Recent Posts
Topic: Need help with Medicare
I have medicare and they cover weight loss surgery and have no 6 month supervised weight loss diet. But the company that administers medicare for the state of Kentucky on my last medicare summary notice , was CGS and they require the 6 months supervised diet. But today i got another medicare summary notice and the administrator is National Government Services. I thought maybe this new paper was for part A or something but no. They are both for Part B services, in which i was told Bariatric is covered under. But the thing is i cant find anything about requirements on their website. Can someone please help me out!!!!
Topic: post op work
Has anyone had any luck with getting post ope surgeries done through insurance for example breast lift/reduction and abdominal. Before my surgery my surgeon mention because of the size of my breast that i would need to get them done after weight lost. They hung then and the do now and there is irritation more now. the area between my lower abdomin(panny) and private are is even more irritable..any advice. I have aetna again this is the insurance i had for my WLS since then i had carefirst but only had follow up care via them
WLS 1/19/07
preop/current/drgoal/mygoal/ideal wt
320/240
/220/180/155
Topic: RE: BCBS MN???
I have BCBC MN and was just told that because I have not had a minimum BMI of 35 for two years, and even though I have sleep apnea and degenerative joint disease and now have a bmi of 43, I do not qualify.
Topic: RE: Insurance question... out of pocket costs....
How did you get approved through United Healthcare? I have an exclusion on any kind of weight loss methods including surgery. I asked them about taking out a personal plan without that exclusion and they dont have one.
(deactivated member)
on 1/22/12 5:26 am
on 1/22/12 5:26 am
Topic: Ins covers rny and band not sure about vsg
If ins says it won't pay for vsg how do I appeal. I have a blood coloring disorder and have to take aspirin for the rest of mt life.
Please tell me of your experience with this and please everyone please pray the ins covers this for me vsg is my only choice.
Thanks in advance for your input and prayers!
Please tell me of your experience with this and please everyone please pray the ins covers this for me vsg is my only choice.
Thanks in advance for your input and prayers!
Topic: RE: Anthem BC/BS of NH -Insurance Nightmare Just starting
Thank you for the reply and I do know these requirements but my revision does not fall into this categor, mine is in the medical necessaty because of the fact the infection in my band almost killed me.I have been talking with BC/BS all week and since my revision is caused by this infection to the device implanted there are no requirements to meet as I had no chioce in having it removed, an I had lost all the weight I needed too. This automatically qualifies me for the revision. What I have found out from Anthem themselves is that their doctor for reason's they do not understand never read my file and denied my revision on the grounds that he thought it was my first surgery. I was really surprised when BC/BS admitted this to me and I think they have been angrier than I was. As we speak my surgeon is having a peer to peer review to makes sure this time it is clear why this revision is necessary. I am more than a little concerned however because if he did not read my information where very clearly in the second paragraph states that the revision is for a failed Lap Band, one has to wonder what else this doctor may have missed for other people.
Topic: RE: Anthem BC/BS of NH -Insurance Nightmare Just starting
Here is the Anthem Medical Policy regarding revisions or change to different procedure after complications, hope this helps and hope that you will be approved. It will be a fight I am sure but don't give up.
Repeat surgical procedures for revision or conversion to another surgical procedure (that is also considered medically necessary within this document) for inadequate weight loss, (i.e., unrelated to a surgical complication of a prior procedure) are considered medically necessary when all the following criteria are met:
- The individual continues to meet all the medical necessity criteria for bariatric surgery (see page 1); and
- There is documentation of compliance with the previously prescribed postoperative dietary and exercise program; and
- 2 years following the original surgery, weight loss is less than 50% of pre-operative excess body weight and weight remains at least 30% over ideal body weight (taken from standard tables for adult weight ranges based on height, body frame, gender and age, an example is available from the National Heart Lung and Blood Institute [NHLBI] at: http://www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.htm.
(deactivated member)
on 1/19/12 12:30 pm
on 1/19/12 12:30 pm
Topic: My Coventry covers WLS
RNY and the Band but my surgeons offie has to call and see if they pay for VSG which is really what I want.
Has anyone ever had this insurance issue?
Has anyone ever had this insurance issue?
Topic: RE: Has anyone written their own letter?
Thanks Nan! I friended you...and made my profile public...thanks so much!
Topic: RE: Has anyone written their own letter?
Hi Michelle,
I would be glad to send it to you. I can't PM you because your profile is not public or something. Can you add me as a friend??
I see you are from MI. where are you having your surgery? I had my surgery at Hurley, along with all three of my kids!
Nan
I would be glad to send it to you. I can't PM you because your profile is not public or something. Can you add me as a friend??
I see you are from MI. where are you having your surgery? I had my surgery at Hurley, along with all three of my kids!
Nan
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
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