Recent Posts
Topic: RE: sleeve vsg has anyone had it approved?
We are hoping blue cross will approve the sleeve as it is the right surgery for him... but haven't got a lot to go on...
They were fantastic with my RNY so hopeful... but his pain issues are a deal breaker...
If anyone with bcbs insurance has had some luck with the sleeve being approved we would love to hear from you... thanks
BCBS bases their decisions on the sleeve because they consider it investigational. I wouldn't appeal based on NSAIDs, BCBS covers the band and you can take NSAIDs with a crappy band.
I would appeal based on the FACT that a sleeve is not investigational in the least. It's actually older than the band. Provide studies showing it is not investigational, the ASMBS endorses the sleeve, and it is anything but investigational.
On November 19, 2010 at 10:15 AM Pacific Time, suzle wrote:
I have bcbs massachusetts... Husband needs to be able to take advil because he has had his knees replaced... We are hoping blue cross will approve the sleeve as it is the right surgery for him... but haven't got a lot to go on...
They were fantastic with my RNY so hopeful... but his pain issues are a deal breaker...
If anyone with bcbs insurance has had some luck with the sleeve being approved we would love to hear from you... thanks
BCBS bases their decisions on the sleeve because they consider it investigational. I wouldn't appeal based on NSAIDs, BCBS covers the band and you can take NSAIDs with a crappy band.
I would appeal based on the FACT that a sleeve is not investigational in the least. It's actually older than the band. Provide studies showing it is not investigational, the ASMBS endorses the sleeve, and it is anything but investigational.
Previously Midwesterngirl
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
Topic: RE: sleeve vsg has anyone had it approved?
Are you saying that your ins co excludes WLS completely? If WLS is excluded from your policy it means that your employer does not pay the additional premium for WLS. If your employer does not pay the additional premium for WLS, you don't have coverage for WLS.
Ins co's want to be paid premiums for services they cover. It's kinda like having car ins but also having a flood in your home. Car ins isn't going to pay for your flood. Medical ins isn't going to pay for WLS if you don't have the coverage to begin with.
If the employer buys the WLS rider, you will have coverage.
On December 8, 2010 at 8:18 PM Pacific Time, LOVELAUGHLIVE wrote:
Wisetears, Have you heard of an exclusion being approved? Right now I'm still in the appeal process, and I had Humana w/the exclusion, so i appealed through my husbands job through the union. I talk to the rep thats handling it ,and it has been oveer a year now,she thinks it may go through its just this healthcare reform thats slowing this up. But now she thinks she may have an answer in Jan.2011. So I told her if she doesnt call I will be contacting her.My best friend thinks I will get somehow I will,but sometimes I really dont see it, like I'm wasting my time,but everytime I want to give up something tells me is not the right time yet and something willsoon. My employer has single plans,but she was willing to offer me funds to pay for it, but she didnt have funds either, but she said maybe next year soon and she will keep me posted. So I'm still waiting and we shall see. Thanks for reading.Are you saying that your ins co excludes WLS completely? If WLS is excluded from your policy it means that your employer does not pay the additional premium for WLS. If your employer does not pay the additional premium for WLS, you don't have coverage for WLS.
Ins co's want to be paid premiums for services they cover. It's kinda like having car ins but also having a flood in your home. Car ins isn't going to pay for your flood. Medical ins isn't going to pay for WLS if you don't have the coverage to begin with.
If the employer buys the WLS rider, you will have coverage.
Previously Midwesterngirl
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
Topic: RE: Your surgery out-of-pocket costs after insurance
I have GEHA (United Healthcare)
I am trying to gauge how much my out of pocket expense is going to be after the insurance covers their share. I know it varies but I want to get an range. I know I have to pay 15% of the hospital fee but I am expecting more bills as UHC seems to suck. (In my experience).
Amazingly, in comparison UHC is one of the better ins co's. They all kinda suck. ;o)
It's hard to tell, nobody can give you accurate numbers because it depends on which UHC policy you have and what the contractual agreement is between your doc and ins co. But do know, you do not have to pay 15% of what the hospital/doc charges, you will only have to pay 15% of the contracted price. Big, huge, mega difference!
On December 12, 2010 at 4:51 PM Pacific Time, Crabadams72 wrote:
Hey all,I have GEHA (United Healthcare)
I am trying to gauge how much my out of pocket expense is going to be after the insurance covers their share. I know it varies but I want to get an range. I know I have to pay 15% of the hospital fee but I am expecting more bills as UHC seems to suck. (In my experience).
Amazingly, in comparison UHC is one of the better ins co's. They all kinda suck. ;o)
It's hard to tell, nobody can give you accurate numbers because it depends on which UHC policy you have and what the contractual agreement is between your doc and ins co. But do know, you do not have to pay 15% of what the hospital/doc charges, you will only have to pay 15% of the contracted price. Big, huge, mega difference!
