Update on Medical Insurance

(deactivated member)
on 4/21/09 4:07 am - AZ
On April 21, 2009 at 11:00 AM Pacific Time, smileyjamie72 wrote:
OK, here is a little more.......  This is under the "Defined Terms" section:  A little above, and a little below


Mental Disorder

Mental Disorder in the current edition of International Classification of Diseases, published by the U.S. Department

of Health and Human Services or is listed in the current edition of Diagnostic and Statistical Manual of Mental

Disorders, published by the American Psychiatric Association.

means any disease or condition, regardless of whether the cause is organic, that is classified as a

Morbid Obesity

shortened life span. The current clinical standard measure for Morbid Obesity is a BMI (Body Mass Index) of 40+.

The BMI is a factor produced by dividing a person’s weight (in kilograms) by his/her height squared (in meters).

is a serious disease associated with a high incidence of medical complications and a significantly

No-Fault Auto Insurance

reparations provision of a law providing for payments without determining

fault in connection with automobile accidents.
----------------------------------------------------------------------------------
And this is under the "Plan Exclusions"

Charges for nutritional supplements.

(24) Obesity.

part of the treatment plan for another Sickness. Medically Necessary non-surgical charges for Morbid

Obesity will be covered.

Care and treatment of obesity, weight loss or dietary control whether or not it is, in any case, a

(25****upational.

work for wage or profit including self-employment.


This is all just as it is written in my primary insurance plan booklet.

Thanks again, for making me look back at it.
-Jamie

Care and treatment of an Injury or Sickness that is occupational -- that is, arises from

(23) Nutritional supplements.

is the basic

Please.... go to the band boards and do a shout out for Vicki the Ins Guru.  She volunteers her time to read stuff like this and she will HELP you work through all this.  She doesn't charge a dime, she just helps people with ins issues.

Do a shout out for her and supply this link.  She'll come over here and she will talk you through every step of the process.

smileyjamie72
on 4/21/09 4:52 am - Palmer, AK
THANK YOU!!!!!!!

RNY 2/26/2002                           DS 12/29/2011
HW 317                                     SW 263 BMI 45.1
SW 298                                     CW 192 BMI 32.9~60% EWL
LW 151 in 2003  
TT 4/9/2003

Normal BMI 24.8 is my GOAL!!!

 

 

 


 

 

 

GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**

JROLFSON
on 4/21/09 6:50 am - St. George, UT
Dear MWG:

I just wanted to tell you how nice and informative you are! You go to great lengths to help others on this board.


In case you haven't been told before, you're special!

JRolfson
(deactivated member)
on 4/21/09 7:27 am - AZ
On April 21, 2009 at 1:50 PM Pacific Time, JROLFSON wrote:
Dear MWG:

I just wanted to tell you how nice and informative you are! You go to great lengths to help others on this board.


In case you haven't been told before, you're special!

JRolfson

Thank you, that is very sweet of you to write.

There are vets here that really do try to help people.  Vicki will help anyone with any insurance issue.  Mindy will help people clean up their credit to get loans for surgery.  I help people research doctors and verify information vs. believing what the coordinators tell them.  Others are experts in surgery types... we all do what we can.  It's the right thing to do.

lousea47
on 4/21/09 8:27 am - maplewood, MN
Jamie, your doing a wonderful job of researching.  I've started to see a surgeon here in Minnesota who is from the University.  The U is considered a "Center of Excellance", so my insurance will cover almost everything providing I go through their requirement hoops.  I had a RNY back in 1998 by another surgeon here in the Twincities.  This new surgeon came highly  recommended.  I just cannot find any information on the revision he wants to do.  He told me that he was going to give me a "longer Arm" to bypass more of the smaller intestine.  But that it is not considered a DS.  He said I essentially had the RNY with a DS back in 98, it just didn't have enough of the small intestine bypassed.  So, I'm a bit confused.  I go April 29 for an Upper GI and swallow study to see how things are looking in there.  I'm somewhat worried, but the right things will happen as they need to.  before my first RNY I was at 285, got down to 140 for about 2 years.  Started expriencing very Low iron that required iron transfusions.  I always feel better after those, and they seem to be 18mos to 2 years apart.  I have been experiencing pain in my upper abdomen, from Left to Right side, nothing debilitting, just irritating..I'm hoping next Wednesday will show something.  I honestly can't say I regret a minute of the first surgery, and if possible, I'll go through it again and work harder at it, I'll work for it this time, not expect the surgery to be my magic wand.  You have all my best wishes.  If you find Minnesota offers you a good option for surgery, and can stand 2 dogs and a 21 year old "redneck" kid, you can by all means stay with me and enjoy a Minnesota season. 
btw, my surgeon will be Dr Buchwald at the University of MN.  Almost a pioneer in the procedures, very knowledgable, up front, and caring.....
Take care, I'll look forward to hearing how things pan out for you.

