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Topic: Tricare Reserve select
My Doctor sent ina request for revision surgery which was denied due to not meeting requirements. I'm 5'2' and weigh 185 which puts my bmi at 33.8 but Tricare says it has to be 35.I have highbood pressure and im taking too pills,and I take byetta shots twice a day along with metformin 4 pills a day. They said I can appeal because they say my bmi is 31.89...UGGGG!!!!Help please
Topic: UHC 6 month diet/My Experience
VSG Surgery May 1, 2012
I'm writing this because maybe it might help someone. You REALLY have to be your own advocate.
When I first started this journey I was told by my physician's office that my particular UHC (united healthcare) plan required me to do a 6 month Supervised diet. I had already known the criteria prior to even going to the surgeon's. Actually, I called roughly 3 times and each time the rep told me "either a structured diet for 6 months with a physician and/OR weigh****chers, jenny craig". The coordinator insisited that the reps don't know what they're talking about etc etc. I went home and called them probably another 6 times and eachtime had them read me the qualifications. Each time they ALL said the same clause.
Anyhow, to make a long story short, I had my weigh in book from WW (8months worth) and asked the coordintor to please just submit the case and we'll see what they say. Well, I was APPROVED!
Make sure you check with your insurance and don't always go by what the dr's office says, sometimes they don't know.
When I first started this journey I was told by my physician's office that my particular UHC (united healthcare) plan required me to do a 6 month Supervised diet. I had already known the criteria prior to even going to the surgeon's. Actually, I called roughly 3 times and each time the rep told me "either a structured diet for 6 months with a physician and/OR weigh****chers, jenny craig". The coordinator insisited that the reps don't know what they're talking about etc etc. I went home and called them probably another 6 times and eachtime had them read me the qualifications. Each time they ALL said the same clause.
Anyhow, to make a long story short, I had my weigh in book from WW (8months worth) and asked the coordintor to please just submit the case and we'll see what they say. Well, I was APPROVED!
Make sure you check with your insurance and don't always go by what the dr's office says, sometimes they don't know.
VSG Surgery May 1, 2012
Simone B.
on 3/26/12 4:06 am - Corpus Christi, TX
on 3/26/12 4:06 am - Corpus Christi, TX
Topic: RE: BCBS Healthselect State of Texas employees
How did this work out for you? I am in the same boat..but dont know where to start?
Topic: RE: Anyone from Iowa with UnitedHealthCare and fighting
That is all they do. The Doctor is a provider but the Insurance Company is saying the hospital is not a provider. The Doctor's insurance clerk swears that they are a provider since they joined forces with another hospital in the area. I've been hospitalized at the other hospital and if they were out of network I would have ended up with a large bill and didn't receive one bill. This is the web site for my doctor Dr. Glas**** about what they do there for WLS.
http://www.wheatoniowa.org/programs-services/weight-loss-sur gery/default.aspx
My UnitedHealthCare is through John Deere and is also referred to as John Deere Premier. The insurance has changed names so many times we have trouble keeping up, but the coverage stays the same.
I'm looking into a revision from a VBG done in July 1999 to and RNY and when I was trying to get approved for the 1st one I was approved in 4 days.
I have spoken with them before I started this and the insurance company read of the qualifications for them to pay for the revision and I more than meet them. The Doctor’s Insurance clerk has done this for others with this same insurance and says they are getting more and more difficult to work with. She called them to find out I was denied the first time since we hadn't heard a thing from them and they agreed with her that they were a provider and when I called and she called back after getting the denial letter that made No sense we were both told the hospital is not a provider. It all depends on who you talk to and UHC. It's sad to have to go through all this with as sick as I am and this surgery would help me out in so many ways. That is all they do. The Doctor is a provider but the Insruance Company is saying the hsopital is not a provider. The Doctor's insurance cllerk swears that they are a provider since they joined forces with another hospital in the area. I've been hospitalized at the other hospital and if they were out of network I would have ended up with a large bill and didn't receive one bill. This is the web site for my doctor Dr. Glas**** about what they do there for WLS.
http://www.wheatoniowa.org/programs-services/weight-loss-sur gery/default.aspx
My UnitedHealthCare is through John Deere and is also referred to as John Deere Premier. The insurance has changed names so many times we have trouble keeping up, but the coverage stays the same.
