Recent Posts
Consider switching your plan to Mercy Care, they approve more often then Health plan.
They all, meaning AHCCCS have to follow the same guidelines for approval.
They claim they are: 5 years medial history of obesity, 6 month supervised weight loss losing 5% of body weight, and then all the pre op evaluations and tests.
They really are: 2 years medical history of obesity, 6 month supervised weight loss program where you do not gain any weight, and the pre op evaluations and tests.
I went to Dr Simon first, and was denied, for I gained 2 lbs in my weight loss regimen. If I had known what I now know, I would of considered wearing heavier clothing on the first weigh in then the last. If they had known, and informed me, I would of starved myself a week to lose those 2 lbs, but at that point I already thought I had failed. I did not know the truth was all I needed to do is stop gaining.
I switched to Banner Gateway bariatric Center, in East mesa. They are so knowledgeable with dealing with insurance companies hoop jumping and excuse making, that they have a 95% approval rate from them. They require more then they do, but in a good way. All surgeons tell you not to smoke, it interferes in healing, but they actually nicotine test you. All tell you support groups and education are benefits, but they require attendance in a minimum of 2 information sessions. These are examples.
They also have much better success rate then average with keeping the weight off, because they use a comprehensive weight loss program, where the surgery is just a tool. I highly recommend them. I will be submitting a request fcor coverage again really soon, and am 98% sure they can not deny me this time.
I am looking to get the VSG...if anyone has Harvard Pilgrim HMO and got any type of WLS... how long did it take for Harvard to approve your surgery?
Also any information you may have in regards to what type of health conditions a person needs to have so Harvard can approve surgery.
thanks
-May
Have you or anyone you know of been successful at getting Kaiser Northern California or Medicare to cover a revision from VSG to DS?
Almost 2 yrs ago I was injured quite badly in a car accident which I am still recovering from. I had my VSG 1 yr before the car accident and was initially quite successful.
Now I am only down about 25 lbs since the surgery (although still down about 150lbs from my highest weight). There are so many issues at play it’s difficult to determine what caused the weight regain but I think it is largely due to having traumatic brain, spinal and other injuries which have not allowed me to fully follow my food plan or exercise. Adding in depression and profound fatigue as a result of the accident with a re-occurance of serious thyroid issues and menopause it has been a difficult couple of years all round.
The weight loss allowed me to feel freedom in my body for the first time ever. I want that back.
Currently I have COBRA coverage with Kaiser N Cal and eventually hope to have Medicare coverage.
Any insights or suggestions on how I could possibly get a revision to DS covered?
Thanks very much for your feedback.
My insurance excludes weight loss surgery, so I am going to have to be self pay. Because my insurance will not cover WLS or any complications resulting from the surgery, I won't consider a Dr. without BLIS insurance. I am having trouble finding a dr. who is affordable with BLIS, that is also a COE. I found one, but after doing research discovered that he was sanctioned. A patient died in his care and the board felt that the Dr.'s actions contributed to the death. Does anyone know of a Dr. they can recommend that is with a COE and has BLIS and does not charge the moon and the stars?
I know?! It is infuriating. And so frustrating. Good luck, Keep me posted!
Has anyone who is trying to get WLS through UHC had this problem? They say 2013 plans are not loaded into the system. I mean, we can put a Man on the Moon, but we can't load this info 10 day before a New Year? Anyone else? Any advice? I have gone to HR and all they have is the Medical SPD. They've sent me back to UHC....
I'm asking for a friend - what BMI and co morbidities do you have to have to get into their program - I am asking for a friend who wants WLS. Thanks!
.any info if medicare covers?