Recent Posts

ADW222
on 3/3/11 5:27 am - ENCINO, CA
Topic: Is this unusual???
HELLO EVERYONE,


I HAVE FOUND THE SURGEON THAT I WANT TO GO WITH. THIS SURGEON IS ASKING ME TO PAY $500 DOLLARS FOR A PSYCHOLOGICAL EVALUATION AND $80 FOR THE NUTRITIONIST. MY INSURANCE COVERS BOTH. I HAVE IN NETWORK AND OUT OF NETWORK COVERAGE. THE OFFICE WANTS ME TO PAY FOR THE PSYCHOLOGIST APPOINTMENT UP FRONT BECAUSE SHE DOES NOT BILL AND THEN GET REIMBURSE BY INSURANCE. I HAVE BLUE CROSS BLUE SHEILD OF TENNESSEE. SHOULD I DO THROUGH WITH THIS OR FIND ANOTHER SURGEON? HAVE ANY OF YOU DONE THAT? AND HOW LONG DID IT TAKE TO GET REIMBURSE FOR IT?

laurabelle2009
on 3/3/11 4:29 am
Topic: Empire Blue Cross Blue Shield
Anyone out there have success with approval?? I thought i was going to get approved and they changed their plan and I have to complete 6 mos. before submitting??? A little afraid of getting denied??
Rhie P.
on 3/3/11 3:46 am
Topic: RE: Tricare Prime Approval - North Region
Awesome!!  I have Tricare Prime as well and I had no problems getting approved.

Rhie

 

 

   

Crabadams72
on 3/3/11 1:30 am - Silver Spring, MD
Topic: RE: meeting high deductible
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. 
Chana
on 3/2/11 9:18 am
Topic: losing weight during presurgery diet - disqualification?
I'm just a little over 40 BMI.  My insurance requires a 6 month diet.  My question is if I lose weight during this time period while following the programs, I'll actually be below 40 BMI.  Will the insurance company then turn around and deny me for being too LITTLE?!  LOL - the first time I'll have ever been too small for anything!  I'd actually like to try my hardest to lose and get a head start during the next few months, but it seems to be kind of an awkward position if being diligent is going to bite me on the tush! 

As far as I know I have no comorbidities...
apod1991
on 3/2/11 9:09 am - staten island, NY
RNY on 04/19/11 with
Topic: how long for bc/bs ny to decide
hey forum, just signed consent and was told to wait for my insurence to get back to me i have bc/bs prism epo plan how long do they normally take to answer?
4_them_2
on 3/2/11 4:17 am - Northern, VA
Topic: RE: Tricare Prime Approval - North Region
 Thank you and the same to you.  I was so worried but it turned out to be a snap.  I waited 2 days bc the mytricare site kept saying it was "in process" and nothing else.  When I called the case manager she said "I'm just waiting on a date from your surgeon".  It was freakin' fantastic to hear those words.  I'll see you on the loser bench!
  
 03/29/2011  --  RNY @ INOVA!!  Surgery went great. Weighed 260
 03/30/2011  --  Discharged w/ 12 pounds of fluid WTH??  Weighed 272
 04/04/2011  --  One week followup w/ PA. Weighed 259    
Day_dream_believer
on 3/2/11 2:49 am
Topic: RE: Tricare Prime Approval - North Region
That is great news.  I am hoping to submit the first of next week.  Good luck. 
Krissymk
on 3/2/11 2:43 am
Topic: RE: Any idea how long Aetna takes to decide?

My paperwork was submitted to Aetna Friday 2/18 and I just found out today at 11am that I was approved :)

havasquez075
on 3/2/11 1:44 am
Topic: Aetna Appeal Letter
I'm currently drafting up a letter for my husband's appeal to Aetna for surgery denial and am needing some help.

Let me tell the whole story so it's better to understand....
He began the process in Sept 2009, covered under my insurance which was BCBS.  He need 6 months of weight management but he had to stop because we lost our insurance coverage.  He was only able to do 4 months of weight management.  His current employer covers the surgery, so he's back at it again.  Last month was his first month back at it.  From what the insruance counselor said, Aetna would consider the previous 4 months because it was all within a 2 year gap.  (Aetna seems to have a mind of their own because they're denying that).  Another issue was for some reason either his weight management history wasn't submitted or didn't get faxed thru in error because they're saying that they only have weight history from Sept 2009.  I know that's incorrect because I'm a stickler with him seeing the doctor.

So I'm writing the appeal and am needing some assistance or input.

Thanks in advance!!!
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