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(deactivated member)
on 2/7/12 9:14 am
on 2/7/12 9:14 am
Topic: RE: Insurance Pre Approval question
I don't have an answer for you but I want to wish you luck. I've looked online to try to find you an answer. It seems this portion of the forum has TONS of questions and only a few answers. I think everyone is uncertain about some things!
(deactivated member)
on 2/6/12 6:23 am
on 2/6/12 6:23 am
Topic: new here and have a question
Today I found out my insurance covers bariatric services when I originally thought they didn't so that was happy news! My doctor told me I needed to call and find out co-pays and that type of stuff to find out what my financial responsibility would be. I called (I have United Healthcare) and they told me there is a $20,000 lifetime max for this surgery. I know I've read a question about this on here before (I've been lurking for awhile), but was if anyone here has dealt with that and wondered about how much you had to pay out of pocket if. I know all surgery costs are different, but I'm just curious since my doctor's office is closed for the day.
Topic: Insurance Pre Approval question
Hi Guys
I am getting ready for my third weigh in for my 6 month supervised diet. This visit will be the end of the 2nd month and start of the 3rd month.
I have already had my pysch exam also.
My advocate with the program that I am going through told me that after the 3rd visit (scheduled 2/15) that the information would be sent into the insurance for pre-approval in which the insurance would approve or disapprove at that point. If they approve all we would have to do is send in the info that I finished the diet and everything would be approved at that point.
Has anyone heard anything about this.
I am getting ready for my third weigh in for my 6 month supervised diet. This visit will be the end of the 2nd month and start of the 3rd month.
I have already had my pysch exam also.
My advocate with the program that I am going through told me that after the 3rd visit (scheduled 2/15) that the information would be sent into the insurance for pre-approval in which the insurance would approve or disapprove at that point. If they approve all we would have to do is send in the info that I finished the diet and everything would be approved at that point.
Has anyone heard anything about this.
Topic: RE: Tricare Prime (North)
Sorry.. It wouldn't let me keep typing. I chose my surgeon, he accepted tricare. It was done a a very well known hospital here in southern california .
Things I wish I had known...
1. Start taking vitamins NOW. It needs to become a daily habit.
2. Find a protein drink that you really enjoy now. Even though your tastes may change ( mine did not) that is the thing I struggle with the most.
3. Start making protein the most important part of your daily intake. TODAY.. I know it sounds " preachy" but in your future it will become the most important thing in your life.
4. Start drinking water.. Or crystal light or any other sugar free food/ beverage. This was a major issue for me, as I never drank sweetened beverages. I am not a sugar lover so the ohhhh so sweet favors drive me crazy lol.
5. NSAIDS are the devil.. You will never be able to have MOTRIN, ADVIL, IBUPROPHIN again. If those medications are a part of your life ask your doc if there are alternatives that you can use.
And lastly. If you are not happy with your life... This surgery isn't going to make you happy. It will help you lose weight, but you have to do the rest of the work :) I wish you all of the best luck possible. PM me if you want to ask anything.. There are so many questions to ask, don't hesitate. Ohhhh and bariatric foodie ( google her) and the world according to eggface.. Great sites! Good luck!!!!!
Things I wish I had known...
1. Start taking vitamins NOW. It needs to become a daily habit.
2. Find a protein drink that you really enjoy now. Even though your tastes may change ( mine did not) that is the thing I struggle with the most.
3. Start making protein the most important part of your daily intake. TODAY.. I know it sounds " preachy" but in your future it will become the most important thing in your life.
4. Start drinking water.. Or crystal light or any other sugar free food/ beverage. This was a major issue for me, as I never drank sweetened beverages. I am not a sugar lover so the ohhhh so sweet favors drive me crazy lol.
5. NSAIDS are the devil.. You will never be able to have MOTRIN, ADVIL, IBUPROPHIN again. If those medications are a part of your life ask your doc if there are alternatives that you can use.
And lastly. If you are not happy with your life... This surgery isn't going to make you happy. It will help you lose weight, but you have to do the rest of the work :) I wish you all of the best luck possible. PM me if you want to ask anything.. There are so many questions to ask, don't hesitate. Ohhhh and bariatric foodie ( google her) and the world according to eggface.. Great sites! Good luck!!!!!
