Recent Posts
Topic: Lapband was self pay; insurance may not pay for removal?
I got my lapband almost exactly five years ago. I was self pay so did not need to jump through the insurance hoops to prove that it was medically necessary for me to have it although I could have if I had insurance at the time. I wasn't employed but I had come into some money so I could afford to do it self pay. A wonderful thing so I thought at the time.
Now my lapband has eroded and I need to have it removed but my insurance is giving me the run around trying to say that I got it for "cosmetic" reasons. I guess if an insurance company doesn't give their blessing that it is medically necessary then they assume that it wasn't.
Anyway, I was just wondering if anyone had experienced this before and what the outcome was. I'm terrified that my insurance company isn't going to cover the removal of my band much less the revision surgery to the gastric sleeve that I want just because I was original self pay.
Thanks for any input anyone can provide.
Now my lapband has eroded and I need to have it removed but my insurance is giving me the run around trying to say that I got it for "cosmetic" reasons. I guess if an insurance company doesn't give their blessing that it is medically necessary then they assume that it wasn't.
Anyway, I was just wondering if anyone had experienced this before and what the outcome was. I'm terrified that my insurance company isn't going to cover the removal of my band much less the revision surgery to the gastric sleeve that I want just because I was original self pay.
Thanks for any input anyone can provide.
Karen
02/07/08
270/257.5/170
[url=http://www.TickerFactory.com/weight-loss/wsyRugb/]
[img]http://tickers.TickerFactory.com/ezt/t/wsyRugb/weight.png[/img]
[/url]
02/07/08
270/257.5/170
[url=http://www.TickerFactory.com/weight-loss/wsyRugb/]
[img]http://tickers.TickerFactory.com/ezt/t/wsyRugb/weight.png[/img]
[/url]
Topic: You can be successful
Hi Everyone,
I can remember how I searched these boards trying to figure out what to do when I wanted to have Weight Loss Surgery. Where should I go since I was paying for it. I wanted the best I could find even if it was in the US.
The one name for a doctor that just kept coming up over and over with great reviews about him was Dr. Aaceves. He is in Mexicali, Mexico-- a very safe board to cross.
I just want you to know that it has been 3 1/2 years since I had my WLS with Dr. Aceves. He is fabulous, and his entire staff are highly qualified. I was 63 when I had the surgery and I am 66 now. I lost 105 pounds and have kept the weight off.
He gave me the tool to do it, and it did require work and effort on my part too.
Please feel free to ask me any questions that you might have about Dr. Aceves and his excellt hospital and staff. There are all kinds of ways to finance your surgery too. You know we never think twice about making "car payments" well how about making some body payments--you are worth every dime you will spend to be healthy.
Hugs,
Suzanne
I can remember how I searched these boards trying to figure out what to do when I wanted to have Weight Loss Surgery. Where should I go since I was paying for it. I wanted the best I could find even if it was in the US.
The one name for a doctor that just kept coming up over and over with great reviews about him was Dr. Aaceves. He is in Mexicali, Mexico-- a very safe board to cross.
I just want you to know that it has been 3 1/2 years since I had my WLS with Dr. Aceves. He is fabulous, and his entire staff are highly qualified. I was 63 when I had the surgery and I am 66 now. I lost 105 pounds and have kept the weight off.
He gave me the tool to do it, and it did require work and effort on my part too.
Please feel free to ask me any questions that you might have about Dr. Aceves and his excellt hospital and staff. There are all kinds of ways to finance your surgery too. You know we never think twice about making "car payments" well how about making some body payments--you are worth every dime you will spend to be healthy.
Hugs,
Suzanne
Suzanne B
Eugene, OR
Dr. Aceves
10/21/2008
Start lbs 225
Now 120
Eugene, OR
Dr. Aceves
10/21/2008
Start lbs 225
Now 120
VSG on 04/22/12
Topic: New Requirements for BCBS ?
Hi All...
