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Topic: University of Texas health insurance - UnitedHealthCare Choice Plus
Does anyone have any experience with this insurance? i will continue to be a graduate student at the university until august, and am considering paying the 300 for the policy, but i don't think it'll be worth it if it doesn't cover WLS, since i already have a "free" one from work that excludes WLS.
I'd appreciate any help on the lingo if possible! I can't seem to tell whether it covers WLS. It seems to say that it covers stuff that is "medically necessary", but then has weight loss treatments, etc. as exclusions.
I can email you the insurance brochure if you'd be able to provide me with any insight. I've been morbidly obese for the last 28+ years and I've felt defeated all my life by my weight...this gives me a tiny bit of hope until I can confirm whether it covers it or not.
I'd appreciate any help on the lingo if possible! I can't seem to tell whether it covers WLS. It seems to say that it covers stuff that is "medically necessary", but then has weight loss treatments, etc. as exclusions.
I can email you the insurance brochure if you'd be able to provide me with any insight. I've been morbidly obese for the last 28+ years and I've felt defeated all my life by my weight...this gives me a tiny bit of hope until I can confirm whether it covers it or not.
Topic: RE: BCBS 24 visits....so discouraging
Thanks a lot Rebecca.
Yes, that 24 visits was a long time. The only way I would have been approved by BCSBS would have been my PCP appealing on my behave, but you know how some doctors are. He was taking his own sweet time, and I never heard from him regarding the matter. So with when I spoke with the surgeon's office, she informed me that Medicaid in Illinois is more laid back regarding approval, virtually you only need your physician's recommendation, I would get approved. BCBS was my primary and Medicaid was my supplemental, and I had my employer drop me from BCBS and and now Medicaid is my primary and now I have appointment tomorrow with my surgeon. I am so excited. Hold on, cuz a change is coming.
Thanks for the wishes and good luck to you too dear. Keep me posted on you progress as I will do the same.
Yes, that 24 visits was a long time. The only way I would have been approved by BCSBS would have been my PCP appealing on my behave, but you know how some doctors are. He was taking his own sweet time, and I never heard from him regarding the matter. So with when I spoke with the surgeon's office, she informed me that Medicaid in Illinois is more laid back regarding approval, virtually you only need your physician's recommendation, I would get approved. BCBS was my primary and Medicaid was my supplemental, and I had my employer drop me from BCBS and and now Medicaid is my primary and now I have appointment tomorrow with my surgeon. I am so excited. Hold on, cuz a change is coming.
Thanks for the wishes and good luck to you too dear. Keep me posted on you progress as I will do the same.
Topic: RE: BCBS 24 visits....so discouraging
Thanks a lot Rebecca.
Yes, that 24 visits was a long time. The only way I would have been approved by BCSBS would have been my PCP appealing on my behave, but you know how some doctors are. He was taking his own sweet time, and I never heard from him regarding the matter. So with when I spoke with the surgeon's office, she informed me that Medicaid in Illinois is more laid back regarding approval, virtually you only need your physician's recommendation, I would get approved. BCBS was my primary and Medicaid was my supplemental, and I had my employer drop me from BCBS and and now Medicaid is my primary and now I have appointment tomorrow with my surgeon. I am so excited. Hold on, cuz a change is coming.
Thanks for the wishes and good luck to you too dear. Keep me posted on you progress as I will do the same.
Yes, that 24 visits was a long time. The only way I would have been approved by BCSBS would have been my PCP appealing on my behave, but you know how some doctors are. He was taking his own sweet time, and I never heard from him regarding the matter. So with when I spoke with the surgeon's office, she informed me that Medicaid in Illinois is more laid back regarding approval, virtually you only need your physician's recommendation, I would get approved. BCBS was my primary and Medicaid was my supplemental, and I had my employer drop me from BCBS and and now Medicaid is my primary and now I have appointment tomorrow with my surgeon. I am so excited. Hold on, cuz a change is coming.
Thanks for the wishes and good luck to you too dear. Keep me posted on you progress as I will do the same.
Topic: RE: Did you have to appeal to have the VSG?
A BMI of over 50 for the VSG? Or is it the same for any wls? I was approved for VSG with my first application with a BMI of 44. I wish I could help but I've never heard of that! Good luck.
Topic: RE: BCBS 24 visits....so discouraging
24 months? That's a really long time. My insurance required 6 months and I know people here (in Arizona) who've had wls with medicaid and they had to wait 6 months too and jump through lots of other hoops, but 24 months seems like so long. Do you have problems that could justify your doctor asking for an exception?
I don't have much advice but to say I'm so sorry. I do understand. I had insurance that I did all the preop stuff (cardiologist, pulmonologist, nutritionist, blood work, psych eval, 6 months of doctor supervised visits) and then was dropped right before we submitted. I was hysterical. Now, a year and half later with new insurance, I am scheduled for April 27. Good luck to you! I really wish you the best.
~Rebecca
Mother to 4, married to a wonderful man, trying to find myself again.
Mother to 4, married to a wonderful man, trying to find myself again.
