Angry and frustrated in Toledo!

[Sandy3 0]

I am probably going to ramble a little. Over a year ago I attended a seminar with Dr. Duckett in Maumee. Paramont is my insurance. Dr. Duckett's office said they were in the process of signing a contract with Paramont for lapband. I was told to keep calling the Dr's office as they expected to sign soon. Finally in Sept. they reportedly signed and Paramount will now pay for lapband through Dr. Duckett.....they neglected to say that only 25% of the company policies will cover with 75% not covering even if it is a Paramont covered service. Additionally, NOBODY seems to know that Paramont will cover the surgery as long as it is not excluded from your employer policy. Of course it is excluded from our company policy because, as our insurance broker said, "it has never been a covered service and is excluded from all paramont policies". So, I said to the Dr.'s office rep that I have spent the last year gettiing all the documentation ready for when it was a covered service. I had my psych eval (a year ago on 10/5/05); I hve continued in therapy to address eatiing disorder issues; I have been visiting my PCP monthly for the last 6 months for medically supervised diet; he is willing to write a letter indicating it is a medically necessary procedure as is my cardioligist and my therapist (who is affliated with the surgeon). So the office manager says "Why have you been doing all that stuff when the procedure wasn't even covered during the time you were doing all that stuff? You were just wasting your time!" And I sez, "Well, each tiime I called your office during the year I was told "call back next week ....call back next month...we're very close to signing!' She sez, "Well that's what we thought", I sez "If I hadn't done anything while waitiing you would have said "well why didn't you prepare?" I AM SO TIRED!!

Soo..I am gettiing the letter from my PCP today, letter from my therapist tomorrow, letter from cardiologist this week. I will present them to my employer along with the name of the Paramont manager who is handling the lapband stuff. Hopefully once my employer has the information that the procedure is medically necessary and that Paramont will pay if not excluded from company policy, the company will add the procedure to our policy. The other issue is the fact that my employer will be asking for quotes from other insurance companies as this is the time of year that they will change insurance companies if they can get a better deal. Another company may or may not allow the surgery. At this point self pay is not an option so on with the red tape!

Thanks for listening

Sandy3

[Guest Michael S.]

So sorry to hear about all the red tape hope it works out in the end good luck

Michael S.

[Sandy3 0]

Thanks Michael...things are better already.

[Guest fattygirl]

hope things can get better for you

[DiSanders 1]

I applaud your tenacity. I am blessed to be able to "self-pay" because I KNOW I would not have the patience to wade through the insurance hassle. Why don't the insurance companies recognize that this is actually a cost-EFFECTIVE procedure in the long run? I know my meds for anxiety, depression, and heartburn (all weight-related!) EQUAL what this band will cost in one year's time! Do you have a retirement plan to borrow against, or a

generous relative? This is the time to get industrious! I would take out a loan at any interest rate if I had decided this was right for me. The best investment is YOURSELF!!! Hang in there-Diane:Bunny