Insurance

[Guest guest]

Dear ,

Just from my experience alone, I would recommend keeping on top

of your insurance company. Remember, that you are the one that pays

their premium, it's time that they started returning some favors,

don't you think? I have to stay on my insurance company all the time

because they keep giving me the run-around. They even had me

thinking that Barbara wasn't doing what she was supposed to be doing

(although she was!). It was the insurance company the whole time

that was dragging their feet! A whole month has passed by and I am

still in the review process. (My letter JUST arrived on May 23!!)

Refax it you say? YES!!!! Do it everyday if you have access to a fax

machine...LOL. I ended up having my letter faxed like 5 times I

think until it FINALLY arrived! And don't worry , you have the upper

hand here. (At least try and think that...smile)

Love,

> I just got off the phone with my insurance (Prucare) and they said

they have

> not gotten the request for approval from Dr.R. It was sent in last

> Wednesday. Should I go ahead and refax it or am I jumping the gun?

>

> Memory

> BMI 53

> Waiting on the Word

[Guest guest]

Dear ,

Just from my experience alone, I would recommend keeping on top

of your insurance company. Remember, that you are the one that pays

their premium, it's time that they started returning some favors,

don't you think? I have to stay on my insurance company all the time

because they keep giving me the run-around. They even had me

thinking that Barbara wasn't doing what she was supposed to be doing

(although she was!). It was the insurance company the whole time

that was dragging their feet! A whole month has passed by and I am

still in the review process. (My letter JUST arrived on May 23!!)

Refax it you say? YES!!!! Do it everyday if you have access to a fax

machine...LOL. I ended up having my letter faxed like 5 times I

think until it FINALLY arrived! And don't worry , you have the upper

hand here. (At least try and think that...smile)

Love,

> I just got off the phone with my insurance (Prucare) and they said

they have

> not gotten the request for approval from Dr.R. It was sent in last

> Wednesday. Should I go ahead and refax it or am I jumping the gun?

>

> Memory

> BMI 53

> Waiting on the Word

[Guest guest]

Dear ,

Just from my experience alone, I would recommend keeping on top

of your insurance company. Remember, that you are the one that pays

their premium, it's time that they started returning some favors,

don't you think? I have to stay on my insurance company all the time

because they keep giving me the run-around. They even had me

thinking that Barbara wasn't doing what she was supposed to be doing

(although she was!). It was the insurance company the whole time

that was dragging their feet! A whole month has passed by and I am

still in the review process. (My letter JUST arrived on May 23!!)

Refax it you say? YES!!!! Do it everyday if you have access to a fax

machine...LOL. I ended up having my letter faxed like 5 times I

think until it FINALLY arrived! And don't worry , you have the upper

hand here. (At least try and think that...smile)

Love,

> I just got off the phone with my insurance (Prucare) and they said

they have

> not gotten the request for approval from Dr.R. It was sent in last

> Wednesday. Should I go ahead and refax it or am I jumping the gun?

>

> Memory

> BMI 53

> Waiting on the Word

[Guest guest]

Dear ,

Take 's advice! Also, if you send it to the insurance company USPS

registered mail return receipt requested or Fed Ex or some other overnight

service, the person who accepts will ahve to sign for it: that way they

can't deny they received it.

Best of Luck,

Judy

Seattle, WA

[Guest guest]

I have decided that if I have to fax and call every day I am going to.

Thank you all for the support! I don't think I would be pursuing this as

much as I am without everyone's help. I truly appreciate it!!!!

Memory

----------

From: Judith A. Phelan [sMTP:japhelan@...]

Sent: Wednesday, May 31, 2000 3:25 PM

To: MiniGastricBypass (AT) e

Subject: RE: Re: Insurance

Dear ,

Take 's advice! Also, if you send it to the insurance

company USPS

registered mail return receipt requested or Fed Ex or some other

overnight

service, the person who accepts will ahve to sign for it: that way

they

can't deny they received it.

