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Topic: RE: Empire Blue Cross Blue Shield says VSG is still Experimental????
I got approved for VSG through BCBS North Dakota, PPO. I had to appeal an initial denial, and BCBS sent my appeal out for an external review on thier own. As usual the reason for denial was "investigational". I am almost 3 months out from surgery and including the 3 months prior to surgery that I was off my immunosuppressant meds, I have saved them more than $12,000 in prescription costs alone. The VSG is a much less expensive procedure than RNY, and way more effective than the band in most cases. I wish BCBS would embrace it instead of fighting it.
Do you have any comorbidities or health issues that could preclude you from the RNY or Band? I could send you a copy of my appeal letter if you want. PM me your email if you are interested. Good luck!
Do you have any comorbidities or health issues that could preclude you from the RNY or Band? I could send you a copy of my appeal letter if you want. PM me your email if you are interested. Good luck!
Topic: RE: HOW DOES "SELF INSURED" affect approval
The advantage to your company being self insured, is that if Aetna continues to deny you for surgery, you may be able to appeal to your company's HR department. I thought I was going to have to do that with BCBS, but they approved me on appeal.
Topic: aetna - peer to peer APPROVED
I am completely shocked. After being given a verbal approval, receving a denial letter, my surgeon did a peer to peer yesterday & the denial was overturned.. I AM APPROVED!
Topic: RE: How did you do your 6 mo. of medically supervised WL if your insurance required it?
No the way I typed that sounded like I did but I did the 3 month multidiscipline program for Aetna. I did have 8 months worth of WW and when I submitted my paperwork to the surgeon's office, they saw the 8 months of WW and submitted my paperwork, thinking that Aetna would recognize it as the 6 mo medically supervised diet.
At the time, I was about 2 1/2 months into the 3 mo multidiscipline program. I had no idea the surgeon's office was going to submit....I thought they knew I was still seeing my physician for the 3 mo MD program. The insurance specialist at the surgeon's office was new on the job and was going to 'surprise' me by getting me approved and sending in my paperwork. I was sick when I got the letter and heard the news that I was denied because I was still in the process of meeting the requirement of the 3 mo multidisciplinary program.
so what I did is finish up with the remainder of the 3 mo MD program and submitted my own appeal. And I won.
So long story short (LOL) no, I only did the 3 month MD program, not that plus 6 months physician supervised.
My daughter was also approved on the 3 mo MD program, and my son has just been approved by doing the 6 month physician supervised diet. I have one other son, who just finished his 3 mo MD program and we are submitting at the end of this week for approval!
Nan
At the time, I was about 2 1/2 months into the 3 mo multidiscipline program. I had no idea the surgeon's office was going to submit....I thought they knew I was still seeing my physician for the 3 mo MD program. The insurance specialist at the surgeon's office was new on the job and was going to 'surprise' me by getting me approved and sending in my paperwork. I was sick when I got the letter and heard the news that I was denied because I was still in the process of meeting the requirement of the 3 mo multidisciplinary program.
so what I did is finish up with the remainder of the 3 mo MD program and submitted my own appeal. And I won.
So long story short (LOL) no, I only did the 3 month MD program, not that plus 6 months physician supervised.
My daughter was also approved on the 3 mo MD program, and my son has just been approved by doing the 6 month physician supervised diet. I have one other son, who just finished his 3 mo MD program and we are submitting at the end of this week for approval!
Nan
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
Topic: RE: Updates on Aetna Appeal Denial/Peer to Peer question
i am so sorry this is happening to you. i went to this site: www.obesitylaw.com to see what services they offered in case i need them. i think they are worth a call. i dont understand how insurance company can get away with what they are doing. please keep me posted!
Topic: RE: surgery codes
if you google the surgery, say VSG CPT Code, you should be able to locate the codes. Most insurance companies will also have the Codes listed on their medical policy that they cover.
Keep a smile on your face....it makes people wonder what you are up to!
Topic: RE: Updates on Aetna Appeal Denial/Peer to Peer question
they are upholding the lack of six month documentation, even though I had 6 visits with a physician and two pages of notes per visits... very confusing.... the worst part is they will not tell me why they are not accepting the documentation
Topic: RE: Is the deductible pd to hosptial or surgeon?
It depends on the hospital or the surgeon. When I had my surgery, they did not collect anything up front other than a very small co pay. But my out of pocket amount, which was about $1800, I received bills for after I had my surgery from different people (hospital, anesthesiologist, surgeon).
When my daughter had surgery, about a year after me, same bariatric center, same hospital, they collected the co pay (approx $1,800) upfront. Apparently they changed their policy from the time when I had it.
You would need to check with your surgeon to see what his policy is on that.
Nan
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
Topic: RE: Are nut & psych evals covered by Cigna?
My physician supervised diet was paid for by my insurance. I had to go to my pcp for 'weight management' and all's I had to pay was the $20 co pay. The remainder of the bill was paid by insurance.
Also, my psych eval (as well as my kids, all of which have been approved for or are going through the approval process) was covered by insurance. Again, I had to pay the co-pay, the the rest was covered.
As far as the dietician, where I work we have a registered dietician on site and I was able to go to her. Her service is free of charge to employees, so I lucked out there. I know when my son went to a dietician a few years back, the insurance did not cover that visit.
Hope this helps,
Nan
Also, my psych eval (as well as my kids, all of which have been approved for or are going through the approval process) was covered by insurance. Again, I had to pay the co-pay, the the rest was covered.
As far as the dietician, where I work we have a registered dietician on site and I was able to go to her. Her service is free of charge to employees, so I lucked out there. I know when my son went to a dietician a few years back, the insurance did not cover that visit.
Hope this helps,
Nan
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
Topic: Is the deductible pd to hosptial or surgeon?
I keep reading conflicting things. Is the deductible paid to hosptial or surgeon? Does it have to be paid in full prior to surgery?
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