna

Just wondering if you had Cigna. In case you do it is well documented with

them that our son Dan has the disease. We have not had to fight for a NG

Tube but have fought for treatment at Mt Sinai etc. My advice , KEEP

FIGHTING. Our doctors had to write letters on our behalf to get treatment

outside of network.

Mom to Dan 18 yrs old EE

donna zuber wrote:

>

>

> HELLO. EVERYONE

>

> HAS ANYONE HAD ANY TROUBLE WITH THEIR INSURANCE COMPANIES SAY THAT

> THE NG TUBE ARE NOT NEEDED? MICHELLE IS 15 YRS OLD AND MY INSURANCE

> IS SAYING THAT SHE CAN EAT AND THAT THEY NEVER HEARD OF THIS ILLNESS

> AND ARE REFUSING TO PAY FOR ANYTHING TO DO WITH THE NG TUBE. I TRIED

> TO FILER AN APPEAL LAST WEEK WITH THEM AND THEY TOLD ME THAT IT'S

> EITHER ME OR THE DOCTOR BUT NOT BOTH OF US CAN FILER. SO I CHOOSE

> THE DOCTOR THIS TIME AND SHE SEEMS TO WENT TO FIGHT THEM. WE SEND

> THE INSURANCE COMPANY AN COPY OF BOTH ARTICLES THAT APPEARED ALONG

> WITH SOME MEDICAL INFORMATION. BUT I'M REAL NERVES THAT THEY ARE

> GOING TO FIGHT ME ALL THE WAY. ANY SUGGESTION ON WHAT TO DO NEXT

> WOULD BE HELPFUL. THANKS AND HAVE A GOOD DAY

>

> DONNA MOTHER OF MICHELLE 15 EE (UNKNOWN ALLERGIES)

> KATIE 13, SARA 10, MICKEY 4 AND ONE ON THE WAY IN AUGUST

>

> ------------------------------------------------------------------------

> Show your style! Choose from 6 great card designs when you

> apply for Capital One's 9.9% Fixed APR Visa Platinum.

> http://click.egroups.com/1/1894/4/_/474479/_/951882431/

> ------------------------------------------------------------------------

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Guest guest

Donna,

As you might suspect this is illegal. FInd out who your insurance

comissioner is for your state " NOW and make sure he gets copies of

everything you're sending to the insurance companies. You can also contact

your congressman/senator if things get really out of hand.

Steph.

[eosinophilic gastroenteritis] insurance

>

>

>HELLO. EVERYONE

>

>HAS ANYONE HAD ANY TROUBLE WITH THEIR INSURANCE COMPANIES SAY THAT

>THE NG TUBE ARE NOT NEEDED? MICHELLE IS 15 YRS OLD AND MY INSURANCE

>IS SAYING THAT SHE CAN EAT AND THAT THEY NEVER HEARD OF THIS ILLNESS

>AND ARE REFUSING TO PAY FOR ANYTHING TO DO WITH THE NG TUBE. I TRIED

>TO FILER AN APPEAL LAST WEEK WITH THEM AND THEY TOLD ME THAT IT'S

>EITHER ME OR THE DOCTOR BUT NOT BOTH OF US CAN FILER. SO I CHOOSE

>THE DOCTOR THIS TIME AND SHE SEEMS TO WENT TO FIGHT THEM. WE SEND

>THE INSURANCE COMPANY AN COPY OF BOTH ARTICLES THAT APPEARED ALONG

>WITH SOME MEDICAL INFORMATION. BUT I'M REAL NERVES THAT THEY ARE

>GOING TO FIGHT ME ALL THE WAY. ANY SUGGESTION ON WHAT TO DO NEXT

>WOULD BE HELPFUL. THANKS AND HAVE A GOOD DAY

>

>DONNA MOTHER OF MICHELLE 15 EE (UNKNOWN ALLERGIES)

>KATIE 13, SARA 10, MICKEY 4 AND ONE ON THE WAY IN AUGUST

>

>

>------------------------------------------------------------------------

>Show your style! Choose from 6 great card designs when you

>apply for Capital One's 9.9% Fixed APR Visa Platinum.

