| PART ONE |
| 07-31-02 Website is not available yet. I am getting prepared for my journy Consultation set up for August 1st. 08.01.02 Met w/ Dr. V today he was nice. Had my physical done and now he says we have to send a letter to the ins company and wait. He says it takes about 3-4 weeks after he sends the letter. He told me not to call the insurance company untill 3-4 weeks after I receive the copy of the letter he is sending. 08.12.02 Today I recieved the letter from Dr.V that he sent to BC/BS. I had a problem with my insurance they did not input me in the system till last thursday my ins started August 1. I hope I don't get lost in the system. So now I am awaiting for the approval letter (being positive). 08.16.02 Called Ins today to see if they got the letter. They said no but gave me a fax number. I will try to Fax them on Monday morning. 9.19.02 Called ins company today they said the doctor called and surgery has been approved they faxed it to the doctors office. :) 9.23.02 Called doctors office and they said they did get the approval and they will call me back next week with a date and information!! OMG............ 9.26.02 I thought I would have to wait till next week but they called me today. My surgury date is DECEMBER 9,2002 at 11:30. I am so happy and all my emotions are mixed up............. 10.9.02 Today I got a call from Franklin Square Hospital for my pre registration. I also booked my pre op test to be done on Nov 15th 10.12.02 Just started working on my story on my website..... www.geocities.com/mywlsprogress My mom just pointed out to me that it is only eight weeks from S-Day (start over day/ Surgery Day/ Sunny Day : )) I can't wait...... 11.4.02 Was apv for surg on dec 9.................then My heart was broken on Monday. I got a call from DR.Vs office today and they said that the ins co called them and said that they are retracting the apprvl. They said that it is excluded from the policy. I was in tears..... I called the Ins company today and they said it was an over sight........HOW I CALLED THEM EVERYDAY FOR A MONTH and they said it would be covered......anyway. They said I can't do anything I need to go to HR they can waive the exclusion on the policy and then it will be covered. So I went to HR and she said she knew that there was no way they were going to cover it(((((hugh i was in the office with her and my director for about 1/2 talking about the time I needed off why didn't she say it then) I asked to see the exclusion and also asked Y is it excluded. She said it is cheaper for the company not to have it on the plan and would make it more expensive for everyones premium if it was not excluded. And since the majority of employees don't need the surgery then they opt not to have it. So she said I could appeal it but don't hold my breath. She also said the HR in the Hosp makes the final say and she only apv one person before and that is because she had some kind of infection. What the hell ever.....I am so Pissed... since it is so few the need to get it done Y not wave those few through. So if you are dying they will wave it...... So since DR V says it is med nec.then I don't know.........But this sucks...... 11.06.02 I am trying to get this approved. I called the Head of HR and she tried to say that I was only doing this for self esteem issues and not for health reason (how the f............... would she know) I then pointed out that she can over ride the contract and have the ins pay she said she cant do that. I said well you paid for one lady that had med necessity for it. She spit out no that was bcbs error they apvd it and they should not have so they ate the cost for the surgery. She was very nasty. I work for Sini Hospital I work in the billing office for them. My ins is Care first bcbs. She also said with was a self funded company. She told me that BCBs suggested not to cover the surgery and make it an exclustion because it cost to much for the little bit of the population we have that would need it then she said it is proven that the surgery does not work and people get it to lose wait but gain it back I am in tearssssss............... I faxed a letter to the Ins company asking them to reconsider and please let me have the surgery.......Bev is giving me till Friday to find out if I can do anything. Please Please how could they do this to me......... 11.7.02 Today I was fired. Still no word on my apv. I faxed a letter in to the bcbs office and they put a rush on it and told me to call back tuesday. I am waiting!!!!!!!!!!!! 11.12.02 Well I changed my status from apv surgery to dny first appeal. I finally got a response from the Nurse at BC and she said that the exclusion holds and I need to send another appeal then I can contact the MD Ins agency wich I already did and they can not investigate untill I have been dny 2 xs .My mother even got on the phone with them in tears and they can't do a thing they said my employer can waive it and that is the only way. So My drs and my ins all say it is Medically Necessary for me to have the Surgery but some HR Manager says no because it is just for self esteem and looks and does not work. Is this a bunch off bull. However my mom got a hold of the COO of the company and he says he did not know about a thing but will get to the bottom of this and call her back. I can't beleave she called him. I hope he can help me. I also called a reporter for the chanel 11 news he still has not called me back. I also called channell 13 news. I called and e-mailed obesitylaw.com and never got an answer or a call back. Bev says she can hold my date till Thursday and she has to let it go so tommorwo Is the day of truth. The COO can probally pull some strings but if he wants to is the other question. If anyone can help me please contact me. Thank You 12.01.02 I want to know if anyone knows anything about Pre existing info. I have CFA Cobra now (start DEC 1) I am waiting for an application for an open enrollment from BCBS Carfirst of MD they said I will get in DEC and coverage will start on Jan 1. I was dnyd for surgery because exclusion on policy. Then I was fired so now I am searching for my own policy. My boyfriend has IND Coverage through BCBS Carefirstof MD and I read his exclusion for WLS it says "For treatment of any kind of obestity, weight reduction or dietary control: So do you think that exclusion will alow WLS? Please read my story on my profile page if you want. It has been a trying journy. Thanks for any help. |
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| PART ONE |
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