Insurance, Cash Pay and Financing

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Izabelle G.
on 8/13/12 12:40 pm - Cheltenham, PA

VSG on 10/15/12

Topic: RE: Insurance won't cover so I need $25,000

Thanks everyone for the feedback. I decided to look around and found that Abington Memorial Hospital in PA has self pay rates. I have the 2012 rates for a VSG, it will be $7000 hospital fee, $1736 Surgeons Fee, plus the cost of Anethesia. A lot less than $25000. They also have self pay rates for the other surgeries and I highly recommend them.

I am walking 60 Miles in 3 Days to fight cancer! Donate today!!

http://www.the3day.org/goto/igomes

Surgery 10/15/12 - HW-263lbs GW-150lbs CW- 170.8

richmondmom
on 8/13/12 8:40 am

Topic: New and angry: 12 month diet!

Anthem Blue Cross / Blue Shield COVA (state of VA) requires 12 months of diet (WW, Jenny Craig) before covering bariatric surgery. And they only pay 50% of the weight loss program for employees, not spouses, and this my husband's policy. If I can get through a year, I may or may not be approved anyway. SO MAD.

josher_m
on 8/12/12 7:00 am

Topic: RE: no longer needed

Thanks! Good luck to you and hope you get it approved!

Cards44
on 8/12/12 2:09 am - IL

VSG on 07/24/12

Topic: RE: BCBS NJ Direct Question

Hi

I have Hoizon BCBS-NJ not sure if that is direct or not...

I just had the VSG on 7/24/12 and had to do a 6 month diet. I finished my 6 month diet on 5/2/12 and the insurance took almost 7 weeks to approve the surgery. I was worth the wait.

I hope all goes well for you.

jennibean1027
on 8/11/12 8:31 am

Topic: RE: no longer needed

So far insurance has paid for the consultation so we are going forward...just hoping that come time to file for approval, it goes through.congrats on your success and thanks for responding.

josher_m
on 8/11/12 6:48 am

Topic: RE: no longer needed

No, I browsed these forums and did a lot of internet research but I just don't have the money to do it. So, I found something that is actually working and am losing weight the old fashioned way . . slowly but steady. I've lost 40 lbs since the end of March using ViSalus. Figured I'd end up on shakes before/after a surgery anyhow. lol

jennibean1027
on 8/10/12 5:57 pm

Topic: RE: no longer needed

I am having the same problem. Did you ever find a resution or get approved for the surgery?

jennibean1027
on 8/10/12 5:42 pm

Topic: RE: Here goes something (I hope)

Did you ever get an answer? Who is your employer?

autigers10
on 8/10/12 6:42 am

Topic: RE: Aetna Appeal Letter

Hey NAN~
i did go on there website last night and saw that it has to be @ leasat 2 years of bmi over 40. and then bmi 35 w/ hypertension. but from the letter that i will be receiving stats that my hypertension is being controlled. I dont know its frustrating. My surgeons coordinator told me that I should appeal. But then again, i dont know what records my PCP sent them. Thanks for your help. I will PM you my email address. And just hope for the best. I was reading all your post and they gave me alittle hope. all i can do is appeal. And go from there. Thanks for your time.

Paige

Nan2008
on 8/10/12 4:48 am - Midland, MI

RNY on 03/09/09

Topic: RE: Aetna Appeal Letter

Hi Paige,

I will be glad to help and send you copies of my appeal letters however it looks as if you have not meeting their criteria of being morbidly obese for at least two years as defined in their clinical bulletin 0157. If you go to Aetna's website and in the search box, type in 0157 andit will bring up their clinical bulletin for the requirments to qualify for WLS.

The requirement for proving you have had at least a two year history of being morbedly obese states that your BMI must be >40 for at least two years or >35 with 2 co-morbidies. Since your BMI was 35 and 37 in those years you will need to have documented co-morbidies.

Nan

Nan

HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010

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