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talksoupslp
Marietta, GA
Member Since: 04/07/08
[Latest Posts] | Post Date: 9/3/08 4:40 pm Topic: RE: Update...GA State Employees Look Here! Good, I'd be real interested in what they wrote you. I got my letter yesterday from the Dept of Community Health. I'm not all that impressed with the letter.
First of all, Dr. Medows is not the one *****sponded. It was a Trudie Nacin, the Deputy Chief of the SHBP. She started out with quoting me the paragraph from our benefit book about not covering the surgery. Well, no duh! I think I mentioned it page and verse in MY letter to THEM.
The letter goes on to say:
"The basic purpose of the SHBP is to provide healthcare coverage for the treatment of illness or injury of our members and their enrolled dependents. While the Plan covers most diagnoses and treatment, policy and regulations have limited or excluded coverage of certain services regardless of medical necessity, such as the surgical management of weight loss. State law allows the Department of Community Health to design the benefit plan in such a manner that promotes the fiscal strength of the Plan as well as the strongest possible mix of benefits and services to SHPB members.
Periodically, the Department does review and re-evaluate procedures that are excluded from coverage to assess for any changes or new developments that might otherwise result in a benefit change. We will include an evaluation of gastric-restrictive procedures in our future deliberations.
I certainly understand your frustrations regarding your specific medical needs and while I may not have provided favorable answers to your inquiries, the SHBP and all of its employees remain committed to providing quality health care services and customer service to its members."
Yea, right! Obesity is an illness and they need to cover it. I think it's discrimination. I guess we'll see what happens next. I called UHC yesterday and the customer no-service rep was arguing with me. "Why did I file my own pre-authorization determination?" and "Why did I bother, WLS is excluded." She finally looked in the computer to see that a "letter was requested on August 29th". I assume it's a denial letter, but I haven't received it yet. I wi**** would arrive so I could get this ball rolling.
-Elli |
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GAman
GA
Member Since: 06/23/08
[Latest Posts] | Post Date: 9/3/08 3:32 pm Topic: RE: Hi, I'm new... Hi Alison!
I had the DS with Dr. Smith on July 3rd and I wasn't scared a bit. My surgery ran way long and I had no problems. I knew what to expect because Dr. Smith's program was so thorough.
I do remember being in the room after the surgery saying Oh crap what if I dont like it? What if it doesnt work? But over the days, I realize it does work. I found going to group and talking with other people (which was not my thing when I began) was really helpful, especially after when you wonder what is happening to you is normal.
The short answer is we all felt this way. hang in there. Its worth it
John |
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GAMOM23
Hinesville, GA
Member Since: 08/14/08
[Latest Posts] | Post Date: 9/2/08 5:51 pm Topic: RE: Hello Again and Again Thanks for the good news... I feel really good about everything, just nervous.... its always good to hear what others experience to back those feelings up....
Dee |
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Amy Williams
Augusta, GA
Member Since: 08/13/02
[Latest Posts] | Post Date: 9/2/08 11:18 am Topic: RE: Which insurance approved you? These are some that do pay for the surgery.
AT&T
Wachovia
Target
Alltel
Comcast
T-Mobile
Starbucks
These are some well known companies that have coverage for bariatric surgery, usually small companies don't have the benefit because of the costs. |
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Amy Williams
Augusta, GA
Member Since: 08/13/02
[Latest Posts] | Post Date: 9/2/08 11:13 am Topic: RE: Update...GA State Employees Look Here! Thank you so much.
Elli, I will tell you they have given everyone a complete run around. The State Health plan has made it very clear to me that the governor has the final say so in the budget and he would be the only one to override the decision. I have call Rhonda's office on several attempts myself, they will never take a message, I have even written to her. At this point through we all need to write and call whom ever will listen. Enough people complain they will realize this is a BIG issue. |
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BrookieWookie
Member Since: 08/24/08
[Latest Posts] | Post Date: 9/1/08 7:36 pm Topic: I have my bags packed! I am flying out to Dallas, TX on September 3rd and having my lap-band on Sept 4th. Can anyone tell me what I am looking forward too? I am ok but getting nervous the closer it gets.I still cant wait. Thanks for reading. If you had the lap-band done in August I would like to here about your weight loss and story. Thanks ~*Brooke*~ |
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talksoupslp
Marietta, GA
Member Since: 04/07/08
[Latest Posts] | Post Date: 8/31/08 4:34 pm Topic: RE: Update...GA State Employees Look Here! They aren't going to brush me off without a fight. I have applied for pre-authorization for WLS. Once I get my denial, I will hire an attorney. I realize that the attorney may look at all the info from our health plan and say he won't take the case, though I'm hoping to fight...they won't be able to "brush me off" then.
-Elli |
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Becoming Anne in 2008
GA
Member Since: 09/13/07
[Latest Posts] | Post Date: 8/30/08 5:49 pm Topic: RE: Hiya Georgia! Hi Pixiemom...sorry it took so long for me to get back with ya.
Look at obesitysolutions.com
The support group is on Tuesday nights at Lanier Park Hospital on white sulphur road.
Its a good meeting. 310/200/144(for now this is my goal weight) Before/Current/Goal
was 315 pre-surgery
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I've lost over 400 pounds! 