I'm needing a revision from a VBG done in July 1999 to and RNY and when I was trying to get approved for the 1st one I was approved in 4 days.
I have spoke with them before I started this and the insurance company read of the qualifications for them to pay for the revision and I more than meet them. The Docotrs Insurance clerk has done this for others with this same insurance and says they are getting more and more difficult to work with. She called them to find out I was denied the first time since we hadn't heeard a thing from them and they agreed with her that they were a provider and when I called and she called back after getting the denial letter that made No sense we were both told the hospital is not a provider. It all depends on who you talk to and UHC. It's sad to hae to go through all this with as sick as I am and this surgery would help me out in so many ways.
http://www.wheatoniowa.org/programs-services/weight-loss-sur gery/default.aspx
My UnitedHealthCare is through John Deere and is also referred to as John Deere Premier. The insurance has changed names so many times we have trouble keeping up, but the coverage stays the same.
I'm looking into a revision from a VBG done in July 1999 to and RNY and when I was trying to get approved for the 1st one I was approved in 4 days.
I have spoken with them before I started this and the insurance company read of the qualifications for them to pay for the revision and I more than meet them. The Doctor’s Insurance clerk has done this for others with this same insurance and says they are getting more and more difficult to work with. She called them to find out I was denied the first time since we hadn't heard a thing from them and they agreed with her that they were a provider and when I called and she called back after getting the denial letter that made No sense we were both told the hospital is not a provider. It all depends on who you talk to and UHC. It's sad to have to go through all this with as sick as I am and this surgery would help me out in so many ways. That is all they do. The Doctor is a provider but the Insruance Company is saying the hsopital is not a provider. The Doctor's insurance cllerk swears that they are a provider since they joined forces with another hospital in the area. I've been hospitalized at the other hospital and if they were out of network I would have ended up with a large bill and didn't receive one bill. This is the web site for my doctor Dr. Glas**** about what they do there for WLS.
http://www.wheatoniowa.org/programs-services/weight-loss-sur gery/default.aspx
My UnitedHealthCare is through John Deere and is also referred to as John Deere Premier. The insurance has changed names so many times we have trouble keeping up, but the coverage stays the same.
I'm needing a revision from a VBG done in July 1999 to and RNY and when I was trying to get approved for the 1st one I was approved in 4 days.
I have spoke with them before I started this and the insurance company read of the qualifications for them to pay for the revision and I more than meet them. The Docotrs Insurance clerk has done this for others with this same insurance and says they are getting more and more difficult to work with. She called them to find out I was denied the first time since we hadn't heeard a thing from them and they agreed with her that they were a provider and when I called and she called back after getting the denial letter that made No sense we were both told the hospital is not a provider. It all depends on who you talk to and UHC. It's sad to hae to go through all this with as sick as I am and this surgery would help me out in so many ways.
Topic: RE: Anyone from Iowa with UnitedHealthCare and fighting
Is the facility where you would have the pro cedure a "Bariatric Center of Excellence"?
I have UHC and one of their requirements is that the procedure is done at a "Bariatric Center of Excellemce". This could be why you are getting denied and confusing the insurance clerk.
If I were you I would look for a doctor who does primarly WLS.
I have UHC and one of their requirements is that the procedure is done at a "Bariatric Center of Excellemce". This could be why you are getting denied and confusing the insurance clerk.
If I were you I would look for a doctor who does primarly WLS.
(deactivated member)
on 3/23/12 3:22 pm - Chapel Hill, TN
on 3/23/12 3:22 pm - Chapel Hill, TN
Topic: Deeply depressed
30 years of diet failures
almost had wls in 2000
always just "one more try" c'mon you can do it! (me to myself)
now, sick of all my failures, I decide to just go for it. give it my all and don't look back.
missed seminar 2 weeks ago and rescheduled for this Tues.
just got an email from the insurance specialist at the medical center I chose.
