Proper Introduction
I thought I would give a proper introduction---
Hi!! I am Amie from Burlington, NC. I am 42yo working mom to 4 wonderful kids and have been married for 14 years.
I am researching my options and where to go from here. If anyone has any suggestions on doctors in the area, I am half way between Durham and Greensboro.
Also, I called my primary insurance yesterday, Wellpath, and told that bariatric surgery is not covered. So, I am going to call my secondary coverage, BCBS Anthem of VA, next week. So any insurance advice would also be appreciated.
I look forward to getting to know each of you and offering my support!!
Amie
Hi Amie,
Welcome to the NC forum of OH. I look forward to getting to know you. Check with your primary insurance to see if there is a 'specific exclusion' for bariatric surgery. Next, check with your secondary and see if they have any verbage that deals with coverage when the primary declines coverage because of a specific exclusion. The secondary will most likely require that you file with your primary and have them decline coverage. When they decline, generally, it will cite the specific exclusion. If they deny for another reason that could cause the secondary to decline as well, but when it is because of a specific exclusion, then it usually rolls over to the secondary and the secondary picks up and pays the claim as if they were the primary. You will want to see if they cover, which procedures they cover or exclude and what the guidelines are ... i.e., RNY, Lap okay w/bmi over 40 no comorbidities, over 35 w/one more comorbidity, DS w/bmi over 50 ... etc... Check and see if they require a Center of Excellence (COE) and if it can be any ASBS COE or if it needs to also be a BCBS Anthem of VA COE, or if it can be any BCBS COE... THis will help as you look for providers.
Wishing you all the best in your quest for a healthier you,
Barbara
ObesityHelp Coach and Support Group Leader
http://www.obesityhelp.com/group/bcumbo_group/
High-264, Current-148, Goal-145
I had my surgery through UNC in Chapel Hill I also have bcbs of NC and they have been great covering the cost of my RNY.
I could talk your ears off about how pleased I have been with the bariatric team at UNC.
If you would like a number to contact them and or email PM and I will be happy to send it to you.
Annie
My name is Donna and I had my surgery done at Wake Forest Baptist in Winston-Salem.
Dr. Fernandez was my surgeon and he and his team are awesome. Baptist is considered a Center of Excellence by BCBS I believe and from what I hear, that makes approval almost guaranteed by them. I may not have that 100% correct and if not, I'm sure someone will correct me on that!
I have moved up to Virginia since my surgery (I lived in the High Point/Thomasville area) but I still consider the NC board my home and these ladies and gents here are very knowledgeable and kind. So ask lots of questions and gather all the advice you can from them ~ they are the best! Good luck with your journey!
Life is short ~ dance like no one's watching!!
305/292/167/159
High/Surg/Curr/Goal
Welcome to the NC board!!!!! I had the best doctor in the world Dr MacDonald, but he's in Greenville so he's a bit too far for you. I know we all think our doctor's are the best. Anyway, welcome again and I'm sure you will find us all very supportive and full of advise! Congratulations on beginning your Weight Loss Adventure! It's a wild ride!!!!
I hope you have a great holiday season!!!!
08/22/2002 (WLS date)
425/177/238/160 (high/low/current/goal)
"Don't count the moments but make the moments count!!"
