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Sharon D.
on 5/13/08 11:57 pm - Mondovi, WI

Have you gone to the Ombuds for help at all? That's what I did back in 2001. There were a lot less of us doing this back then, but they backed me up. I was denied twice and they got me through the Administrative Appeal. Each insurance company is different, so you might want to find out exactly what ground they're basing their denials on, too. That way, you can go to your medical records and use them to counter their denials in your appeal. For instance, if they're just saying it's cosmetic, your medical records probably have reams of documentation showing medical basis for this surgery. In the Wisconsin Administrative Code (I don't have it right at hand, but could get the exact chapter), there's an exception for social appearance and function (that's not the exact wording, but it's the gist of it). That's what I'm basing my appeal for the excision of the arm skin on. I have a grievance hearing in 30 days with Group Health. Hopefully some of what I'm fighting for will help y'all later!

Denise32
on 5/13/08 5:55 am - Appleton, WI

RNY on 04/28/08

Topic: RE: Insurance update!!

My visit was with Betsy and it went well. I'm at my 2 week stall.. which can be frustrating.. but I know that it will pass and to keep doing what I am doing. The appt. went well.. I still have the open wound on my side and it will be there for a few weeks while that heals. I see Dr. on Friday.. and then after that I will be able to progress to other foods. woo hoo! Right now I discovered turkey hormel chili high in protien and 98% fat free and low in carbs.. its working out great for me right now.

Now lets discuss insurance. I was denied first pass. Then my appeal was denied, and then I won the appeal. If insurance denies you, the surgeons office will SUBMIT the information for you.. but they leave the appeal up to you. You will have to be proactive in making sure all of the needed information is sent to them (dr. office) so they can fax it. I personally did it all myself... that way I knew it got done. The whole process wass rather long to be honest. My last appt with Lori was on12/04/07. My information was sent to insurance almost a month later on 12/27. I was denied on 1/4/08, appealed with in 30 days and then had my 2nd appeal and won on 02/26.08. It was close to a 3 month process that made me want to scream! So I understand how you feel when you say your life is on hold waiting for someone else to make up their mind!

Denise ~Do not judge me. I know I'm not perfect nor do I live to be. But before you start pointing fingers make sure your hands are clean~

ikagram
on 5/12/08 11:21 pm

Topic: RE: Insurance update!!

How did your visit go with the doctor? Yes I had been working with Elaine, but she stopped answering my emails so I forwarded all of them to Julie Dr. Wasco's nurse. I got an email from her yesterday saying she would have someone investigate it. Hopefully, that will help. Medicaid has the info and it is in committee. But Medicare (Secure Horizons) has never recieved it they say. So I will try to contact them again tomorrow. See if the office sent it to them yet. I just get frustrated when it feels my life is on hold. How long did the whole insurance process take you??

Cindy Strickland
Neenah, Wisconsin
Dr. Wasco
Midwest Bariatrics COE
Open RNY
07/09/2008

High/Sugery/Now/Dr. Goal/My Goal
354/299/229/170/150

Denise32
on 5/12/08 10:58 pm - Appleton, WI

RNY on 04/28/08

Topic: RE: Insurance update!!

I'm sorry you are going through this Cindy... but being on Medicare/medicaid doesn't mean they are dragging their feet and hoping you would go away. I am on medicaid and had no issues with them gettng to work with me. One thing I did tho, is I took matters into my own hands. I don't know who you are working with at the office, but I was working with Elaine. I asked Elain to fax ME everything, and then I made damn sure it got to the insurance on time for the appeals and everything else. I went to the Dr. again yesterday and everybody there has been wonderful.. don't give up on them just yet. They aren't "hoping you go away"...I found that they were my cheerleaders when I needed support after denial. As always.. keep us posted!

Denise ~Do not judge me. I know I'm not perfect nor do I live to be. But before you start pointing fingers make sure your hands are clean~

Denise32
on 5/12/08 10:53 pm - Appleton, WI

RNY on 04/28/08

Topic: RE: NOT COVERED!!!!

I'm so sorry! I understand you frustration... I wish I had some advise on employers in your area.. but I don't. Good luck on your journey and don't give up...perserverence pays off!

Denise ~Do not judge me. I know I'm not perfect nor do I live to be. But before you start pointing fingers make sure your hands are clean~

Tammy C.
on 5/12/08 12:31 pm

Topic: Top 10 Reasons You Should Attend OH's Detroit Event!

