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Topic: RE: looking to buy insurance in PA help please
Private policies do not cover WLS. If they did people would buy a policy long enough to get surgery and then drop the ins. No ins co could afford that.
You would need to join a group policy, one where they do cover WLS. Either that, or self pay.
On September 23, 2010 at 2:11 PM Pacific Time, crivas0512 wrote:
i am looking for a insurance company in PA that covers most of the cost of bariatric surgery any one know of any insurance company i can apply to help please
Private policies do not cover WLS. If they did people would buy a policy long enough to get surgery and then drop the ins. No ins co could afford that.
You would need to join a group policy, one where they do cover WLS. Either that, or self pay.
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!
I am 31 years old and weigh 285. Been dealing with obesity for my whole life. The lady that I am working with from Dr. Custers office thru all this said I did everything 110% correct. My file was submitted to aetna on June 22nd 2010. July 3rd I got word that it was denied and would go to appeal. I was told that the medical reviewer denies 9 out of 10 cases that get to his desk..so it went to appeals which means that in July it went to my employer which is the East OHio Conference. I wrote a letter to go with my file at that time telling more about myself and all the options i have did before to try and lose weight....a 2 page letter that I wanted to go with my file so that I wasnt' just a number. Well, I head back from the lady at Dr. Custers office yesterday morning and she said it was denied again. She feels that the East Ohio Conference are just siding with Aetna becasue they don't know how/or what to do to handle this. I got on the phone after that call and called and spoke to the lady at the East Ohio Conference that handled my file and asked her for more info. What she told me is that she feels I should try optifast again....she feels that there are other ways I can lose weight..she feels that I should do another month diet...I got all these answers from her and it was like her opinion!! She kept referring to an insurance program that the east Ohio Conference used to have that was more strict on guidlines for weight loss surgery..I feel like I have hit a very hard wall.
I KNOW I have met all the crriteria to get the weight loss surgery. I did everything 110%. If I appeal this again..it will just go back to the East Ohio Conference. And I was told within time the 12 week nutritional class does expire. So I will have all that plus more dr. offices out of pocket to meet my deductable yet again.
What do I do? I feel sick at the thought that this means I am back to the drawing board.
Any advice out there? I need it terribly.
Thank you,
Angie
Have you looked at your policy regarding WLS with your own eyes? Have you personally read the requirements? If so, please post the requirements and let's go through them. If not, get a copy and post them.
If you met all the criteria and they still deny you then you go to the state ins commission.
But post it here first and let us go through each item so you have all your ducks in a row,
BTW, you would not be a good candidate for banding. It's not a good surgery type for anyone let alone someone that has more than 75# to lose. It's not designed to be forever, maybe 10 years but usually 5. Ins co's are switching to a 'one surgery in a lifetime' policy. Think long and hard about this.
If you want restriction only a sleeve is far more effective and tons safer long term.
On September 22, 2010 at 4:54 AM Pacific Time, Malg22 wrote:
Hello all. I began this jounrney to my weight loss surgery in March of 2010. I visited Dr. Custer in Ohio and he felt I would be a good canidate for the Lap band. I have aetna insurance with Buckeye as a secondary. (I just got Buckeye within the last month). So, with aetna you can do the 12 week nutritional class or the 6 month with your pcp. I did the 12 week class at the barix clinic and also met with my pcp once every 3 months. My pcp was very supportive-filled out in detail what I did during those 3 months on my file. There was other ciriteria to meet of course and I did. I am 31 years old and weigh 285. Been dealing with obesity for my whole life. The lady that I am working with from Dr. Custers office thru all this said I did everything 110% correct. My file was submitted to aetna on June 22nd 2010. July 3rd I got word that it was denied and would go to appeal. I was told that the medical reviewer denies 9 out of 10 cases that get to his desk..so it went to appeals which means that in July it went to my employer which is the East OHio Conference. I wrote a letter to go with my file at that time telling more about myself and all the options i have did before to try and lose weight....a 2 page letter that I wanted to go with my file so that I wasnt' just a number. Well, I head back from the lady at Dr. Custers office yesterday morning and she said it was denied again. She feels that the East Ohio Conference are just siding with Aetna becasue they don't know how/or what to do to handle this. I got on the phone after that call and called and spoke to the lady at the East Ohio Conference that handled my file and asked her for more info. What she told me is that she feels I should try optifast again....she feels that there are other ways I can lose weight..she feels that I should do another month diet...I got all these answers from her and it was like her opinion!! She kept referring to an insurance program that the east Ohio Conference used to have that was more strict on guidlines for weight loss surgery..I feel like I have hit a very hard wall.