>http://click.egroups.com/1/1894/4/_/474479/_/951882431/

>------------------------------------------------------------------------

>

>

__________________________________________________

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Guest guest

Donna,

As you might suspect this is illegal. FInd out who your insurance

comissioner is for your state " NOW and make sure he gets copies of

everything you're sending to the insurance companies. You can also contact

your congressman/senator if things get really out of hand.

Steph.

[eosinophilic gastroenteritis] insurance

>

>

>HELLO. EVERYONE

>

>HAS ANYONE HAD ANY TROUBLE WITH THEIR INSURANCE COMPANIES SAY THAT

>THE NG TUBE ARE NOT NEEDED? MICHELLE IS 15 YRS OLD AND MY INSURANCE

>IS SAYING THAT SHE CAN EAT AND THAT THEY NEVER HEARD OF THIS ILLNESS

>AND ARE REFUSING TO PAY FOR ANYTHING TO DO WITH THE NG TUBE. I TRIED

>TO FILER AN APPEAL LAST WEEK WITH THEM AND THEY TOLD ME THAT IT'S

>EITHER ME OR THE DOCTOR BUT NOT BOTH OF US CAN FILER. SO I CHOOSE

>THE DOCTOR THIS TIME AND SHE SEEMS TO WENT TO FIGHT THEM. WE SEND

>THE INSURANCE COMPANY AN COPY OF BOTH ARTICLES THAT APPEARED ALONG

>WITH SOME MEDICAL INFORMATION. BUT I'M REAL NERVES THAT THEY ARE

>GOING TO FIGHT ME ALL THE WAY. ANY SUGGESTION ON WHAT TO DO NEXT

>WOULD BE HELPFUL. THANKS AND HAVE A GOOD DAY

>

>DONNA MOTHER OF MICHELLE 15 EE (UNKNOWN ALLERGIES)

>KATIE 13, SARA 10, MICKEY 4 AND ONE ON THE WAY IN AUGUST

>

>

>------------------------------------------------------------------------

>Show your style! Choose from 6 great card designs when you

>apply for Capital One's 9.9% Fixed APR Visa Platinum.

>http://click.egroups.com/1/1894/4/_/474479/_/951882431/

>------------------------------------------------------------------------

>

>

__________________________________________________

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Guest guest

Donna,

As you might suspect this is illegal. FInd out who your insurance

comissioner is for your state " NOW and make sure he gets copies of

everything you're sending to the insurance companies. You can also contact

your congressman/senator if things get really out of hand.

Steph.

[eosinophilic gastroenteritis] insurance

>

>

>HELLO. EVERYONE

>

>HAS ANYONE HAD ANY TROUBLE WITH THEIR INSURANCE COMPANIES SAY THAT

>THE NG TUBE ARE NOT NEEDED? MICHELLE IS 15 YRS OLD AND MY INSURANCE

>IS SAYING THAT SHE CAN EAT AND THAT THEY NEVER HEARD OF THIS ILLNESS

>AND ARE REFUSING TO PAY FOR ANYTHING TO DO WITH THE NG TUBE. I TRIED

>TO FILER AN APPEAL LAST WEEK WITH THEM AND THEY TOLD ME THAT IT'S

>EITHER ME OR THE DOCTOR BUT NOT BOTH OF US CAN FILER. SO I CHOOSE

>THE DOCTOR THIS TIME AND SHE SEEMS TO WENT TO FIGHT THEM. WE SEND

>THE INSURANCE COMPANY AN COPY OF BOTH ARTICLES THAT APPEARED ALONG

>WITH SOME MEDICAL INFORMATION. BUT I'M REAL NERVES THAT THEY ARE

>GOING TO FIGHT ME ALL THE WAY. ANY SUGGESTION ON WHAT TO DO NEXT

>WOULD BE HELPFUL. THANKS AND HAVE A GOOD DAY

>

>DONNA MOTHER OF MICHELLE 15 EE (UNKNOWN ALLERGIES)

>KATIE 13, SARA 10, MICKEY 4 AND ONE ON THE WAY IN AUGUST

>

>

>------------------------------------------------------------------------

>Show your style! Choose from 6 great card designs when you

>apply for Capital One's 9.9% Fixed APR Visa Platinum.

