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Recent Posts
| Author | Message |
 Reinbeck, IA (08/10/10) Member Since: 05/24/10[Latest Posts] | Post Date: 5/24/12 7:45 am Topic: RE: Anyone from Iowa with UnitedHealthCare and fighting Thank you for being my one and only person with any advice. I know my post was long but I was just trying to explain everything so you had a clear picture. With the help of me calling and complaining and my husband Union getting involved they have finally approved my Revision VBG to RNY with Dr. Glas**** |
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IL Member Since: 11/10/11 [Latest Posts] | Post Date: 5/23/12 3:30 pm Topic: RE: Horizon BCBS of NJ Approval/denial time HI My paperwork was faxed 3 weeks ago today to Horizon by the surgeons office. So it looks like its going to be close to the 30 days. Three years ago was a bad setup. The surgeon wasn't much help with the paperwork and I also did not have the required 6 month diet. I was denied due to the diet. This time around I changed hospitals and also got a new PCP that has been great with the process. I also did the 6 month diet through the surgeon. So hopefully everything is in line and no worries. |
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 FL Member Since: 04/22/12 [Latest Posts] | Post Date: 5/23/12 3:15 pm Topic: RE: Horizon BCBS of NJ Approval/denial time I have bcbs ppo, and it took just over a month for them to approve me. I have heard that BCBS has really short wait times, (my mother was approved in 3 days). Why were you denied 3 years ago, could that affect your current application?  |
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 Irvine, CA Member Since: 03/31/05 [Latest Posts] | Post Date: 5/23/12 11:54 am Topic: Weight discrimination and insurance appeals Have you been denied insurance benefits for your weight loss surgery? Have you experienced weight discrimination? Have weight-related limitations imposed on your resulting in discrimination? Navigating the legal maze of insurance appeals and weight discrimination can be challenging and overwhelming. As a four-year WLS post-op (he lost 160 pounds!!) and an attorney, John Panico wants to help. As an attorney, John's primary focus is weight discrimination, obesity bias and insurance appeals, and experienced with the Airline Carrier Access Act (ACAA). John is an OH member - If you would like to contact him, send him a PM on his OH Profile. Thanks John!! |
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Member Since: 05/21/12 [Latest Posts] | Post Date: 5/21/12 10:19 am Topic: MMSI insurance? Hi everyone. I am new to the forums. I have been considering WLS for a few years now, but know that now is the time I need to take action. My weight seems to keep increasing year after year and it is getting to a point where I am uncomfortable or in pain every day due to some problem. My husband just started a job with the Mayo Health System in MN (not the Rochester Mayo Clinic, we are in Southern MN). All I know so far is that the insurance will start on June 1 and is through MMSI - SWMR (?) plan. Does anyone else have this insurance? I am hoping they cover WLS without crazy expectations. Also, throughout the years, I have seen endocrinologists, behavior modification specialists, dieticians, etc....but my BMI during that time was probably just in the overweight category, and not obese. Will those attempts at weight loss still be seen as applicable to an insurance company, even though I was not obese at the time? Thanks for any help!!! |
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Member Since: 04/27/12 [Latest Posts] | Post Date: 5/16/12 12:07 pm Topic: Here goes something (I hope) My insurance carrier is UHC Choice plus and my employer did not purchase the plan with the WLS approved. When talking with a representative she told me to write a letter to the Medical Review Board to appeal for approval. I included in my letter how much my comorbidities have cost them over the past 12 months which total just over $22K and the Gastric Sleeve is $25K. I also included the National Standards for treating obesity. I will keep you posted as to what I have found out. |
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(02/25/09) Member Since: 12/25/11[Latest Posts] | Post Date: 5/11/12 3:13 pm Topic: X-Post Cancelled -pre-ops, *READ THIS* drink deep, or taste not the Pierian spring: there shallow draughts intoxicate the brain, and drinking largely sobers us again." English poet & satirist (1688 - 1744) Because the doctor I was approved for and scheduled for did not request proper authorization, I had to cancel my thighplasty with my alternate doctor. The first doctor cancelled *me*, because I insisted on asking questions, and I'm glad they did, because they lied and said they approved Medicare (primary) insurance when they did not. I called and checked my AARP Medicare plan, alerted the doctor's office, they called and cancelled me the next day. The second surgeon sang the same tune as the first. They