Best of Luck,

Judy

Seattle, WA

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[Guest guest]

Debbie, I had tricare standard and they approved my surgery with Dr. R. I had

surgery on 12/20/99. All I had to pay was my 25.00 for the hospital stay. Any

questions feel free to get in touch with me. Liz down 94 pounds

[Guest guest]

Debbie, I had tricare standard and they approved my surgery with Dr. R. I had

surgery on 12/20/99. All I had to pay was my 25.00 for the hospital stay. Any

questions feel free to get in touch with me. Liz down 94 pounds

[Guest guest]

You have my prayers.

Lv Judi in Fla

Quoting Vaughn and SaraSchütz

vaschutz@...>:

> My husband just called the insurance company for me.

Dr. R's office sent

> my

> letter to them on June 8th. Our insurance

representative at my husband's

> workplace faxed them a copy of Dr. R's letter on June

15th. Guess what?

> They

> haven't received either. Unfortunately, after

reading about everyone's

> insurance

> hassles on here, I wasn't surprised. They even told

my husband that we had

> the

> wrong fax number, even thought it is the one THEY

gave us just a few days

> ago, and

> it is the same one that my husband's employer has to

fax pre-approvals to.

> So now

> my sweet husband has just run out to fax the letter

again to the correct

> (?!)

> number. They did start a file on me over the phone

with the info we have

> in Dr.

> R's letter (procedure and diagnosis codes), so maybe

that will move things

> along

> and get this latest fax routed to the right place.

They did say that we

> should

> know something 3-5 days after they receive Dr. R's

letter (if they ever

> admit they

> have received it!)

> I get so sick when I read about all these insurance

companies giving people

> (me

> included) the run around. If any other type of

company gave this kind of

> poor

> service, they would fold in a week.

> Of course, if they will just approve me, I will be

thrilled!!!!

> I'd appreciate prayers. And if anyone has any advice

on how to handle this

> insurance stuff, I'd love to hear it.

>

> Sara

>

>

>

>

--------------------------------------------------------

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>

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>

> This message is from the Mini-Gastric Bypass Mailing

List at Onelist.com

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

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>

>

>

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[Guest guest]

Can anyone tell me how to get insurance to pay for

this durgery if you have it done in another state?

The only place I can go to have this surgery in my own

state charges an additional 4500.00 for behavior

modifications after surgery and they want it paid up

front. The problem is I can't drive 6 hours every

week or what ever indefinitely for this behavior

modification so I don't want to waste money on that.

I know that I will have to pay for a tummy tuck in the

year or 2 following surgery so this 4500.00 could go

for that instead. Does anyone have any suggestions.

thank You all so much for being here.

Happy Spring

--- Jodie and jjjwats@...> wrote:

> Hi. I had surgery 3 weeks ago and Aetna paid! Good

> luck to you.Jodie W.

> Age 28

> BMI 49.9

> Dr. Hess

> March 28, 01/325 lbs

> Paid By Coresource and Aetna

> 04-06-01 Down 20 pounds!

> 04-09-01 297 1/2 lbs Down 27 1/2 lbs!

> 04-20-01 288, Down 37 lbs!

>

>

>

>

> ---

> Outgoing mail is certified Virus Free.

> Checked by AVG anti-virus system

> (http://www.grisoft.com).

> Version: 6.0.237 / Virus Database: 115 - Release

> Date: 3/7/01

>

__________________________________________________

[Guest guest]

Can anyone tell me how to get insurance to pay for

this durgery if you have it done in another state?

The only place I can go to have this surgery in my own

state charges an additional 4500.00 for behavior

modifications after surgery and they want it paid up

front. The problem is I can't drive 6 hours every

week or what ever indefinitely for this behavior

modification so I don't want to waste money on that.

I know that I will have to pay for a tummy tuck in the

year or 2 following surgery so this 4500.00 could go

for that instead. Does anyone have any suggestions.

thank You all so much for being here.

Happy Spring

--- Jodie and jjjwats@...> wrote:

> Hi. I had surgery 3 weeks ago and Aetna paid! Good

> luck to you.Jodie W.

> Age 28

> BMI 49.9

> Dr. Hess

> March 28, 01/325 lbs

> Paid By Coresource and Aetna

> 04-06-01 Down 20 pounds!

> 04-09-01 297 1/2 lbs Down 27 1/2 lbs!