I KNOW I have met all the crriteria to get the weight loss surgery. I did everything 110%. If I appeal this again..it will just go back to the East Ohio Conference. And I was told within time the 12 week nutritional class does expire. So I will have all that plus more dr. offices out of pocket to meet my deductable yet again.
What do I do? I feel sick at the thought that this means I am back to the drawing board.
Any advice out there? I need it terribly.
Thank you,
Angie
Have you looked at your policy regarding WLS with your own eyes? Have you personally read the requirements? If so, please post the requirements and let's go through them. If not, get a copy and post them.
If you met all the criteria and they still deny you then you go to the state ins commission.
But post it here first and let us go through each item so you have all your ducks in a row,
BTW, you would not be a good candidate for banding. It's not a good surgery type for anyone let alone someone that has more than 75# to lose. It's not designed to be forever, maybe 10 years but usually 5. Ins co's are switching to a 'one surgery in a lifetime' policy. Think long and hard about this.
If you want restriction only a sleeve is far more effective and tons safer long term.
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 Surgeon who is here who I adore will only accept people with insurance.
I know there are a lot of places who will accept self pay, but then what do people do for after care? Besides one other surgeon who has only done a little over 100 surgearies there is no one else close by.
Looking for ideas and suggestions!
Well, you have several options here but buying a private policy to get ins isn't one of them. Private policies do not cover WLS because people would get it long enough to get surgery and then drop the plan. No ins co could afford that.
That leaves self pay.
First you have to decide on a surgery type. If you are self pay i'd strongly suggest a sleeve because it is the safest surgery type available long term and has better stats than bypass but the best part is there is no aftercare, there is no maintenance. With bands they don't work well and aftercare can be quite expensive, weight loss is slow, regain is high, etc.
Bypass requires very specific labs that may be hard to convince your ins to pay for. If they don't cover WLS they won't cover follow ups for labs related to WLS. Those labs are thousands of dollars each time.
Same with DS.
I have self paid x2. First a band then a revision to a sleeve. I went to MX. You might be shocked to see the quality of care and the number of us that go there. If you do your research you can find the best of the best for half the price of the US and the care is actually better because they keep you in the hospital longer.
Find 50 people that went to MX and ask them about their experiences. You might be shocked.
Research is free, surgery in the US is double the cost of MX. A sleeve by the sleeve expert in the US is $18K. In MX it is $8750.
On September 23, 2010 at 1:30 PM Pacific Time, KimberlyHeidi wrote:
I have been frustrated with this for years. I do not have insurance and my husbands insurance is beyond awful and does not cover WLS or any weight issue. They will not add a rider either.The Surgeon who is here who I adore will only accept people with insurance.
I know there are a lot of places who will accept self pay, but then what do people do for after care? Besides one other surgeon who has only done a little over 100 surgearies there is no one else close by.
Looking for ideas and suggestions!
Well, you have several options here but buying a private policy to get ins isn't one of them. Private policies do not cover WLS because people would get it long enough to get surgery and then drop the plan. No ins co could afford that.
That leaves self pay.
First you have to decide on a surgery type. If you are self pay i'd strongly suggest a sleeve because it is the safest surgery type available long term and has better stats than bypass but the best part is there is no aftercare, there is no maintenance. With bands they don't work well and aftercare can be quite expensive, weight loss is slow, regain is high, etc.
Bypass requires very specific labs that may be hard to convince your ins to pay for. If they don't cover WLS they won't cover follow ups for labs related to WLS. Those labs are thousands of dollars each time.
Same with DS.
I have self paid x2. First a band then a revision to a sleeve. I went to MX. You might be shocked to see the quality of care and the number of us that go there. If you do your research you can find the best of the best for half the price of the US and the care is actually better because they keep you in the hospital longer.
Find 50 people that went to MX and ask them about their experiences. You might be shocked.
Research is free, surgery in the US is double the cost of MX. A sleeve by the sleeve expert in the US is $18K. In MX it is $8750.
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: looking to buy insurance in PA help please
i am looking for a insurance company in PA that covers most of the cost of bariatric surgery any one know of any insurance company i can apply to help please
CAROLINA
Topic: Buy insurance to get WLS or Self pay??
I have been frustrated with this for years. I do not have insurance and my husbands insurance is beyond awful and does not cover WLS or any weight issue. They will not add a rider either.
The Surgeon who is here who I adore will only accept people with insurance.
I know there are a lot of places who will accept self pay, but then what do people do for after care? Besides one other surgeon who has only done a little over 100 surgearies there is no one else close by.
Looking for ideas and suggestions!
The Surgeon who is here who I adore will only accept people with insurance.
I know there are a lot of places who will accept self pay, but then what do people do for after care? Besides one other surgeon who has only done a little over 100 surgearies there is no one else close by.