do not pre-authorize Medicare prior to surgery, but bill afterwards. I had already received prior authorization from Medicaid. No prior authorization, as most of us know, *guarantees denial from any insurance, public or private* and is a tactic used to strongarm patients out of cash who have it to pay, and weed out those of us who are less than middle-class or affluent. I was middle class before lupus and fibro took over. Not anymore. My weight loss surgery helped bring getting off disability within my grasp. Medicare is not welfare, but senior/disability health insurance that my tax dollars paid for when I was working. I'm convinced that this tactic is used as a form of economic discrimination. I did go to college, and had a very rewarding and well-paying career, until SLE and fibro took over, so I don't fit what most doctors assume when profiling low-income patients: that they are uneducated and maladapted to life in general. It also doesn't help that I'm African-American. That's right. Law enforcement is not the only profession engaging in this horrendous activity. First, I am on these government plans because of disability from lupus and fibromyalgia, not because I don't want to work. I'm trying to get back to being productive. The steroid treatment for lupus helped push my weight up to 405 at its highest. I am now at 165, just five pounds away from my PCP-imposed limit of 160 pounds pre-plastics, thanks to my DS, which was approved by and paid for with the same Medicare coverage I have now. Just 20 pounds from my "chart weight" of 140. My doctor estimated that 15 pounds of my remaining weight was skin and the uneven fat deposits clinging to it. My surgery was reconstructive, not cosmetic. I had been referred for thigh reduction after several bouts of cellulitis, which is an infection of the fat cells just under the skin. The dermatologist that I was referred to determined that it was being caused by abrasion from the compression garment I must wear to keep my lower body skin in place, enabling me to fit into clothes and walk. Partly because my skin had been stretched out for so long, and partly due to genetics, it did not "snap back" after my massive weight loss. Instead of empathy when I called to cancel, I got a chipper "OK, bye!" -CLICK- I played by the rules. I put forth the extra effort to personally retrieve and deliver medical records and make sure everything was in order. ****ep a set of every lab and procedure related to my weight loss surgery, and I even have a copy of my surgical report from my DS) My Medicaid prior authorization expires June 23rd, and there simply wasn't enough time for me to do another consult and find someone who would do the prior authorization correctly. I have Medicaid because of disability. This was a year and a half in the making. I went to four consults after I'd lost the majority of my weight. Only one surgeon said he would not do the surgery. Perhaps if I had not exercised due diligence, and just played dumb, I would be having my surgery, recuperated during the summer and be on my way back to school in the fall. I was seeing light at the end of the tunnel. Now all I can see is darkness once again. Lesson: DUMMY UP WHEN NECESSARY!  |
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 NY RNY (06/11/12) Member Since: 03/28/12[Latest Posts] | |
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NY RNY (06/11/12) Member Since: 03/28/12[Latest Posts] | Post Date: 5/9/12 6:47 am Topic: Please explain... I do have insurance, in fact recieved a pre-approval for WLS. I just completed all my specialist appointments, and met all criteria. So now I have to wait for Final approval??? Well what was the point of the pre-approval, and why does it take 2 plus weeks?? |
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CA Member Since: 05/07/12 [Latest Posts] | Post Date: 5/7/12 11:22 am Topic: Looking For Info About Insurance And Vsg Hi everybody! I'm a journalist at a marketing company based in Los Angeles which specializes in medical and law fields. I'm writing an article about whether insurance companies cover the vertical gastric sleeve. If someone would be willing to speak with me about their experience in whether your insurance covered the procedure or if you had to convince them to, I'd like to hear your story. You could even tell me your experiences anonymously, if you don't want your name to appear. If you'd like to talk to me, either respond to this post or email me at meg@trafficbyte.com. Thanks! |
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CA Member Since: 05/07/12 [Latest Posts] | Post Date: 5/7/12 10:19 am Topic: RE: Approved! UHC community plan Congrats on being approved. Which surgery are you getting (lap band, gastric bypass, VSG)? |
