Recent Posts

Stacy Sikes
on 10/20/13 6:37 am - OR
Topic: RE: Denied-for the second time

I have UHC Insurance in Oregon through my employer. I started this less than two months ago, I had a lot of hoops to jump through for my Surgeon,(I had to see a Cardiologist, Therapist, Nutritionist, Endocrinologists, and sleep study)   but my insurance only required 5 years paper work showing that I have been heavy for the past 5 years.   I was approved this past Friday and on Wed I set up my surgery date. I am so sorry you are having so much trouble with the insurance company. I just don't understand how UHC has so many different rules depending on state and employer that the health plan is under. Seems same insurance company would have the same rules.

 

hevnbnd
on 10/20/13 6:15 am
Topic: UHC

Im a City of OKC employee, and Im covered by UHC health Ins. There is an exclusion on policy for weight loss surgery. Ins will pay for everything leading up to surgery, but not the surgery itself. Its open enrollment at this time and I was thinking about switching over to BCBS but Im not able to afford all the deductibles. Can this exclusion with UHC be appealed? When I called UHC, a rep told me that surgery wasnt covered but it all depends on how doctor "words" it.....(didnt quite get that one)

Any suggestions on how to deal with this?

 

Thanks in Advance

uglymouse
on 10/20/13 2:04 am - newnan, GA
Topic: RE: Denied-for the second time
I will submit my paperwork on November 5th.

kitkat88
on 10/20/13 2:02 am - Metairie, LA
RNY on 11/18/13
Topic: RE: Denied-for the second time

How long did it take to get approval

nhandy
on 10/19/13 9:25 am
Topic: Aetna Insurance - 2 year history of BMI

Hi All,

I have Aetna insurance and am planning on attempting to get approval for VSG. My only issue is that I do not have the 2 year MEDICAL record of my BMI. After I had my son in 2009, I did not have a medical record of my weight until February of this year. I was a slacker and didn't see my PCP and I didn't get sick at all and need to see a Dr. Since February of this year, I have seen the Dr a LOT, as well as a cardiologist, etc. I was just wondering if anyone has had experience with getting around this requirement or if there is anything I can provide in lieu of a medical record. For example, in 2012, I started a weight loss blog online and I actually posted photos of the scale while I was standing on it which clearly shows my weight during the year 2012. And of course I could provide photographs, although that too seems like it may be a stretch. I plan on asking my PCP for a letter of medical necessity to explain that I have been morbidly obese for the entire time I have been her patient (over 10 yrs), but I don't know if that is enough.

I don't have any records from urgent care, WW, a gym or anything like that. My personal blog and photos are really all I have to document my weight during the year 2012 (which is the year I need to meet the 2 yr requirement). I know I can just put off having the surgery for another year but I probably won't be with the same employer in a year and my husbands insurance doesn't cover WLS so I feel like this is my only chance.

What do you guys think? Is it worth submitting this information and seeing what they say? Has anyone ever heard of a success story using other means of documentation? Am I just out of luck? Any advice??

Thanks!

VSG on 06/12/13
Topic: RE: Won an APPEAL???
When talking with Lindstroms office regarding my own appeal, Kelley Lindstrom was explaining how the way some plans are structured might allow you to win on appeal at the independent review level. Reach out to Lindstroms before you give up. Good luck!

   

Sleeved 6/12/13 - 100 pounds lost to get to goal!

VSG on 06/12/13
Topic: RE: Denied-for the second time
Please give Walter Lindstroms office a call. They helped me win vs UHC. Best of luck to you-

   

Sleeved 6/12/13 - 100 pounds lost to get to goal!

KyFlower
on 10/18/13 2:28 pm
Topic: Question about Medicaid

Does anyone know if KY Medicaid thru Anthem BCBS requires a 6 month supervised diet? Any info. would be appreciated! Thanks!

curvygirlww
on 10/18/13 1:31 pm - TX
Topic: RE: Uhc revision questions
Any updates. I'm trying for the same.

Virgie Tschirhart
on 10/18/13 7:29 am - Midwest City, OK
RNY on 12/27/17
Topic: RE: Revision from VSG to RNY - Going to my 1st appointments with Dietician & Psychologist

Hi there kitkat88,  

The Lap Band or the Sleeve was not for me.   Had the LB in 2008 I hated it, lost 14 lbs and gained 17 lbs.  I was revised to the Sleeve in 2009 I lost some weight about 30 lbs and gained back most of the weight.  If you have a problem with eating white carbs like I do the the Sleeve will stretch and you will gain weight.  I also have a Hiatal Hernia with the Sleeve.  There was a study made this year and it showed more Sleevers gained their weight back and developed a sweet tooth, even if you never had one before.  That is exactly what happened to me, now I love cake, cookies, candy etc.....  I did not want to get the DS because, first of all BCBS Federal will not cover it if your BMI is lower than 50.  So, that is my story.  I am going for the Gastric Bypass RNY.

Thanks for replying.

Virgie Tschirhart

Lap Band - 2008, Sleeve - 2009, RYN - 2017

Started Program Weight July 13, 2017 - 194.2

Before Surgery Weight December 27, 2017 - 185.0

Current Weight - February 2018 - 161.0

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