Called in the "Big Guns" - Page 3 - ThinnerTimes

Baron Patrick · 01-22-2007, 09:45 AM

All of you are so wonderful! I'd have never made it this far (or this long) without you! I can just see everyone heading to the corporate office, with Donna in the lead ( I pity the poor fool who has to face her!)

You know, if all you did come to see me in the hospital, people there will think I'm some sort of celebrity (of course I AM, but that's another story!)

Like I said in my signature - It ain't over till I say it's over. And to think, this could have all been resolved and over with last October.

Whatever happened to PREVENTIVE healthcare? It's simply amazing the things they will do to NOT give a patient something that will help the patient (and their bottom line) in the long run.

Thanks again!

sdgrrl · 01-22-2007, 10:03 AM

Yeah, there's more than a few peeps who would agree with you about facing me down...my fam cracks up because when I'm not pleased about something I will say "My expectation is that ____________ will happen." ex: "My expectation is that Pat's appeal will be approved in a timely manner and we can get this taken care of." Then I just stand back and wait for their response. Fools are the only ones who don't attempt to comply, since I only get more assertive from that point on....

sdgrrl · 01-22-2007, 10:09 AM

It occurs to me that probably the reason why your insurance is being so resistant to doing the preventive thing is that they are afraid of all those patients being like me and costing many more thousands than just paying for you to be overweight. For this I apologize, but cripes, look at the board. I am not the norm, but I surely have cost my insurance a ton. Sorry!

Baron Patrick · 01-22-2007, 10:29 AM

Quote:

Originally Posted by sdgrrl

It occurs to me that probably the reason why your insurance is being so resistant to doing the preventive thing is that they are afraid of all those patients being like me and costing many more thousands than just paying for you to be overweight. For this I apologize, but cripes, look at the board. I am not the norm, but I surely have cost my insurance a ton. Sorry!

Donna - Never apologize - it's a sign of weakness

That's what health insurance is for (last time I checked). Did they ever consider what problems you would have without the surgery? I didn't think so. Most likely, much more than what you've gone through already, if you didn't have the surgery.

If the insurance company doesn't like the odds, they should'nt be in the business!

I can just see the next step for them - refusing to insure people because they are obese. I'm sure that has happened as well, only to have the government step in and tell them they can't do that.

I have my appointment with the dietician - Feb. 1st. 11 am. By that time, the managed care agency will have my paperwork!

sdgrrl · 01-22-2007, 11:20 AM

Right on the street of your thoughts...a friend of mine recently sent me an article about how certain insurance companies are thinking of denying approval for surgery on smokers. This really pissed me off, and I fired off a missive regarding the slippery slope--no surgery for fatties, no surgery for heart patients, recreational drug users (like our esteemed president) etc. There has to be a line insurance companies won't cross regarding providing care for peeps who need it.

Before anyone gets on their high horse regarding smokers, think about your objections. Delete the word smoker and insert MO--I think you'll get my drift. They are both supposed "acquired habits".....

xlntsrvc · 01-22-2007, 01:56 PM

Patrick-
I appealed to the State also and they overturned the denial so my insurance has to pay for it. The State was really good and pretty much told my insurance that it is stupid to make someone do the 6 months supervised because it does not change the success rate of the Bypass surgery. They did take the full 30 days though.

Baron Patrick · 01-22-2007, 02:16 PM

Quote:

Originally Posted by xlntsrvc

Patrick-
I appealed to the State also and they overturned the denial so my insurance has to pay for it. The State was really good and pretty much told my insurance that it is stupid to make someone do the 6 months supervised because it does not change the success rate of the Bypass surgery. They did take the full 30 days though.

Thanks for the encouraging note Staci -

The surgeons insurance specialist told me the same thing, every patient who she had get the state involved - all had the decision reversed, and with the same reasoning. I understand the insurance people has 3 days to comply once they receive the response from the state?

JenBear7 · 01-22-2007, 10:17 PM

Quote:

Originally Posted by sdgrrl

It occurs to me that probably the reason why your insurance is being so resistant to doing the preventive thing is that they are afraid of all those patients being like me and costing many more thousands than just paying for you to be overweight. For this I apologize, but cripes, look at the board. I am not the norm, but I surely have cost my insurance a ton. Sorry!

You & your health are worth EVERY penny.. I (being pre-surg).. appreciate your posts (and blueyez).. sharing your major hurdles.. keeps us all in check, and shows us that its not always textbook...

Baron... your post about not insuring MO is probably not as far from the truth as we would like! Ack.. scary stuff.. How many times I saw over the last few years employers not only not insuring smokers, but not employing them... and I am sure I am not the only person that thinks weight has slowed down the climbing of the proverbial ladder at work.. I have even hypothosized, that post-surg, I bet I am promoted within a year LOL.. keep keeping us posted.. and good LUCK n'stuff!

xlntsrvc · 01-23-2007, 07:28 AM

Patrick-
Yes, they have 3 days to respond. After they overturned the appeal everything progressed very quickly. I was the one who still needed to get things together. My surgery date is the 19th of February. I do payroll and needed to get W2's out first otherwise I would of already had the surgery.