Recent Posts

SugarGrl
on 3/6/11 9:42 am
Topic: RE: has anyone had their nutrional counseling or phsy eval done on base
Hi.  I paid for mine out of pocket.  I used the NUT the surgeon uses and I got that done for $85.  Tricare would not accept the on base Health and Welness Center counseling as that is not done by a licensed NUT.  The phsy eval I paid for myself also.  Call around, let them know what you need and get a good price.  I finally got it down $250.  The docs office had a $250 "administrative" charge that tricare wouldn't pay so I had to cough that up too, but it will be worth it.

    
  WE ARE ALL IN THIS TOGETHER!  LET'S GET HEALTHY!     STARTING WEIGHT 211.8, SURGERY 23 MAR 11; ONEDERLAND 30 MAR 11 199.2                                                                                                                                                                                                                                                    

SugarGrl
on 3/6/11 9:38 am
Topic: RE: Tricare Prime Approval - North Region
Congrats!  Tricare Prime and I get my RNY on 23 Mar!

    
  WE ARE ALL IN THIS TOGETHER!  LET'S GET HEALTHY!     STARTING WEIGHT 211.8, SURGERY 23 MAR 11; ONEDERLAND 30 MAR 11 199.2                                                                                                                                                                                                                                                    

nikkidianna
on 3/6/11 5:38 am
Topic: RE: Anyone know if Medicaid will pay???
Hi I just got GA medicad in january and began my search for a bariatric surgeon that would accept it with the help of my cousin I found peachtree surgical bariatric at atlanta mcal center they except amerigroup and peachstate which are medicaid HMO's I hope this helps you in your journey Good Luck
lovemypugs
on 3/5/11 2:31 am - VA
Topic: RE: External appeal
Hi Sandy,

My external appeal was submitted at the end of June and I didn't hear anything until September. It seemed to be forever! It was worth it though because I was approved! Good luck!

Duodenal Switch on February 21, 2011

Surgery weight: 276; Current weight: 122; Height: 5'5

Plastics scheduled for 10/3/14: BL/BA, LBL, TL

 

 

 

sandy_mt
on 3/5/11 1:59 am
Topic: RE: External appeal
 Hi there-

I know your post is many, many months old, but I just wanted to ask you a few questions about your external appeal.  I am trying to revise from RNY to DS and have Aetna.  My plan does not pay for out-of-network coverage for bariatric surgery, and all of the DS specialists who do revisions are out-of network.  After my first appeal was denied, I contacted Walter Lindstrom.  He wrote a kick-butt letter to Aetna that I thought for sure would get me approved, but they denied me again just yesterday for the same reason (no out-of-network benefits for bariatric surgery).  I believe our next step is the external appeal.  Can you tell me how long that particular process took for you?  I'm so glad to see that you finally got your DS!!!  I hope to be able to say the same eventually!  I'm so miserable!!

Sandy

rmv101575
on 3/4/11 8:19 am - WA
Topic: RE: losing weight during presurgery diet - disqualification?
I asked my surgeon the same question...he said the insurance goes by the starting weight/ BMI. I have lost over 20 lbs since January on his strict diet and exercise program, which is great, but I would be devastated if the insurance decided I was 'too small' for surgery after all this! Good luck to you!
~Ronda

    
slhobbs81
on 3/4/11 7:12 am - Goldsboro, NC
Topic: RE: meeting high deductible
That is good news! A big difference, I'm glad things are working out.

I had concerns about Mexico and post-op care too, I didn't think it would be worth the trouble.
Dale W.
on 3/3/11 8:16 pm - Canonsburg, PA
Topic: RE: losing weight during presurgery diet - disqualification?
I am answering this only from something I heard at attending my seminar to launch the whole process just last night.  One of the things they covered is that the insurance is mainly looking for proof of meeting with a doctor or nutritionist during that six months to make sure that you are loosing or staying steady with weight and not bouncing up and down.  Also that monthly visit is to make sure that the doctor or nutritionist is talking with you about setting weight loss goals, exercise goals, etc...  Specifically they said that loosing too much weight would not be a reason to loose approval. 
Crabadams72
on 3/3/11 9:34 am - Silver Spring, MD
Topic: RE: meeting high deductible
I got good news today.

I talked to my Dr's office and my tab is a LOT lower that I thought.  I owe like $130-something. Much better than the $4000.00.  I think I'll owe less than $1k for my testing and then my $5000 for surgery.

I seriously thought about going to Mexico but had concerns about any complications and aftercare. 
slhobbs81
on 3/3/11 7:52 am - Goldsboro, NC
Topic: RE: meeting high deductible
On March 3, 2011 at 9:30 AM Pacific Time, Crabadams72 wrote:
My deductable is $5000

I started getting my pre-op tests in December 2010 and some of my big bills only apply towards 2010.  My amounts that I owe after the insurance co-pay are enormous!.  Like $5000 for 2010 alone.  My tests for 2011 are going to be just as high. 

I could've gone to Mexico with that $5k. 

I know right! It is ridiculous. When you have to pay a bill does the whole amount apply towards your deductble, or is it a certain amount? Just trying to figure this whole thing out.

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