Here's the email:: Carol,
My reply::::Hi I have a letter of support. I didn't know anything about a six month diet. Does my insurance require that? I am attending a seminar on Tuesday. I've been dieting for 30 years. Is the 6- month diet a must? Carol
------end of email----
are you fckg kidding me? I feel like a total failure in every way, that's why I am turning to surgery. No one in their right mind has surgery if a "diet" will work! I have wasted so much of my life already,, REALLY??? so let me understand this; now that I have made peace with my decision i would finally be able to have a more fulfilling, healthy life and you want me to not only do another "diet" but document in black and white every mistake, every pound regained, you want me to voice my frustrations and share my failures with another human being for another freaking half a year of my sorry life?? do you know what that would do to me? I am at my breaking point now....that's why I'm willing to have surgery that will forever change my life. I'm 52 damn years old. when do i get to start my new life???? I can't do it.. I -CAN -NOT face another failure, it would destroy me.
They have no idea :o(
almost had wls in 2000
always just "one more try" c'mon you can do it! (me to myself)
now, sick of all my failures, I decide to just go for it. give it my all and don't look back.
missed seminar 2 weeks ago and rescheduled for this Tues.
just got an email from the insurance specialist at the medical center I chose.
Here's the email:: Carol,
We have not heard from you since you registered for the seminar in January. I wanted to see if you were still interested in the surgery? If so, have you started the 6 month diet with your physician? Have you talked to him about the letter of support? If you could give us an update, I would greatly appreciate it. Thanks!
My reply::::Hi I have a letter of support. I didn't know anything about a six month diet. Does my insurance require that? I am attending a seminar on Tuesday. I've been dieting for 30 years. Is the 6- month diet a must? Carol
------end of email----
are you fckg kidding me? I feel like a total failure in every way, that's why I am turning to surgery. No one in their right mind has surgery if a "diet" will work! I have wasted so much of my life already,, REALLY??? so let me understand this; now that I have made peace with my decision i would finally be able to have a more fulfilling, healthy life and you want me to not only do another "diet" but document in black and white every mistake, every pound regained, you want me to voice my frustrations and share my failures with another human being for another freaking half a year of my sorry life?? do you know what that would do to me? I am at my breaking point now....that's why I'm willing to have surgery that will forever change my life. I'm 52 damn years old. when do i get to start my new life???? I can't do it.. I -CAN -NOT face another failure, it would destroy me.
They have no idea :o(
Topic: Anyone from Iowa with UnitedHealthCare and fighting
I have passed all their criteria plus some but they denied me saying the hospital wasn't a provider when their insurance clerk says they are. The denial letters reasons for not saying yes didn't make any sense.
The Insurance Clerk told me they are having more and more trouble with UnitedHealthCare even though I meet all their requirements. There is also a form that can be filled out and sent to the UHC to be approved if the facility isn't a provider and even though the insurance clerk swears they are beacuse they have done other's surgeries with the exact same insurance through the same employer is going to go ahead and fill out that form and re-file it and try it that way. The insurance company didn't even send out the letter of denial until I called the doctors office to see if they had heard from them yet and she said NO - I will give them a call and call you back. She returned my call the next day saying they had denied it and sent us the letters but neither of us received them. I finally got mine 2 weeks later but dates several weeks before.
I've asked if there is anything I can do to help out and she said no let me re-file the paperwork and see if I can get them to reverse their decision. It all depends on who you talk to at UHC. I am a Chronic Pain patient due to three failed back surgeries and have a few more things wrong with my back and at my weight I am too high risk for them to help me when that time will come. My neurologist wrote a letter of recomendation for this as well. I have a list of co-morbidities a mile long and my BMI is 42.? I am not suppose to gain anymore than 5 pounds before the surgery and it's tough as I am unable to get very much exercise because of my pain.
