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anonymous_one
on 1/1/13 1:43 am, edited 1/1/13 1:46 am
with
Topic: RE: Phoenix Health plan, AHCCCS

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. 

May Q.
on 12/31/12 1:09 am
VSG on 06/26/13
Topic: anyone have Harvard Pilgrim HMO of Mass?

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

A_Whole_New_Me
on 12/26/12 4:52 am
Topic: Revision from VSG to DS covered by Kaiser N California or Medicare???

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. 

serenity1959
on 12/23/12 11:37 pm
VSG on 08/05/13
Topic: Looking for a Dr.

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?

sarapilar
on 12/23/12 9:43 am
VSG on 02/21/13
Topic: RE: UHC won?t give me my benefits and WLS requirements for 2012 - argh!

I know?!  It is infuriating.  And so frustrating.  Good luck, Keep me posted!

"The most difficult part of changing how you live and eat is believing that change is possible. It takes a fierce kind of love for yourself."Geneen Roth
    
sweetangelmd37
on 12/22/12 8:50 am
Topic: RE: UHC won?t give me my benefits and WLS requirements for 2012 - argh!
I have UHC and I am getting mixe messages. Was originally told no 6 month diet and no Psych evaluation. I was then told I needed both. My surgeon sent in documents as they were told, only consultation and 40 plus BMI. I spoke with UHC and they received documents on 12/17 and it is pending. I am praying I get the approval call.
sarapilar
on 12/21/12 1:30 am
VSG on 02/21/13
Topic: UHC won?t give me my benefits and WLS requirements for 2012 - argh!

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....

"The most difficult part of changing how you live and eat is believing that change is possible. It takes a fierce kind of love for yourself."Geneen Roth
    
sarapilar
on 12/21/12 1:27 am
VSG on 02/21/13
Topic: Requirements for Kaiser Bariatrics?

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!

"The most difficult part of changing how you live and eat is believing that change is possible. It takes a fierce kind of love for yourself."Geneen Roth
    
bellen
on 12/20/12 1:50 pm
Topic: RE: Revision
U have to prove a complication with the band such as acid reflux disease etc....then its medically necessary.
bellen
on 12/18/12 1:52 pm
Topic: medicare coverage question
I had the lap band 5years ago with blue cross/sheild.......im needing the band out with a revision to rny.
.any info if medicare covers?
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