MiladyB

I received a couple letters this week telling me my revisions of my pannilectomy and breast reduction won't be covered by my insurance. I was pretty disappointed since my pannilectomy and breast reductions were covered under my insurance. My PS was pretty sure these revisions would be covered. Looks as if he was wrong. I'm wondering if it is worth my time and energy to try to fight this or if I should just bite the bullet and pay for it on my own. My PS said he will be able to do the revisions in his office under local to save on the cost which is a route I'm willing to go but if there is a good chance I can over-ride my insurance companies decision, well I would go for it.

Just curious if anyone had any information, experiece or words of wisdom. I did pull up criteria for scar revisions under my insurance company and so far haven't found a loop hole to jump through.

__________________
~Beth~

Little Victories; Grand Rapids, MI
Bariatric Support Group

Diabetes, high blood pressure, sleep apnea, high cholesterol,
peripheral vein disease, joint pain and 210 lbs GONE!!


Century Club: July 3, 2006
ONE-derland: Dec. 22, 2006
Double Century: May 29, 2007
Goal: June 15, 2008

Lap RNY: 1/30/06-Dr Randal Baker
TT/BL: 09/21/07-Dr Ronald Ford
PS Revisions: 04/29/08-Dr Ronald Ford
Gallbladder: 05/14/08-Dr Randal Baker
Emergency surgery (Intussusception): 02/29/09-Dr James Foote

soon2bthin

Beth,

I would definitely appeal it first. What is the worst that will happen? They will deny the appeal and you will still have to self pay. I say fight the power first and then self pay if have to. Just my two cents.

Cassie

xlntsrvc

I guess it would matter on why you need the revisions. If they are medically necessary then yes I would fight. I would probably fight anyway...but you would have a better leg to stand on. I actually had to appeal to the state to even get the surgery to begin with so I am a fighter anyway

__________________
Staci
333/185/180
Surgery/Current/Goal
Onderland Finally July 28, 2008
Century Club Aug 07
February 19, 2007 Surgery
"] Finally starting my journey to weight loss
November 27, 2006 State overturned Appeal
October 2006 Appeal to the State
August 2006 2nd Referral (denied appeal)
March 2006 Referral (denied).

From this perspective, everything is equally forgivable, whether it’s our laziness, self-hatred, impatience, large thighs, or tendency to overeat.

MiladyB

Stacie, Cassie...thank you for your words of advice. I spoke with my PS's office later today about this. They spoke to my PS and he has offered to do the revisions at an extremely discounted price. He offered to do them for only $600. So I think I'm just going to go ahead and self-pay. There really is no medical reason for the revisions...truly they are only cosmetic...my PS just had thought because they were both revisions of surgeries previously covered by the insurance company there was a good chance they would cover them.

$600 is a fair amount of money but considering the fact that he will be doing 3 seperate areas it is more than a fair amount to charge. I know he has to be taking a big cut in the standard charge.

__________________
~Beth~

Little Victories; Grand Rapids, MI
Bariatric Support Group

Diabetes, high blood pressure, sleep apnea, high cholesterol,
peripheral vein disease, joint pain and 210 lbs GONE!!


Century Club: July 3, 2006
ONE-derland: Dec. 22, 2006
Double Century: May 29, 2007
Goal: June 15, 2008

Lap RNY: 1/30/06-Dr Randal Baker
TT/BL: 09/21/07-Dr Ronald Ford
PS Revisions: 04/29/08-Dr Ronald Ford
Gallbladder: 05/14/08-Dr Randal Baker
Emergency surgery (Intussusception): 02/29/09-Dr James Foote

coptergirl

Glad it all seemed to work itself out, love. If the cost couldn't be cut in the manner it was I was gonna vote for "fight it"

__________________
Blessings,

Whitney
272/243/123.5/135
Highest/Pre-op/Current/Goal

GBS 3/7/06
Dr. Stanley Klein -Torrance, CA

Hernia Repair/Tummy Tuck 3/9/07!!!!