Topic: RE: BCBS 24 visits....so discouraging
Don't give up. I felt the same way. I had BCBS and had Medicaid as a supplemental. I didn't attempt to apply with BCBS because they informed me ahead of time that with the medical group I had, I was required to undergo weight managment for 24 months before I would be considered for the surgery. So, I left BCBS and went to my medicaid full time and now I am able to have the surgery.
I'll never understand why it's easier with Medicaid than most insurance, but that's just the way it goes.
Don't give up, if the surgery does not work, the nurt vists appears to be if you're losing your BMI. I will pray for you
. Good Luck.
I'll never understand why it's easier with Medicaid than most insurance, but that's just the way it goes.
Don't give up, if the surgery does not work, the nurt vists appears to be if you're losing your BMI. I will pray for you
. Good Luck. 
Topic: RE: BCBS 24 visits....so discouraging
I was denied 2x in 2009 because I was to small (BMI 38) and then in December I tried again because not trying I got to a BMI of 40. I have been denied 2x in February and I have 3 nut. visits. Last one is Monday April 16th then they are going to submit again. Now I am under 40 because I have been following the directions. I am not getting my hopes up. If I get denied again I will just throw in the towel and realize I am ment to be fat forever. I have BCBS Illinois and I meet all the requirements they just are jack a**.
Topic: RE: Bariatric Co-Pays
Thanks Dani,
I had to laugh at the "bucket of chicken"
comment.
Don't get me wrong, I know that I have a $1000 co-pay and that I am fortunate to have my insurance cover the majority of all of the costs, but I have had suregery before where I NEVER had a co-pay. My incsurance BCNM only has a co-pay for Bariatric surgery! Which I think is wrong and a discriminatory practice to have. I will pay the money on my surgery date and be happy to just get the surgery behind me and start moving forward.
Have a great day and stay in touch,
I had to laugh at the "bucket of chicken"
comment.Don't get me wrong, I know that I have a $1000 co-pay and that I am fortunate to have my insurance cover the majority of all of the costs, but I have had suregery before where I NEVER had a co-pay. My incsurance BCNM only has a co-pay for Bariatric surgery! Which I think is wrong and a discriminatory practice to have. I will pay the money on my surgery date and be happy to just get the surgery behind me and start moving forward.
Have a great day and stay in touch,
Topic: RE: Bariatric Co-Pays
had my surgery at the same place. I prepaid my copay and after all was said
and done, I had overpaid. The doctors office owed me about $400. They would
not refund it because it had already been paid to the hospital. And the hospital
said it was the doctors office who owed me. Well it took 8 months before I finally
got my refund back. So I think I would talk to another coordinator or give her the
name of the person at the insurance company that you spoke too. How do they
really know how much your cost is prior to the surgery. You are not a bucket of
chicken. They don't know what YOU specifically need prior to surgery.
What if you only need "one" aspirin versus "two".
Go get em!!!
Dani
and done, I had overpaid. The doctors office owed me about $400. They would
not refund it because it had already been paid to the hospital. And the hospital
said it was the doctors office who owed me. Well it took 8 months before I finally
got my refund back. So I think I would talk to another coordinator or give her the
name of the person at the insurance company that you spoke too. How do they
really know how much your cost is prior to the surgery. You are not a bucket of
chicken. They don't know what YOU specifically need prior to surgery.
What if you only need "one" aspirin versus "two".
Go get em!!!
Dani
Topic: RE: Bariatric Co-Pays
My RNY is scheduled for April 25, 2012 at DMC Harper in Detorit, Michigan. I was told by the surgery coordinator that on the day of my surgery that I am required to bring the $1000 copay with me.
My insurance company BCNM told me that it would be billed to me after my surgery from the hospital and that I am not required to pay the copay upfront.
Has anyone else out there had to deal with this situation? My friend had her surgery and paid off her co-pay within 6 months.
I can pay the money, but I thought that this was a strange thing that was on the list of "things to bring for your hospital stay" paperwork from the surgery coordinator.
It is hospital choice. I think what your ins co might have been talking about is the copay after you pay the $1K. If it is a percentage of the bill you have to wait to see what the bill is and how much will be written off due to contractual agreements between the ins co and hospital. Only then can you know what the rest of your co pay will be.
On April 7, 2012 at 8:03 AM Pacific Time, Suzyqwms wrote:
My RNY is scheduled for April 25, 2012 at DMC Harper in Detorit, Michigan. I was told by the surgery coordinator that on the day of my surgery that I am required to bring the $1000 copay with me.My insurance company BCNM told me that it would be billed to me after my surgery from the hospital and that I am not required to pay the copay upfront.
Has anyone else out there had to deal with this situation? My friend had her surgery and paid off her co-pay within 6 months.
I can pay the money, but I thought that this was a strange thing that was on the list of "things to bring for your hospital stay" paperwork from the surgery coordinator.
It is hospital choice. I think what your ins co might have been talking about is the copay after you pay the $1K. If it is a percentage of the bill you have to wait to see what the bill is and how much will be written off due to contractual agreements between the ins co and hospital. Only then can you know what the rest of your co pay will be.
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