Insurance battle looms

Well we got our benefits newsletter from 5/3rd Bank yesterday in the mail and I read it this morning. QUOTE All medical plans will NOT cover gastric bypass and related services This means for 5/3rd employees if you are planning a bypass you are going to have to be done by 12/31/03. Also The univercity of Cincinnati will not be offering the gastric bypass as a benefit to its employees either. Together that is over 50,000 employees.

With all these insurance companies reducing benefits, the State of Louisiana OSG just did the opposite. It appears that they are now encouraging MO employees to have the procedure. There was a feature on the local news in Columbus a couple days ago.

i'm going to be nasty and it is not directed at any of you......i think they all want us to roll over and die if we won't go away first...sorry- found out 10 mins ago that med mut won't even look at my new request for diff surgeon and site- i have to appeal first denial- and have now lost 30 days of my 180...they wouldn't even LOOK at the new comorb etc...why didn't they say that 2 weeks ago instead of saying 'no, they had not rec'd my new request please send again' ok- i'll stop whining--i'm so bummed i can't even cry!

Margo, Keep fighting. Don't give up. We are behind you.

thank you, jack! i know that! i may have another strike but i'm not out yet!!!

What are they thinking? Instead of shelling out a one-time fee for WLS they may have to pay for: monthly meds to control asthma, insulin for diabetes, heart medications, oxygen, and numerous others. Also, how about heart attacks and open heart surgeries? Or, as in my case, 4 hospitalizations in 6 months for asthma. (3-8 days each time including numerous tests) It boggles the mind to see how some big companies work. They continually raise the cost health insurance because of their cost but don't look at what they can do, such as WLS, to SAVE money! I wonder, is there any way we can get our legislators involved in this fight?

I was wondering about a class action lawsuit. Bit do you sue the employer who buys the policy or the insurer who offers it. Any shark lawyers out there have an opinion on this????

Patients of St. Vincent's have their own message board. Another patient just posted the following information that should be a help to those who are being denied. Talk about timing! Here is a link to the State of Ohio's laws and a new bill concerning WLS for morbid obesity. http://www.legislature.state.oh.us/bills.cfm?ID=125_SB_41 Someone else wrote the following information: At that same sight if you go to the 123rd Assembly and House Bill 4 (it is law now) there are tips in there on how to appeal and the steps needed to be taken. We need to be aggressive about our health! Mary Beth

Mary Beth; Thank you !!! now HOW do we get it passed?????? yes, we need to be aggressive!!!! ? tho-at the very very bottom sect 2 sect 1751.69----i am not legalese so doe sthat mean that only upon renewal of policy or to add to existing-say of MMO????

I am not sure myself, but I think this part means that after the effective date of this act, ALL policies, new or those being renewed, MUST include WLS if there are any other health risks involved. I am not sure this will help your case but I know there are other sites concerning appeals for those denied. I will let you know what I can find out. I do know our hospital has helped people with these problems, I happen to have a really good insurance policy and was approved without incident. (sorry) Any lawyers out there want to help us interrpret this act? Maybe you know of other recourses for those denied?