> 04-20-01 288, Down 37 lbs!

>

>

>

>

> ---

> Outgoing mail is certified Virus Free.

> Checked by AVG anti-virus system

> (http://www.grisoft.com).

> Version: 6.0.237 / Virus Database: 115 - Release

> Date: 3/7/01

>

__________________________________________________

[Guest guest]

> Can anyone tell me how to get insurance to pay for

> this Surgery if you have it done in another state?

-

I just checked my online provider directory, putting in each dr who

does DS. I had 3 hits.. all were out of state, but still in network,

so it was not a problem.

Hugs,

Liane

[Guest guest]

> Hi all,

>

> Happy mother's day. I am considering changing jobs and have a job

> offer from a company who has aetna as their insurance (we are

> currently with healthnet). has a gtube and will eventually

> need growth hormones. Can anyone who has (or had) aetna please let

> me know how they are with gtube supplies and GH. I need to decide

> if I should accept this job or not immediately.

>

> Thanks,

>

> Judith, Steve, jason (RSS) and (non RSS)

[Guest guest]

Judith and Steve,

While I can't give you answers about Aetna and gtube supplies and GH,

I can offer you advice on insurance changes. My husband's plan

switched over this past January. Of course we were so fearful and we

did tons of research and had lots of discussions. Everything worked

out fine. Is there a way you can ask to talk to the HR rep and ask

them to provide you a copy of the evidence of coverage for your

particular Aetna plan before you accept the job offer? I know it is

always a tough since you hate to bring attention to the fact that you

have special health needs. But if you ask for a copy and read it

yourself you might not need to give out too much details. Jake's

gtube supplies are considered Durable Medical Equipment under his

last two insurance companies. Some plans have this written into the

main section of the contract while others have it added to the plan

as a rider. As far as the growth hormones I know Dr. H's office has

been able to help many people in this area. Jake started GH just

days before we switched insurance companies and we had no problem

with our new insurance company. Dr. H took care of everything.

However, I think there was a discussion on this listserve a couple of

months ago about Aetna specifically declining GH for RSS kids. I

believe someone even cut and pasted information from the Aetna

website regarding this. So you might want to check the archives.

Also, maybe you could ask Dr. H's office what their success rate is

with Aetna and GH.

I wish you guys the best, I know how stressful insurance changes

are. I think RSS makes it tougher because so many things fall into

gray areas of insurance coverage.

Best of luck,

Alison

> Hi all,

>

> Happy mother's day. I am considering changing jobs and have a job

> offer from a company who has aetna as their insurance (we are

> currently with healthnet). has a gtube and will eventually

> need growth hormones. Can anyone who has (or had) aetna please let

> me know how they are with gtube supplies and GH. I need to decide

> if I should accept this job or not immediately.

>

> Thanks,

>

> Judith, Steve, jason (RSS) and (non RSS)

[Guest guest]

That's a good idea Alison, thanks. I know that a lot of insurance

companies only pay 50% of items that they consider to be durable

medical equipment so that's not what we want this qualified as.

Under our insurance plan, all gtube supplies, including the formula

are covered at 100% as gastrostomy. That makes a big difference for

us.

Hopefully I will get some more responses from people.

Judith, Steve, (RSS) and (non RSS) 3 year old twins

> > Hi all,

> >

> > Happy mother's day. I am considering changing jobs and have a

job

> > offer from a company who has aetna as their insurance (we are

> > currently with healthnet). has a gtube and will

eventually

> > need growth hormones. Can anyone who has (or had) aetna please

let

> > me know how they are with gtube supplies and GH. I need to

decide

> > if I should accept this job or not immediately.

> >

> > Thanks,

> >

> > Judith, Steve, jason (RSS) and (non RSS)

[Guest guest]

From: Faith Webb

Sent: Sunday, May 18, 2003 7:54 PM

To: 'schisum'

You need to check with your insurance company. Northshore was an in network

provider for our family but because M and B were not --- the insurance

company placed North Shore as out of network. Some insurance companies

require the admitting doctor to be in network for the facility to be

considered in network.

Just a word of caution.

