Recent Posts
Topic: PCIP insurance
I am new to to this website and I am in the process of trying to get insured for the VSG. I was looking into applying for the pre existing condition insurance through the government, but the only thing is that they want me to have no "credible" insurance for 6 months. I have already started my 6 month supervised diet a couple of months ago in anticipation of getting the surgery. My question is, if when I get approved for the PCIP insurance and submit my previous supervised diet, will they not except it due to the fact that I am not supposed to have been insured within the last six months? Or should I just start my six months of supervised diet under PCIP once I am covered? Thanks in advance.
Topic: RE: Has anyone written their own letter?
hi Nan!! I'm wondering if you could PM me the letter, too?
I'm going to add you as a friend because your story is amazing! I'm in Lansing!
Courtney
I'm going to add you as a friend because your story is amazing! I'm in Lansing!
Courtney
Topic: RE: Insurance won't cover so I need $25,000
There is no need to pay $20k+ to get WLS. Head just over the border to Mexico and get it done for $5-8k. There are seversal veteran Bariatric surgeons to choose from who cater to U.S. clients. Virtually every surgeon you will run across offering WLS has tons of feedback on them that you can find with simple google searches.
If you are dead set against going to Mexico, shop around. I've seen WLS offered at various places throughout the Unitied States for as little as 10k.
If you are dead set against going to Mexico, shop around. I've seen WLS offered at various places throughout the Unitied States for as little as 10k.
Topic: RE: Medicare coverage for VSG is currently under review
Final Binding CMS Decision (6/27/2012)
www.cms.gov/medicare-coverage-database/details/nca-decision- memo.aspx
VSG MEDICARE APPROVED!! (case per case basis determined by regional Medicare Administrative Contractors)
I Spoke directly with my Bariatric Director this afternoon about Medicare's VSG decision. She reviewed the CMS memo decision and agreed with my interpretation that this decision was a good one and coverage appears imminent. While the "fine" details for Medicare contractors (ie hospitals) have not yet been released (billing code, guidelines for submitting, etc) she did say everything looks like a go and I will be the first patient she submits for Medicare approval next month!
For those of you who have not yet had the opportunity to get a personalized nod of approval from your hospital, read this and you should feel better. This is a summarized analysis and decoding of CMS's VSG memo from The American Society for Metabolic and Bariatric Surgery (ASMBS). A true authority in all matters concerning Bariatric's.
asmbs.org/2012/06/access-to-care-alert-the-cms-final-decisio n/
At long last the wait is FINALLY over!
~Greg
www.cms.gov/medicare-coverage-database/details/nca-decision- memo.aspx
VSG MEDICARE APPROVED!! (case per case basis determined by regional Medicare Administrative Contractors)
I Spoke directly with my Bariatric Director this afternoon about Medicare's VSG decision. She reviewed the CMS memo decision and agreed with my interpretation that this decision was a good one and coverage appears imminent. While the "fine" details for Medicare contractors (ie hospitals) have not yet been released (billing code, guidelines for submitting, etc) she did say everything looks like a go and I will be the first patient she submits for Medicare approval next month!
For those of you who have not yet had the opportunity to get a personalized nod of approval from your hospital, read this and you should feel better. This is a summarized analysis and decoding of CMS's VSG memo from The American Society for Metabolic and Bariatric Surgery (ASMBS). A true authority in all matters concerning Bariatric's.
asmbs.org/2012/06/access-to-care-alert-the-cms-final-decisio n/
At long last the wait is FINALLY over!
~Greg
(deactivated member)
on 6/28/12 7:13 am, edited 6/28/12 7:23 am
on 6/28/12 7:13 am, edited 6/28/12 7:23 am
Topic: RE: Denied new health ins. policy bc of past WLS
Reading back through some old posts... check this out for you... especially since you have already been declined by Humana...
https://www.pcip.gov/StatePlans.html
OH just reread... have to not have had insurance for 6 months prior to getting this. Does the school have a policy that you can get? Otherwise, the only option will be cobra unless your husband can get insurance through his work and if it is a group policy they do not look at pre exisiting, only the individual policies do that.
https://www.pcip.gov/StatePlans.html
OH just reread... have to not have had insurance for 6 months prior to getting this. Does the school have a policy that you can get? Otherwise, the only option will be cobra unless your husband can get insurance through his work and if it is a group policy they do not look at pre exisiting, only the individual policies do that.
Topic: Coventry Healthcare of Georgia
Hello everyone-
I am a new member looking for some help and advice. I am 28 years old and weigh 270lbs. After several years (most of my life really) I have finally decided that surgery may be the best treatment for my struggle. I contacted my insurance company and was a little confused. The representative I spoke to said that my plan does not cover weight loss surgery but after asking several other questions she said it would take something drastic to get approved. When I asked her elaborate she wouldn't.
Does anyone know anything about Coventry and what they will and/or will not cover?? I'm pretty desperate right now and would love to see the light at the end of the tunnel.
Thanks!!
I am a new member looking for some help and advice. I am 28 years old and weigh 270lbs. After several years (most of my life really) I have finally decided that surgery may be the best treatment for my struggle. I contacted my insurance company and was a little confused. The representative I spoke to said that my plan does not cover weight loss surgery but after asking several other questions she said it would take something drastic to get approved. When I asked her elaborate she wouldn't.
Does anyone know anything about Coventry and what they will and/or will not cover?? I'm pretty desperate right now and would love to see the light at the end of the tunnel.
Thanks!!
Topic: Self Pay
My insurance has the dreaded exclusion, but it didn't take me long to decide that I need this surgery. So, I'll be doing self pay.
My dad is a member of a great credit union with nice interest rates, so he is looking in to getting a loan for me. That way I'm not paying 20% (or more) in interest rates every month.
Has anyone done this before - with a family member? I know he took out a loan before on a boat, and he had to have all sorts of paperwork in order. Just wondering if this will be the same way and if it will be a problem that the surgery is for me.
My dad is a member of a great credit union with nice interest rates, so he is looking in to getting a loan for me. That way I'm not paying 20% (or more) in interest rates every month.
Has anyone done this before - with a family member? I know he took out a loan before on a boat, and he had to have all sorts of paperwork in order. Just wondering if this will be the same way and if it will be a problem that the surgery is for me.
Topic: insurance
Hello guys!
I am 2 years out and I want to have reconstructive surgery. Does anyone know how insurance can play a part in this. I live in Louisiana and have BCBS. thanks in advance!!!
I am 2 years out and I want to have reconstructive surgery. Does anyone know how insurance can play a part in this. I live in Louisiana and have BCBS. thanks in advance!!!
Topic: RE: Does this mean what I think it means?
There isn't any more, that is the entire section. I cry if I think about it. I was so excited that our insurance changed on June 1st because I thought that Cigna did cover it... I guess they do, our company has just decided not to. SO bummed :(
Topic: RE: Does this mean what I think it means?
It does sound like it's probably an exclusion, but I would be curious to know the context. My insurance is worded similarly in the it says that it says surgery to primarily treat morbid obesity is not payable. At first, it sounds like they won't cover it, but it goes on to say it is payable in the presence of morbid obesity and particular co-morbidities which will benefit from surgery treatment. Can you copy and paste more of that section, possibly?
Disclaimer: I don't work in insurance, but I was employed as a worker's compensation medical biller, and specialized in appeals.
Disclaimer: I don't work in insurance, but I was employed as a worker's compensation medical biller, and specialized in appeals.
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