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Topic: RE: Medicare payment issues
UPDATE..... I hate to be the bearer of bad news blueaprildew buts it looks like that is the new change. I made numerous phone calls to get to the bottom of the issue and learn it's a SC addition to the requirements for surgery. Due to the fact that so many of this type of surgery is being performed they are now reviewing most all cases and have said they are not seeing enough evidence of past attempts. So they sent out letters in Jan. saying other insurance companies have this guideline as 6-12 mths of previous supervised attempts and they feel that is a fair and appropriate standard. It also has to be within the last 18 mths to qualify. That's where I ran into a prob. because mine was outside that time frame. I started my 6mths last week with my family phys. and am now looking at late Sept. maybe Oct. according to scheduling. Medicare has no preapproval so Dr. Rowitz office has to make sure all guidelines are met or they can refuse the claim. I was heartbroken as my surgery date was April 26 but I am continuing forward and it's still gonna happen at least!!!
Topic: RE: Don't know what to do!
Sorry, I'm not really able to give you any help. However, maybe if you went to school your Mother's insurance would carry you again?
Our sons were covered by our insurance longer because they were in school. Look into community colleges in your area. See if you can get a grant.
It'll kill two birds with one stone... you'll get training in a field where you may be able to get a job and your mom can cover you again.
Good luck!!
Our sons were covered by our insurance longer because they were in school. Look into community colleges in your area. See if you can get a grant.
It'll kill two birds with one stone... you'll get training in a field where you may be able to get a job and your mom can cover you again.
Good luck!!
Topic: Moving to SC - questions (have Tricare Prime ins)
Hi everyone.
Have a question I'm hoping someone here can help with.
We are in the process of moving to Lugoff, SC. Currently we live in MS.
My PCM referred me for wls, the referral center sent it to Tricare to approve and it was approved. Yay! However, this was prior to me knowing that we would be moving. Not so much yay anymore. I was so very excited and was referred to a wonderful doctor in LA who is very advanced in this surgery.
After talking with them though we realized that I really can't schedule my surgery there as it would be done right before I moved.
So, I called Tricare to see if they would give me a referral to a surgeon in the Columbia area. I was then told that I would have to wait and be referred through my new PCM in SC. grrrrr
I'm worried because I don't know if I will find a PCM that will even request a referral. Also worried about being approved again. I realize that it's the same insurance company but it's a different division.
Then if all that goes well... I'm worried about where is the best place to go. Don't know if I'll get choices, but if I do - how do I choose? I don't know a soul in SC.
Can you tell me if you have had the surgery there and who you would recommend?
Also, if anyone is with Tricare, can you tell me how the experience went for you?
Thanks!
Toni
Have a question I'm hoping someone here can help with.
We are in the process of moving to Lugoff, SC. Currently we live in MS.
My PCM referred me for wls, the referral center sent it to Tricare to approve and it was approved. Yay! However, this was prior to me knowing that we would be moving. Not so much yay anymore. I was so very excited and was referred to a wonderful doctor in LA who is very advanced in this surgery.
After talking with them though we realized that I really can't schedule my surgery there as it would be done right before I moved.
So, I called Tricare to see if they would give me a referral to a surgeon in the Columbia area. I was then told that I would have to wait and be referred through my new PCM in SC. grrrrr
I'm worried because I don't know if I will find a PCM that will even request a referral. Also worried about being approved again. I realize that it's the same insurance company but it's a different division.
Then if all that goes well... I'm worried about where is the best place to go. Don't know if I'll get choices, but if I do - how do I choose? I don't know a soul in SC.
Can you tell me if you have had the surgery there and who you would recommend?
Also, if anyone is with Tricare, can you tell me how the experience went for you?
Thanks!
Toni
Topic: RE: Insurance Recomandations.
Hello:
FOR ANYONE THAT VIEWS THIS POST AND HAS THE SAME QUESTION, THERE IS LINK HERE FOR MEMEBERS AT http://www.obesityhelp.com/morbidobesity/members/insurers.ph p
IT LIST POST BY MEMBERS ABOUT THEIR EXPERINCES WHETHER ACCEPTED OR DENIED BY INSURANCE COMPANY, ALPHAPHETICALLY.
FOR ANYONE THAT VIEWS THIS POST AND HAS THE SAME QUESTION, THERE IS LINK HERE FOR MEMEBERS AT http://www.obesityhelp.com/morbidobesity/members/insurers.ph p
IT LIST POST BY MEMBERS ABOUT THEIR EXPERINCES WHETHER ACCEPTED OR DENIED BY INSURANCE COMPANY, ALPHAPHETICALLY.
Topic: RE: Medicare payment issues
Please get back to me ASAP because now I am concerned I went to Dr Rowitz yesterday and they were telling me all along that I could have my surgery as soon as April and then they called and told me that they had to change it because I had to have 6 months of dieting history also. Whats going on?
Topic: RE: MEDICAID AND MEDICARE SURGEONS LIST!
i used the list of surgens on here and called every single one, however my daughter was banded in mexico when she was 13 and is now 17 and am having a hard time finding someone to take her here in the states due to age and the fact she went to mexico....UGGH now she has a slip AGAIN (#2) and maybe someone will budge now!!!
Topic: RE: CAROLINA Lap-Banders
I'm in......let me know what you come up with!
Highest-212 Surg Weight -206.4 Current- 169 Surgeons Goal-150 Goal- 125
Pre-baby weight 148 Delivery weight 177 Current weight 169
Topic: SC blue Cross
SC BCBS state plan does not cover any weight loss surgery. Does any one have an idea how I can get help in paying for surgery?
Thanks,
Cathy
Thanks,
Cathy
Topic: Medicare payment issues
I have a surgery date for 4/26/10 with Dr. Rowitz and only like my psch. eval. to be completely ready. Then the Dr. office calls out of the blue and says Medicare has changed and now I have to have 6mths of supervised dieting in the last 18 mths; can I get this info to them asap. I called Medicare and they say they only require a past history of failed diet attempts with no specific time frame mentioned. Although my other Drs. have counseled me on my weight and I've done the prescribed med to lose weight. Has anyone filed and had Medicare pay recently? Has anyone else come against an issue like this?
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Surgeon recommendation near Rock Hill SC that accepts First Choice medicaid
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