Commonwealth Care...BMC Healthnet....Masshealth Anyone?

goalechica
on 12/16/08 9:21 am - Waldorf, MD
Do any of you have Commonwealth Care...BMC Healthnet? I do, and I'm wondering if that means we need to see surgeons specifically at BMC. I mean, I'd assume so and that's fine because I've picked mine already.

That said I haven't found ONE person yet who has BMC Healthnet or even Commonwealth Care or Masshealth that's had it done. So if you have...please reply to this thread. I really like to pick your brain a little because lets be honest, the website is pretty hard to navigate. I did however find this
info which seems very helpful.

But I want to hear some real info from you guys. Anyone?

Who did you have?
What were your administrative fees?
How long to get approved?
How long to get a surgery date?
Etc.

Starting Weight/ Surgery Weight
        255                   237                     

            
purplefans
on 12/16/08 11:20 am - MA
Sorry, don't have those insurances.  Have United Health Care.

 

 

 


 


 


goalechica
on 12/17/08 3:54 am - Waldorf, MD
:)

Starting Weight/ Surgery Weight
        255                   237                     

            
mary B.
on 12/29/08 2:15 am - new bedford, MA

I have  Masshealth / Neighborhood health plan, I went to Dr Kruger in Wareham, I went to the listing of surgeons and  see who took my insurance then went from there.
I had  to attend an informational seminar first then they called me for first  appt. then  went  through the nutrition and pysch visits  now i have the four classes I have to take and thats  all I have  had to pay for  which is 500. for the  classes..
any  other  questions I can answer for you  feel free to  email me..

Mary

goalechica
on 12/29/08 7:38 am - Waldorf, MD
Mary,

What did or do you have to do in terms of your insurance in order to be approved?

Jenna

Starting Weight/ Surgery Weight
        255                   237                     

            
mary B.
on 12/29/08 8:33 am - new bedford, MA
From what the woman  said  when I called  NHP to see if they allow the  surgery  she said unless it is a medical  neccesity they  will not let it go through. But  if you have comorbities  and a slight history of problems then they  will allow it, but  today when I was at the doctors the nurse said that if you  loose weight then  gain it back sometimes they  will deny you...I have a history  from the last four years  showing my health issues I have  had so i dont  feel I will have a problem getting approved.  Also my bmi  was  44.. so that helped my situation.
I have to  finish my classes that my surgeon requires you to go to before they will get  it to insurance for approval.. Most of the doctors know how to word it  so it goes through in most cases.
If it  gets denied  you fight back!! if you have gone  that far  dont give up! I know of a girl at work that they denied her three times and then they finally  let it go through..only because she  did not have a history of problems. thats why  denied... all depends on  the insurance and their mood of the day  lmao...

Have you chosen a surgeon? is your  bmi high..??
goalechica
on 12/31/08 7:51 am - Waldorf, MD
I have BMC Healthnet which is part of commonwealth care, like your insurance is. But I  had to choose someone from BMC. That wasn't hard though, I was already looking at Dr. Hess as a potential surgeon and that is who I am going with. I have a consult on Jan. 29th.

My BMI is not high. It was 39.9 when I started this process and is around 37 now. But I have many comorbidities such as high cholesterol, spinal issues, arthritis of the lumbar spine and right hip, as well as some other issues. So I think that may qualify me but am unsure. I'm in chronic pain due to the back issues I have. I have arthritis now due to an accident in 2003 that resulted in back fracture. This extra weight sure doesn't help. Ready to be active again, I was a gym rat and a damn good soccer player. Weighed in at 155lbs when the accident occured and now am 247.

Starting Weight/ Surgery Weight
        255                   237                     

            
mary B.
on 12/31/08 8:56 am - new bedford, MA
Go for it! you have so many health issues I  think you  have a  good chance of  being  accepted..
I have  had to go for a stress test because I get  chest  pains from time to time  but the test  showed I was  fine  and then they asked about my  sleep habits and I dont  sleep much but it is because of the pain..I turn and  OMG  instant pain in the hips and legs.. so thats mostly my problem other wise they would of  sent me for a sleep  test also. I have a friend that had to go for all the " lil " extra  tests  and she complained the  whole time  but the way I figure it if it is what I have to do  to get rid of this constant pain and the high cholesteral and high blood pressure then I will do whatever it takes.. they are  doing the extra tests for my  benefit so I have no problems later  on...it isnt  doing  anything for them...
I have found alot of  people  are not open minded about the  surgery so you  will need a very  supportive group of friends around you to  help you and also  having OH has  been a god send to me. I have met some great people from here that have given me thier knowledge so I am totally  prepared. Good luck to you and dont worry so much about the insurance..Most of the  surgeons  know how to work around  what they are looking for..
Good luck to you and  keep in touch.. any  questions  just ask ...we are all in the same boat.. I start my  support group  meetings  at Tobey next  week and then they say  anytime after that is my surgery.. so I figure end of  February or March for mine.

Keep up the  losing the more you lose now the faster the recovery I have  been told. plus makes liver smaller for them to  move it around   lol...
goalechica
on 1/1/09 8:39 am - Waldorf, MD
Thanks for the info Mary! I've noticed some people think the WLS is the "easy" way out. But I'm a pretty self aware person. I'm going to do what is best for me and I don't need to surround myself with negativity. Ya know?

All any of us can do is our best with what we have, for me that means taking advantage of this tool and making my health and therefore my life better.

I hope you've had a wonderful holiday. Make sure to keep in touch!

Starting Weight/ Surgery Weight
        255                   237                     

            
(deactivated member)
on 1/1/09 7:07 am
Hello!!!! Omg , finally someone else on BMC healthnet!! I am not on the masshealth portion (masshealth will not approve lapband, only RNY just an FYI for ya!), I have commonwealth care type 1 which means I still have copays for RX and stuff...
Anyway I am going to Dr. Hess too! He is awesome and ya know what? His nurse Tony is so comforting, kind, and caring... such a cute little guy. He really understands situations... Also you will work closely with Wendy who is the surgical dietician.. she really put me at ease this past Wednesday.


I was so excited to find you on here because the weight management center there is sooo busy yet I cant find anyone online who has had it there. It seems like they are all other places in MA.

I am having surgery in March and have gone through most of the process so contact me and we can chat!!! We should exchange AIM names or something... it  really helps to talk to someone going to the same surgeon!
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