Recent Posts
Topic: Questions about Deductibles/copays
Hi! I'm in the process of getting approved for the VSG surgery. With my insurance, I have a $2000 deductible for surgery and 80/20 with a max out of pocket of $5000. I'm curious how much my VSG might cost. I know I'll have to get exact numbers from my surgeon, just looking for ideas of what to expect! Also, does anyone know if you normally pay the deductible up front, or after surgery? Thanks so much!
Rebecca
Rebecca
Topic: RE: Tricare help!
My BMI was right at 40 with no comorbidities and I was approved with no problems. (I have Tricare Prime and am getting the sleeve at an MTF.) As it turned out, the sleep study determined that I have severe sleep apnea (I was shocked...I didn't think I had any sleep issues at all) so now I do have one.
GL!
GL!
Topic: RE: Aetna Driving Me CRAZY!!!!
At least BCBS Fep did tell me they had received my packet on the 29th of August. They told me it might take as long as 30 days for them to adjudicate and then I would be mailed the results.
It looks like you did get your approval. Congratulations! Best wishes.
It looks like you did get your approval. Congratulations! Best wishes.
Topic: RE: United Healthcare... conflicting info on requirements
Im going through the same thing right now.. I have UHC and im currently trying to get the sleeve done and for the past 5 years my BMI has averaged about 36 to 39 and im nervous they are going to deny me, idk if they are really strict or if they go case by case but im talking to a case manager Sep 12th so i'll see,, Good luck i hope you get it!
Topic: RE: united heatlh care ppo
This is their website and everything they cover take a look and see if it is on there.
https://fhs.umr.com/oss/cms/FHS.UMR.com/content/provider/ProviderForms/medicalInfoForPredetermination/
https://fhs.umr.com/oss/cms/FHS.UMR.com/content/provider/ProviderForms/medicalInfoForPredetermination/
Topic: RE: Tricare help!
You have to be 200% over your ideal body weight. If you are a 100 pounds you need to have at least one co-morbid. Here is the info from the Tricare site.
Gastric Bypass
TRICARE covers gastric bypass, gastric stapling and gastroplasty to include vertical banded gastroplasty and laparoscopic adjustable gastric banding (Lap-Band surgery) is covered only when the beneficiary meets one of the following conditions:
- Is 100 pounds over ideal weight for height and bone structure and has one of these associated conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome, hypothalamic disorders or severe arthritis of the weight-bearing joints
- Is 200 percent or more over ideal weight for height and bone structure
- Has had intestinal bypass or other surgery for obesity and because of complications, requires another surgery (takedown)
TRICARE does not cover:
- Nonsurgical treatment of obesity, morbid obesity, dietary control or weight reduction
- Biliopancreatic bypass, gastric bubble or balloon for the treatment of morbid obesity
Note for Active Duty Service Members: Bariatric surgery represents a major and permanent change in your digestive system that requires strict adherence to a specific dietary regimen that may interfere with operational deployment. A history of bariatric surgery is already a bar to military service and receiving bariatric surgery while on active duty may be grounds for separation. For more information, view the Health Affairs Policy 07-006.
Proud army wife and mom of 2 ♥ 
Topic: RE: CIGNA 6 month medical weight loss requirement
I have cigna as well. I was denied with weigh****chers orginally and have a long standing history of morbid obesity for the last five years.
I started my medical supervised program and missed the final appointment of my 6 months due to scheduling. I rescheduled it for the following month, but my Cigna Health Advocate told me that I had to restart again. I will finish in December of this year, but I am doing all the pre surgery appointments at the same time.
The most important line in the policy is: Programs such as Weigh****chers®, Jenny Craig® and Optifast® are acceptable alternatives if done in conjunction with the supervision of a physician or registered dietician and detailed documentation of participation is available for review.
According to the nurse coordinator at my hospital said "For individuals with long-standing, morbid obesity, participation in a program within the last five years is sufficient if reasonable attendance in the weight-management program over an extended period of time of at least six months can be demonstrated" still has to have the medical guidence diet for six months, they just increase the overall year requirement of five years vs. two years.
Best of luck! At the end of the day, during those six months you will learn how to adapt and work towards new eating habits to ensure you success post op.
I started my medical supervised program and missed the final appointment of my 6 months due to scheduling. I rescheduled it for the following month, but my Cigna Health Advocate told me that I had to restart again. I will finish in December of this year, but I am doing all the pre surgery appointments at the same time.
The most important line in the policy is: Programs such as Weigh****chers®, Jenny Craig® and Optifast® are acceptable alternatives if done in conjunction with the supervision of a physician or registered dietician and detailed documentation of participation is available for review.
According to the nurse coordinator at my hospital said "For individuals with long-standing, morbid obesity, participation in a program within the last five years is sufficient if reasonable attendance in the weight-management program over an extended period of time of at least six months can be demonstrated" still has to have the medical guidence diet for six months, they just increase the overall year requirement of five years vs. two years.
Best of luck! At the end of the day, during those six months you will learn how to adapt and work towards new eating habits to ensure you success post op.
Topic: RE: XP: Pre-existing Condition Insurance Program (PCIP)
Hi! I have PCIP and YES! It does cover bariatric surgery, as long as you meet the requirements (same as all the others). I'm in the middle of the 6 months medically supervised diet right now. I'm very excited and was so grateful to find this coverage when no one else would cover me. BTW, mine declination was due to PCOS...crazy.
~Rebecca
Mother to 4, married to a wonderful man, trying to find myself again.
Mother to 4, married to a wonderful man, trying to find myself again.
Topic: RE: Tricare help!
I think I am going to move forward as well, and just hope for the best. I might call tomorrow and just ask what they think the odds will be. I feel like if I am obese, then I need to do something about it. And I'd rather do it now then years down the line when I could afford it, and I am 40 or 50lbs heavier. If I could do it on my own I would have by now!
(deactivated member)
on 9/1/11 11:44 am
on 9/1/11 11:44 am
Topic: RE: Tricare help!
I haven't been approved yet, but I'm right there with you. I have 97 lbs to lose, BMI 37.8, and I have BCBS FED. I have done everything they want me to do except my last visit to my PCP on 12 Sept. and that same day my NUT appt. I was told the same thing - lightweight and no Diabetes or high blood pressure (Being checked for sleep apnea) I may or may not be approved. I decided to go ahead anyway. I would rather be told NO than to not try at all. I am placing a LOT on this...I REALLY want this surgery, but I can't afford it on my own. I have to do something. If I wait until I am BMI 40 and older I will have more issues than I already have (back pain, hip pain, incontenence, asthma) and I will probably need plastic surgery (beyond what I will need for my tummy) as well. It's worth the risk to me. (However I am praying for an APPROVAL!!) :)
Most Active
Recent Topics
My insurance will not pay for my excess skin that hang down to my knees
Hockeymom87 · 0 replies · 732 views
Hockeymom87 · 0 replies · 732 views