Date: Saturday, May 31st, 2008
Place: Detroit Airport Crowne Plaza
Time: 8am - 5pm
Cost:   FREEEE!!!!

Hi Folks! We've got an incredible day planned on Saturday, May 31st . . . Don't miss out!! Be sure to get your tickets to this free OH event now!

TOP TEN REASONS TO COME TO OH'S DETROIT EVENT:

10. Meet Dr. Ayoub Sayeg, Plastic Surgeon, while he introduces his plastic surgery practice to you.
9. Meet and learn from Bariatric Surgeon Dr. Mark Pleatman who has performing laparoscopic surgery for over 19 years!
8. Win some fantastic door prizes and have fun while learning about WLS!
7. Hear from motivational speaker and WLS post-op Laura Preston and learn her keys to long-term success
6. Get a FREE makeup consultation from our friends at Astute Artistry
5. Learn style secrets for any size with Indigo Zuri of Detroit's P2Styles
4. Discover the complex nature of Food Addiction through Addition Expert Jason Wilkinson
3. Meet and connect with local support groups and you obesityhelp peers!
  2. It's FREE!
1. Get inspired by Detroit's very own William "Big Will" Elijah -Author.Entertainer/Singer/Producer and Motivational Speaker featured on OH Magazine's July 2005 Cover. Visit Big Will's OH Profile here: http://www.obesityhelp.com/member/bigwill/

Remember, space is limited - please register today at our events page (click on the events tab) and we'll see you there!  Or click on the link below:

http://www.obesityhelp.com/events/

All the best, Tammy Colter, Director of PR/on behalf of Joanna Fee and the Events team at OH

All my best,

Tammy Colter
Director of Media & PR
Editor-In-Chief
ObesityHelp.com
OH Magazine

cc.76
on 5/12/08 11:17 am - WI

RNY on 10/24/07

Topic: RE: DS Wisconsin Doctors?

LLINOIS

* John C. Alverdy, MD E-mail: [email protected] Professor of Surgery, University of Chicago Phone: 773-834-2710 Fax: 773-834-0201 Center for Advanced Medicine 5758 S. Maryland Ave. Chicago, IL 60637 http://www.uchospitals.edu/physicians/john-alverdy.html

* Vivek N. Prachand MD E-mail: [email protected] Phone: 773-834-8360 Fax: 773-834-0201 Assistant Professor of Surgery University of Chicago Medical Center Department of Surgery 5841 S. Maryland Ave. MC 5036 Chicago, IL 60637 http://www.uchospitals.edu/physicians/vivek-prachand.html http://www.uchospitals.edu/minisurgery/bariatric/

jela6789
on 5/12/08 7:12 am

Topic: DS Wisconsin Doctors?

I am looking for a surgeon in Wisconsin or even N. Illinois to perform a DS. Does anyone know any? I need a revision.

Nic M
on 5/12/08 2:12 am, edited 5/12/08 2:14 am

Topic: RE: Experience of Lap-Band surgeon

I had a VERY bad experience with a surgeon who had very little experience and had only a proctor present. I would highly advise against it. I can't stress enough how much my life changed (for the WORSE) after having a botched lapbanding surgery. If you have access to a more experienced surgeon, please consider him or her. I have posted about my problems with banding on the Failed WLS-Second Time Around Forum. (It's on a thread called I Hate the F***lapband.) I don't hate the lapband, itself. I think it can be an effective tool. I hate what the misplacement of my lapband did to my system... and it's been corroborated by other physicians that my problems stemmed from surgeon error. Feel free to contact me if you'd like any more info. I have regrets every single day and have had them for the past 5 years. Best of luck to you. Please know that while they SAY the band is "reversible', it is only "removable". The most likely way for you to be successful with your surgery is if your surgeon gives you the right tools, in the right way. Nicci

wenniewo
on 5/11/08 3:27 am - IL

Topic: Experience of Lap-Band surgeon

I had my initial consult with a Lap-Band surgeon. I am 100% set on this surgery, but am unsure about the surgeon. She told me she has performed 20 of these surgeries, and all patients are doing well. Later in conversation, her nurse mentioned some of the more "complicated" patients have surgery on a particular day when the surgeon's proctor can be present in surgery with her. I am considering having this surgeon perform my Lap-Band only if her proctor is present as well. I would love some feedback on whether or not you would use this surgeon for the Lap-Band procedure. Thanks!

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