I tried to go shopping last weekend to buy some clothes for my 9 year old grandson for whom I am guardian of and was hoping to pick up something nice to wear to an uncle funeral this weekend but after only 30 minutes I could hardly walk and was in so much pain AI could not wait to leave. I didn't get clothes so I won't be able to go to my Uncle's funeral and it will be the first funeral that I had been aware of I have to miss and I've had a lot of loss in the past 10 years between family and friends. I'm sick because I can't be there. I am walking on my treadmill each day several time a day to get in the amount I am suppose to before surgery. I am also suppose to use a BiPaP machine for my pretty bad sleepl apnea but I'm uanble to use it. No matter what type of mask I use I can't sleep with it on. To get the mask tight enough so air doesn't slip out around it and wake me up or cause me not to fall asleep - it's so tight it acutally is painful. I've tried everything they have to offer me. I will be calling again today to see if they have any other sugggetions for me as I'm suppose to be wearing it.
Anyone have any ideas on what I need to do to get this insruance Company UnitedHealthCare to approve this surgery. My surgeon I found is Dr. Glas**** with Sartori Memorial Hospital in Cedar Falls, IA. I have passed my psych eval and all I'm waiting for is the ok from the insurance company so they may run all the tests they want to do before surgery and then the surgery.
You can tell that I am very frustrated as I want to live a better quality of life that I do now by laying around most of the time in bed due to pain and the pain doctors and neurologists all agree as do I that at a much lower weight my pain was not near as bad as it is now. I take quite a dose of morphine daily to just try to help control the pain so it is almost bareable. I have needed an increase in the dose as your body gets use to what you take qand you have to continue increasing as I have since my last back surgery and the day of my disability 5-1-2001 and I have been refusing to increase my pain medicine as I don't live a normal life as it is and on more mg's of pain medication I will just become a total zombie. I need this surgery for me. I want to live a better qualilty of life - I want to be able to go places, shopping and actually take a vacation or something.
If anyone has any advice that may help me I would love to hear it. I am open to anything you have to offer. PLEASE ANYTHING!
The Insurance Clerk told me they are having more and more trouble with UnitedHealthCare even though I meet all their requirements. There is also a form that can be filled out and sent to the UHC to be approved if the facility isn't a provider and even though the insurance clerk swears they are beacuse they have done other's surgeries with the exact same insurance through the same employer is going to go ahead and fill out that form and re-file it and try it that way. The insurance company didn't even send out the letter of denial until I called the doctors office to see if they had heard from them yet and she said NO - I will give them a call and call you back. She returned my call the next day saying they had denied it and sent us the letters but neither of us received them. I finally got mine 2 weeks later but dates several weeks before.
I've asked if there is anything I can do to help out and she said no let me re-file the paperwork and see if I can get them to reverse their decision. It all depends on who you talk to at UHC. I am a Chronic Pain patient due to three failed back surgeries and have a few more things wrong with my back and at my weight I am too high risk for them to help me when that time will come. My neurologist wrote a letter of recomendation for this as well. I have a list of co-morbidities a mile long and my BMI is 42.? I am not suppose to gain anymore than 5 pounds before the surgery and it's tough as I am unable to get very much exercise because of my pain.
I tried to go shopping last weekend to buy some clothes for my 9 year old grandson for whom I am guardian of and was hoping to pick up something nice to wear to an uncle funeral this weekend but after only 30 minutes I could hardly walk and was in so much pain AI could not wait to leave. I didn't get clothes so I won't be able to go to my Uncle's funeral and it will be the first funeral that I had been aware of I have to miss and I've had a lot of loss in the past 10 years between family and friends. I'm sick because I can't be there. I am walking on my treadmill each day several time a day to get in the amount I am suppose to before surgery. I am also suppose to use a BiPaP machine for my pretty bad sleepl apnea but I'm uanble to use it. No matter what type of mask I use I can't sleep with it on. To get the mask tight enough so air doesn't slip out around it and wake me up or cause me not to fall asleep - it's so tight it acutally is painful. I've tried everything they have to offer me. I will be calling again today to see if they have any other sugggetions for me as I'm suppose to be wearing it.
