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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!!!
Topic: What does Ins. Co. want to see in pre surgery diet?
What does the insurance companies look for in the presurgical diet. Min only requires a 3 month physician supervised program. But will they deny you because you did well on the diet? Or if you dip below the required bmi do they deny you.
I guess I'm not sure if they are looking for succes in the diet program to suggest that you will be able to stick to the program after surgery (then why have the surgery?) or are they looking for you to try but fail with the program showing that you need the support of the surgery?
thanks in advance.
I guess I'm not sure if they are looking for succes in the diet program to suggest that you will be able to stick to the program after surgery (then why have the surgery?) or are they looking for you to try but fail with the program showing that you need the support of the surgery?
thanks in advance.
Topic: RE: Horizon BCBS NJ
This is actually my second trip through the process...
Two years ago I went through the process and was denied by BCBS-NJ.. The hospital group that I was going through did not help out alot and did not give much info. It seems like when I was denied they pretty much just dropped me.
BCBS denied me due to lack of a 6 month diet. I had a PCP that did not believe in WLS. Now the new group that I am working with is saying due to my size that they maybe able to get me by without the diet... This is the biggest problem so far is the different stories that you get.
This new hospital group is in network and they stated that it would be the 80/20 split in which I would be responsible for the 20% with no Deductible. Not sure if this applies to the out of pocket max or not.
Good Luck to you.
Two years ago I went through the process and was denied by BCBS-NJ.. The hospital group that I was going through did not help out alot and did not give much info. It seems like when I was denied they pretty much just dropped me.
BCBS denied me due to lack of a 6 month diet. I had a PCP that did not believe in WLS. Now the new group that I am working with is saying due to my size that they maybe able to get me by without the diet... This is the biggest problem so far is the different stories that you get.
This new hospital group is in network and they stated that it would be the 80/20 split in which I would be responsible for the 20% with no Deductible. Not sure if this applies to the out of pocket max or not.
Good Luck to you.
Topic: RE: Horizon BCBS NJ
I also have Horizon BCBS of NJ, but unfortunately I am too early in the process to be of much help. I called them this past week to ask what the requirements would be to obtain precertification, but the customer service rep said she didn't have the information and the department that did would only work directly with physicians' offices. So I'll have to wait and see what happens after my initial consult next week.
Regarding the 20% - are you looking at an out-of-network surgeon? I was hoping with an in-network surgeon they would cover more than that, but maybe I'm dreaming. I am being switched from Direct 10 to Direct 15 as of January 1st, so if they make eveyone pay out-of-network costs, I guess I'll be looking at 30% instead of 20%.
Regarding the 20% - are you looking at an out-of-network surgeon? I was hoping with an in-network surgeon they would cover more than that, but maybe I'm dreaming. I am being switched from Direct 10 to Direct 15 as of January 1st, so if they make eveyone pay out-of-network costs, I guess I'll be looking at 30% instead of 20%.
Topic: RE: Horizon BCBS NJ
With Horizon BCBS-NJ my deductible has been hit for the year. If I am approved this year would there be any charges billed or is WLS are you still respomsible for the 20%. After the first of the year our deductible will go up to 2500.00 Does this surgery apply to the deductible I guess is my question.
Update...
I just heard from the surgeons office today and they are saying that I am covered but I will be responsible for 20% with no deductible...
Is this 20% of the total cost or does BCBS have a negotiated price that they go off of.
On November 13, 2011 at 7:54 PM Pacific Time, Cards44 wrote:
I have one more question With Horizon BCBS-NJ my deductible has been hit for the year. If I am approved this year would there be any charges billed or is WLS are you still respomsible for the 20%. After the first of the year our deductible will go up to 2500.00 Does this surgery apply to the deductible I guess is my question.
I just heard from the surgeons office today and they are saying that I am covered but I will be responsible for 20% with no deductible...
Is this 20% of the total cost or does BCBS have a negotiated price that they go off of.
Topic: Insurance Question
Does anyone have Anthem Blue Cross Blue Shield PPO (Virginia) and was approved for the Vertical Sleeve?
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