Shot down ....

Well shot down..... For now Berlin - the insurance coordinator at Dr Lauters office - has been talking with my insurance on the phone. The finally told her that they are appproving NO ONE else for the rest of the year for bypass surgery. They are 're-evaluating' their policy on weight loss surgery by researching past patients who have had it to see if the risks/complications outweigh the cost of the surgery or not. They will be making this decision come the first of the new year. UGH Needless to say i was a mess yesterday when Berlin called. But she also said that she has my paperwork (and a few others with my insurance) and she will be sending them into the insurance the middle of december. Took me a little while to realize that isnt all that far away but i still cried and i'm nervous they will decide not to approve the surgery anymore. That would be just my luck - they made this decision mid august 2003. IF ONLY i had been a few weeks ahead in my journey *sigh* take care of yourselves. I may be down but i'm not out...yet wendy

Hold on a minute....Now I am not an attorney, just a paralegal who helps people to make good arguments to get their insurance approval BUT.... This is the biggest run-around I've ever heard. If you have and pay for a policy and the policy you are paying for covers this then they can "re-think" all they want...until they formally make the change that excludes this coverage, and give you written notice of the change, well, I don't think they can say no, especially if your policy says yes! I would do some more research or have someone representing you find out. Sharon Weinberg WLS Insurance Advocate

i wi**** was that easy Unfortunately...while i do pay a monthly fee for my insurance...it is still basically through Medicaid for my state...which i suppose they take to mean they can do whatever they want without notice..which they did..they sent out letters to all the WLS surgeons in their network explaining it... i have read the exlusions and coverages and it actually does not cover WLS but it does NOT exclude it either ugh so dealing with the state..even in my - fee for service - plan i have a feeling all i can do is wait wendy