Recent Posts

Dean66
on 1/8/13 3:03 pm - Clackamas, OR
Topic: UHC Help or advice Needed They say it is excluded in Oregon

Hello there, So today I started two additional medications and now up to 8. This is for blood pressure, diabetes and not sure what else they are trying to control except for these two things.

I have the support of my regular doctor. I went to see a cardiologist to make sure I was healthy enough for the surgery and that my heart was in good shape. This doctor is also a  true believe and feels I am an excellent candidate. We contacted OWLLS and were told that the insurance will not pay for it. I do have an exclusion for weight loss surgery. To get around this I was told to have everyone go in with angles of all the needs to be done to remedy what is wrong.

I have never gotten a letter from anyone saying NO. I only get this over the phone. How does a person get past the main people answering phones? Get someone to look at all the records?

 

Anyone in Oregon know any way to get around this or some advice?

Thank you,

Dean

 

Dean
laquita88
on 1/8/13 6:48 am - wilmington, DE
VSG on 05/29/13
oklahomafarmgal
on 1/8/13 2:32 am
Topic: RE: United Healthcare

I hit the 40 mark This past year. Keeping my fingers crossed.

noftessa0401
on 1/8/13 1:25 am - San Diego, CA
RNY on 12/27/12
Topic: RE: United Healthcare

I don't have any information, but I wanted you to know that I feel your worry.  Hopefully someone will have an answer for you.  When did you hit the 40 BMI?  I have heard insurance companies that have a written policy of 5 years 40+ BMI, but really will accept a 2-year history on appeal.  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)

oklahomafarmgal
on 1/7/13 11:57 am
Topic: United Healthcare

I am really concerned with United Healthcare approving my surgery. One of the requirements is 5 years of morbid obesity documented. I believe morbid obesity is considered a bmi of 40 plus. I have a bmi of 40 this past year, but the previous years started at 36 and keep going up till now. Does anyone know if UHC are real sticklers on that? I have about worried myself sick over it. I meet all the other criteria except this one.Thanks for any information anyone can give. Thanks.....

CoCoBrown313
on 1/4/13 10:58 am - MI
Topic: Out of pocket with medicare
Just wondering if anyone knew what if any is the out of pocket for RNY. I only have regular medicare. If there is an expense does it have to be paid up front or do they allow payment plans?
Tammy C.
on 1/2/13 9:22 am
Topic: 2013: 20 Funny New Year's Resolutions

2013:  20 Funny New Year's Resolutions

When it comes to New Year's resolutions, our family members and friends can get quite creative and even funny with what they resolve to do in the New Year.  Here a few good ones I have heard along the way...Oh, and a few of my own!

1.  I resolve to stop procrastinating about procrastinating!

2.  I will stop sending Facebook messages and emails to my loved ones when they are in the same room as I am!

3.  I will use my treadmill for something other than a place to hang my jacket.

4.  I will not sit at the kitchen table in my PJ's all day.  Instead, I will move my computer to my bedroom.

5.  I vow to never take a laxative and a sleeping pill on the same night!

Click here to read more!

All my best, 

Tammy Colter
Director of Media & PR
Editor-In-Chief
ObesityHelp.com
OH Magazine
May Q.
on 1/2/13 9:03 am
VSG on 06/26/13
Topic: RE: anyone have Harvard Pilgrim HMO of Mass?

Thanks I really appreciate your help... Drrr why didn't I think of thatlol

-May /http://newday4may.blogspot.com/

 

noftessa0401
on 1/1/13 5:27 am - San Diego, CA
RNY on 12/27/12
Topic: RE: anyone have Harvard Pilgrim HMO of Mass?
Don't have this insurance so I'm unsure of the time frames, but for your other question, google is your friend.

https://www.harvardpilgrim.org/pls/portal/docs/PAGE/PROVIDERS/MEDMGMT/MEDICAL_REVIEW_CRITERIA/BARIATRIC_SURGERIES-6-27-12.PDF

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)

anonymous_one
on 1/1/13 1:53 am
with
Topic: RE: Has anyone written their own letter?

Can anyone PM me the letter too please? 

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