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Topic: Looking for medical lender... Any suggestions?
Hi...
I am trying to finance my procedure and see many medical lenders online... Has anyone actually used any of them, and what was your experience? So many scams these days... So, I need a little help from my friends!!!
Thanks so much in advance!
Davina
I am trying to finance my procedure and see many medical lenders online... Has anyone actually used any of them, and what was your experience? So many scams these days... So, I need a little help from my friends!!!
Thanks so much in advance!
Davina
God bless all of our efforts... Davina 
You can give without loving, but you cannot love without giving.
~ Amy Carmichael ~
You can give without loving, but you cannot love without giving.
~ Amy Carmichael ~
Topic: RE: Questions about 6 month diet and weightloss
Thank you! That was really helpful. :) I'm hoping that I'll be able to meet his request of losing 20lbs within the 6 month period!
Topic: RE: Questions about 6 month diet and weightloss
what insurance wants and what your surgan wants are not dependant on each other. Your surgan is looking out for your best interests with the surgery and how things can go complication wise. Insurance is looking at ways to try and weed out those who are not committed to the changes needed.
For example, with my insurance as long as I could check off the boxes that I met with my primary Dr 6 times over a 6 month window, meet the BMI requirements, met with a shrink, met with a diatician then they are happy. My surgan's office wanted me to start making the changes I need now, looked to see if they could predict any complication based on blood work, helped me start dealing with head hunger... and so on.
While your surgan may not want to do the surgery until you have met their requirements, it does not mean that insurance will deny you. In my case the surgan's office just will not submit to insurance for approval until they feel I am ready. Lucky for me they submit to insurance on Monday
For example, with my insurance as long as I could check off the boxes that I met with my primary Dr 6 times over a 6 month window, meet the BMI requirements, met with a shrink, met with a diatician then they are happy. My surgan's office wanted me to start making the changes I need now, looked to see if they could predict any complication based on blood work, helped me start dealing with head hunger... and so on.
While your surgan may not want to do the surgery until you have met their requirements, it does not mean that insurance will deny you. In my case the surgan's office just will not submit to insurance for approval until they feel I am ready. Lucky for me they submit to insurance on Monday
Topic: RE: Medicare coverage for VSG is currently under review
Thanks for the report, Greg. Since we also have felt quite confident that CMS will decide to approve VSG, that's what my wife and I are doing, too (i.e., getting all the preconditions satisfied so we are "ready to go into surgery").
It is noteworthy that CMS initiated the "solicitation for comments" on their own, which we believe indicated that CMS already knew with some strong likelihood the final decision before they even started the review ... because all the data that has been generated is very consistent ... that VSG is far superior to lap band and will save money for Medicare. So I believe that your advice to start the approval process is "right on"!
I had planned to go self-pay since I was concerned that I couldn't risk waiting for Medicare to reach a decision to approve VSG ... but when I learned on October 7 that CMS had a week earlier announced the Solicitation for Comments and announced the timeline for a decision, I decided to wait because the evidence indicated a strong likelihood of a decision to approve VSG. Because VSG is the only type of gastric surgery we would consider (as I suspect is also true for many other people), the likely imminent decision from CMS is MAJOR to us!
Because my wife's medical situation is tenuous and any surgery is risky, we only feel comfortable with her VSG being done at Mayo Clinic in Rochester (in case of problems during surgery), and VSG is the type that Mayo recommended for her, given her situation. But the cost of self-pay at Mayo was likely going to be about $40,000. So the CMS decision is potentially a matter of life or death for her.
Again, thanks for the info, Greg! Here's hoping! 8>)
It is noteworthy that CMS initiated the "solicitation for comments" on their own, which we believe indicated that CMS already knew with some strong likelihood the final decision before they even started the review ... because all the data that has been generated is very consistent ... that VSG is far superior to lap band and will save money for Medicare. So I believe that your advice to start the approval process is "right on"!
I had planned to go self-pay since I was concerned that I couldn't risk waiting for Medicare to reach a decision to approve VSG ... but when I learned on October 7 that CMS had a week earlier announced the Solicitation for Comments and announced the timeline for a decision, I decided to wait because the evidence indicated a strong likelihood of a decision to approve VSG. Because VSG is the only type of gastric surgery we would consider (as I suspect is also true for many other people), the likely imminent decision from CMS is MAJOR to us!
