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I just wanted to throw a thought out there with my personal experience on 2/13/13
So I am self pay however I will only be paying for the actual procedure for the surgeons' fee which is $7,000.00. After a big issue of me not having $16,100.00 to cover the facility fee (hospital). I decided to call the insurance company... They won't cover the sleeve but they will cover the hospital portion because it falls under inpatient. So all I have to do is get a letter from my actual doctors' office saying Prior auth for inpatient for surgery sent to insurance from primary care doctor and they will cover the rest except for my copay.. But I rather pay $400.00 a day vs $16,100.00. So I don't know if anyone is going thru what I've just been thru but spread the word because this is really great for those who can get approved for carecredit credit card to take care of procedure and then insurance pay the rest
I am sure you will get a letter, but I would ask them specifically for the documentation in your policy (or certificate of coverage) that excludes WLS coverage for those under 21. I see no mention of it in their online medical policy (Policy Number: 2012T0362P; Effective Date: December 1, 2012). It might be listed in your specific policy or cert of coverage, but usually those 18 and over are covered.
This might just be them grasping at straws to try to deny you on the first go around. I think your doc would likely be successful on his appeal - there are just too many studies showing the benefits of surgery, especially on the younger patients.
Good luck!
HW: 274 | SW: 232 | CW: 137 | Goal: 145 (ticker includes a 42 pound loss pre-op) | Height: 5'4"
M1: -24 (205) | M2: -14 (191) | M3: -11 (180) | M4: -7 (173) | M5: -7 (166) | M6: -8 (158) | M7: -11 (147) | M8: -2 (145) | M9: -3 (142) | M10: -2 (140) | M11: -4 (136) | M12: -2 (134) | M13: -0 (134) | M14: -3 (131) | M15: +4 (135) | M16: +2 (137)
So whats the deal with having to be 21. i got told that but i know a lot of people that have had it before they were 21
I was just told by UHC they wont cover my surgery because im not 21. My surgeon is doing everything he can to appeal that because he said it was a ridiculous claim and hes done patients as young as 16. Im tired of waiting. My friend had his when he was 20 why cant i? :(
Anyone have any experience with tricare prime? I'm wondering how long it takes for them to get the referral to your surgeon in the computer. Thanks!
HW 280 SW 258 GW 165
What is BLIS and where are you located. I am self pay VSG to DS and working on saving the $$ for OR. I am in St Louis, MO. been quoted 23K for the revision. Maja
Even if anyone responds to this, I am not sure how much it will help you, as all plans are different, as are all policies. You really need to look at the policy YOU have to see if it is covered. If WLS is not excluded, and you fit the criteria, then you will be covered. Those are pretty big ifs, however, and you should probably call your insurance company to get the most accurate information.
Good luck!
HW: 274 | SW: 232 | CW: 137 | Goal: 145 (ticker includes a 42 pound loss pre-op) | Height: 5'4"
M1: -24 (205) | M2: -14 (191) | M3: -11 (180) | M4: -7 (173) | M5: -7 (166) | M6: -8 (158) | M7: -11 (147) | M8: -2 (145) | M9: -3 (142) | M10: -2 (140) | M11: -4 (136) | M12: -2 (134) | M13: -0 (134) | M14: -3 (131) | M15: +4 (135) | M16: +2 (137)
Hockeymom87 · 0 replies · 857 views
