Recent Posts
Topic: RE: employer NOT insurance co opted out to cover bariatric surgery
I admire your optimism! I am where you are now. I have been trying to have the sugery for 7 yrs and no luck with insurance coverage. I am going to file a claim on my own again and see what happens.. ive never appealed the deniel so I will go from there.
Dont let those ppl get you down! That is a skinny person views on WLS... odviously they have NEVER had a weight problem!
My insurance exclusion simply reads ...Surgical and non-sugical treatment of obesity.. nothing more. So I want to see if there is a loop hole in the policy.. I have a long fight on my hands. I have went as far as calling MDH employer and asking for a Rider, but they tell me they do not offer them? Which is a bunch of bull! They do not want to pay for it. all companys can chose what they want to cover and not cover.. its all cost.
I wish you luck in your journey!! Take Care :))
Dont let those ppl get you down! That is a skinny person views on WLS... odviously they have NEVER had a weight problem!
My insurance exclusion simply reads ...Surgical and non-sugical treatment of obesity.. nothing more. So I want to see if there is a loop hole in the policy.. I have a long fight on my hands. I have went as far as calling MDH employer and asking for a Rider, but they tell me they do not offer them? Which is a bunch of bull! They do not want to pay for it. all companys can chose what they want to cover and not cover.. its all cost.
I wish you luck in your journey!! Take Care :))
Topic: RE: Deeply depressed
Yes, I have to agree with the previous post. I am currently doing my 6 month "diet". It is not a succeed or fail "diet". I go, they weigh me in, they check my blood pressure, and then I listen to the nutritionist who talks to us (in a group setting) about a topic on nutrition. My last "diet" visit, she talked to us about how to read (and interpret) food labels. It was really very helpful. Last time, I had actually gained 4 pounds and the doctor did not say a word about it.
I firmly believe that the insurance companies make this requirement just to see who is willing to wait out the 6 months. A test of sorts.... if we stick with it then they think that we are more likely to stick with the lifestyle changes that we have to make after the surgery.
I firmly believe that the insurance companies make this requirement just to see who is willing to wait out the 6 months. A test of sorts.... if we stick with it then they think that we are more likely to stick with the lifestyle changes that we have to make after the surgery.
Topic: Medicaid- United Healthcare
HW 365 SW 317
Anyone here have medicaid united healthcare? I was wondering their process and what they expect. I called them but didn't get much info! Any help would be greatly appreciated!
HW 365 SW 317
Topic: Aetna Open Choice PPO
Hi Everyone,
I'm new to OH and I have questions regarding insurance approval for VSG.
I had an appointment with my PCP yesterday (I got a physical) and I told her that I have been considering weight loss surgery for years and researching it and I am finally ready to have it done. She said I carry my weight well and I'm young so she would prefer to see me lose it without surgery. However, since I have tried and it has not worked, she recommended that I schedule an appointment with a bariatric surgeon at George Washington University hospital. She agreed with me that VSG is the best route and said she has several patients who have had weight loss surgery at GWU & she highly recommends them.
I have my first appointment with Dr. Lee at GWU on June 25th. I would like to know if any of you guys know what I should expect in terms of getting my insurance company to approve VSG. I have Aetna International Open Choice PPO.
Thanks in advance for any help you can give!
I'm new to OH and I have questions regarding insurance approval for VSG.
I had an appointment with my PCP yesterday (I got a physical) and I told her that I have been considering weight loss surgery for years and researching it and I am finally ready to have it done. She said I carry my weight well and I'm young so she would prefer to see me lose it without surgery. However, since I have tried and it has not worked, she recommended that I schedule an appointment with a bariatric surgeon at George Washington University hospital. She agreed with me that VSG is the best route and said she has several patients who have had weight loss surgery at GWU & she highly recommends them.
I have my first appointment with Dr. Lee at GWU on June 25th. I would like to know if any of you guys know what I should expect in terms of getting my insurance company to approve VSG. I have Aetna International Open Choice PPO.
Thanks in advance for any help you can give!
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.
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My insurance will not pay for my excess skin that hang down to my knees
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