>http://click.egroups.com/1/1894/4/_/474479/_/951882431/

>------------------------------------------------------------------------

>

>

__________________________________________________

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  • 2 months later...
Guest guest

In a message dated 5/1/00 5:02:13 PM Eastern Daylight Time,

MiniGastricBypass (AT) e writes:

> Do we have to print off the ins

> letters (from his web site), and tweek them to fit our circumstances

> and submit them to our ins by ourselves?

Debbie will submit the letter to your insurance company.

Safe journey,

MGB 03 MAY 00

Dr. Rutledge clos.net

Self-funded company plan administered by Interactive Medical

Denied on appeal as an excluded benefit

Self Pay

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  • 2 weeks later...
Guest guest

Darlene,

I also need the same patience NOW. The tuesday letters must all be

together in MGB land. Can you believe it? Maybe Dr. R is planning a special

party for us.

Holding My Breath,

Genz

Young wrote:

> Hi all!

> I got a little nervous after hearing that some insurance info got lost.

> I called to check on mine and was told it is being reviewed and they

> will call me as soon as they are done with it. What exactly does that

> mean? I was originally told that I would know in 1 week and it was a

> week today. I have no patience. I want a " yes " now. My husband said,

> now repeat after me. He started reciting the serenity prayer. I need

> to pray for patience, NOW!

>

> Darlene

>

> ------------------------------------------------------------------------

> Save up to 54% on Quest & Kelty tents, backpacks, sleeping bags and

> outdoor gear. FREE Shipping and a 30 Day Money-Back Guarantee at

> screaminghotdeals.com

> http://click.egroups.com/1/4012/2/_/453517/_/957918514/

> ------------------------------------------------------------------------

>

> This message is from the Mini-Gastric Bypass Mailing List at Onelist.com

> Please visit our web site at http://clos.net

> Get the Patient Manual at http://clos.net/get_patient_manual.htm

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Guest guest

Darlene,

I also need the same patience NOW. The tuesday letters must all be

together in MGB land. Can you believe it? Maybe Dr. R is planning a special

party for us.

Holding My Breath,

Genz

Young wrote:

> Hi all!

> I got a little nervous after hearing that some insurance info got lost.

> I called to check on mine and was told it is being reviewed and they

> will call me as soon as they are done with it. What exactly does that

> mean? I was originally told that I would know in 1 week and it was a

> week today. I have no patience. I want a " yes " now. My husband said,

> now repeat after me. He started reciting the serenity prayer. I need

> to pray for patience, NOW!

>

> Darlene

>

> ------------------------------------------------------------------------

> Save up to 54% on Quest & Kelty tents, backpacks, sleeping bags and

> outdoor gear. FREE Shipping and a 30 Day Money-Back Guarantee at

> screaminghotdeals.com

> http://click.egroups.com/1/4012/2/_/453517/_/957918514/

> ------------------------------------------------------------------------

>

> This message is from the Mini-Gastric Bypass Mailing List at Onelist.com

> Please visit our web site at http://clos.net

> Get the Patient Manual at http://clos.net/get_patient_manual.htm

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Guest guest

Darlene,

I also need the same patience NOW. The tuesday letters must all be

together in MGB land. Can you believe it? Maybe Dr. R is planning a special

party for us.

Holding My Breath,

Genz

Young wrote:

> Hi all!

> I got a little nervous after hearing that some insurance info got lost.

> I called to check on mine and was told it is being reviewed and they

> will call me as soon as they are done with it. What exactly does that

> mean? I was originally told that I would know in 1 week and it was a

> week today. I have no patience. I want a " yes " now. My husband said,

> now repeat after me. He started reciting the serenity prayer. I need

> to pray for patience, NOW!