HW 274. CW 129
Topic: RE: Tricare Prime (North)
Hi Courtney,
I am Tricare ( west) . I had RNY in October.
I was approved to see my surgeon within a week of my request.
I was not required to be on a pre surgery diet but that is sometimes determined by your surgeon.
I was required to see a nutritionist and a psychologist. I was required to be cleared by a cardiologist ( pre-existing condition)
I went to my first seminar at at the end of February 2010 my initial surgery date was in May.. Then July haha then October (other health issues kept pushing me back lol)
My initial stay for the RNY was three days. I developed an infection in the infamous left side port entry ( read the boards and you will find that this particular place is a real bear) and was readmitted for another three days.
With the exception of the infected wound site it took me about ten days to feel "pretty good"
I had a couple of issues that developed after my surgery... They were not what I expected. By thanksgiving I had 4 ulcers ... So my beginning was not fun.
I can tell you that I have no regrets. I feel great now. And I would do it again!
I am Tricare ( west) . I had RNY in October.
I was approved to see my surgeon within a week of my request.
I was not required to be on a pre surgery diet but that is sometimes determined by your surgeon.
I was required to see a nutritionist and a psychologist. I was required to be cleared by a cardiologist ( pre-existing condition)
I went to my first seminar at at the end of February 2010 my initial surgery date was in May.. Then July haha then October (other health issues kept pushing me back lol)
My initial stay for the RNY was three days. I developed an infection in the infamous left side port entry ( read the boards and you will find that this particular place is a real bear) and was readmitted for another three days.
With the exception of the infected wound site it took me about ten days to feel "pretty good"
I had a couple of issues that developed after my surgery... They were not what I expected. By thanksgiving I had 4 ulcers ... So my beginning was not fun.
I can tell you that I have no regrets. I feel great now. And I would do it again!
HW 274. CW 129
Topic: RE: trying to qualify with kaiser
Good news, well depending on how you look at it. Since I have had my sleep test and have to go on a CPAP, my PCP finally agreed to send my referal paperwork in 
Topic: RE: Need info on financing WLS in Mexico!!
Hello! I am planning my sleeve surgery with Dr. Almanza in Tiijuana, Mexico. He has hundreds of satisfied patients that go to him from Canada and the U.S. If you get denied through medicalfinancing.com, you can apply through "No Patient Left Behind." They require that you pay 1/2 the cost of the surgery (prior to your surgery date - in payments) and then they will finance the 2nd half of the sugery for 1-4 years. Good Luck!
Topic: RE: United Healthcare trauma
I also have UHC insurance through my employer that I have paid premiums on for 10 years and they have done the same thing. I work for a small company with 45 employees (world-wide) and I just happen to be the only one that is morbidly obese and in need of WLS.
Not unlike most, they have negotiated the exclusion from coverage for "WLS, Weight Management Programs of any kind, and Doctor -Supervised Diets, even if medically necessary, for morbid obesity - for any reason," to "keep the premiums as low as possible for everyone."
I have found out that this "exclusion-language" is pretty much rock-solid and I'm unable to get my surgery covered with insurance, in any way, because of it.
I've spoken to several patient advocates, their consensis is the same. It truly sucks!
I have gone to my company executives and asked for them to change our insurance coverage, so I have a chance to get healthy thereby costing less in medical expenses for both them and I, but the response was a resounding "No, not gonna happen."
So I even went so far as to ask the president of the company if he would consider authorizing financial assistance from the company to help me pay for the surgery, since their negotiations have prevented my coverage. That question got the same response.
It's difficult, depressing and debilitating, to say the least, when you have to deal with people whom have the audacity to think they have the right to make life-altering decisions for you, pertaining to your health, even though they know nothing about your life and the health conditions that you struggle with daily. I feel greatly discriminated against because of this, but also because almost everyone I work with thinks that WLS is a cop-out, a lazy person's answer to loosing weight. This attitude is one of the reasons why we obese people have so many problems with very prevalent discrimination in society.