Faith

_________________________________

and Faith Webb

-----Original Message-----

From: schisum

Sent: Sunday, May 18, 2003 5:33 PM

To: WACMA

Hello,

The doctors Milhorat and Bolognese may not take insurance other than

Medicare. However, the hospital, staff physicians, lab tests that are done

at the hospital are all covered by the insurance that the hospital accepts.

Out of state folks want to check that their insurance will work there by

calling their benefits dept. Even if the hospital says they accept XYZ

insurance, it may be that your insurance will not cover you in that state

without going through an appeal process.

Suzanne

Help section: http://www.yahoogroups.com/help/

NOTE: NCC refers to posts with No Chiari Content

To Unsubscribe Yourself:

chiari-unsubscribe

WACMA Home: Http://www.wacma.com

WACMA Online Group: http://groups.yahoo.com/group/chiari/

[Guest guest]

From: Faith Webb

Sent: Sunday, May 18, 2003 7:54 PM

To: 'schisum'

You need to check with your insurance company. Northshore was an in network

provider for our family but because M and B were not --- the insurance

company placed North Shore as out of network. Some insurance companies

require the admitting doctor to be in network for the facility to be

considered in network.

Just a word of caution.

Faith

_________________________________

and Faith Webb

-----Original Message-----

From: schisum

Sent: Sunday, May 18, 2003 5:33 PM

To: WACMA

Hello,

The doctors Milhorat and Bolognese may not take insurance other than

Medicare. However, the hospital, staff physicians, lab tests that are done

at the hospital are all covered by the insurance that the hospital accepts.

Out of state folks want to check that their insurance will work there by

calling their benefits dept. Even if the hospital says they accept XYZ

insurance, it may be that your insurance will not cover you in that state

without going through an appeal process.

Suzanne

Help section: http://www.yahoogroups.com/help/

NOTE: NCC refers to posts with No Chiari Content

To Unsubscribe Yourself:

chiari-unsubscribe

WACMA Home: Http://www.wacma.com

WACMA Online Group: http://groups.yahoo.com/group/chiari/

[Guest guest]

Hil,

Mind if I ask how old you were when you were first diagnosed?

The reason I ask is that your children should be tested AT LEAST 10yrs before

you were first diagnosed, if your 36yrold daughters doc refuses to let her have

one she needs to find a doc that will!!!!!!!! My husband is only 33yrs old and

diagnosed passed Sept with Stage 4!!!

Kick that doc for me will ya!!

Deb

Hil hilsshop@...> wrote:

My daughter's company just changed hands so she got her new health insurance

policy in the mail today. Blue Cross Traditional. They had no choice. Well it

really ticked me off when she was reading some of the benefits and co pays. Mri,

cat scan, chemo, radiation etc etc 20.00 co pay. Now we come to colonoscopy and

co pay is 75.00! I thought we were trying to encourage people to get a

colonoscopy but with the difference in co pay I doubt people will with that

insurance unless they really have a reason to. Every other test was 20.00. Well

she had hers on her other insurance so she won't need one for awhile. Two of my

four daughters have and one has appt 7/15. The other 36 yr olds Dr says she is

to young so won't refer her for one.

Hil

-----

[Guest guest]

Hil,

Mind if I ask how old you were when you were first diagnosed?

The reason I ask is that your children should be tested AT LEAST 10yrs before

you were first diagnosed, if your 36yrold daughters doc refuses to let her have

one she needs to find a doc that will!!!!!!!! My husband is only 33yrs old and

diagnosed passed Sept with Stage 4!!!

Kick that doc for me will ya!!

Deb

Hil hilsshop@...> wrote:

My daughter's company just changed hands so she got her new health insurance

policy in the mail today. Blue Cross Traditional. They had no choice. Well it

really ticked me off when she was reading some of the benefits and co pays. Mri,

cat scan, chemo, radiation etc etc 20.00 co pay. Now we come to colonoscopy and

co pay is 75.00! I thought we were trying to encourage people to get a

colonoscopy but with the difference in co pay I doubt people will with that

insurance unless they really have a reason to. Every other test was 20.00. Well

she had hers on her other insurance so she won't need one for awhile. Two of my

four daughters have and one has appt 7/15. The other 36 yr olds Dr says she is

to young so won't refer her for one.

