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Topic: RE: please help me with insurance appeal letter
Have you spoken to your insurance providier? In talking with someone on the phone, sometimes they will provide more thorough details on how to submit the details / information if you ask them. If not, start with your Dietician. What records do they have and will they provide copies of that information along with a note to the Ins. company?.
When you are ready to submit...Summarize for the insurance company what you were asked to provide and what you are including in the documentation being submitted. (Use -bullet points and list everything. Include copies of all of your logs. Make sure there are dates, details, etc. Provide it in an organized fashion.
Do you have a Primary care physician? If so, generally most insurance companies want a letter of necessity from your doctor...that would be the where they would note your health issues (i.e. diabetic, high blood pressure, sleep apnea..back problems, etc.). Make a copy of all that you send. Some people say you should send your documentation by registured mail...
Follow up in a week to ensure the letter/documents were received.
When you are ready to submit...Summarize for the insurance company what you were asked to provide and what you are including in the documentation being submitted. (Use -bullet points and list everything. Include copies of all of your logs. Make sure there are dates, details, etc. Provide it in an organized fashion.
Do you have a Primary care physician? If so, generally most insurance companies want a letter of necessity from your doctor...that would be the where they would note your health issues (i.e. diabetic, high blood pressure, sleep apnea..back problems, etc.). Make a copy of all that you send. Some people say you should send your documentation by registured mail...
Follow up in a week to ensure the letter/documents were received.
Topic: RE: Cigna questions
I'm going to have surgery on Dec. 12th and my insurance is Cigna. It is a PPO plan.
I had the same conditions in having a 6 month medically approved weight loss program...having a BMI over 40, etc. While I saw my Primary Doctor at annual physicals and she had suggested diets in the past...her documentation wasn't good enough and I wasn't visiting her on a regular enough basis to have Cigna consider this as an approved weight loss program.. So....the weight loss/surgery center where I was interested in going for bariatric surgery set me up on a program where I was seen by a Dietician, given a high protein diet to follow and then see her each month for six months. I kept a journal of what I was eating, doing for physical activity, etc. She would weigh me each month, tracking my progress. When my 6 months was up....I had lost about 13 lbs., but was still obese with a high BMI. Another requirement is to have a physological evaluation...something the center set up for me. I met with the Physchologist for about 90 minutes for an evaluation. She would then write up her evaluation in a report. With that completed, all of that, along with my physical information was submitted by the center to Cigna. When submitted, it took about 2-3 weeks to get a reply. The first time...they denied my submission. They stated I needed to have a letter of authorization/acceptance from my Primary Care Physician. Once my regular doctor wrote/sent the letter in noting my health issues and agreeing with my going forward with surgery, within 10 days I got an acceptance letter from Cigna. (I have to say that overall Cigna was pretty helpful. They were pretty clear about what the requirements were and I could call to get clarification or ask a question anytime. I called once on a Sunday to find out the status of my submission and the Cust. Service person was able to tell me where it was and approximately how much more time it would take to go through review. It's really a matter of dotting the i's and crossing the "t's"....you just have to know all those things up front...otherwise you can run into issues. )
My suggestion is to look for a surgery center that is a comprehensive weight loss center. That way they have the programs and staff that can handle all aspects of preparing for surgery, understand the insurance requirements and then follow-up and group meetings to help after surgery. Good luck to you.....
I had the same conditions in having a 6 month medically approved weight loss program...having a BMI over 40, etc. While I saw my Primary Doctor at annual physicals and she had suggested diets in the past...her documentation wasn't good enough and I wasn't visiting her on a regular enough basis to have Cigna consider this as an approved weight loss program.. So....the weight loss/surgery center where I was interested in going for bariatric surgery set me up on a program where I was seen by a Dietician, given a high protein diet to follow and then see her each month for six months. I kept a journal of what I was eating, doing for physical activity, etc. She would weigh me each month, tracking my progress. When my 6 months was up....I had lost about 13 lbs., but was still obese with a high BMI. Another requirement is to have a physological evaluation...something the center set up for me. I met with the Physchologist for about 90 minutes for an evaluation. She would then write up her evaluation in a report. With that completed, all of that, along with my physical information was submitted by the center to Cigna. When submitted, it took about 2-3 weeks to get a reply. The first time...they denied my submission. They stated I needed to have a letter of authorization/acceptance from my Primary Care Physician. Once my regular doctor wrote/sent the letter in noting my health issues and agreeing with my going forward with surgery, within 10 days I got an acceptance letter from Cigna. (I have to say that overall Cigna was pretty helpful. They were pretty clear about what the requirements were and I could call to get clarification or ask a question anytime. I called once on a Sunday to find out the status of my submission and the Cust. Service person was able to tell me where it was and approximately how much more time it would take to go through review. It's really a matter of dotting the i's and crossing the "t's"....you just have to know all those things up front...otherwise you can run into issues. )
My suggestion is to look for a surgery center that is a comprehensive weight loss center. That way they have the programs and staff that can handle all aspects of preparing for surgery, understand the insurance requirements and then follow-up and group meetings to help after surgery. Good luck to you.....
Topic: Insurance question... out of pocket costs....
Ok.... I've been approved and now its a matter of cost.
Here's my info:
deductible remaining to be met is $118.xx
Out of pocket max remaining is $618.xx .....
I use UHC's consumer driven health plan .....
Will I end up paying more than the remaining of my out of pocket max?
Here's my info:
deductible remaining to be met is $118.xx
Out of pocket max remaining is $618.xx .....
I use UHC's consumer driven health plan .....
Will I end up paying more than the remaining of my out of pocket max?
Topic: RE: Sample Letter of Medical Necessity from PCP or Surgeon
I agree!
I know this post is 8 years old, but did anything ever come of it?
I know this post is 8 years old, but did anything ever come of it?
Topic: RE: Should I get my hopes up?
Just a update to say all the paper work is going out this week. It had to be sent as a hard copy with photos ect. I have with it a letter from my surgeon, gyno and primary! Wish me luck!
VSG Aug 9, 2010 with Dr. Shieh in Fort Myers, FL 
HW 366 Day of Surgery 334
PS: Extended TT, Arm Lift, Fat Transfer to the rear 6/6/2012.
HW 366 Day of Surgery 334
PS: Extended TT, Arm Lift, Fat Transfer to the rear 6/6/2012.
Topic: RE: What does Ins. Co. want to see in pre surgery diet?
Thank you for your response. That is helpful since physician's letter is the next thing I need.
Topic: RE: What does Ins. Co. want to see in pre surgery diet?
Don't know. So sorry I wont be helpful. My insurance just required that I see my PCP for three months and she just documented "pt continues to diet and exercise". Thats all my insurance required. I havent lost any weight at all. Call your insurance and ask to speak with a nurse in the pre-cert dept or ask your surgeons office they should know. I told my PCP the things I started cutting out of my diet such as orange juice, soda, alcohol and that I started drinking protein shakes for breakfast. She documented that also. Hopefully someone else will come along with a better answer. You may also want to repost this on the main forum.
Topic: RE: X post APPROVED !!!
Thanks for youur help nan. Im doing great, no complications and im drinking like there is no tommorow!
God grant me with the serenity to accept the things i cannot change ; Courage to change the things that i can ; and the wisdom to know the difference!!!
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