Recent Posts

Amy1352
on 7/18/11 7:21 am - NE
Topic: RE: How long for Aetna's insurance decision?
 Hi! This is my first post (be gentle! haha).

I'm looking into all of my options at this point but I've narrowed it down to either the sleeve or banding.

I also have Aetna and trying to figure out options there as well. How long is the process usually from the first information class to having the surgery (using the 3 month track)?

Also, what exactly IS the 3 month track? I've had Aetna supply me the details but I guess I would like to hear from people who've done it already.

I haven't had an official weight loss program although I have been on weigh****chers for years. I have a BMI of about 41 and High Blood Pressure for about 3 years (just had to start medication this year).

Is it remotely possible to have it done by the end of the year? I usually wouldn't be in such a rush but I've already hit the max out of pocket for this year due to the birth of my son in February. So, financially, it would make more sense to have it done this calendar year, know what I mean?

Thanks to everyone!!! :) 
Eliza55
on 7/16/11 9:08 pm - PA
Topic: RE: How long for Aetna's insurance decision?
I have AETNA, and worked closely with the insurance coordinator at my surgeon's office.  She indicated that AETNA usually responds very quickly - within a week.   The three-month option is also OK as long as it is done with the nutritionist at the surgeon's office.  I'm going self-pay because I haven't had a consistent  BMI greater than 35 for two years. (I'm a yo-yo dieter)  The insurance coordinator states that AETNA is very picky about that unless your co-morbidities are quite severe. 

The clinical policy bulletin spells out all the requirements quite clearly, and it's available on the AETNA website.

Good Luck
Eliza
Consult:239   SW:217  1mo:195  2mo:182  3mo:169   6mo:139  9mo GOAL CW: +2 from underweight
  
tutsebaby
on 7/15/11 7:27 pm
Topic: RE: Medi- Cal?
 I was just wondering if Medi-cal, California, approved your gastric bypass surgery?  And how you went about getting it?
Paradise220
on 7/15/11 12:42 pm
Topic: Insurance help!
I have been debating the idea of weight loss surgery, and after MONTHS of research, I have settled on the Lap Band procedure. I recently turned 26 and my coverage with my father's insurance company has ended. It is seemingly impossible to find an insurance company that covers it. Any suggestions. I am 26 years old, I'm 5'5" and I weigh 334 pounds. Please HELP!!

Thank you!
windyacres
on 7/15/11 6:25 am - Garner, NC
Topic: RE: BCBSNC
 It feels so great to be spreading this news to other people who have been waiting and waiting!
I have an appt. with my surgeon on Tuesday.  

Edie
Approved 8-1-11, Surgery 8-22-11  SW 231, Goal 140, CW 165


    

slhobbs81
on 7/14/11 11:28 pm - Goldsboro, NC
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!
smh77777
on 7/14/11 10:01 pm
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.

All Time High Weight - 370
Starting Weight pre-WLS - 367.4
Surgery Weight - 333
Current Weight - 248
Surgery Date - July 6, 2011 
   
windyacres
on 7/13/11 11:35 am - Garner, NC
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.


Edie
Approved 8-1-11, Surgery 8-22-11  SW 231, Goal 140, CW 165


    

ready4bikinis
on 7/13/11 10:36 am - NC
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! 
(deactivated member)
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!
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