I found a petition on one of the ObesityHelp blogs that is asking the government to force insurance companies to include WLS surgery in their coverage for morbid obesity. It's short, but to the point. It says that we should not be denied treatment of any kind for our obesity disease when the law provides for drug and alcohol addicts the same protection of coverage as we are asking for.
I would encourage you to seek and find that petition and sign it. And I encourage you to petition in any and all other ways possible to get the coverage you need. But please don't let the negative responses discourage your efforts. I am not letting them stop me and I hope we both will find a way to achieve the necessary financing we need without having to resort to putting ourselves in harms ways to do it.
Good luck! = ; }
Not unlike most, they have negotiated the exclusion from coverage for "WLS, Weight Management Programs of any kind, and Doctor -Supervised Diets, even if medically necessary, for morbid obesity - for any reason," to "keep the premiums as low as possible for everyone."
I have found out that this "exclusion-language" is pretty much rock-solid and I'm unable to get my surgery covered with insurance, in any way, because of it.
I've spoken to several patient advocates, their consensis is the same. It truly sucks!
I have gone to my company executives and asked for them to change our insurance coverage, so I have a chance to get healthy thereby costing less in medical expenses for both them and I, but the response was a resounding "No, not gonna happen."
So I even went so far as to ask the president of the company if he would consider authorizing financial assistance from the company to help me pay for the surgery, since their negotiations have prevented my coverage. That question got the same response.
It's difficult, depressing and debilitating, to say the least, when you have to deal with people whom have the audacity to think they have the right to make life-altering decisions for you, pertaining to your health, even though they know nothing about your life and the health conditions that you struggle with daily. I feel greatly discriminated against because of this, but also because almost everyone I work with thinks that WLS is a cop-out, a lazy person's answer to loosing weight. This attitude is one of the reasons why we obese people have so many problems with very prevalent discrimination in society.
I found a petition on one of the ObesityHelp blogs that is asking the government to force insurance companies to include WLS surgery in their coverage for morbid obesity. It's short, but to the point. It says that we should not be denied treatment of any kind for our obesity disease when the law provides for drug and alcohol addicts the same protection of coverage as we are asking for.
I would encourage you to seek and find that petition and sign it. And I encourage you to petition in any and all other ways possible to get the coverage you need. But please don't let the negative responses discourage your efforts. I am not letting them stop me and I hope we both will find a way to achieve the necessary financing we need without having to resort to putting ourselves in harms ways to do it.
Good luck! = ; }
Topic: RE: employer NOT insurance co opted out to cover bariatric surgery
I have insurance through my employer that I have paid premiums on for 10 years and they have done the same thing. Small company with 45 employees (world-wide) and I just happen to be the only one that is morbidly obese and in need of WLS.
They have negotiated the "exclusion of coverage for WLS, weight management programs and doctor supervised diets, even if medically necessary, for morbid obesity, for any reason," from our insurance coverage "to keep the premiums as low as possible for everyone." I have found out that this "exclusion language" is pretty much rock-solid and I'm unable to get surgery coverage, in any way, because of it. I've spoken to several patient advocates, their consensis is the same.
I have gone to the company executives and asked for them to change our insurance coverage so I have a chance to get healthy & cost less in medical expenses for both them and I, but the response was a resounding "No, not gonna happen." So I even went so far as to ask the president of the company if he would consider authorizing financial assistance from the company to help me pay for the surgery, since they've prevented coverage. That question got the same response.
It's difficult, depressing and debilitating, to say the least, when you have to deal with people whom have the audacity to think they have the right to make life-altering decisions for you, pertaining to your health, even though they know nothing about your life and the health conditions that you struggle with daily. I feel greatly discriminated against because of this, but also because almost everyone I work with thinks that WLS is a cop-out, a lazy person's answer to loosing weight. This attitude is one of the reasons why we obese people have so many problems with prevalent discrimination in society.
I found a petition on one of the ObesityHelp blogs that is asking the government to force insurance companies to include WLS surgery in their coverage for morbid obesity. It's short, but to the point. It says that we should not be denied treatment of any kind for our obesity disease when the law provides for drug and alcohol addicts the same protection of coverage as we are asking for.
