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Topic: RE: Medicaid and WLS
It's true that we don't know what we've got until we lose it, but it's also true that we don't know what we've been missing until it arrives.
I have to do 6months and my doctor said the exact same things that its about seeing if Your consistent and stay on the plan not even so much if you lose the weight! Do YOU know when Your 6months is up?? Mines is in April!
It's true that we don't know what we've got until we lose it, but it's also true that we don't know what we've been missing until it arrives.
Topic: RE: My 2 sons are approved by Aetna & have a surgery date!!!!!
Hi! I am in Ohio and have Aetna Open Access. I had RNY in 2003 and have had problems with ulcers requiring scopes twice a year since 2006. I'm getting ready to be scoped again on Friday and am going to start looking into a revision to a DS because I am afraid I have ulcers in the part that is closed off where the Dr can't see. I'm worried that Aetna won't cover it -- although my BMI is still 39 -- I started off at 299 lbs and never got below 230 -- now am back at 250 because the only foods that don't hurt are the soft foods that you aren't supposed to eat.
My original surgery wasn't with Aetna -- how was the approval process? Did you have a lot of requirements and did they deny you up front?
Thank you!
Traci
My original surgery wasn't with Aetna -- how was the approval process? Did you have a lot of requirements and did they deny you up front?
Thank you!
Traci
Topic: RE: Update: Approved! (Anthem is giving me hissy fits)
Yes, that is Anthem BCBS. Of course, within Anthem you have PPO and HMO as well as different rules and coverage for different companies/organizations. My husband's company is self insured using Anthem to manage. My husband's company covers everything as long as BMI is met, but others may not.
Topic: RE: Update: Approved! (Anthem is giving me hissy fits)
Do you have Anthem BCBS? My insurance will be Anthem starting January 1st. Do you know if Anthem is approving the sleeve? I was in the process of being approved through Cigna, but found out last month that we will no longer have Cigna. Back to square one, I'm so disappointed. I hope you get good news soon!
Topic: Medicaid and WLS
Has anyone delt with Medicaid recently for WLS. After I have started the WLS program I am now told that they believe my insurance is going to require a 6 month dr supervised diet plan. I have tried contacted medicaid several times with no luck. NO one knows what I am talking about. The WLS Center said they that lately they have been getting feed back on some patients some requesting the 6 month diet and some just want 3 year showing obesity and others coming back with no problems at all. They said Mainecare is very unpredicable right now and they want to play it safe. My PCP is not impressed about this at all she says it is a waste of time and money and nothing but a big hold up. She said why cant I just write a letter. I said because they said they are requiring a 6 month diet to be in the safe side. My PCP had a point and her point was ok lets start the diet appointments but in the mean time get everything else done and then have them submit to insurance if it comes back that you need to continue on with the 6 months then we continue. She said I dont want to get to the end of your 6 months and then they deny you or want something else. Anyone out there have this happen to you?
Topic: Update: Approved! (Anthem is giving me hissy fits)
My stuff was actually sent the 5th, not the 8th like I thought. I call daily. Still sitting on someone's to do list. Then I see people getting a turn around in less than a day!!?!?!?!?
I almost wonder if part of the problem is that there is no surgery date scheduled. Every time I call, they ask me the date of the surgery. My surgeon doesn't schedule a date until after approval. So maybe the ones with dates on them go first since they are more seemingly urgent???
Trying to rationalize what cannot be rationalized...
I almost wonder if part of the problem is that there is no surgery date scheduled. Every time I call, they ask me the date of the surgery. My surgeon doesn't schedule a date until after approval. So maybe the ones with dates on them go first since they are more seemingly urgent???
Trying to rationalize what cannot be rationalized...
Pamelalalala
Switched on Feb 9, 2011!
Switched on Feb 9, 2011!
Topic: what the heck is it
what is pre-certification paper work and when does it get submitted, just wondering saw someone else's posted that they submitted it
Topic: RE: Got a referral from my PCP for Surgery. Does this mean I am approved?
Now it's tiem for the HAPPY DANCE! (HAPPY DANCE is wonderful aerobic ecxercise, too)
Topic: RE: DS denied because of BMI under 50
~Michelle
"Everything I did in my life that was worthwhile I caught hell for." ~Earl Warren
Besides the BMI requirement I also have the out of network obstacle.
CONGRATS on your referral!!! It's AWESOME that a RNY surgeon suggested the DS and wrote a recomendation for it! I think that's unheard of.
CONGRATS on your referral!!! It's AWESOME that a RNY surgeon suggested the DS and wrote a recomendation for it! I think that's unheard of.
~Michelle
"Everything I did in my life that was worthwhile I caught hell for." ~Earl Warren
Topic: RE: Got a referral from my PCP for Surgery. Does this mean I am approved?
Well I got an email from the surgery coordinator today just hours after I sent them my referral letter. It said that BCBS approved my surgery. Wow! That was fast! Great feeling
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My insurance will not pay for my excess skin that hang down to my knees
Hockeymom87 · 0 replies · 808 views
Hockeymom87 · 0 replies · 808 views
