Can't get the surgery if over 50+ BMI

gak
on 12/22/11 1:35 pm
Revision on 06/21/13
 You have to remember to that people have to check and see what state their insurance is underwritten in. Just because they live in a certain state it does not mean that is the same state where their policy is underwritten. This is why it is so important you personally get information directly from the insurance company and on the requirements and not reply on anyone else to get it right. 

Ginger<><  
 Revision #2 Dr John Rabkin June 21, 2013; First Revision DS - Dr Maguire
  5-18-09; First DS 7-15-2003 Dr Clark Warden = Third time is the charm   


 



 

ericklein
on 12/22/11 1:54 pm - Mission Viejo, CA
Thanks.
State where underwritten .... is that likely to be the same as {insurance name} {state}?
Ex: "Blue Cross of Texas"... if that is the name of the insurer, then could that be underwritten from multiple different states, with different consequences?
gak
on 12/22/11 2:00 pm, edited 12/22/11 2:17 pm
Revision on 06/21/13
 It is not always in conjuntion with the Name on t he Policy, but it will be stated in the policy somewhere. We have BCBS which is processed in MN, yet we live in AL. and this same policy has people in hubby's company nationwide and they cover the DS as long as the facts are their to what they have determined for this policy. It is ALWAYS best to get written of the exact wording, then go from there. 

There are many consequences and all based on how the wording of the policy is. I thought you would of know that ? 

Ginger<><  
 Revision #2 Dr John Rabkin June 21, 2013; First Revision DS - Dr Maguire
  5-18-09; First DS 7-15-2003 Dr Clark Warden = Third time is the charm   


 



 

ericklein
on 12/22/11 9:44 am - Mission Viejo, CA
On December 22, 2011 at 3:59 PM Pacific Time, S. durso wrote:
 Hi All , 
   I'm planning on getting WLS in April.  Although, I was reading through tricare ( my insurance)  rules and it says if your BMI is 50 + they won't do surgery.  Have any of you had the WLS using tricare insurance?  

One more thing... if you were interested...
On this topic of pre op weight loss..... it was generally merely a stalling tactic by insurance companies. A hoop to jump through. Yes, they would cover surgery, but only if you were in a medical weight loss program for 6 months...  Typically it is a duration hoop, regarless of outcome.... well, would have to 'fail' a medically supervised program -- which is a perverse requirement when you think about it.

Anyway, the informed medical community became so fed up with that that a position statement was issued (below) where they basically say "we're not going to take this any more" :

s3.amazonaws.com/publicASMBS/GuidelinesStatements/PositionSt atement/ASMBS%20Position%20Statement%20on%20Preoperative%20S upervised%20Weight%20Loss%20Requirements.pdf

Now, the wording of that statement is pretty strong. It seems to ignore the reality that a majority of weight loss surgeons happily encourage (if not require) some pre op weight loss.

Well, good news .... a few months after that position statement a few major carriers started removing that criteria. I don't know which ones.

So, some background on this.
As I ramble out loud, I wonder if the requirement to be below a certain BMI might actually be a type of substitution of the exact same barrier, for the same reason (delaying having to pay for surgery).  If so, that would make sense (as to why they would have it).

Question -- and excuse my ignorance -- are you _sure_ that 50 BMI is universal? or, is there a chance that it is customized to you. ?  Like, is there, say, a table saying that if your current BMI is 60, then they'll pay for surgery if your BMI goes down to 50. ?   If so, that would be the same as a weight loss requirement.

If NOT, then that's an interesting actuarial fiat on their end (merely having a universal flat rate).  So, if someone with a BMI of 89 has Tricare, is tricare really PREFERING to perpetually pay for the comorbidities associated with that?

Anyway, more than you asked for.  Part of a very old debate though.


Renee2007
on 12/22/11 3:15 pm - Central, FL
 Since the majority of the brain trust left OH over the last week, the quality of the advice here - including both insurance and medical information - has dropped significantly. Half-witted drunks posting about applying aspirin to prevent skin sag was bad enough, but now we have idjits talking out their asses about stuff that THEY DON'T KNOW WHAT THEY'RE TALKING ABOUT - like insurance issues. 

One person assures the OP that if their insurance company covers the RNY, they can be forced to cover the DS - BUT DOESN'T UNDERSTAND that Tricare is an exception to that rule, with ONE narrow exception that requires specific knowledge that resides - where? - why in those who have left. 

And then, the cherry on top is the OWNER of this site, who has decided for SOME reason to suddenly grace us with his presence, is dispensing WORTHLESS and INCORRECT advice - with the authority of being the owner of the site behind him - on issues about which he knows jack-**** - if the OP follows his advice, they may DIE before they ever get any kind of WLS, much less the DS.

I wonder when someone is going to DIE because the inmates are now running the asylum?