I would encourage you to seek and find that petition and sign it. And I encourage you to petition in any and all other ways possible to get the coverage you need. But please don't let the negative responses discourage your efforts. I am not letting them stop me and I hope we both will find a way to achieve the necessary financing we need without having to resort to putting ourselves in harms ways to do it.
Good luck! = ; }
They have negotiated the "exclusion of coverage for WLS, weight management programs and doctor supervised diets, even if medically necessary, for morbid obesity, for any reason," from our insurance coverage "to keep the premiums as low as possible for everyone." I have found out that this "exclusion language" is pretty much rock-solid and I'm unable to get surgery coverage, in any way, because of it. I've spoken to several patient advocates, their consensis is the same.
I have gone to the company executives and asked for them to change our insurance coverage so I have a chance to get healthy & cost less in medical expenses for both them and I, but the response was a resounding "No, not gonna happen." So I even went so far as to ask the president of the company if he would consider authorizing financial assistance from the company to help me pay for the surgery, since they've prevented coverage. That question got the same response.
It's difficult, depressing and debilitating, to say the least, when you have to deal with people whom have the audacity to think they have the right to make life-altering decisions for you, pertaining to your health, even though they know nothing about your life and the health conditions that you struggle with daily. I feel greatly discriminated against because of this, but also because almost everyone I work with thinks that WLS is a cop-out, a lazy person's answer to loosing weight. This attitude is one of the reasons why we obese people have so many problems with prevalent discrimination in society.
I found a petition on one of the ObesityHelp blogs that is asking the government to force insurance companies to include WLS surgery in their coverage for morbid obesity. It's short, but to the point. It says that we should not be denied treatment of any kind for our obesity disease when the law provides for drug and alcohol addicts the same protection of coverage as we are asking for.
I would encourage you to seek and find that petition and sign it. And I encourage you to petition in any and all other ways possible to get the coverage you need. But please don't let the negative responses discourage your efforts. I am not letting them stop me and I hope we both will find a way to achieve the necessary financing we need without having to resort to putting ourselves in harms ways to do it.
Good luck! = ; }
Topic: Tricare Prime (North)
Hey Everyone,
I'm new here and have a few questions...
On January 25th I visited with my Dr. to get a referral for RNY. She agreed that surgery would be a good option for me. So she has sent the request to Tricare Prime (North) to approve the referral with a Bariatric Surgeon. So here are just a few questions I have.
1. Has anyone else here gone through Tricare Prime (North) ?
2. How long did it take to get in to see the surgeon?
3. How many of you had to go on a preop diet, and how long was the preop diet?
4. How long did it take for you to get your surgery from first consultation with surgeon to surgery date?
5. How long was your stay in the hospital?
6. How did you feel after surgery?
7. Does anyone have any regrets about the surgery?
8. Who was your surgeon?
9. If there was one thing you wish you knew before you had surgery, what would it be/ Any words of wisdom?
10. When do you think I should contact Tricare to see how my referral is going?
11. Will they choose the surgeon for me?
Thank You! Courtney!!
Hey Everyone,
I'm new here and have a few questions...
On January 25th I visited with my Dr. to get a referral for RNY. She agreed that surgery would be a good option for me. So she has sent the request to Tricare Prime (North) to approve the referral with a Bariatric Surgeon. So here are just a few questions I have.
1. Has anyone else here gone through Tricare Prime (North) ?
2. How long did it take to get in to see the surgeon?
3. How many of you had to go on a preop diet, and how long was the preop diet?
4. How long did it take for you to get your surgery from first consultation with surgeon to surgery date?
5. How long was your stay in the hospital?
6. How did you feel after surgery?
7. Does anyone have any regrets about the surgery?
8. Who was your surgeon?
9. If there was one thing you wish you knew before you had surgery, what would it be/ Any words of wisdom?
10. When do you think I should contact Tricare to see how my referral is going?
11. Will they choose the surgeon for me?
Thank You! Courtney!!
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