>

> Darlene

>

> ------------------------------------------------------------------------

> Save up to 54% on Quest & Kelty tents, backpacks, sleeping bags and

> outdoor gear. FREE Shipping and a 30 Day Money-Back Guarantee at

> screaminghotdeals.com

> http://click.egroups.com/1/4012/2/_/453517/_/957918514/

> ------------------------------------------------------------------------

>

> This message is from the Mini-Gastric Bypass Mailing List at Onelist.com

> Please visit our web site at http://clos.net

> Get the Patient Manual at http://clos.net/get_patient_manual.htm

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  • 2 weeks later...
Guest guest

In a message dated 5/18/2000 9:48:46 PM Eastern Daylight Time,

@... writes:

<< I will have my answer by noon

tomorrow and so far it looks positive. I need as many prayers as

possible. I want this so badly and all my family and friends are

supportive. If the answer is NO, I will need even more prayers. >>

My prayers are with you Darlene!!!!

Wanting

to be on the other side,

Cathy in Lenoir, NC

Patient Info Emailed on 5/2/00

BMI 42

" A Journey Of A Thousand Miles Begins With A Single Step! "

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In a message dated 5/18/2000 9:48:46 PM Eastern Daylight Time,

@... writes:

<< I will have my answer by noon

tomorrow and so far it looks positive. I need as many prayers as

possible. I want this so badly and all my family and friends are

supportive. If the answer is NO, I will need even more prayers. >>

My prayers are with you Darlene!!!!

Wanting

to be on the other side,

Cathy in Lenoir, NC

Patient Info Emailed on 5/2/00

BMI 42

" A Journey Of A Thousand Miles Begins With A Single Step! "

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Guest guest

In a message dated 5/18/2000 9:48:46 PM Eastern Daylight Time,

@... writes:

<< I will have my answer by noon

tomorrow and so far it looks positive. I need as many prayers as

possible. I want this so badly and all my family and friends are

supportive. If the answer is NO, I will need even more prayers. >>

My prayers are with you Darlene!!!!

Wanting

to be on the other side,

Cathy in Lenoir, NC

Patient Info Emailed on 5/2/00

BMI 42

" A Journey Of A Thousand Miles Begins With A Single Step! "

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  • 2 weeks later...
Guest guest

Insurance

,

>

>Well, I have Blue Cross, and it is very good. For my medical needs I

>need to see private doctors at any time for any reason, so I do NOT have

>an HMO and just last week I saw an article about an HMO that had been

>sued for neglect. I would say make a list of what your medical needs

>are, then compare that to plans you're offered. Also look for anything

>that says 'preexisting conditions not covered' then don't sign up with

>that one.

>

>Gretchen

>

I have an HMO and it pays 90% to a very long list of Dr's to

choose from or 80% to a Dr. of my choice. My modified KAFO braces were

$6,511.00 and they paid 90% as I had met my deductions and they were

prescribed by my neurologist who happens to be on their list of approved

Dr's. I have had no compalints with my HMO thus far. >Becky M.

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Guest guest

Re: Pre-existing not covered - there are laws to protect us from such

exclusions. Of course, criteria must be met, but pre-existing does not mean

no coverage anymore. The law is " HIPAA " Or the Health Insurance

Accountiblity and Portability Act. It is also known as the

" Kennedy-Kasselbaum Act " after the 2 Senators who wrote it. I'm sure there

is info on the ADA web site. My copy of the act is on paper.

>

>Reply-To: CMTUS (AT) e

>To: CMTUS (AT) e

>Subject: Insurance

>Date: Sun, 28 May 2000 19:10:23 -0700

>

>Hi Marti,

>

>Well, I have Blue Cross, and it is very good. For my medical needs I

>need to see private doctors at any time for any reason, so I do NOT have

>an HMO and just last week I saw an article about an HMO that had been

>sued for neglect. I would say make a list of what your medical needs

>are, then compare that to plans you're offered. Also look for anything

>that says 'preexisting conditions not covered' then don't sign up with

>that one.

>

>Gretchen

________________________________________________________________________

Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com

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Guest guest

Re: Pre-existing not covered - there are laws to protect us from such

exclusions. Of course, criteria must be met, but pre-existing does not mean

no coverage anymore. The law is " HIPAA " Or the Health Insurance

Accountiblity and Portability Act. It is also known as the

" Kennedy-Kasselbaum Act " after the 2 Senators who wrote it. I'm sure there

is info on the ADA web site. My copy of the act is on paper.

