Rose Big Medicine and Payment

i was thinking about Rose from big medicine.  Wouldn't have she gotten something for being on Big Medicine.  They don't expect these people to appear on tv for nothing do they. Brenda

I thought about that too, I mean it is good for them to show this side of the struggle too, but if she is on the show bearing her pain for the world the Drs. Garth should do her surgery pro bono.  JMHO.  I know the pain she feels, I was denied 5 times and finally used retirment fund to self pay and it is painful enough without being on national tv. Darlene

No kidding.  Especially after appearing on TV.  She answered some pretty personal questions that even her family did not know the answer to.   Wow, you went through a lot also.   One thing about it, it sure has made me appriciate having had my surgery. Brenda

I was surprised that they didn't explain to her how to appeal, or what she needs to do to get approved. I felt bad for her. lol jen

Maybe she will be the cliffhanger at the end of the season.  If so I will just die.  I don't like messing with people's lives who are not emotionally ready for that sorta thing. B

i think after the first episode, the gal that had plastics posted and said she paid full price for it.  i was amazed that rose opened up like that in front of cameras. no way no how would i have done that.

i too hope she keeps fighting. 

they have to edit out a lot for an hour tv show, im actually cutting them some slack. judi

Most good programs like that...check your insurance before they let you go through what she did...so if she had an exclusion...I doubt they would have even let her do the nut, psych, etc...I know I've been to a surgeon for revision and they said...nope your insurance won't cover so unless your selfpay...give us a call when you figure things out.(not saying doctors don't want to invest their time into you, but it also gets your hopes up, etc if their is an exclusion...plus all that pre-stuff isn't usually covered either...so better to figure out your plan for the exclusion then move forward) ..so...I'm hoping...fingers crossed...that her insurance does cover WLS and she was denied on some technical thing like maybe all her pre stuff we saw wasn't 6 months...or some 5 year history was missing...something like that...oh please let it just be something like that...the insurance can't possible say this surgery isn't medically neccesary for Rose!

Sarah, I think it's because she wasn't fully compliant on the liquid pre-op diet. She gained weight while on it. And I don't think the psych doctor gave her a very good recommendation, based on what they showed on camera I feel Rose wasn't mentaly ready, she needs to have counseling and fully understand what's in store; "wrap her head around it" so to speak. One of many reasons for a pre=op diet is to show the doctor and insurance company you can comply with the diet/lifestyle change. She didn't. I hope she'll get counseling and really get serious about proving she can and will comply, then appeal the decision. Also, you stated; "...plus all that pre-stuff isn't usually covered either...so better to figure out your plan for the exclusion then move forward)"  That's not always true, I had a written exclusion in my first insurance company policy, I still kept a positive attitude, hoping it'd get overturned, and did all of the recommened/required testings; 2 sleep studies, blood work, pysch eval, pysch follow up appointments, complete physical etc. The insurance paid for everything, even the CPAP and supplies. But,  I was still denied the surgery, go figure, everyone, even the doctors thought I'd get approved if the insurance was covering all those tests. But the dang dreaded "Written exclusion". So, even though there's an exclusion, they  could still and more than likely cover the rest of the testing. In hind sight I'm glad they did, it got me one step closer and ready for when the new insurance was brought into the picture.

Cynthia, My roommate interupted part of the show for me...I knew she had gained a pound at one of her weigh ins but wasn't sure what her overall result was. Hoping I can catch a repeat. I agree with you on the insurance stuff...usually insurance wouldn't cover when coded for obesity if they have an exclusion for obesity...but if the surgeon or PCP codes it for your co-morbs then you are right...they will cover things like the sleep study, etc. My insurance that had the exclusion paid for the list o' tests that my surgeon ordered...mind you post WLS but was seeking revision...the only one they said no to was the PT eval for exercise...because she put my dx as MO...but I countered that with my lymphedema as I had my legs wrapped at the time and she needed them to give me things to do when wrapped, etc. So what you and I did...was still in figuring out the plan...if she did all that knowing she was up against an exclusion then you have your appeal, etc....ready if you still get denied..but yeah...glad you got them to pay for the testing.

Hey Sarah, I think the doctors' daughter/sister said the repeat is on tonight, check your tv listings maybe?