Previously Midwesterngirl
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
Topic: Your surgery out-of-pocket costs after insurance
Hey all,
I have GEHA (United Healthcare)
I am trying to gauge how much my out of pocket expense is going to be after the insurance covers their share. I know it varies but I want to get an range. I know I have to pay 15% of the hospital fee but I am expecting more bills as UHC seems to suck. (In my experience).
I have GEHA (United Healthcare)
I am trying to gauge how much my out of pocket expense is going to be after the insurance covers their share. I know it varies but I want to get an range. I know I have to pay 15% of the hospital fee but I am expecting more bills as UHC seems to suck. (In my experience).
Topic: RE: Changes to FEP BCBS for 2011
Just an update. I changed back to my old plan. BCBS is also requiring you be at 40.bmi for 2yrs and I am just hitting that bmi this year. Bummer.
Topic: RE: Surgery is scheduled
CONGRATULATIONS on getting your date!!! Feb 14th will be here before you know it!
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
(deactivated member)
on 12/8/10 12:18 pm - LOUISVILLE, KY
on 12/8/10 12:18 pm - LOUISVILLE, KY
Topic: RE: sleeve vsg has anyone had it approved?
Wisetears, Have you heard of an exclusion being approved? Right now I'm still in the appeal process, and I had Humana w/the exclusion, so i appealed through my husbands job through the union. I talk to the rep thats handling it ,and it has been oveer a year now,she thinks it may go through its just this healthcare reform thats slowing this up. But now she thinks she may have an answer in Jan.2011. So I told her if she doesnt call I will be contacting her.My best friend thinks I will get somehow I will,but sometimes I really dont see it, like I'm wasting my time,but everytime I want to give up something tells me is not the right time yet and something willsoon. My employer has single plans,but she was willing to offer me funds to pay for it, but she didnt have funds either, but she said maybe next year soon and she will keep me posted. So I'm still waiting and we shall see. Thanks for reading.
Topic: RE: Aetna Approved
Hi! I'm new here. I have Aetna and have read the guidelines for how they approve under my policy and I'm fairly confident I'll be approved. Just curious how long it took you to get approved by Aetna once you started the process.
Thanks!
Thanks!
Topic: RE: Insurance Denied by Dr Bertha with 2 weeks to surgery date
Oh, one other issue. Are you aware that not all US medical schools are using the Hippocratic Oath anymore? Many haven't been for many years. They are permitting the student body to write their own in some medical schools.
Oh, one other issue. Are you aware that not all US medical schools are using the Hippocratic Oath anymore? Many haven't been for many years. They are permitting the student body to write their own in some medical schools.
Previously Midwesterngirl
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
Topic: RE: Insurance Denied by Dr Bertha with 2 weeks to surgery date
While of course we all do something that will support us, that is not usually enough, especially not for anyone in a professional career. Most of us find a higher purpose in our jobs that meets our standards for ethical, moral, etc. behavior. Doctors are required by their profession to go beyond doing anything for the money. Haven'y you ever heard of the Hippocratic oath?
i'm not suggesting what he did was right, I'm not suggesting it was moral. I don't know the legal side, maybe he could tell you, maybe he couldn't. No idea. But as a medical professional myself I do get tired of the overall, general assumption that we should all work for free and be happy that we did a good job and you'd be shocked at the number of people who actually believe this. If we earn money for our daily 8-16 hour days we are somehow unethical.
I'm not saying this is your attitude to the same degree but again.. yes, he should have a right to earn money. Doctors are just like grocery stores, if you don't like one then find another.
So yes, clearly I have heard of the Hippocratic oath. Have you heard of US Law?
On December 8, 2010 at 11:53 AM Pacific Time, JillinWarren wrote:
Dear BubbleButt,While of course we all do something that will support us, that is not usually enough, especially not for anyone in a professional career. Most of us find a higher purpose in our jobs that meets our standards for ethical, moral, etc. behavior. Doctors are required by their profession to go beyond doing anything for the money. Haven'y you ever heard of the Hippocratic oath?
i'm not suggesting what he did was right, I'm not suggesting it was moral. I don't know the legal side, maybe he could tell you, maybe he couldn't. No idea. But as a medical professional myself I do get tired of the overall, general assumption that we should all work for free and be happy that we did a good job and you'd be shocked at the number of people who actually believe this. If we earn money for our daily 8-16 hour days we are somehow unethical.
I'm not saying this is your attitude to the same degree but again.. yes, he should have a right to earn money. Doctors are just like grocery stores, if you don't like one then find another.
So yes, clearly I have heard of the Hippocratic oath. Have you heard of US Law?
Previously Midwesterngirl
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/