Because my wife's medical situation is tenuous and any surgery is risky, we only feel comfortable with her VSG being done at Mayo Clinic in Rochester (in case of problems during surgery), and VSG is the type that Mayo recommended for her, given her situation. But the cost of self-pay at Mayo was likely going to be about $40,000. So the CMS decision is potentially a matter of life or death for her.
Again, thanks for the info, Greg! Here's hoping! 8>)
Topic: RE: Medicare coverage for VSG is currently under review
I spoke with my Bariatric Surgeons P.A. today and discussed the Medicare coverage review of the VSG. He told me based on his attendance at the annual Bariatric Surgeons convention he was told coverage for the VSG is very likley to be approved for Medicare. He did not want to cite names but did say this tip off came from very reliable sources close to the review process. He went so far as to say (without prompting) "He would be shocked if the review panel rejected covering it this year".
Im starting my 6 month required supervised diet (ie Nutritionist) consultations now to be ready for submittal come October when Medicare updates it's coverage. Those of you on Medicare and Medicade who have been holding out for VSG surgery coverage I strongly suggest contacting your Hospitial's Bariatric cordinator and starting the nessicary legwork now. Starting now, I will have everything needed for insurance approval ready to go the moment coverage goes live.
In closing, just a reminder that the review board for Medicare will be posting a memo indicating their purposed decision and findings in just a couple of weeks (3/30/2012). Final binding decision by no later than 6/28/2012.
~Greg
Im starting my 6 month required supervised diet (ie Nutritionist) consultations now to be ready for submittal come October when Medicare updates it's coverage. Those of you on Medicare and Medicade who have been holding out for VSG surgery coverage I strongly suggest contacting your Hospitial's Bariatric cordinator and starting the nessicary legwork now. Starting now, I will have everything needed for insurance approval ready to go the moment coverage goes live.
In closing, just a reminder that the review board for Medicare will be posting a memo indicating their purposed decision and findings in just a couple of weeks (3/30/2012). Final binding decision by no later than 6/28/2012.
~Greg
Topic: Questions about 6 month diet and weightloss
I started my 6 month dr. observed diet on 2/7/12. I just had a few questions about weightloss during this time. I really have been trying very hard to loose some weight during this time. My surgeon would like me to lose 20lbs before my surgery. I have only lost 8lbs in the last 2 months. I was wondering if any of you had this problem? Can I be denied if i do not lose the weight that my surgeon reccommended? I was also wondering about how long it takes for approval after you have finished this proccess? Has anyone been denied after doing this? If so, why? Just trying to make sure that I'm doing everythat that I'm supposed to do so that I am not denied by my insurance.
Topic: Humana Gold Plus (Medicare)
Does anyone have any information on what Humana Gold Plus requires for bariatric surgery? Specifically, do you know if they require a 6-month supervised diet? I called my insurance company today, but was not able to speak with anyone; they are supposed to call me back. I'll be calling them again tomorrow if I don't hear from them by then.
If you know anything, I sure would appreciate hearing from you. Thanks.
Beth
If you know anything, I sure would appreciate hearing from you. Thanks.
Beth
Consult WT: 312 SW: 274 CW: 244
Topic: RE: BC/BS of Alabama
I have them too. I noticed after searching that someone in 2010 said that as long as you have EVERYTHING they ask for that they are easy to work with. I hope that is true for both of us. Good Luck!
I believe in me...the best is yet to be!
Topic: Connecticare
Hi everyone, I have Connecticare and my employer does not have the bariatric surgery rider. I have a BMI of 42 am diabetic, arthritic and sleep apnea. Will the insurance cover the surgery because of these co-morbids? Anyone know?
Thanks so much,
Maria
Thanks so much,
Maria
Topic: RE: Totally off topic...State Disability
It's based on your income in CA, I don't remember the exact amount, but it's between 1/2 and 2/3 of what your income is. I was making ~$1800 at my job and earn $1100 on disability.
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