Recent Posts
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.
RNY on 09/13/12
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
RNY on 09/05/12
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!
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.
Topic: RE: Totally off topic...State Disability
No...at least in California.
I was making ~$1800 while working and I'm getting $1100 on disability.So, just plan to be taking in a little less than usual. :)
I was making ~$1800 while working and I'm getting $1100 on disability.So, just plan to be taking in a little less than usual. :)
Topic: RE: Medi- Cal?
i have medi-cal but cant find a doc who accepts medi-cal.Where did you get your RNY done at?
Topic: RE: Oxford freedom plan, ny
Hey there. Best of luck to you. It may be difficult. I just went through the process with Oxford. Be prepared for a fight. They will do everything they can to deny you. They are pretty specific with what they consider a co-morbidity, and I am pretty sure they will deny you. Where is your policy written? Your appeal options will vary by state where the policy was issued as well as if you are fully-insured vs. self funded..
If your BMI is less than 40, you have to have one of the following:
If your BMI is less than 40, you have to have one of the following:
-
- Cardiovascular disease (e.g., stroke, myocardial infarction, stable or unstable angina pectoris, hypertension or coronary artery bypass)
- Life-threatening cardiopulmonary problems (e.g., severe sleep apnea, Pickwickian syndrome, obesity-related cardiomyopathy)
- Type 2 diabetes
- AND
- Patient selection criteria for bariatric surgery include (NHLBI, 1998):
- Active participation in an integrated clinical program that involves guidance on diet, physical activity and behavioral and social support prior to and after the surgery.
- Psychological evaluation to rule out major mental health disorders which would contraindicate surgery and determine patient compliance with post-operative follow-up care and dietary guidelines.
- Documentation of a motivated attempt of weight loss through a structured diet program, prior to bariatric surgery, whi*****ludes physician or other health care provider notes and/or diet or weight loss logs from a structured weight loss program for a minimum of 6 months.
Topic: Oxford freedom plan, ny
Just starting this journey. Has anyone dealt with Oxford freedom plan? I have a bmi of 36 with pcos, prediabeties, mild sleep apnea. What has your insurance process with Oxford been like?
Topic: BC/BS of Alabama
I am working on the requirements to have the sleeve done. I am really worried Blue Cross and Blue Shield of Alabama wont cover the surgery. I called and they told me they pay 100% up to the allotted amount? My yearly is $1000 for me and $2000 for the family. I'm worried the allotted amount is not enough to cover the surgery. Has anyone had BC/BS of Alabama, and it the allotted amount enough to cover the surgery?