Recent Posts
Topic: RE: Self Pay
I was self pay and my doctors office had several financing options; however, I just went to my credit union and took out a 3 year loan and decided to drive my Trailblazer for a few more years.
I had the RNY in Alabama and total (doctor, hospital, anesthesia) was right at $20,000.
Hope this helps...Good luck.
I had the RNY in Alabama and total (doctor, hospital, anesthesia) was right at $20,000.
Hope this helps...Good luck.
Topic: RE: Aetna Weight History
Thanks for responding! I have a documented weight from 2009 and I might have one from the beginning of 2010. I didn't see my PCP but I did have my weight checked at our Health Department. If I can get those records, should that be enough to qualify for the 2 year weight history?
Topic: RE: Aetna Weight History
They are looking for a 2 year history. I was approved as well as my 3 kids through Aetna. All 4 of us had to show a 2 year history. If you do not have anything from 2009, you will have to show a 2 year history from 2011. So that would be 2011, 2012, and 2013. Do you have anything that has your weight shown in 2010?? It doesn't have to be a dr visit? In both my daughter's cases, it was records from weigh****chers showing our weights because I had not been to the dr in a specific year, same as you, but I did have weigh****cher records that had my weight documented.
Nan
Nan
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
Topic: Aetna Weight History
Aetna insurance requires a 2 year weight history to be approved for weight loss surgery. In my case, I hadn't been to a doctor for a few years before my pregnancy in 2008. I believe I have a documented weight from a postpartum checkup in early 2009. However, I did not see a doctor at all in 2010 and have no weight history for that year. I do have a documented weight for 2011 but since Aetna requires two years of weight history, I'm afraid that I may not qualify. Would my weight for 2009 and 2011 count towards the weight history? Do I need to wait another year to have the surgery? I would appreciate any help or advice. Thanks!
Topic: RE: can anyone approved by Aetna answer a couple questions for me?1
I too was approved by Aetna, but it was after 2 appeals.
I agree with everything Nan says and used some of her letters to help get my approval through. I agree, get everything documented, take it to your PCP and get them to clearly document your efforts in each of the three areas in their notes. This would typically be sent with the surgeonsrequest for the actual surgery. I also sent the visit verification from the counselor I went to.
The 90 day vs 3 month or 180 days vs 6 months is very true and important. They will deny you over just this....
Good luck!
I had my surgery 12-21 and am down over 50 lbs already! ; )
I agree with everything Nan says and used some of her letters to help get my approval through. I agree, get everything documented, take it to your PCP and get them to clearly document your efforts in each of the three areas in their notes. This would typically be sent with the surgeonsrequest for the actual surgery. I also sent the visit verification from the counselor I went to.
The 90 day vs 3 month or 180 days vs 6 months is very true and important. They will deny you over just this....
Good luck!
I had my surgery 12-21 and am down over 50 lbs already! ; )
Topic: has anyone had their nutrional counseling or phsy eval done on base
i was just wondering if there is anyone out there that has tri care prime, we are retired military, i just found out that tri care prime does not cover the nut counseling so i have to pay out of pocket with that, so i was wondering if anyone has had it done on base? i know they have lost of different types of nutritional counseling done on base at the base gym as i have gone to one for a dibetic class a long time ago...
i have my first drs appt tomorrow and will find out for sure what this $600 out of pocket charge if for me...but i think its for the nutritional and maybe the phsy eval..
thanks for any help on this matter, it seems like there are quite a few of us on here that tri care prime.
debby
i have my first drs appt tomorrow and will find out for sure what this $600 out of pocket charge if for me...but i think its for the nutritional and maybe the phsy eval..
thanks for any help on this matter, it seems like there are quite a few of us on here that tri care prime.
debby
Topic: appealing bcbs of delaware
I was denied VSG by BCBS of Delaware as they only cover it for those with BMI of 50 or above and those with BMI 50 that are going to get DS after the sleeve. Of course I am covered to get lapband or RNY which neither is something I want.
My current bmi at 43. Does anyone have any advice on what I should do,say or include in my appeal letter to try and reverse this decision?
My current bmi at 43. Does anyone have any advice on what I should do,say or include in my appeal letter to try and reverse this decision?
Topic: RE: Tricare Claim question
so i was wondering, have you had to pay anything out of pocket except for the co-pays of $12.00? i am also on tri care prime and i am just starting this, and i got from my surgeons office, an estimated amounts due that are out of pocket, they said $612 for the surgeon for his deductalbe and what ever the anesthes is that is not covered or what ever thier deductable is...and it said i had a $25/00 co pay for the hospital overnight stay which i knew i had that but....i am not sure about the other $600 as a deductable to the surgeon.
i only have 2 drs to choose from and this one is one of them,
thanks so much for your help,
debby
i only have 2 drs to choose from and this one is one of them,
thanks so much for your help,
debby
Topic: Does anyone have UHC Epo from Florida??????
Just submitted my second appeal. My chances of getting approve are? I need some asdvice.
Topic: Self Pay
I am brand new to the forum as a member. I attended my first information session on weight loss surgery yesterday and I am ready to get the ball rolling.
I already know that my insurance does not carry a "bariatric rider" to the policy, so I will be a self pay.
I would like to have the RNY. I am wondering if anyone here has been a self pay for this procedure. If so, how did you go about financing it? What were your costs, etc? I realize that every case is different and costs will vary, but just lookinf for some insight into this process. Thanks!



