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Jen
Have you received a denial and don't know what to do?
Are you trying to get approval for bariatric surgery, a revision or reconstructive surgery?
Does the insurance process seem as though it is a maze of obstacles with no solution?
Join us at our ObesityHelp Annual Conference on October 5 and 6, 2013, in Anaheim, California. Attorney Walter Lindstrom will be joining us to answer your questions. Attorney Lindstrom is a successful post-op and an attorney that specializes in obesity and bariatric advocacy.
Check out our Event page for more information about our Conference and the great line-up of speakers.
If you are looking to self insure, that will be a different question, and you may just need to go through the sites one by one. From other posts, I think it is tough to get them to cover on a self-paid plan. Have you done a search here for other, similar posts?
Don't give up hope on your current insurance. There may be a way to appeal even if WLS is excluded from your policy. In this case, I would get an advocate to help navigate those waters.
Finally, here is a blog post from Walter Lindstrom's site that explains some differences in insurance: http://wlsappeals.com/1915/walters_bariatric_surgery_blog/is-there-a-difference-when-it-comes-to-approval-for-bariatric-surgery
Good luck on your journey-
Sleeved 6/12/13 - 100 pounds lost to get to goal!
Hi, Going for my initial consult for wls. I have BCBS NC Blue Medicare PPO. I know that BCBS NC covers the hospital aspect of wls. My question is for the Medicare part of the coverage. I have a BMI of 36 and a co-morbidity of OSA. I know medicare requires a 6 month dr. supervised weight loss program. I was wondering what their weight record requirement it 2 or 5 years or any? Has anyone gone through wls and had medicare? I have not found very much information regarding bariatric surgery and medicare, so if anyone can help guide me through this process, I would appreciate it!
Thanks,
Demi
This is a tough question to answer. Not only does the coverage vary from insurance company to insurance company, it varies widely policy to policy within that company. I have found that most individual plans (meaning, not ones that you get as an employee), do NOT cover WLS. Group plans often cover it, but it really is dependent on what the specific company subscribed to, or whether they opted for a specific WLS exclusion.
Sorry I couldn't be of more help.
HW: 274 | SW: 232 | CW: 137 | Goal: 145 (ticker includes a 42 pound loss pre-op) | Height: 5'4"
M1: -24 (205) | M2: -14 (191) | M3: -11 (180) | M4: -7 (173) | M5: -7 (166) | M6: -8 (158) | M7: -11 (147) | M8: -2 (145) | M9: -3 (142) | M10: -2 (140) | M11: -4 (136) | M12: -2 (134) | M13: -0 (134) | M14: -3 (131) | M15: +4 (135) | M16: +2 (137)
They don't seem to give a lot of info, do they? (I just did a quick google search).
You need prior authorization, and it seems to be based on whatever they deem medically necessary. I would think that a high BMI, such as yours, would qualify. In fact, some of insurance companies forego the 6-month medically supervised diet if the BMI is higher than 50.
Good luck!
HW: 274 | SW: 232 | CW: 137 | Goal: 145 (ticker includes a 42 pound loss pre-op) | Height: 5'4"
M1: -24 (205) | M2: -14 (191) | M3: -11 (180) | M4: -7 (173) | M5: -7 (166) | M6: -8 (158) | M7: -11 (147) | M8: -2 (145) | M9: -3 (142) | M10: -2 (140) | M11: -4 (136) | M12: -2 (134) | M13: -0 (134) | M14: -3 (131) | M15: +4 (135) | M16: +2 (137)
I'll definitely keep you updated. I've got my last psych evaluation on Aug. 6th and am hoping to have my request to submitted and responded to by the end of August....I'm trying to get my hands on my document now too. I'm hoping its as straight forward as what they've told me...fingers crossed. If not, I'll just buckle down and start doing the other stuff too....but at least i'll have all this other stuff out of the way too :) I wish i could find someone that had a similar situation as I do....same BMI, similar background....there's a woman on the boards that's been successful fighting UHC....dont know if she had a dr supervised diet or not in the end but she won appeals etc.....not sure I've got that much energy.....
I'll let you know what I find out :)
Hockeymom87 · 0 replies · 728 views
