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Topic: RE: X-POST Useful Medicare PA insurance nugget
I paid taxes all the 30+ years that I worked, Brianna, and I absolutely *RESENT* your implication that I am sponging off of "you, the taxpayer"!
My taxes probably paid for your arrival on this planet!
I went to college, got my education and went to work. Hell, I went to work at my profession even before I graduated, never once imagining that I would end up on Social Security Disability.
Do you think that I planned prednisone-induced weight gain? Had I not had lupus, I wouldn't have even been taking prednisone!
Apparently you did not read my previous posts regarding cellulitis infections in both legs, due to compression garment abrasions. This has happened multiple times. Also, I must go to extaordinary efforts to clean under all the skin flaps and folds.
This is *NOT COSMETIC* for me. This is a medical issue.
Cellulitis can quickly go into sepsis, and with multiple infections of any kind, and multiple uses of antibiotics, you run the risk of antibiotic resistance and failure, which is the gateway for sepsis, while your health care providers scramble to find antibiotics that will work.
The same thing happens with SMO people when we get skin breakdown, as I did before I lost the weight.
I paid taxes for the 30+ years I worked, That's just like paying for disability insurance as part of your job benefits. I'm trying to get back to work. I'm in Voc-Rehab, training for a different profession more accomodating to my lupus and fibromyalgia, which has improved some with the weight loss, but is something that I will have to deal with for life.
I'm only getting skin excised, this will not be a true "thigh lift", unless the surgeon "gifts" me with that, or finds that's the only way to correct my *MEDICAL PROBLEM*.
I have a suggestion, Brianna. Next time I get an infection, why don't you come over and take a look? It's an infection that can get into your bloodstream very easily! Perhaps you think I'm speaking of cellulite which is quite different, and yes, that would be a cosmetic issue, but this isn't.
I've probably paid taxes longer than you've been alive, Brianna. .
My taxes probably paid for your arrival on this planet!
I went to college, got my education and went to work. Hell, I went to work at my profession even before I graduated, never once imagining that I would end up on Social Security Disability.
Do you think that I planned prednisone-induced weight gain? Had I not had lupus, I wouldn't have even been taking prednisone!
Apparently you did not read my previous posts regarding cellulitis infections in both legs, due to compression garment abrasions. This has happened multiple times. Also, I must go to extaordinary efforts to clean under all the skin flaps and folds.
This is *NOT COSMETIC* for me. This is a medical issue.
Cellulitis can quickly go into sepsis, and with multiple infections of any kind, and multiple uses of antibiotics, you run the risk of antibiotic resistance and failure, which is the gateway for sepsis, while your health care providers scramble to find antibiotics that will work.
The same thing happens with SMO people when we get skin breakdown, as I did before I lost the weight.
I paid taxes for the 30+ years I worked, That's just like paying for disability insurance as part of your job benefits. I'm trying to get back to work. I'm in Voc-Rehab, training for a different profession more accomodating to my lupus and fibromyalgia, which has improved some with the weight loss, but is something that I will have to deal with for life.
I'm only getting skin excised, this will not be a true "thigh lift", unless the surgeon "gifts" me with that, or finds that's the only way to correct my *MEDICAL PROBLEM*.
I have a suggestion, Brianna. Next time I get an infection, why don't you come over and take a look? It's an infection that can get into your bloodstream very easily! Perhaps you think I'm speaking of cellulite which is quite different, and yes, that would be a cosmetic issue, but this isn't.
I've probably paid taxes longer than you've been alive, Brianna. .
HW 405/SW 397/CW 138/GW 160 Do the research! Check the stats!
The DS is *THE* solution to Severe Morbid Obesity!
Topic: Looking for insurance plan - need advice/help
I applied for both HumanaOne and United Healthcare. HO told me that I am ineligible for any of their plans. I do not have any documented health problems that I put on the application forms other than polycystic ovarian syndrome, and obviously my weight.
For UHC, they did not deny me but once I put in my weight they gave me a pop up box saying that something had to be changed in the plan because of something I inputted in the health form (it was after my weight which is right after my name address and height, nothing else) so basically I know it is because of my weight. The 1500 deductible with 5000 coinsurance oop and this was $300/mo and that is a bit too high for me.
I had to put my dreams on hold because I finished school and was getting situated in a career. So now that I work for myself as an independant contractor, I find myself in this predicament of trying to find insurance that is a bit around $220/mo or less perhaps, but will be able to have options of WLS of some sort in the future (my thoughts are roux en y but I am not dead set on that).
So I am asking for help on what to do. Should I try other companies? Should I try calling a representative and talking to them? What should I do?
For UHC, they did not deny me but once I put in my weight they gave me a pop up box saying that something had to be changed in the plan because of something I inputted in the health form (it was after my weight which is right after my name address and height, nothing else) so basically I know it is because of my weight. The 1500 deductible with 5000 coinsurance oop and this was $300/mo and that is a bit too high for me.
I had to put my dreams on hold because I finished school and was getting situated in a career. So now that I work for myself as an independant contractor, I find myself in this predicament of trying to find insurance that is a bit around $220/mo or less perhaps, but will be able to have options of WLS of some sort in the future (my thoughts are roux en y but I am not dead set on that).
So I am asking for help on what to do. Should I try other companies? Should I try calling a representative and talking to them? What should I do?