Renee
 My DS   
SW/263  CW/136 GW/150



Generic User_Name
on 12/22/11 7:35 pm
On December 22, 2011 at 11:15 PM Pacific Time, Renee2007 wrote:
 Since the majority of the brain trust left OH over the last week, the quality of the advice here - including both insurance and medical information - has dropped significantly. Half-witted drunks posting about applying aspirin to prevent skin sag was bad enough, but now we have idjits talking out their asses about stuff that THEY DON'T KNOW WHAT THEY'RE TALKING ABOUT - like insurance issues. 

One person assures the OP that if their insurance company covers the RNY, they can be forced to cover the DS - BUT DOESN'T UNDERSTAND that Tricare is an exception to that rule, with ONE narrow exception that requires specific knowledge that resides - where? - why in those who have left. 

And then, the cherry on top is the OWNER of this site, who has decided for SOME reason to suddenly grace us with his presence, is dispensing WORTHLESS and INCORRECT advice - with the authority of being the owner of the site behind him - on issues about which he knows jack-**** - if the OP follows his advice, they may DIE before they ever get any kind of WLS, much less the DS.

I wonder when someone is going to DIE because the inmates are now running the asylum?
 EXHALT!!!!!!! 



"Just Elizabeth "
on 12/22/11 10:43 pm - Houston, TX
On December 22, 2011 at 11:15 PM Pacific Time, Renee2007 wrote:
 Since the majority of the brain trust left OH over the last week, the quality of the advice here - including both insurance and medical information - has dropped significantly. Half-witted drunks posting about applying aspirin to prevent skin sag was bad enough, but now we have idjits talking out their asses about stuff that THEY DON'T KNOW WHAT THEY'RE TALKING ABOUT - like insurance issues. 

One person assures the OP that if their insurance company covers the RNY, they can be forced to cover the DS - BUT DOESN'T UNDERSTAND that Tricare is an exception to that rule, with ONE narrow exception that requires specific knowledge that resides - where? - why in those who have left. 

And then, the cherry on top is the OWNER of this site, who has decided for SOME reason to suddenly grace us with his presence, is dispensing WORTHLESS and INCORRECT advice - with the authority of being the owner of the site behind him - on issues about which he knows jack-**** - if the OP follows his advice, they may DIE before they ever get any kind of WLS, much less the DS.

I wonder when someone is going to DIE because the inmates are now running the asylum?
I will see Charles EXHALT and raise him a HUZZAH!!!!


Elizabeth                                                      
Back in the U.S.A.


"I have lost the lumbering hulk that I once was.  I don't hide behind my clothes or behind my door.  I am part of life's rich tapestry not an observer."  Kirmy

        
                                                                                    
 

(deactivated member)
on 12/22/11 11:33 pm
On December 22, 2011 at 11:15 PM Pacific Time, Renee2007 wrote:
 Since the majority of the brain trust left OH over the last week, the quality of the advice here - including both insurance and medical information - has dropped significantly. Half-witted drunks posting about applying aspirin to prevent skin sag was bad enough, but now we have idjits talking out their asses about stuff that THEY DON'T KNOW WHAT THEY'RE TALKING ABOUT - like insurance issues. 

One person assures the OP that if their insurance company covers the RNY, they can be forced to cover the DS - BUT DOESN'T UNDERSTAND that Tricare is an exception to that rule, with ONE narrow exception that requires specific knowledge that resides - where? - why in those who have left. 

And then, the cherry on top is the OWNER of this site, who has decided for SOME reason to suddenly grace us with his presence, is dispensing WORTHLESS and INCORRECT advice - with the authority of being the owner of the site behind him - on issues about which he knows jack-**** - if the OP follows his advice, they may DIE before they ever get any kind of WLS, much less the DS.

I wonder when someone is going to DIE because the inmates are now running the asylum?
Bam!
(deactivated member)
on 12/22/11 11:25 pm, edited 12/22/11 11:26 pm
 Oy.   Can't  ya'll  see that  posters are just trying to help ?  I find the information very useful and very informative .  

Of course ... I guess thats because I'm half -witted right lol .... 

Salicylic acid 2%  works wonders to increase  deep cell turnover and pull the skin in seamlessly , inexpensively and scarlessly . . I WON'T  offend you with a bkini picture  after  a 100 lbs weight loss and without plastics lol... but call me a drunk unfairly again i just MIGHT      

If someone would take the time to teach me how to use spell check in posts  ...  I bet U'd have nothing to  sneer at .   Unfortunately I type fast and  often abbreviate  in text speak ... 
Nic M
on 12/22/11 11:31 pm, edited 12/22/11 11:31 pm
You see that check mark with the "ABC" on it above the area where you post? That's spell check.

It's right next to the smiley icon.

 

 Avoid kemmerling, Green Bay, WI

 

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