Recent Posts
Topic: RE: BCBSNC
OMG!!! This is fantastic news! I'm so happy. I was making plans to go to Mexico as well, because I really didn't want RNY or the band. I'm glad I decided to wait. Thank you for posting this!
Topic: RE: TRICARE for DS?
I am retired USAF and I just had RNY. I think my TRICARE only covered RNY and Lapband - and maybe VSG, but I am not sure about that.
I think the reasoning is a cost benefit from a financial standpoint. According to my doc after RNY it takes the insurer 5-10 years to break even - i.e. after WLS you need less treatment and meds for other things. I think there is a significantly higher risk for post-op issues with DS and because of the malabsorbtive mechanism it requires long term monitoring and care - even though it is better for weight loss. So the insurer doesn't recover the expense.
I think the reasoning is a cost benefit from a financial standpoint. According to my doc after RNY it takes the insurer 5-10 years to break even - i.e. after WLS you need less treatment and meds for other things. I think there is a significantly higher risk for post-op issues with DS and because of the malabsorbtive mechanism it requires long term monitoring and care - even though it is better for weight loss. So the insurer doesn't recover the expense.
All Time High Weight - 370
Starting Weight pre-WLS - 367.4
Surgery Weight - 333
Current Weight - 248
Surgery Date - July 6, 2011
Starting Weight pre-WLS - 367.4
Surgery Weight - 333
Current Weight - 248
Surgery Date - July 6, 2011
Topic: RE: BCBSNC
www.bcbsnc.com/content/services/medical-policy/updates/medical-policy-updates-2011-07-01.htm
I found this by going to the provider section of the home page (bottom right) and I did a search for sleeve gastrectomy.
Click on "surgery for morbid obesity" and you will have the .pdf that spells out their bariatric surgery coverage.
It is a miracle! My surgeon's office said they started covering it July 1st.
I found this by going to the provider section of the home page (bottom right) and I did a search for sleeve gastrectomy.
Click on "surgery for morbid obesity" and you will have the .pdf that spells out their bariatric surgery coverage.
It is a miracle! My surgeon's office said they started covering it July 1st.
Edie
Approved 8-1-11, Surgery 8-22-11 SW 231, Goal 140, CW 165
Topic: RE: BCBSNC
Can you sent me a link to page you found this on? We are sending in request to BCBSNC this week.
Thanks!
Thanks!
(deactivated member)
on 7/13/11 9:25 am
on 7/13/11 9:25 am
Topic: RE: APPROVED
Congrats!! That's the news we are all waiting for and so excited when another one gets the green light! 
Topic: RE: APPROVED
It's true that we don't know what we've got until we lose it, but it's also true that we don't know what we've been missing until it arrives.
thanks so much....soon we both will be on the loser bench....yahoooo!!! lol 
It's true that we don't know what we've got until we lose it, but it's also true that we don't know what we've been missing until it arrives.
Topic: APPROVED
It's true that we don't know what we've got until we lose it, but it's also true that we don't know what we've been missing until it arrives.
IM SOOOO EXTREMELY EXCITED!! I WAS APPROVED FOR SURGER ON THURSDAY JULY 7, 2011!!!! IT TOOK 3 WEEKS TO HEAR BACK :) I GO ON TUESDAY JULY 19 TO GET MY DATE :)
It's true that we don't know what we've got until we lose it, but it's also true that we don't know what we've been missing until it arrives.
Topic: BCBSNC
I have a commercial policy with Blue Cross/Blue Shield of North Carolina. They have been denying anyone who wants a vertical sleeve gastrectomy, saying it is investigational.
I checked their site today and they have changed their policy!!
I really thought I was going to end up going to Mexico.
Finally, I'll get something back after all those premiums I've been paying!
I checked their site today and they have changed their policy!!
I really thought I was going to end up going to Mexico.
Finally, I'll get something back after all those premiums I've been paying!
Edie
Approved 8-1-11, Surgery 8-22-11 SW 231, Goal 140, CW 165
Topic: RE: How long for Aetna's insurance decision?
Angie,
Glad to be your friend too! Let me know when you hear from Aetna!!!!
I just read your blog on you profile where it gave the details of what you have been doing. It sounds like you have been doing everything right and what is expected of you!!!! The only thing that stuck out to me was that you started in March and submitted in June which is 3 months but was it 90 days apart?? From your first visit to your last vist has to be at least 90 days (180 if you are doing the 6 month program)
Just to be safe, if I were you, in case you already haven't, continue seeing your PCP so that you don't miss a visit during the approval process. That way, if they come back saying you did not complete the 3 mo MD program because you are xxx many days short, you will have your July visit in.
Just my thoughts......keep me posted on your approval!
Nan
Glad to be your friend too! Let me know when you hear from Aetna!!!!
I just read your blog on you profile where it gave the details of what you have been doing. It sounds like you have been doing everything right and what is expected of you!!!! The only thing that stuck out to me was that you started in March and submitted in June which is 3 months but was it 90 days apart?? From your first visit to your last vist has to be at least 90 days (180 if you are doing the 6 month program)
Just to be safe, if I were you, in case you already haven't, continue seeing your PCP so that you don't miss a visit during the approval process. That way, if they come back saying you did not complete the 3 mo MD program because you are xxx many days short, you will have your July visit in.
Just my thoughts......keep me posted on your approval!
Nan
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
Most Active
Recent Topics
My insurance will not pay for my excess skin that hang down to my knees
Hockeymom87 · 0 replies · 735 views
Hockeymom87 · 0 replies · 735 views
