While We're on the Subject of Insurance

[Guest guest]

I found out today that I was denied because of 2 reasons...1. Pre-

exsiting condition, which I can fix b/c my coverage has been

continuous since 1999.

2. No proof of medical necessity, which I'm required to show b/c my

bmi is 38. I gave my surgeon a supporting letter from my pcp which

says this would be medically necessary and 8 years worth of records

from my gynie, which document my comorbidities and dieting history.

But the surgeon's staff told me today that it's not standard

operating procedure to include this documentation on the first

requuest and all they normally submit is the surgeon's notes from the

consult.

So now I have to start the appeal process, which I'm pretty resentful

of having to do b/c I feel like the surgeon's office dropped the ball.

Sorry, I'm just venting. Tomorrow I'll be back to being a good girl

and start back to jumping through the hoops. (it'll be good exercise,

right?)

I hope everyone has a good evening!

W.

[Guest guest]

oooo, katie! a friend of mine also had trouble b/c the staff

re-submitted the same exact documentation for her appeal that they had

sent in initially:-( so she lost one of her opportunities, it was

really heart-wrenching.

why did they go w/ a subtle approach, esp since you need to PROVE that

you qualify based on co-morbs. hopefully they can redeem themselves.

hang in there!

lori h.

> I found out today that I was denied because of 2 reasons...1. Pre-

> exsiting condition, which I can fix b/c my coverage has been

> continuous since 1999.

> 2. No proof of medical necessity, which I'm required to show b/c my

> bmi is 38. I gave my surgeon a supporting letter from my pcp which

> says this would be medically necessary and 8 years worth of records

> from my gynie, which document my comorbidities and dieting history.

> But the surgeon's staff told me today that it's not standard

> operating procedure to include this documentation on the first

> requuest and all they normally submit is the surgeon's notes from

the

> consult.

>

> So now I have to start the appeal process, which I'm pretty

resentful

> of having to do b/c I feel like the surgeon's office dropped the

ball.

> Sorry, I'm just venting. Tomorrow I'll be back to being a good girl

> and start back to jumping through the hoops. (it'll be good

exercise,

> right?)

>

> I hope everyone has a good evening!

>

> W.

[Guest guest]

I'm having a hard time accepting their answer that they only submit

the surgeon's notes on the first request to save costs. I think they

dropped the ball and that was the only answer they could give me! I

paid $149 for the consult which basically consisted of taking my BP,

getting weighed, talking to the NP for 5 minutes, talking to the

surgeon for 10-15 minutes, and talking to the insurance lady. So I

would think there would be a little bit left of that $149 to send

all the info they had. I do have to say that everyone at the doc's

office has been very nice. However, a friend of mine who has also

dealt with them said that I need to stay on them. But I don't want

to make enemies of them.

Thanks for the support!

W.

> > I found out today that I was denied because of 2 reasons...1.

Pre-

> > exsiting condition, which I can fix b/c my coverage has been

> > continuous since 1999.

> > 2. No proof of medical necessity, which I'm required to show b/c

my

> > bmi is 38. I gave my surgeon a supporting letter from my pcp

which

> > says this would be medically necessary and 8 years worth of

records

> > from my gynie, which document my comorbidities and dieting

history.

> > But the surgeon's staff told me today that it's not standard

> > operating procedure to include this documentation on the first

> > requuest and all they normally submit is the surgeon's notes

from

> the

> > consult.

> >

> > So now I have to start the appeal process, which I'm pretty

> resentful

> > of having to do b/c I feel like the surgeon's office dropped the

> ball.

> > Sorry, I'm just venting. Tomorrow I'll be back to being a good

girl

> > and start back to jumping through the hoops. (it'll be good

> exercise,

> > right?)

> >

> > I hope everyone has a good evening!

> >

> > W.

[Guest guest]

In a message dated 10/16/2003 10:38:54 AM Central Standard Time,

kfwilkins@... writes:

Thanks for the support!

W.

Hi ,

Just remember...you can be subtle and still maintain that pit bull

instinct, lol. Stay on em girl!

Wolfie

Leeds, Alabama

Lap RNY

August 27,2003

Dr. Lee A. Schmitt, M.D.

Medical Center East

Beginning Weight: 336

" Keep Em Laughing! "