Anyone have any ideas on what I need to do to get this insruance Company UnitedHealthCare to approve this surgery. My surgeon I found is Dr. Glas**** with Sartori Memorial Hospital in Cedar Falls, IA. I have passed my psych eval and all I'm waiting for is the ok from the insurance company so they may run all the tests they want to do before surgery and then the surgery.
You can tell that I am very frustrated as I want to live a better quality of life that I do now by laying around most of the time in bed due to pain and the pain doctors and neurologists all agree as do I that at a much lower weight my pain was not near as bad as it is now. I take quite a dose of morphine daily to just try to help control the pain so it is almost bareable. I have needed an increase in the dose as your body gets use to what you take qand you have to continue increasing as I have since my last back surgery and the day of my disability 5-1-2001 and I have been refusing to increase my pain medicine as I don't live a normal life as it is and on more mg's of pain medication I will just become a total zombie. I need this surgery for me. I want to live a better qualilty of life - I want to be able to go places, shopping and actually take a vacation or something.
If anyone has any advice that may help me I would love to hear it. I am open to anything you have to offer. PLEASE ANYTHING!
Topic: RE: AFLAC
TEA,
Funny I saw this. I had a meeting with AFLAC today because my firm is adding them to our benefits. From what the rep told us in the meeting, temporary disability starts after 14 days your leave from work. The Hospital's surgical benefit states that: "AFLAC will pay 50-1000 when a surgical operation is performed..... on a covered person for a covered sickness or injury in a hospital or an ambulatory surgical center."
Temporary Disability may be the way to go because they will pay for 3 months to 6 months leave and possibly up to 24 months leave considering the cir****tances. You would get a monthy check for a percentage of your income.
From what I am seeing on my packet, it appears to me the hospital benefit only covers "sickness or injury" which I don't think the surgery applies but, however, I could interpreting this wrong.
You could get both the Temporary and the Hospital and if they both work out, you can get checks for both because they are seperate benefits.
There is also a benefit that covers spouses earnings that they may loose if they have to assist with caring for you, providing you opt in for that coverage.
I hope this helped you out a little bit. Also I would like to mention, I am in Illinois so I don't know if the location makes a difference in coverage.
Good Luck.
Funny I saw this. I had a meeting with AFLAC today because my firm is adding them to our benefits. From what the rep told us in the meeting, temporary disability starts after 14 days your leave from work. The Hospital's surgical benefit states that: "AFLAC will pay 50-1000 when a surgical operation is performed..... on a covered person for a covered sickness or injury in a hospital or an ambulatory surgical center."
Temporary Disability may be the way to go because they will pay for 3 months to 6 months leave and possibly up to 24 months leave considering the cir****tances. You would get a monthy check for a percentage of your income.
From what I am seeing on my packet, it appears to me the hospital benefit only covers "sickness or injury" which I don't think the surgery applies but, however, I could interpreting this wrong.
You could get both the Temporary and the Hospital and if they both work out, you can get checks for both because they are seperate benefits.
There is also a benefit that covers spouses earnings that they may loose if they have to assist with caring for you, providing you opt in for that coverage.
I hope this helped you out a little bit. Also I would like to mention, I am in Illinois so I don't know if the location makes a difference in coverage.
Good Luck.
Topic: RE: BCBS 24 visits....so discouraging
Lori,
That is a great idea. I am going to work on my letter as well, hell, I'll do a video if I have to. I never thought to do a letter. I will call my insurance medical group today and find out who I should address my letter too.
Thanks a lot Lori. When I first found out about the waiting period, I cried. I felt as if all hope was lost, but thanks because you have given me hope. I'm not saying I was going to give up, I feelings were just so deflated and disappointed by it. But I wont give up and I definitely will keep you posted.
Thanks again.
Kina.
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