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Cheltenham, PA Member Since: 04/25/12 [Latest Posts] | Post Date: 5/7/12 9:23 am Topic: Insurance won't cover so I need $25,000 I found out my insurance (CIGNA Open Access Plus) won't cover it at all due to the type of coverage that my company decided we needed to have. So I decided I want to finance it myself, either through credit cards or loans. So I would like tips on which lenders are credible and which ones you have used to maybe i can piece together the amount I need. I appreciate any information you all can provide. Thanks! |
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MN VSG (05/07/12) Member Since: 02/05/12[Latest Posts] | Post Date: 5/5/12 10:09 am Topic: RE: 3 year weight recording for Insurance submit them all and see what they say. Worst case is a no, but you never know. |
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Member Since: 05/02/12 [Latest Posts] | Post Date: 5/2/12 10:18 am Topic: 3 year weight recording for Insurance My insurance needs 3 years of weight recording (can be once a year I was told) to be approved. I am bad about going to the doctor so I don't think I can provide that. I do have from years 4-5 ago. Also, I have weigh****chers recordings of weight from the last three years. Any ideas if they will look at something else besides doc weights and will they take from 4-5 years ago? Thanks! |
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IL Member Since: 11/10/11 [Latest Posts] | Post Date: 4/30/12 8:03 pm Topic: Horizon BCBS of NJ Approval/denial time Hey Guys I have my 6th and final visit for my medically supervised diet with the surgeon on Wednesday. Last month they went through all of my paperwork and thought everything looked good. I also did had some blood test to check my thyroid levels. So things are moving at a pretty good. So here's my question. I have Horizon BCBS of NJ Blue PPO. Does anyone have this insurance and has been through this process. I was wondering how long the approval process was for you. I have heard that it could take upto 30 days. Although most take less than 2 weeks. I went through this process about 3 years ago and was denied after 6 weeks of waiting. I was told that at that time that everything had to be mailed which slowed the process. Thanks for any info Bob |
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LOUISVILLE, KY Member Since: 10/19/07 [Latest Posts] | Post Date: 4/29/12 8:12 pm Topic: Grant Hello,I just wanted to let people know about the wlsfa(weightloss surgery foundation association).Its a great foundation where different surgeons,hospitals,anesthesiologists,and sponsors donate money to help people that cant afford to have their surgery, or testing, postop excess skin,etc.Its a great foundation.I urge anyone to go to wlsfa.org to check it out for yourself. I myself have just got approval for a grant for the sleeve.After four years of appeals,letters,phone calls,emotional ups and downs,I finally have a chance to experience the thought of preparing for my surgery.I cant wait! |
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MN VSG (05/07/12) Member Since: 02/05/12[Latest Posts] | Post Date: 4/28/12 8:57 am Topic: RE: 2 year weight requirement Normally the point of that requirement is to show that you didnt just gain the weight and are looking for a quick fix. Since you have documented weights from more than 2 years ago you should be ok. |
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Ypsilanti, MI RNY (05/08/12) Member Since: 02/01/09[Latest Posts] | Post Date: 4/27/12 7:40 am Topic: RE: BCN MI waiting  Congrats, my surgery is coming fast on may 8. so I'm really exicited and nervous !! |
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MI Member Since: 02/13/12 [Latest Posts] | Post Date: 4/26/12 6:37 pm Topic: RE: BCN MI waiting I recieved my phone call from Dr. Robert's office this afternoon. I have been approved for my gastric bypass. I will go in on Monday to set everything up....very excited...but a little scared too! |
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Tacoma, WA Member Since: 08/13/09 [Latest Posts] | Post Date: 4/22/12 7:06 pm Topic: 2 year weight requirement I'm confused reading my employer's policy regarding weight loss surgery. I was thinking that starting the 6 month supervised diet was what I still had to do and I'm going in to my pcp on May 2 to start that but I am really confused on the weight history of 2 years. I have documented weight with a bmi of over 40 for 2009, 2010 and will have it for 2012. I had a visit in July of 2009 where I went to my doctor as a self pay patient to get an antidepressant filled and I have a recorded weight I can get from this time with a BMI of 45.8. I got pregnant shortly after and was on medicaid because I was unemployed. I have a post partum weight from May 2010 with a bmi of 44.2. Right now I have a BMI of 50.6 But I had no insurance and no money for a doctor visit in 2011. I weight myself plenty at home and went on every diet in creation and kept gaining but I had to be at my current job for a year to get health insurance. Now I'm worried I will have to wait until 2014 for surgery and keep gaining weight becuase of no recorded weight in 2011. ugh. |
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