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Hey Guys! I am new to this site and am in the beginning stages of my weight loss surgery journey. I have BCBS of MN through my employer and luckily gastric bypass and the vertical sleeve are covered. (haven't completed decided on which I want) I have gone over the medical policy that was sent to me from the BCBS but I still have questions. My main question is what documentation needs to be gathered to present to the insurance company. I have already gotten my letter of medical necessity from my PCP. I am in the process of getting my psych evaluation completed and I am in second month of the 6 month medically supervised diet. Other than the BMI qualifications, which I am more than meeting, these items are the only thing mentioned as qualifications for approval. However, I have seen other ppl on this site talk about gathering medical records and other items. I am just curious as to what all I need to be gathering over the next few months.![]()
Hi, my name is Kim. I was wondering if you still had a copy of the 6 month medical diet. I am going to have gastric sleeve but it is being put off due to this dietary regulation. My email is [email protected].
Thank you so much for your help. I really appreciate it. ?
Hi my name is Kim. Do you still have a copy of the 6 month diet. If you do would you please email me a copy.
Thank you!!
Is there anyway you could send me a copy of the paperwork for the 6 month diet that you have. My insurance needs me to do the diet too.
My email is: [email protected]
Thank you!!
I have UHC POS and there is a written exclusion. Has anyone been able to get bariatric surgery covered under this plan? I'm desperate and cannot afford the cost of the surgery. I've already asked my employer to add the benefit to the plan. NO response of course. PLEASE ADVISE. Thank you!
I have Aetna. I called member services and asked if it was covered. They got my member number etc. Told me it was covered and then emailed me a detailed document that basically tells what you need to do to qualify. The member services rep was very helpful, but I do know that you have to tell them your member ID number and they will tell you whether or not your company has purchased the obesity rider.
Hollykim,
Thanks for the suggestion. I am hoping to push them into changing the policy due to numerous severe comorbidities. My husband's company is Self Insured, and I plan to throw a lot of stats at them that it would save them money in the long run to allow it for me at least...I've already had 2 spinal surgeries, and need a 3rd, as well as a knee replacement which may possibly be put off IF I were to lose the 200 pounds I am over my ideal.
Cheers,
RhainyC
If you have been approved, what is the name of your insurance company and what type of policy/name of policy did you have?
Which insurance companies are the easiest and worst to deal with?
I really can't get into the politics of it but suffice to say that I know for a fact others with the same policy and exact same insurance had the surgery paid for. No, they did not have their spouses pay for it. I have the most expensive, highest end policy our company offers so that cant be it. HOWEVER, if they did go out and buy their own, I'd be interested in knowing how that works. Mostly, how do you navigate Aetna POS? Anyone have any luck?
I am trying to work through the Aetna system and so far, have been met with a lot of frustration. I was told to check on my approval by my bariatric provider. So, I called Aetna and was told that my policy did not cover bariatric surgery. HOWEVER, I know several people who have my exact same policy in my company who have had the surgery. No, they did not self-pay or go to Mexico. There has to be something that I am not doing correctly. I am appealing to you--what do I need to do? How do you get approved? Aetna is sort of vague on their website. On one hand, they say that tell you the exact steps that you need to take in order to do the surgery. I'm on board with that. Trying to get all of my stuff together. NO PROBLEM. My bariatric provider (on my first visit) went on and on about what I need to do (mirrored exactly what Aetna said on their website). BUT... also on their website it says that they don't cover bariatric surgery. Am I using the wrong words? I told the Aetna rep, when I called, do you cover bariatric surgery? She said, "No, we don't." I asked about riders or buying coverage.
How did you navigate the Aetna maze? What do I have to do to get covered? I have an appointment in 3 weeks with my surgeon. Do I let the provider submit it and then be rejected? What are the steps that I need to take. And, no I can't discuss the surgery with those that had it. They are in another state and I would not feel comfortable in broaching that subject.
THANK YOU!
