Recent Posts
Topic: Approved! UHC community plan
I just called to find out the status and found out I am approved!!
My initial submission was denied after 2 days. I appealed and 30 days later they overturned it and APPROVED me!!!
I didn't do the 6 month diet. I just had my PCP list a few of the diets I had tried and state that none of them will work and that WLS is the only other option.
I also didn't have documentation of being obese for 5 years. I explained in my appeal letter that I didn't have insurance then and therefor could not afford to see a doctor in the past few years. Instead, I made a photo album with pics of me from each of the past 5 years. I signed and dated the back of each one stating my estimated weight at that time.
If you have any other questions, ask away!
My initial submission was denied after 2 days. I appealed and 30 days later they overturned it and APPROVED me!!!
I didn't do the 6 month diet. I just had my PCP list a few of the diets I had tried and state that none of them will work and that WLS is the only other option.
I also didn't have documentation of being obese for 5 years. I explained in my appeal letter that I didn't have insurance then and therefor could not afford to see a doctor in the past few years. Instead, I made a photo album with pics of me from each of the past 5 years. I signed and dated the back of each one stating my estimated weight at that time.
If you have any other questions, ask away!
Topic: RE: UHC 6 month diet/My Experience
I agree. I have UHC, too, and I am submitting w/o the 6 month thing. I was denied initailly, but am currently on appeal. I will have my decision in 2 days (4/18).
I had a breast reduction last year that I had covered by my insurance. My doctor's office said I wouldn't get approved because UHC requires 3 months of physical therapy. Well I said I would like to go ahead and submit w/o it. I was approved after 2 days.
So, I agree w pp, you have to be your own advocate. You have do all your own research and be agressive sometimes.
I had a breast reduction last year that I had covered by my insurance. My doctor's office said I wouldn't get approved because UHC requires 3 months of physical therapy. Well I said I would like to go ahead and submit w/o it. I was approved after 2 days.
So, I agree w pp, you have to be your own advocate. You have do all your own research and be agressive sometimes.
bearomar04
on 4/16/12 1:06 pm
on 4/16/12 1:06 pm
Topic: RE: BCBS Healthselect State of Texas employees
Hello World!!! I have a date yes after trying for over 10 years I am now scheduled to surgery on June 11, 2012. Pray for me. I must say I am a little scared but I have waited long enough. I hope my tests before the surgery are ok. Again pray for me.
Topic: Phoenix Health plan, AHCCCS
Hello all,
I have ahcccs (Phoenix Health Plan) and I was wondering if anybody has been approved through them, what type of surgery, and how long it took...any info is greatly appreciated!!! I am hoping to have the VSG. When I call them directly, nobody can tell me what the requirements are. My surgeon says that they use the Mercy Care requirements because they couldn't get an answer from PHP either. I asked them if the VSG was approved and the guy said no, that it required a prior authorization but I am pretty sure they all do. Just wondering if anybody else has had experience with this. Thanks so much!
I have ahcccs (Phoenix Health Plan) and I was wondering if anybody has been approved through them, what type of surgery, and how long it took...any info is greatly appreciated!!! I am hoping to have the VSG. When I call them directly, nobody can tell me what the requirements are. My surgeon says that they use the Mercy Care requirements because they couldn't get an answer from PHP either. I asked them if the VSG was approved and the guy said no, that it required a prior authorization but I am pretty sure they all do. Just wondering if anybody else has had experience with this. Thanks so much!
Topic: BCN MI waiting
After 7 months of pcp visits, testing evaluations and appointments. my paperwork was submitted 7 days ago. God the waiting is like a slow torture.. Don't know what I'll do if it's denied.. I have suffered for 45 years of being overweight. I think I deserve a break now........G. S Worried in Michigan.
Topic: RE: BCBS Federal - Revision for Light Weight
I would check it out also. I had the rny and have gained back quite a bit of weight. I wish I had researched it better. I didn't know about many surgeries then.
Topic: RE: Feeling Forced to Finance
I was self-employed when I had my surgery. I can't say how things work now, but I got some info off this site about 8 years ago. Every insurance company has an open enrollment month when they pretty much have to take patients they normally wouldn't. I asked the person in the surgeons office that takes care of these things which insurance company I had the best chance with and they told me anthym blue cross, blue shield. I called them and got the information I needed to get approved. Then when It was time for their open enrollment, I sent the money and application. I had to pay over $700 per month and pay ahead but I was approved the first time the surgeon sent in the request. I didn't really have much in the way of co-morbities. My surgeon told me that it's all in the way you write the letter. I didn't see the letter, so I don't know what he said. but it was worth the money it cost. I couldn't get any insurance any other way, I tried. No one would take me.
Theresa
Theresa
Topic: Denied new health ins. policy bc of past WLS
So, this is probably not the usual issue posted about on this forum, but here goes...
I left my job about 2 weeks ago to prepare for going back to school full time. I was in the midst of getting an individual policy for myself and my family to cover the time while I'm in school until I get a job after graduation. After answering all the health history questions (truthfully), I was transferred to the underwriter. She proceeded to tell me that Humana declines to cover people who have had WLS in the past. Now, the insurance I had through my job was with Humana. My policy had an exclusion for WLS, so I paid out of pocket. I'm at my wits' end because I must have health insurance as a nursing student, plus we've got a 3 year old who needs to be covered too. I don't really want to do COBRA because of the high cost, but will do it if I don't have any other options. My husband and daughter could be on a policy by themselves if I have to resort to COBRA.
Does anyone know of a health insurance company that will do an individual policy for someone like me who had WLS in the past? There's got to be one out there somewhere. I'm in Kentucky if that matters.
I left my job about 2 weeks ago to prepare for going back to school full time. I was in the midst of getting an individual policy for myself and my family to cover the time while I'm in school until I get a job after graduation. After answering all the health history questions (truthfully), I was transferred to the underwriter. She proceeded to tell me that Humana declines to cover people who have had WLS in the past. Now, the insurance I had through my job was with Humana. My policy had an exclusion for WLS, so I paid out of pocket. I'm at my wits' end because I must have health insurance as a nursing student, plus we've got a 3 year old who needs to be covered too. I don't really want to do COBRA because of the high cost, but will do it if I don't have any other options. My husband and daughter could be on a policy by themselves if I have to resort to COBRA.
Does anyone know of a health insurance company that will do an individual policy for someone like me who had WLS in the past? There's got to be one out there somewhere. I'm in Kentucky if that matters.
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