Topic: RE: BCBS Tx & VSG
I think it depends on the type of plan his employer has for them (and anyone feel free to correct me if I'm wrong). I have BCBS of TX as well, but just because my employer has any kind of weight loss surgery/treatment as an exclusion, it's not covered for me. You might want to call BCBS and ask, and have him check with the HR people at work, because as it stands BCBS does cover it, it just depends on whether his employer has any exclusions on his plan.
Good luck!
Good luck!
Topic: BCBS Tx & VSG
Anyone have Blue Cross Blue Shield of Texas and got approved for VSG? My hubby has that insurance, a BMI of 34, uncontrollable diabetes, and high colesterol (among other problems). And 33 yrs old. What do we need to do to get him this surgery? I am going the self pay route, I don't have insurance, but we can't afford for both of us to do this out of pocket. As it is it's going to take us a couple of years just to save for mine. So it would be good if we could use his insurance for him. Also has anyone had insurance cover out of country surgery?
(deactivated member)
on 5/27/12 6:06 am
on 5/27/12 6:06 am
Topic: RE: Please explain...
For most people it takes 6-24 months. Two weeks is nothing. You also have the option to self pay if you don't want to wait 2 weeks. I was not willing to wait a year for surgery so I self paid instead.
On May 9, 2012 at 6:47 AM Pacific Time, That.Loser.Chick wrote:
I do have insurance, in fact recieved a pre-approval for WLS. I just completed all my specialist appointments, and met all criteria. So now I have to wait for Final approval??? Well what was the point of the pre-approval, and why does it take 2 plus weeks??For most people it takes 6-24 months. Two weeks is nothing. You also have the option to self pay if you don't want to wait 2 weeks. I was not willing to wait a year for surgery so I self paid instead.
(deactivated member)
on 5/27/12 5:52 am
on 5/27/12 5:52 am
Topic: RE: X-POST Useful Medicare PA insurance nugget
Why in the world should we, the taxpayers, pay for cosmetic surgery? I mean, I understand WLS, but cosmetics? Most can hardly get basic medical care they need covered and you are suggesting we pay for cosmetics?
Topic: RE: Grant
So happy for you!
I found it while searching for PA information on Medicare.
It's a one in a million shot that I will be the one to get the grant, but it's worth a try.
I have a medically documented need for removal of excess thigh skin, but doctors are refusing to file for prior authorization with my Medicare Complete (Secure Horizons) insurance through United Health Care.
I need to complete what wil be major surgery, before continuing with my Voc-Rehab program to get off disability. I'm studying to become a Registered Dietitian, specializing in pre and post-op bariatric nutrition. I also have lupus and fibromyalgia, and my former occupation is not compatible with those conditions. Too physical.
HW 405/SW 397/CW 138/GW 160 Do the research! Check the stats!
The DS is *THE* solution to Severe Morbid Obesity!
Topic: X-POST Useful Medicare PA insurance nugget
In my quest for prior authorization to have excess skin removed from my thighs, I got this little nugget of information from Medicare - I'm going to check with my replacement plan to find out if it works this way with them:
If the surgery is done on an outpatient basis - insurance *cannot* be submitted for prior authorization retroactively. GUARANTEES non-coverage.
If the surgery is done INPATIENT - including hospital stay for at least 24 hours post op - retroactive PA can be done *up to 90 days post-procedure* They could conceivably still deny, but I'm thinking if inpatient is necessary, they would be nuts not to! If they did, you could still appeal!
In my quest for prior authorization to have excess skin removed from my thighs, I got this little nugget of information from Medicare - I'm going to check with my replacement plan to find out if it works this way with them:If the surgery is done on an outpatient basis - insurance *cannot* be submitted for prior authorization retroactively. GUARANTEES non-coverage.
If the surgery is done INPATIENT - including hospital stay for at least 24 hours post op - retroactive PA can be done *up to 90 days post-procedure* They could conceivably still deny, but I'm thinking if inpatient is necessary, they would be nuts not to! If they did, you could still appeal!
HW 405/SW 397/CW 138/GW 160 Do the research! Check the stats!
The DS is *THE* solution to Severe Morbid Obesity!
Topic: RE: Anyone from Iowa with UnitedHealthCare and fighting
Thank you for being my one and only person with any advice. I know my post was long but I was just trying to explain everything so you had a clear picture.
With the help of me calling and complaining and my husband Union getting involved they have finally approved my Revision VBG to RNY with Dr. Glas****
With the help of me calling and complaining and my husband Union getting involved they have finally approved my Revision VBG to RNY with Dr. Glas****
Topic: RE: Horizon BCBS of NJ Approval/denial time
HI
My paperwork was faxed 3 weeks ago today to Horizon by the surgeons office. So it looks like its going to be close to the 30 days.
Three years ago was a bad setup. The surgeon wasn't much help with the paperwork and I also did not have the required 6 month diet. I was denied due to the diet.
This time around I changed hospitals and also got a new PCP that has been great with the process. I also did the 6 month diet through the surgeon. So hopefully everything is in line and no worries.
My paperwork was faxed 3 weeks ago today to Horizon by the surgeons office. So it looks like its going to be close to the 30 days.
Three years ago was a bad setup. The surgeon wasn't much help with the paperwork and I also did not have the required 6 month diet. I was denied due to the diet.
This time around I changed hospitals and also got a new PCP that has been great with the process. I also did the 6 month diet through the surgeon. So hopefully everything is in line and no worries.
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My insurance will not pay for my excess skin that hang down to my knees
Hockeymom87 · 0 replies · 728 views
Hockeymom87 · 0 replies · 728 views