>

>Reply-To: CMTUS (AT) e

>To: CMTUS (AT) e

>Subject: Insurance

>Date: Sun, 28 May 2000 19:10:23 -0700

>

>Hi Marti,

>

>Well, I have Blue Cross, and it is very good. For my medical needs I

>need to see private doctors at any time for any reason, so I do NOT have

>an HMO and just last week I saw an article about an HMO that had been

>sued for neglect. I would say make a list of what your medical needs

>are, then compare that to plans you're offered. Also look for anything

>that says 'preexisting conditions not covered' then don't sign up with

>that one.

>

>Gretchen

________________________________________________________________________

Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com

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  • 1 year later...

In a message dated 11/6/01 10:14:04 AM US Mountain Standard Time,

sbyrne@... writes:

<< They are also atrocious at covering physical therapy >>

Blue Cross Blue Shield also paid for 80 plus sessions of speech therapy for 2

years in a row when all the therapists were telling me that insurance

companies cap at 35-40 visits per year no matter what. The only reason I

share this info is because we hear so many horror stories about insurance

companies and I want to encourage some people on this list that haven't gone

through this yet..........that there are some good stories too! I have also

appealed for orthodontic work for Brett with Intergroup after they said there

is NO way they will cover orthodontics. I came with facts in hand that he

would need jaw surgery in the future if they didn't pay for orthodontics

now...........that convinced them. Now we are with Aetna and it is a whole

different company............you just have to learn how to deal with each

company and find one person to deal with if possible. I am currently fighting

for more speech therapy for Brett because we have exhausted our speech

benefits..............but I will keep trying.

Yours in Him,

Mickey

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In a message dated 11/6/01 10:14:04 AM US Mountain Standard Time,

sbyrne@... writes:

<< They are also atrocious at covering physical therapy >>

Blue Cross Blue Shield also paid for 80 plus sessions of speech therapy for 2

years in a row when all the therapists were telling me that insurance

companies cap at 35-40 visits per year no matter what. The only reason I

share this info is because we hear so many horror stories about insurance

companies and I want to encourage some people on this list that haven't gone

through this yet..........that there are some good stories too! I have also

appealed for orthodontic work for Brett with Intergroup after they said there

is NO way they will cover orthodontics. I came with facts in hand that he

would need jaw surgery in the future if they didn't pay for orthodontics

now...........that convinced them. Now we are with Aetna and it is a whole

different company............you just have to learn how to deal with each

company and find one person to deal with if possible. I am currently fighting

for more speech therapy for Brett because we have exhausted our speech

benefits..............but I will keep trying.

Yours in Him,

Mickey

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In a message dated 11/6/01 10:14:04 AM US Mountain Standard Time,

sbyrne@... writes:

<< They are also atrocious at covering physical therapy >>

Blue Cross Blue Shield also paid for 80 plus sessions of speech therapy for 2

years in a row when all the therapists were telling me that insurance

companies cap at 35-40 visits per year no matter what. The only reason I

share this info is because we hear so many horror stories about insurance

companies and I want to encourage some people on this list that haven't gone

through this yet..........that there are some good stories too! I have also

appealed for orthodontic work for Brett with Intergroup after they said there

is NO way they will cover orthodontics. I came with facts in hand that he

would need jaw surgery in the future if they didn't pay for orthodontics

now...........that convinced them. Now we are with Aetna and it is a whole

different company............you just have to learn how to deal with each

company and find one person to deal with if possible. I am currently fighting

for more speech therapy for Brett because we have exhausted our speech

benefits..............but I will keep trying.

Yours in Him,

Mickey

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In a message dated 11/6/01 10:14:04 AM US Mountain Standard Time,

sbyrne@... writes:

<< They are also atrocious at covering physical therapy >>

Blue Cross Blue Shield also paid for 80 plus sessions of speech therapy for 2

years in a row when all the therapists were telling me that insurance

companies cap at 35-40 visits per year no matter what. The only reason I

share this info is because we hear so many horror stories about insurance

companies and I want to encourage some people on this list that haven't gone

through this yet..........that there are some good stories too! I have also

appealed for orthodontic work for Brett with Intergroup after they said there

is NO way they will cover orthodontics. I came with facts in hand that he

would need jaw surgery in the future if they didn't pay for orthodontics

now...........that convinced them. Now we are with Aetna and it is a whole

different company............you just have to learn how to deal with each

company and find one person to deal with if possible. I am currently fighting

for more speech therapy for Brett because we have exhausted our speech

benefits..............but I will keep trying.

