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Topic: RE: Updates on Aetna Appeal Denial/Peer to Peer question
why did they deny you again? if you met their criteria after their initial denial? what was the reason?
Topic: Denied (Again)
Well, I got my letter back from the insurance company today and my appeal was denied. Here are some of the details from the letter:
"Over Grievance and Appeal medical director, a pediatric critical care physican, Victor N. Blankson, MD KY license # . . . . in conjunction with an external independent reviewer specializing in general surgery and bariatric surgery, Julie Kim, MD, Mass. license # .... thoroughly reviewed the following information: written appeal request, notificaiton of denial issued by Active Health Management, Active Health Management criteria, medical records from Centennial Bariatrics.
We were unable to approve the requested bariatric surgery revision on October 4, 2010 because there are not any documented complications of the Laparoscopic Gastric Banding procedure performed in 2009. . . .As a result you do not meet plan criteria for revision or repeat bariatric surgery, from the Laparoscopic Gastric Banding to the Duodenal Switch, at this time."
So, any suggestions on what to write in my request for the Independent External Review?
Also, I am going to call somebody, either my PCP , or find a GI doc and see about getting an upper GI done.
"Over Grievance and Appeal medical director, a pediatric critical care physican, Victor N. Blankson, MD KY license # . . . . in conjunction with an external independent reviewer specializing in general surgery and bariatric surgery, Julie Kim, MD, Mass. license # .... thoroughly reviewed the following information: written appeal request, notificaiton of denial issued by Active Health Management, Active Health Management criteria, medical records from Centennial Bariatrics.
We were unable to approve the requested bariatric surgery revision on October 4, 2010 because there are not any documented complications of the Laparoscopic Gastric Banding procedure performed in 2009. . . .As a result you do not meet plan criteria for revision or repeat bariatric surgery, from the Laparoscopic Gastric Banding to the Duodenal Switch, at this time."
So, any suggestions on what to write in my request for the Independent External Review?
Also, I am going to call somebody, either my PCP , or find a GI doc and see about getting an upper GI done.
Highest Weight: 564 / Post Band Pre DS Weight: 508 / Surgey Date Weight: 449
Current Weight: 209 / Goal Weight: 150 (BMI of 25).
Topic: RE: Lost Insurance
That's another problem I have, lack of money, I called the Dr this morning and left a message hopefully we can work things out...when it rains it pours... =/
Topic: RE: Lost Insurance
Is it possible for you to self pay for the fills? My friend had the Lap Band and is a self pay. I think she was telling me her fills were $125 or something like that??
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
Topic: Lost Insurance
I lost my insurance now what do I do? Had lap-band 2006 haven't gone in to get adjusted in a long time...starting to gain weight back.....very depressed...HELP!!!! Any ideas?
(deactivated member)
on 10/7/10 3:15 pm - Vacaytown, HI
on 10/7/10 3:15 pm - Vacaytown, HI
Topic: RE: paying for bariatric protein shakes and vitamins
Many manufacturers have programs to help people who cannot afford their products... I would say draft a letter outlining your situation and send it to some of the companies and see what happens. It doesnt hurt and its a write off for the company on their taxes. :) Good luck...
Topic: paying for bariatric protein shakes and vitamins
I know this is probably a frequent question, but I am wondering if there are any suggestions regarding ways to cut costs for bariatric protein shakes and vitamins.
I'm a grad student right now, so instead of having money I OWE money, big time. I can only work a few hours a week because of my classes and internship, and the only way I get groceries now is because I receive Food Stamps. The only reason I'm able to get the surgery is because I have a Medicaid managed care HMO, so there is no costs for me, and with all my co-morbidities it's more costly to "leave me fat" than to help me lose weight! However, Food Stamps won't cover bariatric protein shakes, even though they are the major "meal" after surgery and a primary source of nourishment. Furthermore, Medicaid won't cover such products either.
The only thing I have found thus far that might help is if I can get a prescription for Fleming Pharmaceutical's "ProBarimin QT" and maybe Medicaid would pay for it because it's medically necessary. I know it's not the greatest bariatric vitamin and I'd have to take 2x the recommended dose but I don't see how I could afford any of the other bariatric vitamins!
I did hear from somewhere that Bariatric Advantage has a program to help people get their vitamins - apparently your surgeon fills out a form for them. Has anyone heard anything about this?
Does anybody know of anything else that might help cut costs or help pay for bariatric shakes and vitamins?
I'm a grad student right now, so instead of having money I OWE money, big time. I can only work a few hours a week because of my classes and internship, and the only way I get groceries now is because I receive Food Stamps. The only reason I'm able to get the surgery is because I have a Medicaid managed care HMO, so there is no costs for me, and with all my co-morbidities it's more costly to "leave me fat" than to help me lose weight! However, Food Stamps won't cover bariatric protein shakes, even though they are the major "meal" after surgery and a primary source of nourishment. Furthermore, Medicaid won't cover such products either.
The only thing I have found thus far that might help is if I can get a prescription for Fleming Pharmaceutical's "ProBarimin QT" and maybe Medicaid would pay for it because it's medically necessary. I know it's not the greatest bariatric vitamin and I'd have to take 2x the recommended dose but I don't see how I could afford any of the other bariatric vitamins!
I did hear from somewhere that Bariatric Advantage has a program to help people get their vitamins - apparently your surgeon fills out a form for them. Has anyone heard anything about this?
Does anybody know of anything else that might help cut costs or help pay for bariatric shakes and vitamins?
Surgery Date: 12/13/2010 - Wish me luck!
Topic: RE: looking for cigna approval
I also have Cigna, I did my 6 month diet. Finished on August 20, 2010. Surgeon sent over stuff to Cigna on September 23, 2010. I called the following Monday and they told me there is a 30 day pre-determination and so far its been 15 days. Everyday I call and they tell me they still have time. I know someone else who had to wait the 30 days for them to approve. Hopefully they move a little quicker.
Andrea
Andrea
HW 300, SW (Realize Band) 268, Revision to VSG 264
(deactivated member)
on 10/6/10 8:17 am - Vacaytown, HI
on 10/6/10 8:17 am - Vacaytown, HI
Topic: RE: Final denial from Aetna...going with 2nd insurance Buckeye Community Health plan???
Could you appeal through aetna that an employer review is a conflict of interest?? Just an idea:)
(deactivated member)
on 10/6/10 7:59 am - Vacaytown, HI
on 10/6/10 7:59 am - Vacaytown, HI
Topic: Can't afford medications? Look Here!
I have found many resources for the uninsured to obtain medications free. If there is a medication you take for hight cholesterol, blood pressure, etc. (some of our co morbidities) let me know and i can look it up to see if there is a program to cover it:)
Anyway, how is everyone??? I had RNY 5 years ago and insurance was a nightmare, but I have learned a lot along the way so lets share and help each other :)
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