Hil

-----

[Guest guest]

It seems each Dr has their own opinion on this. I was diagnosed at 66 and had

resect exactly 2 yrs ago. It was my first colonoscopy and just a fluke I

mentioned to my Dr about a little bit of constipation or he probably would not

have suggested the colonoscopy. Two of my daughters Dr's thought they should be

tested. The one who did my colonoscopy thought they all should be tested. My son

in laws father died from colon cancer just a year before mine was found. That Dr

insisted all the boys be tested and all the grandchildren who were teenagers. I

have been fuming ever since she got that insurance policy. I keep telling

everyone how many young people we have on this list! My one daughter has IBS

and had colonoscopies before I ever did. We have the virtual colonoscopy

equipment in our local hospital but no Dr is using them because insurance still

thinks they are experimental and won't cover them. I know they are not as

accurate but more people might have them as they are not invasive. I can't have

a regular colonoscopy and asked my insurance if they would cover the virtual

one. She told me I could have it done. They would deney it but I could appeal

and under the circumstances might pay. I sure can't afford to take a chance on

that.

Hil

Re: Insurance

Hil,

Mind if I ask how old you were when you were first diagnosed?

The reason I ask is that your children should be tested AT LEAST 10yrs before

you were first diagnosed, if your 36yrold daughters doc refuses to let her have

one she needs to find a doc that will!!!!!!!! My husband is only 33yrs old and

diagnosed passed Sept with Stage 4!!!

Kick that doc for me will ya!!

Deb

[Guest guest]

It seems each Dr has their own opinion on this. I was diagnosed at 66 and had

resect exactly 2 yrs ago. It was my first colonoscopy and just a fluke I

mentioned to my Dr about a little bit of constipation or he probably would not

have suggested the colonoscopy. Two of my daughters Dr's thought they should be

tested. The one who did my colonoscopy thought they all should be tested. My son

in laws father died from colon cancer just a year before mine was found. That Dr

insisted all the boys be tested and all the grandchildren who were teenagers. I

have been fuming ever since she got that insurance policy. I keep telling

everyone how many young people we have on this list! My one daughter has IBS

and had colonoscopies before I ever did. We have the virtual colonoscopy

equipment in our local hospital but no Dr is using them because insurance still

thinks they are experimental and won't cover them. I know they are not as

accurate but more people might have them as they are not invasive. I can't have

a regular colonoscopy and asked my insurance if they would cover the virtual

one. She told me I could have it done. They would deney it but I could appeal

and under the circumstances might pay. I sure can't afford to take a chance on

that.

Hil

Re: Insurance

Hil,

Mind if I ask how old you were when you were first diagnosed?

The reason I ask is that your children should be tested AT LEAST 10yrs before

you were first diagnosed, if your 36yrold daughters doc refuses to let her have

one she needs to find a doc that will!!!!!!!! My husband is only 33yrs old and

diagnosed passed Sept with Stage 4!!!

Kick that doc for me will ya!!

Deb

[Guest guest]

Actually, with the latest release on accuracy and pickup rates of colonoscopies

- the virtual picks up more. Weird, huh?

Priscilla A. Savary

Executive Director

Colorectal Cancer Network

PO Box 182, Kensington MD 20895

psavary@...

www.colorectal-cancer.net

_________

Like to help CCNetwork? Go shopping!

That's right, go head and buy something for yourself -- a new CD, the latest

bestseller, essentials like toothpaste or vitamins, even a computer. But first

join www.iGive.com/CCNetwork . Every time you shop at one of the over 500

name-brand stores in the Mall at iGive.com, we'll receive a donation of up to

26% of each purchase you make, at no cost to you.

Remember, donating to CCNetwork won't cost you a thing. But we'll miss out on a

lot of extra dough, if you don't join. So visit www.iGive.com/CCNetwork now.

Membership is free and your privacy is guaranteed.

Click here to join: http://www.iGive.com/CCNetwork

Re: Insurance

Hil,

Mind if I ask how old you were when you were first diagnosed?

