Altius insurance appeals

Has anyone had any luck with an Altius appeal for surgery?  Or is it a lost cause to pursue this route?  What is the estimated cost of the band surgery, bypass? can someone tell me?

I know when I had Altius they had an exclusionary policy. From what I was told they have never approved anyone? I had open RNY back in 2003 and it was about $18,000. Hope that helps a little.

Thanks for the info. It seems there is a no surgery policy.  It sucks.  Do you think it was worth it?

I have Altius Federal High Option (covers more than the standard Altius policy/but lower copays and deductible) HMO.  I was denied on my first request, but approved after the second request (and after having sleep studies, upper/lower GI scopes, 6 month primary doctor monitored diet, losing 5% of my body weight, psychological eval, dietician eval, and whatever other requirements they gave me).  My approval was based on moderate sleep apnea, hyperinsulinism, degenerative arthritis, and possibly my fibromyalgia. 

It takes time and effort to get an approval through any insurance.  Don't give up.  It may take some work to qualify and get approval, but it will take your dedication and work after surgery too.  :)  You didn't put on all your weight overnight, so allow yourself the time that it will take to get insurance approval (or to change insurance companies). 

Oh, Altius also required that I work through a Weight Loss Center of Excellence. I did my homework and found Dr. Daniel Cottam at the Salt Lake Regional Weight Loss Center of Excellence.  He is the doctor everyone goes to when they need to fix what other doctors have screwed up.  He has a wonderful reputation and fabulous numbers (low complication rates, etc.).  He is a pretty quiet guy, but his success rates were great.

Cash pay for the band is about $18,000 for the surgery, plus $150 per band fill/adjustment.  Gastric bypass (RNY) is about $20,000. 

My costs for RNY, after insurance will be:  
--$500 program fee for the psychologist, 1 year followup meetings, dietician, and exercise physiologist
--$100 for the in-patient surgery (2 days with RNY)
--10% of the surgeons fess (2 surgeons), about $1,200
--10% of the anestesiologist
--10% of the radiologist and any in hospital tests (like the fluid test/x-ray done to check your pouch seal)
Total after insurance is expected to be about $2,000 to $2,200.

Best wishes to you and make sure to check out the insurance sections of this site.  Take care and feel free to email me if I can be of any more help. 

Altius does require alot of pre op work.  I had a friend that worked for them.  It depends on your policy.  I changed insurance.  Good Luck!

I had no problems at all getting approved through Altius High Option.  I did everything Altius required before surgery and then some.  One extra thing I did was I had every Dr I saw FOR ANY REASON write a letter in support of my weight loss surgery.  In the end I had about 11 Dr letters in my file at Dr Cottam's office.  Once I had lost the 5% of weight that was required before surgery, Dr Cottams office faxed off all my medical papers to Altius.  I was approved, sceduled and in surgery in about 3 weeks.

(I had worked on getting all my criteria met over the 2 prior years that I was entertaining the possibility of having WLS)

Good Luck

Sandi

Did either of you that had Altius through ATK and did you have the clause in your policy that says no weight loss surgery?
Thanks

Thanks for the info.  I was wondering this as well.  I have the Altius Federal (high option) and was told that they won't cover the sleeve procedure.  I called Altius myself and gave them the surgery code and at first said it wasn't covered, but the lady dug a little deeper into my plan and said that it was covered, but that it had provisions (follow the Dr. assisted 6 month diet, lose 15% of your body weight, have all paperwork into them, etc.).  

So now I'm just waiting the results from my sleep study... this is the one time that I hope a test comes back positive!  LOL!