Yours in Him,

Mickey

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In a message dated 11/6/01 10:14:04 AM US Mountain Standard Time,

sbyrne@... writes:

<< They are also atrocious at covering physical therapy >>

Blue Cross Blue Shield also paid for 80 plus sessions of speech therapy for 2

years in a row when all the therapists were telling me that insurance

companies cap at 35-40 visits per year no matter what. The only reason I

share this info is because we hear so many horror stories about insurance

companies and I want to encourage some people on this list that haven't gone

through this yet..........that there are some good stories too! I have also

appealed for orthodontic work for Brett with Intergroup after they said there

is NO way they will cover orthodontics. I came with facts in hand that he

would need jaw surgery in the future if they didn't pay for orthodontics

now...........that convinced them. Now we are with Aetna and it is a whole

different company............you just have to learn how to deal with each

company and find one person to deal with if possible. I am currently fighting

for more speech therapy for Brett because we have exhausted our speech

benefits..............but I will keep trying.

Yours in Him,

Mickey

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In a message dated 11/6/01 10:14:04 AM US Mountain Standard Time,

sbyrne@... writes:

<< They are also atrocious at covering physical therapy >>

Blue Cross Blue Shield also paid for 80 plus sessions of speech therapy for 2

years in a row when all the therapists were telling me that insurance

companies cap at 35-40 visits per year no matter what. The only reason I

share this info is because we hear so many horror stories about insurance

companies and I want to encourage some people on this list that haven't gone

through this yet..........that there are some good stories too! I have also

appealed for orthodontic work for Brett with Intergroup after they said there

is NO way they will cover orthodontics. I came with facts in hand that he

would need jaw surgery in the future if they didn't pay for orthodontics

now...........that convinced them. Now we are with Aetna and it is a whole

different company............you just have to learn how to deal with each

company and find one person to deal with if possible. I am currently fighting

for more speech therapy for Brett because we have exhausted our speech

benefits..............but I will keep trying.

Yours in Him,

Mickey

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  • 2 years later...

To tell you the truth, I took a job with excellent insurance

benefits, even though I'm making much less that I was at my last job

(but then again, I was laid off from my last job, sooo... )

I'm not planning on working here for more than anohter year or so --

then it's back to school for my Masters.

> Hi. I am new to the group and was wondering if anyone could give me

> advice on getting started. I have not gone to a surgeon yet. Should

I

> get insurance first, or wait and talk to the surgeon and see what

he

> advises me to do? Is it diffacult to find a surgeon who is willing

to

> help me to get the insurance to pay for the surgery? Thanks

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To tell you the truth, I took a job with excellent insurance

benefits, even though I'm making much less that I was at my last job

(but then again, I was laid off from my last job, sooo... )

I'm not planning on working here for more than anohter year or so --

then it's back to school for my Masters.

> Hi. I am new to the group and was wondering if anyone could give me

> advice on getting started. I have not gone to a surgeon yet. Should

I

> get insurance first, or wait and talk to the surgeon and see what

he

> advises me to do? Is it diffacult to find a surgeon who is willing

to

> help me to get the insurance to pay for the surgery? Thanks

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To tell you the truth, I took a job with excellent insurance

benefits, even though I'm making much less that I was at my last job

(but then again, I was laid off from my last job, sooo... )

I'm not planning on working here for more than anohter year or so --

then it's back to school for my Masters.

> Hi. I am new to the group and was wondering if anyone could give me

> advice on getting started. I have not gone to a surgeon yet. Should

I

> get insurance first, or wait and talk to the surgeon and see what

he

> advises me to do? Is it diffacult to find a surgeon who is willing

to

> help me to get the insurance to pay for the surgery? Thanks

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