Recent Posts

Crabadams72
on 12/15/10 10:01 am - Silver Spring, MD
Topic: RE: Window for surgery after approval
The insurance coordinator emailed me today and said that the approval is valid throughout the year in which it's given.

Sadly, my window for participating in the FSA closed Monday. HOWEVER, I do have money in my Thrift savings that I can take a loan against.  I know that isn't a popular option but I know I can quickly re-pay the withdrawn amount and the interest charged is like 2.25%. There is no loan out there where I can get that low of a interest rate. So my plan is to save 1/2 and loan the rest. 

Where there's a will there's a way!
Saintsfan1
on 12/15/10 6:15 am
Topic: RE: Approved!
Congrats to you!

I am in fact going through this same denial process with BCBS of Illinois. I have been to the doctor since September and I get denied every time. The last denial I got I called and asked what exactly me and my doc needed to write down. My doc wrote everything they asked which was very detailed and just got my denial once again. I am so frustrated and will be calling them again tonite. If you have any letters or information that would help me in my case I would truly appreciate it. My email is [email protected]. Thanks!!
furiosmommy
on 12/15/10 4:54 am - Phoenix, AZ
Topic: RE: UHC and a run around, anyone else?
Thanks for the imput, I'm glad you won your appeal! I'm trying to see if they can re-assign my NCM... if it's not one thing it's another. She keeps saying she's not receiving everything then she starts questioning stuff. The diet I sent her I wasn't even pregnant during it, she just took it upon herself to assume that. It's so frustrating. She has all my medical records which are from my OB/GYN and it clearly documents when I was pregnant and wasn't. I just feel like if someone is incompetent they shouldn't be in that position. Not to be mean... but it's a huge deal if I get approved or not. It's very frustrating. I'm glad I'm not the only one but it should be this difficult.
kellykelly
on 12/15/10 4:49 am
Topic: RE: UHC and a run around, anyone else?

I too had many problems with UHC Choice PLUS.  My problem however was that I didn't have any co-morbidities so they kept denying me.  I finally appealed and won the appeal.  If they deny you due to the pregnancy, I would appeal it and make them show you in writing where it states that you cannot be pregnant at the time of the diet.

Good luck!

fypcdqt
on 12/14/10 10:59 pm - Cumming, GA
Topic: RE: Window for surgery after approval
I am not sure of the window after approval for surgery.  However, for the out of pocket expense, do you have a health savings account or flex spending account?  You should be able to use that full amount as needed.

Keep your head up!
      
fypcdqt
on 12/14/10 10:30 pm - Cumming, GA
Topic: Self pay - need advice
After jumping through the insurance hoops, I was told that my surgery would not be covered under my benefits.  It took 8 months for my company to provide a SPD to show the exclusions.  So now I know there is no option for insurance coverage, I am trying to find the best self pay price with the best surgeon.

Today I am calling my surgeon's office to find the cash pay price and what negotiations are available, as I am extremely comfortable with my surgeon and his team and would love to keep him if he's within my price range.  I am open to traveling elsewhere in the US if needed, but Mexico is an option I am not interested in considering, though I have seen others have great success there. 

Are there other self pays out there who loved their doctor, and what range was your total cost?

Any advice and information is much appreciated.

Thanks!

Amy
      
furiosmommy
on 12/14/10 6:03 am - Phoenix, AZ
Topic: UHC and a run around, anyone else?
I've been trying to obtain approval from UHC (Choice Plus PPO) for a couple of months now. My patient advocate at my surgeon's says they are faxing items over, and the nurse case manager is saying she isn't receiving it. Is this a common issue with anyone else?

I was denied earlier this month because they did not have my psych eval info or my 6 month diet info. That has been submitted twice so far this week and they are still saying they are not receiving it. Now, they say they have received the diet, but not the psych eval. And they say that the diet doesn't count because I was pregnant. The diet took place a few months after I gave birth, they even have all of those medical records showing that. Is it possible they are causing this run around just so they don't have to pay for the surgery? We certainly pay enough on our insurance premium. It's just becoming a huge frustrating mess. Any suggestions on how to get the ball rolling and get an approval? thanks!
Crabadams72
on 12/14/10 5:43 am - Silver Spring, MD
Topic: Window for surgery after approval
Hello, 

  I have run into another wall with my insurance.  My out of pocket is going to be $5,000 and I am going to have to think about if we can swing this.  If I do what is necessary and I am approved, how long is that approval valid?.  

I've been in the dumps all day and really want to cry.

My insurance is with UHC if it makes any difference.  Thank you!
WASaBubbleButt
on 12/14/10 4:27 am - Mexico
Topic: RE: So upset with my PCP
On December 14, 2010 at 9:40 AM Pacific Time, windyacres wrote:
Not me - I would go see another doctor who will be behind my weight loss plans.  No game playing for me!
 
Ditto.

I didn't really care what my PCP had to say on the topic, I don't really remember if I told him before surgery or not but I opted not to jump through ins hoops and self pay instead.

If I would have opted to do the six month nonsense I would insist on a doc that was behind me all the way.


Previously Midwesterngirl

The band got me to goal, the sleeve will keep me there.

See  my blog for newbies: 
http://wasabubblebutt.blogspot.com/
WASaBubbleButt
on 12/14/10 4:18 am - Mexico
Topic: RE: Insurance Denied by Dr Bertha with 2 weeks to surgery date
On December 14, 2010 at 10:18 AM Pacific Time, windyacres wrote:
I'm all about full disclosure.  If a doctor takes the Hippocratic oath (and means it) you know where he/she is at.  I just want to know what sort of oath they took - it may be better, it may be worse.
 
I don't really agree with you on this one.  Just because someone takes an oath does not mean they 'really mean it' at all.  How many doctors do you think over the last 100 years really believe in specific healing Gods?  (Can't remember their names right now.)  Do you really think that all the docs that are willing to do abortions really believed in the oath?

To be honest, it's kinda like saying people never lie in court because they took an oath.

How do you know if they really meant it or not?

If you google it you will very likely find a lot of the oaths people are writing to replace the Hippocratic one.


Previously Midwesterngirl

The band got me to goal, the sleeve will keep me there.

See  my blog for newbies: 
http://wasabubblebutt.blogspot.com/
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