Recent Posts

justlookinaround
on 7/4/11 11:36 pm
Topic: Medicaid (repost from main board)
I have Tricare Prime now but will be without insurance starting August 23. I dont have enough time to get surgery thru Tricare. I was wondering how hard is it to get Medicaid after my Tricare runs out? Is it hard to get WLS done thru Medicaid? What is involved for getting WLS approved thru Medicaid. Thanks
Starfish40
on 6/30/11 3:56 pm
VSG on 03/06/12 with
Topic: RE: United health care choice plus???
 That is my understanding too.  I also have UHC and was advised by the patient advocate at my surgeon's office to contact HR rep to determine if they bought the WLS portion of the plan.  Found out they did.  Couldn't give me much details about it, but at least I now know it is covered.  I'm also in the very early stages of this process, still don't know if I will need the supervised diet.  Good Luck.  Hope that helps some.  

      
  
HW: 333, SW : 300 CW: 275. GW; 150

wenklebe
on 6/28/11 11:38 pm - WI
Topic: WLS referred to as Cosmetic?
I am posting this in the cosmetic forum also, but I figured I would post here too.  I have Anthem BCBS, almost 6 years out from lap RNY, lost 150 and have maintained.

I am currently seeking  a corrective/reduction surgery for my breasts.  My PS submitted my preauthorization claim to my insurance (requesting mastopexy) and they came back with the correction/reduction is the result of a previous cosmetic surgery and that they will not cover it.  I have appealed and they have stuck to their decision.  I meet the requirements for reduction with documented neck and back pain over the past 2 years and hand problems. 

  I understand that some people seek WLS as a cosmetic self-pay procedure but mine was considered elective medically necessary and covered by my insurance (Tricare) at the time.   My current insurance also covers WLS as the only method to treat obesity. And I would have met their requirements to have the surgery.  How is it that they determined that it was a cosmetic procedure?
deboralbtn
on 6/27/11 12:37 am - FL
Topic: RE: United health care choice plus???
I'm certainly no expert but I'll tell you my experience.  I had BCBS before UHC.  5 years ago I started the entire process and was told 6 months monitored weight loss or 3 months of 2.  That made no sense to me.  So, I went to ww and my Dr. at least once a month.  They turned me down saying my Dr. wasn't an approved monitored weight loss.  What???  I think they just wanted to say no, no matter what.  Then I had a tragedy in my family and put off the whole process.  Move ahead 5 years and my insurance changes.  I thought I'd just check out and see what UHC will cover.  Gave them a call and they told me it was covered and she did not see that I would have to do the 6 month monitored weight loss program.  So, I just decided to do what my Dr. required and have them submit it and see what happened.  If I need to do the monitored weight loss I would start.  It was very simple for me because I got approved the first time without having to do the 6 month weight loss program.  I know it's a frustrating process because you get so many conflicting answers.  In my case, I wanted them to submit it and go from there.  I know this probably doesn't help much but this is where I've been.  If you have your Dr. submit for approval and you get denied because you need to do the 6 months, is it harder because you have to appeal?  I don't know.  Good luck and let me know what happens.
Rekeca
on 6/26/11 11:36 pm - NC
Topic: Aetna - appeals committee
I have been denied by Aetna for VSG. First because they stated I didn't meet the criteria of weightloss. However,  I appealed and proved that I do meed the medical criteria however,  they came back with a second denial because they say that I didn't meet psych clearance. Which was untrue. I faxed in the pysch clearance but now they want to do a Level II appeal committee tele - conference. I can choose to phone in and state my case to an unknown board I will be given 15 minutes to do this. Then I will be asked to leave the call where they will deliberate without me and send me a letter with their decision within 5 business days. They also state that I can have a lawyer present it I want to. WTF.  Does anybody have any experience with this? What should I expect?
    
Raynbug09
on 6/26/11 3:43 pm - TX
Topic: RE: United health care choice plus???
Congrats!!!!!! I too have uhc, and I know my employer covers it as several of the girls at work are already post op, but im conflicted. Two girls at work say they had to do 6 mos weight loss programs with physicians, but I had my seminar with my surgeon sat, he said based on my insurance I didnt need it. Now im confused, optumhealth said I did, and I printed out the form for it but he said otherwise. What are your thoughts on it?
deboralbtn
on 6/24/11 2:21 am - FL
Topic: RE: United health care choice plus???
I also have UHC and from what I understand it does have much to do with the plan the employer chooses.  I called before hand and was told I had coverage and did not need to do the 6 month weight loss.  So, I started the process at the end of March.  Got everything done the Dr. required and got my letter of approval Monday.  Yesterday I scheduled surgery for August!
chunkymonkey1991
on 6/23/11 1:06 pm
Topic: RE: United Healthcare... conflicting info on requirements
I'm soo nervous about this. I have UHC ChoicePlus and I haven't been able to get a straight answer out of them as to whether or not I need a 6 month supervised diet. Alot of pple with this plan don't seem to need one, so that's promising but I'm nervous that something will go wrong last minute.

I've also heard this thing about your BMI being higher than 40 for 5 years. I haven't heard it from my insurance company but I have from other people. My BMI has been above 35 for over 5 years but only over 40 for 1.

I'm nervous about this whole process. I have all of my appointments scheduled, I just don't want anything to go wrong.
(deactivated member)
on 6/23/11 9:21 am - PA
Topic: RE: United health care choice plus???

I have UHC and WLS is excluded from coverage completly.  So I will be paying my own way.

Jeff Q.
on 6/23/11 4:58 am
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