i'm not giving up yet......some ranting

VBGMOM
on 4/5/08 10:23 am - DE
Hi! Sorry but I need to get this out. I am so frustrated with my husband's insurance. I was denied based on lack of proof of endangerment of death. Did I say that right? My Barretts is not far enough along to consider that it would threaten my life. The hubby's insurance says a revision of my vbg to a ds is considered just a second bariatric surgery and that is an exclusion. Okay, So my doctor appealed and got shot down. I sent in my written appeal.

I have another option but now I am told that wouldn't be good either. I would keep my hubby's insurance and add Medicare Part A and B. However, I am told if I am still under my hubby's insurance that it would be primary since it is a large company. Well get this...if my hubby's insurance declines the procedure then that gives Medicare as secondary insurance to deny coverage even if they as a primary would cover the revision. Medicare does cover revisions.

Another option is to somehow find out if I can opt out of hubby's insurance and then have Medicare Part A and B as my primary...submit the procedure as to medicare as my primary and get covered.
I'm not sure yet if I can legally opt out of my hubby's insurance. I am checking on that.

Third option, wait till my Barretts esophagus gets worse. I am stage 1 now. The scale runs from
stage 0 to stage 4 . A 4 is very bad ..you probably won't live that long.

Fourth option, give up and have the Nissan Fundiplication procedure down to help slow down the Barretts esophagus.

FYI- WLS such as the DS and RNY distal would also slow the progression of Barretts esophagus.

Fifth option- Sue

I can't tell you how much energy it takes to fight for your rights. I applaud everyone here that has. I am doubting myself right now if I have the will to keep this up and it only has been a few days since my denial. I can't tell you how mad I am at insurance companies that only care about the almighty dollar. 
Anyone have any insight to this please post. Thanks for listening.


VBGMOM-Marlene ~ Just jeep moving forward~
Lourdes Medical Center of Burlington County: 609-835-2900 
Surgeon: Dr. David F. Greenbaum- 1-609-877-1737
Surgery Date: To be determined

L. TP
on 4/5/08 4:08 pm
You sound like me 6 months ago.  I got denied.  Everyone told me to fight and not to give up but I was so upset and became depressed over it that I just couldn't emotionally handle an appeal and then a denial again ...or so I thought.  I appealed literally 24 hours before cut off to an insurance that pretty much denies everyone and I won!  Just so you know when I originally got denied my doctor called the TOP person at my insurance which she happened to know!  My doctor then came back to me and told me I didn't stand a chance.  Well, she meant well and it sure did look like I didn't.  Don't give up.  Take some time to collect yourself.  Sometimes insurance companies deny the first time because they know they can save money because lots of people won't appeal.  I think its almost a standard to deny the first time around.  It sounds like you have some options you just need to work it out!  You'll get it, no worries! 
Most Active
×