Calling all PA DS patients, need advice!

tina_stamps
on 7/11/09 3:58 am - New Milford, PA

I know I should post this in the DS forum, but was looking for more state specific advice...

I am very seriously considering the DS instead of the RNY. However my insurance does not cover the DS. I know this is a common problem...

For those of you with the DS, what insurance did you have, and was it covered automatically or did you ahve to appeal? I am thinking about getting different insurance just for the surgery, and wanted some ideas of what companies cover the DS without a huge drawn out fight.

Thanks for any and all advice!

Public service announcement: You LOSE weight, you LOSE hair....
Your clothes become LOOSE... we spend all our LOOSE change on protein supplements...

Jackie W.
on 7/11/09 11:18 am

DS on 08/25/08

Hi Tina!! The insurance that I started with didn't cove WLS at all, so we jumped over to my husbands insurance (because it covered WLS). We have BCBS of Michigan PPO. Its awesome insurance!! They cover just about everything!! I know its only because his work has such a great plan with BCBS. But they covered all types of WLS. Once I discovered the DS, I pursued it until I found a Dr that accepted my insurance. I figured if they were going to pay for it, why not get it! I contemplated paying for it, when the Dr's I found didn't take BCBS. But then I found Dr Bonanni! My biggest problem......they wouldn't give a "pre approval" letter. All the insurance company kept saying is "its a covered procedure, as long as all the required criteria is met." My Dr's office kept getting the run around too. I called about 4-5 times myself! It was in the comments in there computer what I was told in the past conversations. Finally, the one guy says "you have a great plan. Pretty much everything is covered. There isn't much that you aren't covered for. You have been told this same thing by multiple different people. If there is a problem with getting coverage, you can say this is what you were told." I was sweating it all the way up until about 2 weeks before. Then I finally let it seem like a reality that I was really having my DS!! Needless to say, when I got the denial EOB 2 1/2 weeks AFTER surgery......I started crying!!!! Long story short, the hospital put the wrong procedure code in. The second denial was for the wrong diagnosis code. The third time was a charm!!! Paid in full!!

I've seen people work for Starbucks, because the insurance through them pays for the DS.

Good luck to you!! If you have any questions, give me a shout!!

There are never any problems, only solutions. quoted by a dear and special friend!!!

My stats:
Starting weight 234 lbs Height 5 ft 6 in
Goal in 7 months (127 lbs)
Currently: 120-123 lbs
Tops Small Bottoms size 2!!!! UPDATED: 11/11

tina_stamps
on 7/11/09 12:00 pm - New Milford, PA

RNY on 09/10/09

you're so lucky your hubby's insurance is so great! BCBS of Texas doesn't cover the DS at all, no matter what the employer allows for their benefits.

Really?? Starbucks?? There's one on every corner LOL! I'll have to check that out! Would hate to quit my current job for it, but I'd probably make more money as a barista (sp??) instead of a teacher's aide... How sad is that????

Public service announcement: You LOSE weight, you LOSE hair....
Your clothes become LOOSE... we spend all our LOOSE change on protein supplements...

Jackie W.
on 7/11/09 12:06 pm

DS on 08/25/08

That is sad, but probably true!! If I remember correctly, they provide insurance for part time employees...not sure how many hours it has to be. But the best you can do is check it out! I've seen people start there because of WLS and ins......turns out they really enjoyed working for the company!!

There are never any problems, only solutions. quoted by a dear and special friend!!!

My stats:
Starting weight 234 lbs Height 5 ft 6 in
Goal in 7 months (127 lbs)
Currently: 120-123 lbs
Tops Small Bottoms size 2!!!! UPDATED: 11/11

tina_stamps
on 7/11/09 12:32 pm - New Milford, PA

RNY on 09/10/09

I will definitely look into it! Thanks!

BTW, is Kunkletown the same as Kunkle? I drove through Kunkle on Friday....

Public service announcement: You LOSE weight, you LOSE hair....
Your clothes become LOOSE... we spend all our LOOSE change on protein supplements...

Calling all PA DS patients, need advice!

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Calling all PA DS patients, need advice!