The reason I ask is that your children should be tested AT LEAST 10yrs

before you were first diagnosed, if your 36yrold daughters doc refuses to let

her have one she needs to find a doc that will!!!!!!!! My husband is only 33yrs

old and diagnosed passed Sept with Stage 4!!!

Kick that doc for me will ya!!

Deb

[Guest guest]

Actually, with the latest release on accuracy and pickup rates of colonoscopies

- the virtual picks up more. Weird, huh?

Priscilla A. Savary

Executive Director

Colorectal Cancer Network

PO Box 182, Kensington MD 20895

psavary@...

www.colorectal-cancer.net

_________

Like to help CCNetwork? Go shopping!

That's right, go head and buy something for yourself -- a new CD, the latest

bestseller, essentials like toothpaste or vitamins, even a computer. But first

join www.iGive.com/CCNetwork . Every time you shop at one of the over 500

name-brand stores in the Mall at iGive.com, we'll receive a donation of up to

26% of each purchase you make, at no cost to you.

Remember, donating to CCNetwork won't cost you a thing. But we'll miss out on a

lot of extra dough, if you don't join. So visit www.iGive.com/CCNetwork now.

Membership is free and your privacy is guaranteed.

Click here to join: http://www.iGive.com/CCNetwork

Re: Insurance

Hil,

Mind if I ask how old you were when you were first diagnosed?

The reason I ask is that your children should be tested AT LEAST 10yrs

before you were first diagnosed, if your 36yrold daughters doc refuses to let

her have one she needs to find a doc that will!!!!!!!! My husband is only 33yrs

old and diagnosed passed Sept with Stage 4!!!

Kick that doc for me will ya!!

Deb

[Guest guest]

That sure is interesting. Everything I have read said they were not that

accurate. Well if insurance here won't pay guess they will be classified in the

experimental stage for some time here.

Hil

Re: Insurance

Hil,

Mind if I ask how old you were when you were first diagnosed?

The reason I ask is that your children should be tested AT LEAST 10yrs

before you were first diagnosed, if your 36yrold daughters doc refuses to let

her have one she needs to find a doc that will!!!!!!!! My husband is only 33yrs

old and diagnosed passed Sept with Stage 4!!!

Kick that doc for me will ya!!

Deb

[Guest guest]

That sure is interesting. Everything I have read said they were not that

accurate. Well if insurance here won't pay guess they will be classified in the

experimental stage for some time here.

Hil

Re: Insurance

Hil,

Mind if I ask how old you were when you were first diagnosed?

The reason I ask is that your children should be tested AT LEAST 10yrs

before you were first diagnosed, if your 36yrold daughters doc refuses to let

her have one she needs to find a doc that will!!!!!!!! My husband is only 33yrs

old and diagnosed passed Sept with Stage 4!!!

Kick that doc for me will ya!!

Deb

[Guest guest]

Hi! I just mostly monitor postings now, I am just a hair over a year

from my diagnosis. I went thru chemo, rad and surgeries and am doing

ok. Mine was rectal cancer - T2N1, but downstaged after the

rad/chemo. Having the usual issues getting the body back to regular

after all that and I realize it will never be " normal " again. I

recently had cT scan again - since my resect area is showing

some " shadow " or inflammation - frankly they're not sure what it is.

That's why your post caught my eye. My bloodwork, and the

colonoscopy came back good so I wasn't expecting any bad news with

the ct scan. Haven't yet talked with the surgeon who wanted to look

at the films himself before talking with me. I'm fairly certain this

is not a cancer return but found our similarities interesting. I

was interested too in their comments about the balloon. I have not

brought that up with my surgeon yet..and he hasn't either. I'm seven

months out from the resect and it's been a long road. A year out is

when they say that it will probably be like whatever it ends up being

at that point. Most days I'm fine...others, well...let's just say

I'm tired of things hurting and of worrying.

Like you I am trying different doctors too. Some successul some not

so. But I keep trying...and your post is an inspiration to keep

doing so. I know I don't post much now..but I still keep tabs. Our

communication with each other is probably one of the most valuable

tools we have in this war. Wishing you well and good results.

Sheila