Recent Posts

charlee
on 5/25/11 6:54 am - Ashland, MS
Topic: RE: Hello Looking for recommendations for Financing Plastic Surgery...
Hi!!  I am tall like you and also looking for financing options for bad credit and I have only Medicare as insurance, which I have heard will pay sometimes for the tummy  part only.  Let me know, Everyone, if you have any advice!  Thanks so much!  Charlee
overweight68
on 5/20/11 4:46 pm - OK
Topic: Fed BCBS
I am scheduled to see a medical doctor next week for weight loss surgery. I realize I must have three months of medical supervision for weight loss but how specific must it be? Also, does anyone know if they have changed the requirements for the sleeve? Last I heard, you had to have a BMI greater than 60.
Thanks
BumpiestStar
on 5/20/11 4:07 am - MD
Topic: RE: Denial Received - Now What?

I had to do 6 months of supervised program, but it was NOT required by my insurance company. I have Anthem BCBS of CA.,  but I live in Maryland and surgeons have to follow BCBS requirements for pre-authorization in said state, and Maryland requires 6 months documented diet within the past 2 years (2, consecutive 3 months or 6 consecutive months).  Before finding out about the state requirement, I actually posted about the 6 months requirement when I first started out and one member suggested I could file a grievance, here’s part of the response: Second, if it is your insurance, find out whether your insurance policy is fully funded, and if it was "issued, amended, delivered or renewed" in CA.  If so, your plan should be covered by the DMHC rules.  You can file a grievance with the DMHC and they will order the insurer to waive the requirement.  http://www.dmhc.ca.gov/aboutTheDMHC/org/boards/cap/Bariatric REV.pdf

See also
 
http://www.asmbs.org/Newsite07/resources/ASMBS%20Position%20 Statement%20on%20Preoperative%20Supervised%20Weight%20Loss%2 0Requirements.pdf

Hope this helps, Good luck to you 
brady2011
on 5/19/11 10:42 pm
Topic: RE: fed blue cross blue shield
Gracee
Good luck. I also have BCBS fep and trying to get approve. I think the new requirements this year is stupid.  Hope everything goes well for you!
Nan2008
on 5/19/11 10:10 pm - Midland, MI
Topic: RE: no longer needed

You could call the Human Resource department of your employer and find out if it is covered or not.  I would also call the insurance company and ask for a copy of the bariatric surgery requirements.  for example, I have Aetna.  It is their clinical bulletin 0157.  I printed a copy of that and went through it with a fine tooth comb to make sure I met all the requirements. 

Good Luck to you!

Nan

HW 300
/ SW 280 / CW 138 /
GW 140
Hit Goal 4/2/2010

        
Nan2008
on 5/19/11 10:06 pm - Midland, MI
Topic: RE: BCBS Blue Choice
They may cover it but you need to check with your Employer to see if it is covered.  Most insurances cover WLS, but it is up to the employer to exclude it or not.  I would call the the insurance company and aski if WLS is covered, and then call your HR department and ask if there is an exclusion to WLS.

Good Luck!!

Nan

HW 300
/ SW 280 / CW 138 /
GW 140
Hit Goal 4/2/2010

        
Nan2008
on 5/19/11 10:01 pm - Midland, MI
Topic: RE: Denial Received - Now What?
Agree with the pervious poster your firt step in ther process should have been to contact your insurnace company and get a copy of the requirements for qualifying for surgery.  I have Aetna.  They have a 'clinical bulletin' that spells out the requirements.  I used this as my checklist to make sure I met each and every requirement.  If all requirements are not met, they will deny.

Based on the reason you were denied, it sounds like your insurance requires a 6 month physician supervised diet (as do MOST insurances).  This means you have to start with your physician and go 6 consecutive months (not missing one month or they will deny!).  It entrails weighing in, tracking BMI, followoing a reduced calorie diet, etc.....they want to see an attempted weight loss for 6 months, documented in the office notes of your pcp.

Did you do that in the past 2 years?  If you did, you can appeal by proving you have done that by providing copies of the office notes from your pcp.  If you did not do that yet, you need to complete the 6 month supervised diet, then resubmit for approval.  There's no getting around it if your insurnace co requires it.

Good luck to you!

Nan

HW 300
/ SW 280 / CW 138 /
GW 140
Hit Goal 4/2/2010

        
josher_m
on 5/18/11 11:26 pm, edited 1/4/15 12:02 am
Topic: no longer needed

no longer needed

(deactivated member)
on 5/18/11 11:06 am - Bowie, MD
Topic: BCBS Blue Choice
I live in MD and my insurance is Blue Cross Blue Shield-Blue Choice. Do they cover WLS?
Lulu22
on 5/18/11 10:46 am - Hillsboro, OR
Topic: Talk to me about RNY in Mexico?!
Where did you have it, good/bad experience, how much, and anything else you might like to share with me. I can use all the info!

Thank you
Melanie (LuLu22)
        
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