I am hoping someone else might know something about this. I read on another WL forum that as of February 1st. BCBS are requiring a 3 month supervised diet instead of the 6 month supervised diet? My online site for benefits SUCKS and I cannot get any info from there. I have BCBS of Michigan (PPO) I know WLS is covered, but I wanted to know if anyone else has seen or heard this info?
Thanks for any info anyone can give me!
I am hoping someone else might know something about this. I read on another WL forum that as of February 1st. BCBS are requiring a 3 month supervised diet instead of the 6 month supervised diet? My online site for benefits SUCKS and I cannot get any info from there. I have BCBS of Michigan (PPO) I know WLS is covered, but I wanted to know if anyone else has seen or heard this info?
Thanks for any info anyone can give me!
Topic: RE: trying to qualify with kaiser
Hi Jackie,
I am 5'4" and weigh 216 at the moment. My BMI is 37. My PCP says that Kaiser won't qualify me under 40 BMI with just high blood pressure (even though it takes 2 meds to control it). I did the sleep test and was told I have mild apnea + a heavy snoring problem. I am scheduled for a sleep info class tomorrow. I have to sleep with a special CPAP fro a week that will further record my paterns, then they will determine if I need a CPAP. If so, I think I can make my case. If not, I think I will write a detailed letter about why I think this is the right choice for me.
The bummer is I think Kaiser has stopped using Pacific Bariatrics in San Diego, which means a different surgeon. I was really hoping for the same doc as hubby, but that is not likely going to happen unless I win the lotto and can self-pay. I know I couldn't possibly afford this medical group/hospital on my own.
Congratulations on being almost finished with your classes. Do you know where they are sending you for surgery yet?
I am 5'4" and weigh 216 at the moment. My BMI is 37. My PCP says that Kaiser won't qualify me under 40 BMI with just high blood pressure (even though it takes 2 meds to control it). I did the sleep test and was told I have mild apnea + a heavy snoring problem. I am scheduled for a sleep info class tomorrow. I have to sleep with a special CPAP fro a week that will further record my paterns, then they will determine if I need a CPAP. If so, I think I can make my case. If not, I think I will write a detailed letter about why I think this is the right choice for me.
The bummer is I think Kaiser has stopped using Pacific Bariatrics in San Diego, which means a different surgeon. I was really hoping for the same doc as hubby, but that is not likely going to happen unless I win the lotto and can self-pay. I know I couldn't possibly afford this medical group/hospital on my own.
Congratulations on being almost finished with your classes. Do you know where they are sending you for surgery yet?
Topic: RE: Totally off topic...State Disability
Im sad that no one replied. Im trying to figure this out too. Im hoping to have my surgery sometime in April and I have to start looking into this. Especially since I want to take as much time as I can (if i can afford it) I know it varies per state. I live in CA and on the state disability it said that the max weekly payout is $1100 although the average is only $460 a week. $460 a week is not even half of what I make weekly but I might be able to manage. (HOPEFULLY) I really wish I had Aflac! But my employer does not offer Aflac.
Topic: RE: trying to qualify with kaiser
Do you know what your BMI is? I have a referance guide and unless your over 5"11 your BMI should be over 39. My Kaiser Doctor said it must be higher then 39 to qualify UNLESS you had other health issues like Diabetes, High blood presure, sleep apnea, High cholesterol, ect, Im currently in the Kaiser options program and ony have one class left. I qualified because my BMI is 49. Im 5'3 260 lbs.
Topic: Low BMI with BCBS MN (claims response)
So after I was told by my bariatric clinic that I would not qualify for surgery as my BMI was not quite 35 (was 34) and my co-morbidity of degenerative joint disease was also not diagnosed a minimum of two years ago, I called my INS. After talking with TWO different reps the nurse sd she would forward the matter to a claims rep.
Got the call back today and they said case by case basis. NOT NO or MIN two years.
Just thought I would throw that out there.
Got the call back today and they said case by case basis. NOT NO or MIN two years.
Just thought I would throw that out there.
DS on 12/03/12
Topic: RE: Insurance drama
They won't give me a list of providers. They said my pcp will refer me but that's a dead end