Looking for ideas and suggestions!
Topic: RE: My ins co won't disclose pre-reqs to me
Thanks for the offer, I really appreciate that.
Good news, however: I will be switching over to Medicare on 12/1/10, so, problem solved!
Good news, however: I will be switching over to Medicare on 12/1/10, so, problem solved!
Topic: RE: Healthnet PPO/POS or a HMO???
I am undecied yet to get either ppo or hmo healthnet, which is beter to cover lapband? i live in L.A.
Topic: Please read and give me advice!
Hello all. I began this jounrney to my weight loss surgery in March of 2010. I visited Dr. Custer in Ohio and he felt I would be a good canidate for the Lap band. I have aetna insurance with Buckeye as a secondary. (I just got Buckeye within the last month). So, with aetna you can do the 12 week nutritional class or the 6 month with your pcp. I did the 12 week class at the barix clinic and also met with my pcp once every 3 months. My pcp was very supportive-filled out in detail what I did during those 3 months on my file. There was other ciriteria to meet of course and I did.
I am 31 years old and weigh 285. Been dealing with obesity for my whole life. The lady that I am working with from Dr. Custers office thru all this said I did everything 110% correct. My file was submitted to aetna on June 22nd 2010. July 3rd I got word that it was denied and would go to appeal. I was told that the medical reviewer denies 9 out of 10 cases that get to his desk..so it went to appeals which means that in July it went to my employer which is the East OHio Conference. I wrote a letter to go with my file at that time telling more about myself and all the options i have did before to try and lose weight....a 2 page letter that I wanted to go with my file so that I wasnt' just a number. Well, I head back from the lady at Dr. Custers office yesterday morning and she said it was denied again. She feels that the East Ohio Conference are just siding with Aetna becasue they don't know how/or what to do to handle this. I got on the phone after that call and called and spoke to the lady at the East Ohio Conference that handled my file and asked her for more info. What she told me is that she feels I should try optifast again....she feels that there are other ways I can lose weight..she feels that I should do another month diet...I got all these answers from her and it was like her opinion!! She kept referring to an insurance program that the east Ohio Conference used to have that was more strict on guidlines for weight loss surgery..I feel like I have hit a very hard wall.
I KNOW I have met all the crriteria to get the weight loss surgery. I did everything 110%. If I appeal this again..it will just go back to the East Ohio Conference. And I was told within time the 12 week nutritional class does expire. So I will have all that plus more dr. offices out of pocket to meet my deductable yet again.
What do I do? I feel sick at the thought that this means I am back to the drawing board.
Any advice out there? I need it terribly.
Thank you,
Angie
I am 31 years old and weigh 285. Been dealing with obesity for my whole life. The lady that I am working with from Dr. Custers office thru all this said I did everything 110% correct. My file was submitted to aetna on June 22nd 2010. July 3rd I got word that it was denied and would go to appeal. I was told that the medical reviewer denies 9 out of 10 cases that get to his desk..so it went to appeals which means that in July it went to my employer which is the East OHio Conference. I wrote a letter to go with my file at that time telling more about myself and all the options i have did before to try and lose weight....a 2 page letter that I wanted to go with my file so that I wasnt' just a number. Well, I head back from the lady at Dr. Custers office yesterday morning and she said it was denied again. She feels that the East Ohio Conference are just siding with Aetna becasue they don't know how/or what to do to handle this. I got on the phone after that call and called and spoke to the lady at the East Ohio Conference that handled my file and asked her for more info. What she told me is that she feels I should try optifast again....she feels that there are other ways I can lose weight..she feels that I should do another month diet...I got all these answers from her and it was like her opinion!! She kept referring to an insurance program that the east Ohio Conference used to have that was more strict on guidlines for weight loss surgery..I feel like I have hit a very hard wall.
I KNOW I have met all the crriteria to get the weight loss surgery. I did everything 110%. If I appeal this again..it will just go back to the East Ohio Conference. And I was told within time the 12 week nutritional class does expire. So I will have all that plus more dr. offices out of pocket to meet my deductable yet again.
What do I do? I feel sick at the thought that this means I am back to the drawing board.
Any advice out there? I need it terribly.
Thank you,
Angie
Topic: RE: My ins co won't disclose pre-reqs to me
Which ins co do you have? We might be able to do a few searches and find their policies on line.
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: Cigna "Duration of more than 5 years"???
This one is hard, an appeal could go either way. Have you tried a peer to peer review?
Yes, 30 is obese but most ins co's don't pay until you are morbidly obese.
Yes, 30 is obese but most ins co's don't pay until you are morbidly obese.
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/
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