- Username: talksoupslp
- Location: Marietta, GA, USA
- Member Since: 4/7/2008
- BMI: 51.6
- Surgery date scheduled
- Surgery Type: VSG (12/15/08)
- Surgeon: William Johnson
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Member Interests
- Dogs - I have a beautiful black cockapoo named Cupcake. She's the light of my life!
- Judaism
- Teachers - I'm a speech-language pathologist in a local school system.
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I joined OH 4/2008 to get information about WLS. I have been overweight all my life. At 5 years old, my father's nickname for me wasn't "kitten" or "sweetheart", it was "meatball" (and people wonder why I don't have contact with him). I've done lots of diets and I find I can make the lifestyle changes, but I can't fight my genetics.
My mom has been wanting me to have WLS for YEARS. A few years ago, I discussed it with my rheumatologist (I have lupus or UCTD, depends which doc you ask) and he said "NO". In Fall '07, I had to change rheumatologists. My mom convinced me to ask the new doctor. Well, the rheumatologist, the nephrologist and the PCP all agree that this is a viable option for me. So, here I am.
My biggest problem is going to be the insurance. My insurance has a written exclusion policy. I plan to fight it. I feel like everytime someone self pays or goes to Mexico (don't flame me, that's my alternative plan) it's one less person fighting the battle. All of us need to fight the exclusions and denials...that's how companies change, that's how laws change.
Update September '08 on September 29, 2008 5:17 am
So, I got my denial the end of August and hired an attorney to appeal the denial the beginning of September. Not quite sure how the appeal will go. Apparently it's an "animal of the different color" when dealing with a self-insured plan that gives up it's right to handle the appeals itself to the insurance company. But I may have found a back door and we'll try it.
Not expecting much, I also scheduled my surgery date...anticipating self-pay. Scheduled for December 15, 2008. It upsets me to know I will be nearly draining my mom's savings to do this....BUT...
On Friday Sept 16, I was looking on line for information regarding open enrollment for my health insurance. Open enrollment starts October 10th. Anyway, after several phone calls I discovered that the State of Georgia (under certain insurance choices) WILL PAY FOR WLS as of January 1, 2009. So, we'll forge ahead with the appeal (money is already spent...non refundable) but I will plan on my surgery for the new year. A new year, a new me.
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State Employees who want insurance coverage for WLS on August 30, 2008 4:33 pm
I got my response from the Governor yesterday. He said he's concerned about the health of all Georgians, but for the State Health Benefit Plan, I need to contact the Dept of Community Health. So, to anyone who needs her name and address...
Rhonda Medows, M.D., Commissioner of Department of Community Health
Department of Community Health
2 Peachtree Street, NW, Suite 4043
Atlanta, GA 30303
404-656-4479
Write her, call her, bombard her!!!!!
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2 more responses on August 27, 2008 6:23 am
Well, I got 2 more responses to my letters yesterday. First one was very unsatisfying. It was from Representative Tom Knox. He's the Chair of the House insurance committee (I think that's the right one). Anyway, he appreciated my input and would take it under advisement when the new legislative session begins. The second response was from the benefits manager from my school system. She sent me the form I need to use for appeal and said I should send it in with a letter "similar to what I sent her". And she wished me luck. We shall see. I'm just glad people are responding to my letter and not filing it in the "circular file" so to speak.
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Government on August 23, 2008 6:57 pm
The day before sending my insurance package out, I mailed a letter to the Govenor of the State of Georgia, my district state representative, my district state senator, 4 other state representatives/senators who chair state committees related to health, labor and insurance, the state insurance commissioner, the head of the Dept of Community Health (she heads the state health plan), the superintendent of the school system I work in, the chief executive of HR of the school system and the benefits manager of the school system. While Sonny Perdue (the Govenor) hasn't called yet, I have received 2 responses.
One letter was from my district state senator Chip Rogers. It was a very nice letter. In a nutshell, he basically said the legislature doesn't dictate health insurance that if this surgery truly helps to reduce costs and save money that it was something they needed to look into and when the legislature goes into session in January they could potentially take this matter up.
The 2nd letter was from my CEO of HR for my school district. Also, a very nice letter saying that the school system has no input in what benefits the state chooses to place in our health policy (okay, I disagree...while they can't dictate, I have to believe they have right to at least make suggestions). He did say he has made the benefits manager aware of my situation (I sent her a letter too) and she would be getting back with me about how go thru the formal appeals process.
This is almost exciting...who will I get a letter from on Monday?!
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My package arrived on August 22, 2008 11:30 am
Just like the postal lady indicated, it arrived at UHC's PO box in Atlanta on Monday (at 4:40am!). I got back my "return receipt requested" card yesterday. So, today, I called UHC to confirm that they had a record of at least receiving my package and ask what the process was. Natasha put me on hold and looked. She said they had it and she would forward it to the correct department. She said it could take up to 30 days but did not expect it to take that long. Once complete, the provider and I will both get letter notification.
Alright. We'll see what happens. The sooner I get a denial, the sooner I can get this show on the road! And if by some miracle I get approval, Thanksgiving would be great!
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.jpg "I've already lost 31 pounds (no surgery yet) and started at my heightest weight ever. I hate this picture.")