Connie
smileyjamie72
on 4/22/09 3:44 am - Palmer, AK
WOW!!!  Thanks for the invitation!!!!  I sincerely appreciate it, and will definately keep that in mind!!!!

I hope your GI and swallow study go well, and you get some answers. 

I am just trying to figure out the language of the insurance company exclusions.  UUGGHHHH.  Oh well, I will get a translation eventually.

Thanks Again!!!!  I was born in Northern Minnesota.  Warren.  30 miles from Grand Forks.
-Jamie

RNY 2/26/2002                           DS 12/29/2011
HW 317                                     SW 263 BMI 45.1
SW 298                                     CW 192 BMI 32.9~60% EWL
LW 151 in 2003  
TT 4/9/2003

Normal BMI 24.8 is my GOAL!!!

 

 

 


 

 

 

GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**

lousea47
on 4/22/09 9:55 pm - maplewood, MN
Jamie, this is scary....I was born up on the Minnesota/Ndak border of Fargo Moorhead. My home town was Dilworth.  My childhood home was right on Highway 10 near the park and train display.   hehehe, very small world. My offer is good.  Maybe you want to look into the University Of MN.  Lot's of good docs there.  I don't get online a whole lot, but if you post to me, I'll always answer, keep me up to speed.  And of course, if you come to MN, your family is welcome too.  We've got a small place, but there is always a spot to put a mattress or a couch to sleep on.  (I'll kick Alex out of his room for a bit.)  It was nice hearing from you...take care!
smileyjamie72
on 4/23/09 4:42 am - Palmer, AK
Way cool!!!!  I am keeping an open mind about doc's.

Thanks!!!!!
-Jamie

RNY 2/26/2002                           DS 12/29/2011
HW 317                                     SW 263 BMI 45.1
SW 298                                     CW 192 BMI 32.9~60% EWL
LW 151 in 2003  
TT 4/9/2003

Normal BMI 24.8 is my GOAL!!!

 

 

 


 

 

 

GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**

JROLFSON
on 4/24/09 4:59 am - St. George, UT
Dear Connie:

By your post here it sounds like to me your Dr. is planning on giving you a ERNY. Which is an extended RNY...He will probably shorten your common channel or perhaps bypass more intestines. If he's not planning on doing anything with your pouch or stoma, I believe that is what he might do.

I am having an ERNY next month and have done much study on the subject....It's not the fix for everyone but I'm hoping it is for me.

Good Luck you are very generous to offer your home....What a great person!

Janie
lousea47
on 4/25/09 1:08 am - maplewood, MN
thanks Janie.  I'm hoping t his Wednesday tells me more.  I'm more worried about the pain that I have been having in my upper adomen area, not totally a burn, and it stretches from right to left/lleft to right.  there really isn't a rhyme or reason on where.  I've also gained alot of weight back, very quickly.  I just want to know all is well down there...If he has to fix or change something, that's good too....He said I basically had a DS now, and he just wanted to move that and bypass more.  But I remember that when I initially had my surgery, the doc said a RNY, but would help with my "sugar" cravings, and also help to deter the diabetes that is so prevelant in my family, she said nothing about a DS.  Just coming on hear and reading the past week has helped alot to learn, I'm collecting my corrections for the Doc for Wed at my appt.  I'm just hoping that I'll be un-loopy enough to ask and comprehend questions and answers.  Thanks for your insight Janie.....BTW...
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