Recent Posts

Lisa S.
on 3/20/12 2:12 am - NV
VSG on 07/09/12
Topic: RE: BC/BS of Alabama
Hello. The allotted amount is usually the contractual/agreed amount that the insurance pays to the provider. Make sure that your provider, hospital and anesthesiologist are all "participating" or "in-network" providers with your plan. Good luck!!!

    


 


krenee218
on 3/19/12 10:18 pm - mount vernon, NY
Topic: RE: City of New York employee - Empire BCBS & GHI
I have the same insurance GHI/BCBS and they are making me jump throough hoops.
Lori54555
on 3/19/12 12:11 pm - Phillips, WI
Topic: RE: BCBS 24 visits....so discouraging
Definitely appeal that one! I can't believe they are doing this to you. Given your young age, you have many, many years of health issues that may come up due to obesity.

One thing I did was send a letter that I wrote myself, I think it gave them a more heartfelt outlook on what I felt I am going through. i also had 2 other physicians that I had seen in the past to write letters of recommendations, both stating that they felt this surgery would help my current issues and prevent future ones.  

Oh, and in my letter, I told the insurance company not only my issues, but any possible obesity-related family health problems, because these can easily be passed down to you later in life.

Good luck, and keep us posted!
        
HoneyBadger
on 3/19/12 3:13 am
Topic: RE: TEXAS MEDICAID
 Anybody know of any around the Waco Area?
kiki2cool
on 3/19/12 12:53 am - IL
Topic: RE: BCBS 24 visits....so discouraging
Hi Lori,

Yes my BMI is well over 40, 59 to be exact.  Fortunately I don't have sleep apnea or diabetes, but I do have a little high blood pressure.  So far I was told that we can appeal, so that's what my regular doc and I are doing.  So far I haven't heard anything back yet.  But I am working on it.  I am glad to here that yours went through, I too am a young woman (36) and this just sucks so bad.  

Congrats to you, I hope that some of your good fortune rubs off on me.
Lori54555
on 3/18/12 1:09 pm - Phillips, WI
Topic: RE: BCBS 24 visits....so discouraging
What is your situation, meaning weight-wise? Do you have a BMI over 40? If not, do you have a BMI of 35-39 with diabetes, high blood pressure, or sleep apnea? 

Get this one, I have GERD so bad that it has eaten a hole in my esophagus. I suffer with heart burn so badly that I literally feel like I am having a heart attack on a nightly basis (mind you, I am only 38 years old). My BMI was 38.5 and they had me go through the 6 months of preop just to tell me that my GERD was not significant enough to cover my WLS. I had been on meds for 10 years with no help whatsoever, EGDs, etc. So, I have my last preop appt and I actually gained 5 pounds, which is very, very bad. They don't want you to gain weight because then you show that you probably cant keep to a bariatric diet afterwards.

I get a call from my surgeon telling me that I have to have another weigh in (2 months after all my preop appointments), and she asked if I thought I had gained more weight. I told her probably not enough to bring my BMI up to 40 for my insurance to consider approval, and she actually sounded like it was hopeless!! So, I ate like a pig for 2 days, weighed in, and ended up with a BMI of 40.2. My insurance approved me 2 days later. What the heck? I am glad that I am finally approved, but really? I feel like I had to slip downhill in order to get them to approve me. You think they would have been happy with me losing weight, not gaining it!
Lori54555
on 3/18/12 12:58 pm - Phillips, WI
Topic: plsstic surgery after WLS
Does everyone need plastic surgery after WLS? I am currently 220 lbs, 5 feet 2 inches, WLS scheduled fo 4/11/12. Is there something that I can do to prevent having to have plastic surgery for sagging skin later on, or is this just something everyone deals with?
Lori54555
on 3/18/12 12:55 pm - Phillips, WI
Topic: UMR insurance, approval!!
Got approved by UMR insurance, exactly 2 months after my 6-month preop appointments with dietary and physical therapy. Originally I was told that if I didn't have a BMI of 40, it would be a tough approval. (I had a BMI of 38.5). They said that if I had a BMI of 35 to 39.9 with a medical comorbidity they would cover it. After going through the 6 months of noncovered very expensive dietician and physical therapy visits, they called my surgeon to tell me that they would not use GERD (my only medical comorbidity) as a reason. Really?? Like they couldn't tell me that before I spent thousands of dollars on preop appointments? Well anyways, in the meantime I was put on a medication that caused a little bit of weight gain, just enough to get me to 40 BMI (7 pounds). I came in at 40.2, so they approved me within 2 days after that appointment. Never in my life have I ever been happy that I gained weight! So, those of you who are on the border for qualifying, DON'T GIVE UP! My surgery is scheduled for 4/11. and by the way, I was told it is pretty difficult to get WLS approved by UMR if you don't have a ton of obesity-related issues.
Tea
on 3/17/12 7:39 am - Moore Haven, FL
VSG on 07/11/12
Topic: AFLAC
Does anyone have Aflac?? I was told to get it for help when im in the hospital and recovery time for help with finances. Has anyone claimed for that with them?

When I have my surgery in July I wont have enough time on the books to to get paid, so I was just going to eat the pay loss, however my friend at work told me to look at buying aflac insurance for that.

Any info would help.

thanks

TEA

HW 311 - (pre opt liq diet 272) - SW 264 - CW 196- GW 150

Lovin my
SLEEVE

AllieB
on 3/16/12 1:41 am - MI
Topic: RE: BC/BS PPO Michigan, Plastic Surgery
I hope the person that said they cover is right.  I went to see a plastic surgeon and with everything I need, they told me I need to get either rashes or pain documented for 3 months consecutively before they will turn it in into BSBS.  I started out over 400 lbs and lost almost 200. I was told I need my arms done, breast lift, TT, and LBL.  Maybe I need to see a different plastic surgeon!  Good luck!!

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