Recent Posts

nicolejohansen
on 9/5/12 6:53 pm
Topic: One surgery, per lifetime HELP!
Would like your guidance…will try to make this long story short, but want to give you some background info. In 2010 I had Lapband surgery lost 90 lbs and committed to a healthy lifestyle. In 2011, I had the surgery reversed because of the procedure failing and causing major medical issues due to erosion. I am trying to have my surgery to fix the procedure, but they can’t do the same procedure because of the same complications so they want to use the gastric sleeve.

The request to the insurance company and my benefits department at my actual company were denied as were my two appeal due to “One surgery per person per lifetime". They said I've exhausted my two appeals and the corporate benefits people keep referering back to United Healthcare's one surgery per person per lifetime.

I'm at a loss here trying to get them to understand that this is a very different situation, and while I understand the need for the policy due to people trying to use multiple surgeries as a “quick fix", this really an exception to the rule…I’m not trying to have a second procedure, I’m trying to correct the one surgery (procedure) that failed. Had my “one" procedure not failed me, I would still have it and still be doing incredibly exceptional. I'm also at a loss as to who I should be fighting this with....

Just wanted to get your thoughts on who I should appeal to or what help is out there? I can't afford a lawyer and with my company telling me there isn't anything else I can do, I'm not sure where to go
montana28
on 9/5/12 6:42 pm - FL
Topic: RE: BCBS FL State changed policy!!!!!
Thanks Walter. I just found out thru a mutual friend. My Dr. office heard it from a drug rep. Guess BCBS doesn't want to get flooded with requests just yet. The timing didn't make any difference, my Dr was out of town last week and I've been out of town for the last month. Dr. office submitted forms today and BCBS returns denial/acceptance w/in 72 hrs, so it's all good.
Jules
Jules
Jodi_wantstoliveagain
65

on 9/5/12 1:45 pm - Onancock, VA
Topic: Insurance
Post Date: 9/5/12 1:38 pm
Hi All! My name is Jodi I am morbidly obese and have a letter stating surgery is life threatening and is a medical nessesity. I have Anthem HealthKeepers With NO Rider/ Exclusion. It states
OBESITY: Services and supplies related to weight loss of dietary control, including complications that directly result from such surgeries and / or procedures. This includes weight loss reduction therapies / activities, even if there is a related medical problem.  Notwithstanding provisions of other exclusions involving cosmedic surgery to the contrary, services tendered to improve appearence (such as abdominoplasties, panniculectomies, and lipectomies), are not covered services even though the services may be required to correct deformity after a previous therapeutic process involving Gastric Bypass Surgery.

I have sleep apnea
High Blood pressure
Stents in my heart
uncontrolabl diabetes
edema
depression
p.a.d
Sciatica
dyspnea
very high cholestrol
BMI is 51
and a few more issues


My question is does anyone understand this policy and can i get my insurance comp. to pay for my surgery? PLEASE help me. I want to live... Thank you so much in advance
12Rowrena
on 9/5/12 5:36 am - Reinbeck, IA
Topic: RE: Anyone from Iowa with UnitedHealthCare and fighting
I am telling you now that they told me the same thing but as I talking with  Dr. Glas****'s Insurance ClerK, Kim, she can tell you how to get around it and have your surgery closer to home where it should be done.  I had my surgery at Satori with Dr. Glas**** and she got it approved.  So if you are still interested in having somewhere closer to your home it can be done.  Call Dr. Glas****'s office and ask for Kim and she will explain to you what needs to be done to get you approved to have it done somewhere that is not a provider.  I don't know what type of surgery you are wanting but you can go to their page and take a look at what they do http://www.wheatoniowa.org/programs-services/weight-loss-sur gery/about/default.aspx

I had a more involved surgery as I had a previous VBG done in 1999 so I had a revision from a VBG to an RNY and I had many medical problems and my surgery was tough and lasted close to 5 hours give or take a fewe minutes from what I am told.  I was in the hospital 10 days and back to the ER twice with another admision for acute renal failure which means I got very dehydrated because my feeding tube plugged up for the second time.  I hope you all the luck in the world but if I had to do it over again I woldn't have changed a thing.  I still have my feeding tube in till 9-11-12, at my next appointment and then I will be worried about getting in the liquid and protein after that.  I have found a couple items I should never have eaten and will never eat again.  I have different forms of the dumping symdrome depending on what I've done wrong and I'm learned fast as it is no fun. 

Good Luck!

Rowrena Tichy

Walter Lindstrom
on 9/4/12 8:58 pm - Chula Vista, CA
Topic: RE: BCBS FL State changed policy!!!!!
www.obesityhelp.com/forums/amos/4562150/Blue-Cross-Blue-Shie ld-of-Florida/

I posted on this a couple weeks ago - I sure wish you had seen it or known about it sooner but hopefully that delay didn't really impact your approval.  Good luck!
(deactivated member)
on 9/3/12 9:39 pm - Lawrenceville, GA
VSG on 12/15/12 with
Topic: RE: BCBS FL State changed policy!!!!!
Now that is some good news! Thanks for sharing.
(deactivated member)
on 9/3/12 9:37 pm - Lawrenceville, GA
VSG on 12/15/12 with
Topic: RE: Self Pay
I've changed companies since I've started this journey and neither covered this insurance. I personally think its sad. I even started looking into companies that did cover it and considered changing jobs again which was nuts.

I've never done the loan thing with a family member or for myself. I knew I needed the surgery. I just didn't want to be paying back a loan plus interest. But I know there are companies like carecredit.com that doesn't require a co-signer. They are very flexible on the credit score.
montana28
on 9/3/12 7:13 pm - FL
Topic: BCBS FL State changed policy!!!!!
BCBS FL State has changed the policy!! They REMOVED the time requirement for prior weightloss trials. It is no longer six months!!  Joy!
Jules
Lfrost77
on 8/30/12 11:02 am - Waterloo, IA
Topic: RE: Anyone from Iowa with UnitedHealthCare and fighting
 I actually just got off of the phone with United Healthcare and I also have Deere Premier for my coverage. They will not cover Sartori hospital but they do provide coverage as long as it is in network or at university of Iowa. The closest doctor I found to this area is in Fort Dodge and Mason City. I called his office and have my first appointment in 2 weeks! Hopefully you ave gotten some answers by now but I thought this might help!
seattle93
on 8/25/12 9:57 pm
Topic: Insurance Question*HELP
 I'm in the finally stages of meeting my requirments for my insurance company so I can have the Lap-Band surgery performed. The question I have is insurance will only cover 50% and I know that is great being that some people have no coverage but can I request that they cover more? Can I give them a Letter of Necessity from a family doctor? Any advice is grealty appreciated.

Thanks
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