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Sanity Prevails!!!

ReneBean

By ReneBean, in Insurance & Financing

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ReneBean    3

ReneBean
Posted

:flypig: :flypig: :flypig:

Hello Friends and Loved Ones...

As many of you know, I have been trying to get pre-approval from my beloved insurance company for an Adjustable Gastric Band procedure... :confused:

From September thru December, I was denied, appealed and was denied again. Blue Cross determined that I was too fat for Lap Band surgery for weight loss... (!) :mad:

I researched, wrote fabulous arguements and sent it all to the State of California for an Independent Medical Review. I waited, and waited and waited some more. :rolleyes

I got a letter in the mail the night before last - addressed to me, from the Center for Health Dispute Resolution in Rancho Cordova, CA. :nervous

You can imagine my excitement - I was finally going to get The Answer.

I ripped open the envelope to find a letter addressed to some guy named Bruce!!! ARRRRGH!!! :faint:

So, I scurried in to work yesterday, and called. I thought that if I had Bruce's letter, maybe he had mine. Logical, right? WRONG. :tired

The gal who called me back told me that they were waiting for the last document from someone, somewhere, and it was due in that very day. She told me she would call. I waited for the rest of the day... no call. I called again and left a message. :help:

By last night, I was about ready to explode into thousands of tiny fat particles... But, I managed to survive the night and this morning, I got a call from the CHDR.

AT LAST, I am rewarded for my good karma, patience and ability to craft an arguement. The State of CA has determined that the Adjustable Gastric Band procedure is Medically Necessary - and I will be receiving a letter from them, and from my insurance company, to acknowledge this, soon.

:Banane10: :eyebrows: :confused: :Banane41: :Banane52: :not_ripe:

:) :Banane09: :Banane17: :Banane06: :Banane48: :Banane04: :Banane47: :) :) :Banane44: :Banane10: :Banane21: :Banane10: :Banane42:

:rofl::rofl::rofl::rofl:

Now, I may have to have some of the medical test re-done, since a great deal of time has passed since the first one - but now I know that the Delightful Folks at Blue Cross will be forced to pay - whether they want to or not.

Life is Good.

Thanks to ALL who wished well, crossed fingers, said prayers, stuck pins in dolls and thought good thoughts.

I am Stupid Dog Happy right now. If I had a tail, it'd be wagging.

:]

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Alexandra    55

Alexandra
Posted

Renebean, I know EXACTLY how you feel. It's mindbendingly wonderful to succeed in this way!! In June of 2003 I got a letter just like the one you opened. CONGRATULATIONS!!!

You've struck a blow not only for your own health, but for patients everywhere. Every time one of those external reviews overturns the denial, a tiny chip is made in the insurance-industry fortifications. You've done a great thing, and I know you'll be a terrifically successful bandster.

YAY!!!!!

:biggrin1: :biggrin1: :biggrin1: :confused: :) :) :clap2: :clap2: :clap2:

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Guest ASPHALT ANGEL   

Guest ASPHALT ANGEL
Posted

Congrats!!!! Hope You Get Your Surgery Soon,

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Mita    2

Mita
Posted

I am so Doggone Happy for you Rene..:clap2: It could not have happend at a better time. What a way to start of the year Gettin what you want or making that give it to you.. In no time you will be on the banded side of life..:biggrin1:

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aaamom    0

aaamom
Posted

WAY TO GO GIRL ! Good for you for never giving up !!!!!!:clap2:

The next big thrill-getting your surgery date !! YEEEHAAAAAAWWWWWWWWWW

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chichigirl    1

chichigirl
Posted

Oh Rene, I am so thrilled for you!!!!! I have been sending lots of positive thoughts and prayers your way, ever since I heard about your dilema. You have been so persistant, fighting the good fight, you deserve this sooooo much. I hope you also realize how much you have helped others traveling the same path. You are very special and I am so happy for you I can barely stand it.

Wishing you the best New Years ever!!!!!

Cindy

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mousecrazy    2

mousecrazy
Posted

I'm so excited for you, I don't know what to do!!!!!!!!!!!! I know I can uncross everything now, and finally breathe a sigh of relief. I'm so excited I might just burst into a round of aerobic exercise! I'm proud of you for sticking with it, and fighting this battle. Hopefully, you will have also helped somebody else while doing so! Congratulations, Beanie! Hugs, Cindy

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Go To Topic Listing Insurance & Financing

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