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Hello, we have Cigna...care allies and they have denied the claim stating that they are not in receipt of documentation under a physicians care for 3 months, supervised or registered dietician, or supervised weight mgmt for 12 months. This is not true, the bariatric surgeons office has submitted it and called them to verify receipt. My husband is about 5'7" and weighs nearly 300lbs. He has sleep apnea, high blood pressure, and degenerative joint pain in his knees and back. If anyone can assist, your advice/guidance would be greatly appreciated.
Hello
I am a newbie and I have UHC Community Plan through Medicaid. I have a surgeon and have completed 6 months NUT visits and Psych Eval and am as of right now waiting for the hospital to submit my papers for approval. My question is has anyone else gone thru this process with Maryland UHC Community Plan.
Thanks in advance.
on 12/6/13 9:25 pm
I received a notification from Cigna today that my request for an independent review of their denial was being sent to a company called MCMC which I think stands for medical care management corporation. Has anyone else had any contact or experience with these guys before?
Basically what happens is that they will get a nurse or a doctor to read your paperwork and medical records and make sure the insurance company is following the policy to a T. If they are, they will likely side with the ins co.
I wish I would have known about this before you requested a an independent review. They will have the final word. I would have given you more info for an appeal. That would have given the medical professional reason to side with you. For example, studies showing that diagnostics are not the only issue when dealing with bands. Scar tissue is what usually causes the most problems that you describe and that can't be seen until they do surgery.
on 12/6/13 8:16 pm
I have registered with the affordable care act website and I have a registration number
I've tried to look at all the different options for Pennsylvania and it is not looking good
I want to find out if any of the insurance plans offered thru healthcare.gov cover weight loss surgery.
I am beginning to get really depressed after so many years of waiting for my insurance to cover this
all my doctors agree that I definitely need this surgery, but i can't seem to find anyone who will cover even part of the cost and self pay is out of the question
I'm 49 now and the weight is killling me, literally
anybody have any info on insurance that i can buy or a plan thru healthcare.gov that covers bariatric surgery?
Thank You!
They have already made it very clear. Ostupidcare will not cover WLS at all in any state. Their suggestion is to buy a platinum plan privately. The cost for an obese person will be around $3K a month.
It would be cheaper to do what most self pays do. Go to Mexico. For a good surgeon in a safe city it will be about $7-8K.
It would appear the truth is finally coming out about Ostupidcare. Double the premiums for a fraction of the services and no doctor. In California already 70% of doctors are refusing to participate in this idiotic plan. I don't know why anyone thought would could provide medical care to 18 million people with less cost than we had before. Now the poor and the middle class have the honors of paying the most in lost jobs, taxes, and punitive costs via the IRS. But hey, they get cheap insurance that doesn't cover what they need.
Just to give you an idea, Ostupidcare plans to pay doctors (including specialists) $24 for an office call. That won't even cover their overhead. I would imagine very few doctors will be able to afford to provide such care.
I have registered with the affordable care act website and I have a registration number
I've tried to look at all the different options for Pennsylvania and it is not looking good
I want to find out if any of the insurance plans offered thru healthcare.gov cover weight loss surgery.
I am beginning to get really depressed after so many years of waiting for my insurance to cover this
all my doctors agree that I definitely need this surgery, but i can't seem to find anyone who will cover even part of the cost and self pay is out of the question
I'm 49 now and the weight is killling me, literally
anybody have any info on insurance that i can buy or a plan thru healthcare.gov that covers bariatric surgery?
Thank You!
Don't trade what you want the most for what you want right now.
on 12/6/13 3:33 am
I am going to suggest that you rethink a sleeve. You are a higher BMI, sleeves are not great for higher BMIs. Don't misunderstand, I am a huge fan of sleeves, I have one! I am 5.5 years post op from my sleeve. But I also know the stats. Usually a sleeve will buy you about 100-120# LONG TERM weight loss. Many lose more, but the regain is very high for higher BMI folks. It's not just a matter of following the rules, everyone swears up and down they will follow every bloody rule. The problem is that higher BMIs tend to have metabolic problems and sleeves do not address that issue.
I would seriously suggest you look at DS instead. I absolutely promise you about 5-6 years down the road you will be back here looking at info on a revision and the thing is, you will very likely be self pay by that point. Most ins co's are going to a once in a lifetime wls. So when you want a revision, you will be paying for it in full.
Get the right surgery type for you the first time around. Less invasive does not mean effective. Quite frankly, the bigger the problem the bigger the surgery necessary.
on 12/6/13 3:22 am
~~In addition, it was also noted that I was not in compliance with my 2 previous weight loss surgeries as far as dieting and exercising.~~
This is the one that is going to be tricky for you. The Nut appts are easy enough to take care of.
Ins co's are really cracking down on wls folks who have surgery after surgery. Most ins co's are going to a "one wls per lifetime" rule and they are being hard nosed about it as well. Even if someone was self pay for their surgery and they want a revision... the ins co's are looking at that self pay surgery as their once in a lifetime surgery.
They just aren't paying for repeated surgeries anymore. I would jump through whatever hoops are necessary to get your revision before your ins co follows the standard policy most are today... one per lifetime. Make this one right, follow the diet, cut out the white carbs, get to a gym. It is unlikely they will pay for a 4th surgery down the road.
on 12/6/13 3:16 am
Hi everyone question my plan says I' am covered for weight loss surgey. Under the plan Aetna has a lifetime cap of 10,000 is there a way around this? what are my options? Thanks hoping to be a future weightloss grad.I didnt the 3 month visit everything aetna ask but there a cap my wife job place a cap on the procedure.
No, there isn't. That is the cap, period.
Does it say who you have to go to? Some BC/BS plans allow you to go to Mexico where surgery in full would be cheaper than the $10K limit you have. MOST self pays go to MX, about 1% have insurance that will pay for them to go to MX.
Hockeymom87 · 0 replies · 727 views
