Recent Posts

Havalina
on 11/19/11 6:48 am
Topic: Should I get my hopes up?
I posted a short while ago that my husband's employer changed our insurance. The new insurance has an exclusion for the removal of any hanging skin. It does not state unless medically necessary etc. Well, I was planning to have my panni done as soon as this Dec before the change. So, I called the insurance company ( twice actually) and on both calls with two different reps, I was told that the exclusion can be waived in cases that they do believe are a true medical necessity and that the criteria has to be met. Now, I do meet all of their criteria..but I don't know! I have read many people on this board and others that an exlcusion is just that and there is nothing that can be done. It just don't make sense to me that both reps told me to have the Doc. send in everything and make sure it is shown why its medically necessary. Any insights? Should I have some higher hopes? Why wouldn't they just tell me its excluded period, if there wasn't a chance?
 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.
    
WoolyBully
on 11/16/11 9:50 am - MI
Topic: RE: BC/BS PPO Michigan, Plastic Surgery
thanks for the response, that takes a load off my mind.

Unless it becomes medically necessary, I would rather wait so I only have one surgery.

I am still loosing, (163 lbs so far with about a 100 to go) so I hope to be ready for it around this time next year.

Thanks again.

Gary
gonetothedogzz
on 11/15/11 7:24 am - OH
Topic: RE: Ohio Molina approved
Hi Amy,

Congradulations on your date. I am currently starting the process with Molina and like you have been morbidly obese for over five years. I have MS, lower back problems, arthritis, and sleep apnea and was glad to see that they didnt have you do the six months of dieting which leads to my question as I am hoping that I dont have to as well. What makes Molina decide to have some do the six months of doctor supervised dieting and not others?

Thanks


MaMaMaRTiNeZz
on 11/15/11 7:03 am - Los Angeles, CA
RNY on 11/01/12
Topic: United Heathcare/Pacificare for Public Employees

I have an HMO through UH and am currently under HealthCare Partners Network iPA Pasadena. When my Primary doctor requested approval for Bariatric surgery consultation is was approved immediately and I was sent to Association of South Bay Surgeons which is a HCP approved Bariatric Surery Facility. Even though it is about 1 hour from where I live, I travel to Torrance for my appointments with Surgeon and will be admitted to Torrance Memorial for my actual procedure. GB, Lap-Band, DS, and VSG are all covered 100% with NO deductible or copay under my insurance for either of these procedures. Revisions are also 100% covered. I am a Public Sector employee and I thank God everyday for my job because it has terrific benefits (I paid NOTHING to have my son via C-Section in a Top California Methodist Teaching Hospital with S-O-A Facilities). I am just wondering if anyone here has medical insurance due to being a County/State/Government employee and if the process to get approved for Gastric Bypass was smooth. I have a BMI of 45 which automatically qualifies me but I am also Pre-Diabetic with Asthma and a history of bone problems in my feet/ankles because of the weight. I have also been in my Bariatric Surgical Program since March 2010 and documented weight checks ranging from every week to every month or so, very consistent history of seeing the surgeon, nutritionist, nurse practicioner, and doing regular weigh-ins. Also, I have a regular schedule of seeing my Primary Care Physician for my co-morbidities as well. It has taken me almost 2 years being in this program to finally submit for authorization. I am hoping my history will give them enough info to approve me. Please let me know if anyone has similar insurance to me and what the process was like. Thanks :)

              NOTHING tastes as GOOD as SKINNY FEELS...

 Starting Pre-Op Weight: 305     Weight On Day of Surgery: 297 

  
          
                    

    

MichiganGal
on 11/14/11 10:55 pm - Tecumseh, MI
Topic: RE: BC/BS PPO Michigan, Plastic Surgery
BCBS of MI is a great insurance to cover removal of excess skin on the abdomen.  You will meet the criteria so when your ready the procedure will not need to be pre-authorized.  You should wait until the weight loss has slowed down or stopped.  Although, in some cases with a high BMI it is medically necessary to remove the skin before all of the weight has been lost.
Stacey Corsa
on 11/14/11 10:34 pm - Clinton, IL
Topic: RE: X post APPROVED !!!
Congratulations! We are having surgery the same day!  See you on the other side!


-Stacey

Come join my Facebook Bariatric Support Group!

Looking for a decorative, fragrant alternative to candles? Go Wickless!

   

 

 

 

    

    
Christine H.
on 11/14/11 12:06 pm - Cumberland, MD
Vanessa A.
on 11/14/11 5:01 am - FL
Topic: X post APPROVED !!!
You would never understand how much a simple phone call would make your day soooo great . Im sooooo happy to hear the words approved. My surgery date is Nov 21st in exactly 7 days ahhhhhh. Cant wait to become a better newer me ! tahnks for all the support and patience you guys had with me. Love you all

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!!!
    

Cards44
on 11/13/11 11:54 am - IL
VSG on 07/24/12
Topic: RE: Horizon BCBS NJ
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.
prncsstwink
on 11/12/11 7:55 am - Fort Lee, VA
Topic: RE: Tricare help!
I'm at Fort Lee, VA now.  We were out at Fort Irwin, CA.  While out there I was approved but then decided not to go ahead with surgery b/c i didn't want to be PCS'ing shortly after.  So now, i'm running into problems b/c tricare has changed the policy to also include that you have to have 6 months of documented proof that you have tried to lose weight using non surgical methods.  I have done this by far (nutritionist, weight loss clinic off post, paid for privately, weigh****chers, gym, diet plan, etc) but the woman at the referral center that approves whether  the referral gets sent to tricare to get approved to simply see the surgeon, doesn't care to look through my records to see that i have tried all this other stuff.  so she's saying i can't go.  so i have been fighting with her, through the patient advocate.  i can't wait until tues when everyone is back to work and i can hopefully get some answers.  i soooo badly want this surgery!  i'm beginning to wonder if i look and see where the nearest MTF is that does the surgery, and if i can go there.  i know Bragg is just under 3 hrs away. i'm not sure if Norfolk, or Eustis has an MTF that does RNY???
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