Debbi21604

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HelpMeRhonda !! 22 years, 7 months ago

Many prayers and blessings for a safe and uneventful journey. 7/10/02 OPEN RNY

Debbi21604 22 years, 7 months ago

I'M APPROVED!

Debbi21604 22 years, 7 months ago

Well, I have a bit of a set back. I talked to my insurance company today. The Nurses (Med-Value)said they needed a Psych. Eval and history of Medically supervised diets. She wanted specifics in the last 5 yrs. I don't have any. I have not been on ANY medically supervised diets. For one, the pills they put you on, insurance doesn't pay for and I can't afford to get them myself. Two... I have worked as a dietician for a Health Spa when I was 17 & 18 yrs old. I worked in the kitchen of a health spa preparing the meals for ppl who would come there. The Spa, called 'The Heartland' catered to ppl who wanted to get healthy through nutrition and exercise. I KNOW THIS STUFF. I know what it takes. I just can't do it. I told this nurse on the phone that in the last 2 yrs, I haven't really dieted much because I am so tired of every diet I try, I put the weight back on PLUS more. I told her that I have done weight watchers a long time ago - but she just wanted to know about the last 5 yrs. Recently however, I just follow the plan and not join the group because I can't afford it. I told her I have tried the Adkins Diet - both Old and New. I told her that the Dr. Office doesn't have this detailed information, because *I* don't have this information. This has been ongoing for SO SO long that I don't have specific dates. She said in the past year, the criteria has gotten LOTS tougher. She said what will probably happen, is my information will go to "physician Review". Once there, Doctors will look at my case and decide if this is medically necessary since I don't have or meet all the criteria. Once it goes to Physician's Review, I will have an answer by the end of the week. If it is denied, then I can appeal. If I'm still denied, then I can appeal again if my circumstances change. After that, I can not appeal any more. So it looks like I am heading for a Denial.

Debbi21604 22 years, 7 months ago

OK Everybody... Here's what just happened on the phone with the Dr. Office and the Insurance Company. First let me say, I finally got a NICE person at the insurance companyt that didn't make me feel stupid for not knowing how their insurance works. I called the BTC Insurance Handlers and found that my file has been forwarded to MY insurance on Friday. I am assuming by mail since MY insurance (Pacific Life & Annuity) has not recieved it yet. When I talked Pacific Life, I explained to them my situation with my "time crunch" [being if I don't have surgery by Nov 1, I have to wait until January due to family obligations.] PL said that determination of benifits is if it is questionable on wether you will qualify for payment for this surgery. For predetermination, they would need information from PCP and any other Dr regarding diets, comorbidity and things like that. Here's the trick... Because my Dr. at BTC knows I qualify, and *I* know I qualify and my insurance policy says I would qualify, the only persons who DON'T know I qualify is PL. So the lady on the phone with PL said to have my WL Dr. office call and ask for the Benifit's Dept. As if it was already approved. Give them a 'tenitive' surgery date. The benifits department will tell them how much of the procedure they will cover and the amount that I will be responsible for. After that, they will transfer them to the Nurse's. They will ask some questions, ask for certian documents and a letter of medical necessity. IF YOU FAX the letter of medical necessity to the Nurses, they will immediatly start the pre-cert process. Then the rest of your information that they need can be sent/faxed shortly. It means that I can jump ahead 1/2 way -*IF* I can get the BTC to call them and push a bit. Since my 'documents' have already been sent by Mail/FedEx on Friday th 12th, PL should already have them and just need to go find them.

MommaAngel 22 years, 8 months ago

HI DEBBI I just want you to know that I am praying that everything will go smooth as you journey to the losing side. LORD BLESS

Naes Wls J. 22 years, 8 months ago

~*~I SAID A PRAYER FOR YOU TODAY~*~ I said a prayer for you today And know God must have heard- I felt the answer in my heart Although He spoke no word I didn't ask for wealth or fame, I knew you wouldn't mind, I asked Him to send treasures Of a far more lasting kind, I asked that He'd be near you At the start of each new day, To grant you health and blessings And friends to share your way. I asked for happiness for you In all things great and small, But it was for His loving care I prayed the most of all.

Sharon Neva 22 years, 8 months ago

DEBBI~~BEST WISHES ON YOUR WLS JOURNEY~~ May the world hug you today with its warmth, and love.....Pray it whispers a joyful tune in your heart.....And may the wind carry a voice that tells you there is a friend sitting in another corner of the world wishing you well!~~