Recent Posts
Topic: RE: Buy insurance to get WLS or Self pay??
If I sign up for my husbands insurance (excludes all things having to due with weight) sign up is next month but it doesnt go into effect to the first of the year. What if I had WLS before the first of the year but after I signed up for his insurance?
Topic: RE: Empire Blue Cross Blue Shield says VSG is still Experimental????
BC/BS is the hardest for appeals on that specific issue, investigational. Some just flat out refuse to pay for it, a few have won through appeal.
VSG is not investigational anymore, not sure why they play these games.
You have nothing to lose by trying. You can go to the ASMBS site and obtain proof there that it is not investigational. Then find a few peer reviewed studies showing that weight loss is superior to a band and safer than a sleeve.
Fight to the bitter end.
VSG is not investigational anymore, not sure why they play these games.
You have nothing to lose by trying. You can go to the ASMBS site and obtain proof there that it is not investigational. Then find a few peer reviewed studies showing that weight loss is superior to a band and safer than a sleeve.
Fight to the bitter end.
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: Buy insurance to get WLS or Self pay??
The last few surgeons I have spoken with would like me to get insurance before surgery as a back up. I am not sure what to do since I have been denied in the past.
It's a double edge sword. You can't get a private plan when you are obese and then you won't be able to get a private plan after you have WLS for about 5 years. You are out of luck on that one.
I'm still going to suggest Mexico. Research is free, surgery in the US is double the cost. With proper research it's safe. Shopping by price gets you less than skilled surgeons.
On September 24, 2010 at 10:55 AM Pacific Time, KimberlyHeidi wrote:
I am unsure of what to do. I have tried to get insurance before but because of my issues I have been denied. The last few surgeons I have spoken with would like me to get insurance before surgery as a back up. I am not sure what to do since I have been denied in the past.
It's a double edge sword. You can't get a private plan when you are obese and then you won't be able to get a private plan after you have WLS for about 5 years. You are out of luck on that one.
I'm still going to suggest Mexico. Research is free, surgery in the US is double the cost. With proper research it's safe. Shopping by price gets you less than skilled surgeons.
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: Please read and give me advice!
You can hire an attorney... Walter someone, I forget. PM me if you want and I'll get his name. He specializes in this.
You can go through the Ins Commissioner in your state.
She can't do this, it's against the law.
You can hire an attorney... Walter someone, I forget. PM me if you want and I'll get his name. He specializes in this.
You can go through the Ins Commissioner in your state.
She can't do this, it's against the 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/
Topic: RE: DENIED BY AETNA ON APPEAL
What was the reason for the denial?
On September 25, 2010 at 8:05 PM Pacific Time, moving-on wrote:
I so feel your pain. I am going through the same thing. I had the rug pulled out from me. My surgeons office calls me and says I was approved, I do all the pre-op testing and they start me on a liquid diet. I am on liquids for a week and then get a letter from my insurance saying they are denying my surgery. Oh boy was i depressed. My surgeons office does a peer to peer and an appeal and it was denied as well. I just sent in a request for a Fair Hearing on Wed and am waiting myself to see what is going to happen next. I have a BMI of 42, diabetic, sleep apnea, high cholesterol, high blood pressure, so I am well qualified as yourself. I found a copy of a letter on this site and I used it. Hoping that it works for me as i have seen it work for others. My Health Advocate states there is a law stating that they cannot deny us, not sure how to make that work. I wish you the best of luck and we will have to stick together to succeed. I will not quit either. What was the reason for the denial?
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: Super Freaked out and nervous!
I GOT APPROVED BY AENTA IN A DAY SO YES IS WORTH IT DONT THINK NEGATIVE THINK POSITIVE
Topic: RE: DENIED BY AETNA ON APPEAL
I so feel your pain. I am going through the same thing. I had the rug pulled out from me. My surgeons office calls me and says I was approved, I do all the pre-op testing and they start me on a liquid diet. I am on liquids for a week and then get a letter from my insurance saying they are denying my surgery. Oh boy was i depressed. My surgeons office does a peer to peer and an appeal and it was denied as well. I just sent in a request for a Fair Hearing on Wed and am waiting myself to see what is going to happen next. I have a BMI of 42, diabetic, sleep apnea, high cholesterol, high blood pressure, so I am well qualified as yourself. I found a copy of a letter on this site and I used it. Hoping that it works for me as i have seen it work for others. My Health Advocate states there is a law stating that they cannot deny us, not sure how to make that work. I wish you the best of luck and we will have to stick together to succeed. I will not quit either.
Topic: RE: City of New York employee - Empire BCBS & GHI
How did everything work out with you? I too have GHI (PPO) with a BMI of 40 and was wondering if they will give me a hard time to get approved. Thanks in advance.
Topic: Super Freaked out and nervous!
Hello all.
Now that I have read the stories about people with complications with Aetna approving the surgery I am super discouraged.
I am working so hard on the presurgical 12 week program (week 6 of 12 so far) and I am spending so much money, it makes me sick to think that I could get denied.
Is it really worth it?
I am 27 years old, 5' and 3/4" tall. HW: 263 SW: 226 LW: 142 CW: 198
Topic: RE: Please read and give me advice!
Thank you so much for your input. My insurance is Jan-Dec. I started this in March thinking that I would have all year to get the band..and my fills. And now this. My deductable is close to being met of course. How would I find out how many appeals I get..and if I appeal again I know it goes back to the East Ohio Conference. The thought of talking to the lady from EOC again makes my stomach feel sick. BUT I know I have did everything 110%....


