Update...GA State Employees Look Here!

The responses to my letters are trickling in.  I got a letter from Sonny Perdue's office yesterday.  He said the health of all Georgians is very important to him, but sluffed the matter off to the Dept of Community Health if I have issues with the health insurance.  So...if you are a GA State Employee, insured through the state health plans (of which open enrollment starts October 10th) you should write to:

 Rhonda Medows, M.D., Commissioner of the Department of Community Health
 Department of Community Health
 2 Peachtree Street, NW, Suite 4043
 Atlanta, GA 30303
 404-656-4479

I had already sent her one of my letters and am awaiting response.  According to the Governor's letter, he also forwarded my information to her.  We'll see.

I will add that, this lady has been in the news on and off and seems to get sued a lot over trying to cut Medicaid benefits for some of the state's most impaired/disabled children (I know of one of these children and they have sued and won).  She might not like the idea of yet another attorney contacting her (hmmm...).

Just thought I would give this info for anyone who might need it.  And Amy W. if you are reading this, I would give out her name and address to anyone with the State Health Benefit Plan who might call your office.

-Elli

I have address the issue to the Dept. of Community Health regarding wls.  No one has ever acknowledged me regarding the issue.  They just kept brushing me off.... employees are never asked for their opinions.

They aren't going to brush me off without a fight.  I have applied for pre-authorization for WLS.  Once I get my denial, I will hire an attorney.  I realize that the attorney may look at all the info from our health plan and say he won't take the case, though I'm hoping to fight...they won't be able to "brush me off" then.
-Elli

Yeah my dh has state health plan ICK  I called them and they told me no - so I said...oh you are more than willing to pay for my long term health issues but wont pay for the BAND and they said YES - I then asked them how stupid were they.  Thank goodness I have sep insurance that did just pay for mine.  Keep battling them - because you and I both know that pretty soon they will had a fat tax to the premiums - they have already added smoker.  We are next.  
 

After I heard about the "fat tax" in Alabama, I thought about when they would add one of those here in GA.  I'll pay the tax, but then they need to use that "tax" to pay for WLS!

-Elli

Thank you so much.

Elli,  I will tell you they have given everyone a complete run around.  The State Health plan has made it very clear to me that the governor has the final say so in the budget and he would be the only one to override the decision.  I have call Rhonda's office on several attempts myself, they will never take a message, I have even written to her.  At this point through we all need to write and call whom ever will listen.  Enough people complain they will realize this is a BIG issue.

Elli,

I received a personal letter from the state plan yesterday.  When I get home I'll write in here what they said.  It sounded like it was somewhat promising, but we need more people to write and call!

Good, I'd be real interested in what they wrote you.  I got my letter yesterday from the Dept of Community Health.  I'm not all that impressed with the letter.

First of all, Dr. Medows is not the one *****sponded.  It was a Trudie Nacin, the Deputy Chief of the SHBP.  She started out with quoting me the paragraph from our benefit book about not covering the surgery.  Well, no duh!  I think I mentioned it page and verse in MY letter to THEM. 

The letter goes on to say:
"The basic purpose of the SHBP is to provide healthcare coverage for the treatment of illness or injury of our members and their enrolled dependents.  While the Plan covers most diagnoses and treatment, policy and regulations have limited or excluded coverage of certain services regardless of medical necessity, such as the surgical management of weight loss.  State law allows the Department of Community Health to design the benefit plan in such a manner that promotes the fiscal strength of the Plan as well as the strongest possible mix of benefits and services to SHPB members.

Periodically, the Department does review and re-evaluate procedures that are excluded from coverage to assess for any changes or new developments that might otherwise result in a benefit change.  We will include an evaluation of gastric-restrictive procedures in our future deliberations.

I certainly understand your frustrations regarding your specific medical needs and while I may not have provided favorable answers to your inquiries, the SHBP and all of its employees remain committed to providing quality health care services and customer service to its members."

Yea, right!  Obesity is an illness and they need to cover it.  I think it's discrimination.  I guess we'll see what happens next.  I called UHC yesterday and the customer no-service rep was arguing with me.  "Why did I file my own pre-authorization determination?"  and "Why did I bother, WLS is excluded."  She finally looked in the computer to see that a "letter was requested on August 29th".  I assume it's a denial letter, but I haven't received it yet.  I wi**** would arrive so I could get this ball rolling.

-Elli

This is basically the same letter I received.  It did have a tiny section mentioning what I talked about my husband and I having surgery when the benefit was offered for the state.  I have another support meeting tonight, so I plan on handing out the address and numbers again.  We have to keep on them.  The more people who complain and write the more likely they will be to try to make changes in the policy. 

You are VERY right.  Unfortunately, I doubt it will make an impact for the new insurance year.  Maybe next year.

-Elli