148.5 pounds and 64.5 inches gone forever!!

GOAL REACHED 2/6/07!!!

Ducksack Member#3! And TTBear Blondbear!!
www.myspace.com/horsegalwhit

MiladyB

Well I'm not one to run from a fight with the insurance company. I most certainly had to jump threw alot of hoops to get the breast lift/reduction covered but considering the co-pays I had to pay for the covered surgeries I suspect I'm getting a pretty good deal. Dr Ford is a sweetheart of a doctor who has a pretty big heart when it comes to the Burn Unit and it's nurses so I really suspect he is giving me quite the cut on the cost. They didn't say how much he normally charges but considering the aspiration of my seroma alone was close to a $400 charge (insurance paid) surgery even under a local has to be ALOT more than $600.

__________________
~Beth~

Little Victories; Grand Rapids, MI
Bariatric Support Group

Diabetes, high blood pressure, sleep apnea, high cholesterol,
peripheral vein disease, joint pain and 210 lbs GONE!!


Century Club: July 3, 2006
ONE-derland: Dec. 22, 2006
Double Century: May 29, 2007
Goal: June 15, 2008

Lap RNY: 1/30/06-Dr Randal Baker
TT/BL: 09/21/07-Dr Ronald Ford
PS Revisions: 04/29/08-Dr Ronald Ford
Gallbladder: 05/14/08-Dr Randal Baker
Emergency surgery (Intussusception): 02/29/09-Dr James Foote

coptergirl

If I was him...even if you didn't work in the burn unit, I'd give it to you just cuz you are who you are

__________________
Blessings,

Whitney
272/243/123.5/135
Highest/Pre-op/Current/Goal

GBS 3/7/06
Dr. Stanley Klein -Torrance, CA

Hernia Repair/Tummy Tuck 3/9/07!!!!

148.5 pounds and 64.5 inches gone forever!!

GOAL REACHED 2/6/07!!!

Ducksack Member#3! And TTBear Blondbear!!
www.myspace.com/horsegalwhit

MiladyB

hehehehe....Whitney...you are WAY too kind!! You tryin' to brown nose me, love?

__________________
~Beth~

Little Victories; Grand Rapids, MI
Bariatric Support Group

Diabetes, high blood pressure, sleep apnea, high cholesterol,
peripheral vein disease, joint pain and 210 lbs GONE!!


Century Club: July 3, 2006
ONE-derland: Dec. 22, 2006
Double Century: May 29, 2007
Goal: June 15, 2008

Lap RNY: 1/30/06-Dr Randal Baker
TT/BL: 09/21/07-Dr Ronald Ford
PS Revisions: 04/29/08-Dr Ronald Ford
Gallbladder: 05/14/08-Dr Randal Baker
Emergency surgery (Intussusception): 02/29/09-Dr James Foote

coptergirl

Naaah - no need for brown nosing, honey. I just luuuuuv you

__________________
Blessings,

Whitney
272/243/123.5/135
Highest/Pre-op/Current/Goal

GBS 3/7/06
Dr. Stanley Klein -Torrance, CA

Hernia Repair/Tummy Tuck 3/9/07!!!!

148.5 pounds and 64.5 inches gone forever!!

GOAL REACHED 2/6/07!!!

Ducksack Member#3! And TTBear Blondbear!!
www.myspace.com/horsegalwhit

Gwen

Dearest Beth

I'm sorry to hear that your insurance don't want to pay but glad to hear that your dear Dr Ford is willing to cut the price for you - I say go for it!

Glad to see that you are going to take part in Jim's Lesser Friends!

XXX

__________________
GWENNIE POOH ("TT BearLover")
South African girl in UK
"BruggeBabe"


RNY - 26 Sep '07
Then/Now/Dream (22 Oct '08) - 5'7"/1,75m
121.5/79.6/80 kg
19/12.7/12½ st
267/175/176 lbs

TT Gym Rat #43 - 28 Jul '07

"I LOVE THIS LIFE!" as per Shereeks