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Insurance doesn't make sense...



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:angry

In two days, my 30 days will be up and I "should" receive an answer from insurance on approval/denial. But, here is the catcher - after them giving me that line of bull - they are now saying that it is 30 days from the day the "reviewer" receives the request. If that is the case - nothing would ever get approved. And, my Dr.'s office told me that their attorneys say it is 30 days from the day the green card/signature is received on the "return receipt" is signed. AND, the people who answer the phones are so mean. I don't understand why people have to be so hateful! If they don't like their job - they should find something else to do.

Come on HEALTHSCOPE insurance - give me a break!

Tonja

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Tonja: I hate to say it, but half these morons at the ins co could care less what goes on. They have us by the short hairs and they know it. As long as they get their premiums, all is well. First I'd try speaking to a cust svc rep, then insisting on a supervisor. I'd also write down all info, who you spoke with, when, & what was said. Did you try going thru the policy holder's HR department liaison? Also, see if they have a web site where you can email questions.....And who says we don't need health care reform! PLease! This country is so Mucked Up it's not even funny. Then we wonder why all the businesses are heading elsewhere! I'll be sending you good vibes!:cheer2:

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Tonja, go on a hunger strike to protest the insurance company.:mad:

Of course I am kidding, but please don't do the opposite, which is eat to calm your nerves. It took many of us months to get approval and some people I know where turned down at first, but after complaining and taking the request to a higher level, they were approved.

Don't let this waiting game get you down. Stay positive and fight the urge to over-eat. It's hard, but it is good practice.

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tonjasm insurance can be very frustrating. There can still be additional delays if they have to request more info from the docs, etc. So don't get too bent right now. It could be worse in that you could not have insurance at all.

Waiting is definitely the hardest but it will pass.

Let us know how things go.

Myra

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Waiting is the hardest part. I have been playing this game since about April or May. I am trying to use this time to get into good band habits to make the transition easier. Go luck.

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Does any one have Cigna Insurance? I am making an appointment to see the Dr. and I was looking at his web-site and seen this forum and thought I would ask about Cigna?

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Tonja,

My surgeons office started the insurance requests in May. I was denied thirty days later. In the beginning of July the surgeons office submitted the second appeal. I was denied again and had to cancel my surgery for July 25th. At that point, I knew I had only one more appeal to the insurance company and one appeal to the NYS external appeal so I decided to hire Walter and Kelley Lindstrom from Obesitylaw.com. I scheduled my surgery date and hoped that I wouldn't have to self pay. But whatever the decision was going to be, I was going ahead with the procedure in Sept.

Walter Lindstrom sent an appeal letter (18 pages long) to the NYS External appeal and an appeal to the insurance company. According to the attorney's, the insurance company thinks that eventually we will go away and not fight. However, they were wrong. Once they received the letter from Walter Lindstrom and saw that the letter was also copied to the New York State External appeals, they knew how serious we were. I got my denial overturned in 14 days. Thanks to Kelley and Walter I didn't have to pay the wopping $23,000 LapBand bill.

So here I am 3 days pre-op and looking forward to a better and healthier lifestyle. If they don't see how serious you are, they will continually deny you. If you prefer, think about calling Obesitylaw.com and speak to Kelley. She is amazing. They will not take your case unless they truly feel that they can get an approval from the insurance company.

Best of luck to you and don't give up.

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      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

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        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
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