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noftessa0401
on 12/6/12 6:44 am - San Diego, CA
RNY on 12/27/12
Topic: RE: Keep Getting Denials for Insurance

But that is what I am asking - what is your BMI (or height and weight)?  If it is over 40, then it probably is covered by insurance, even though there may be steps you need to take to ensure you qualify (a 6-month doctor supervised diet, exercise regimen, etc.)  If it is between 35-40, it might be high enough if you have 2 comorbidities (whatever BCBS says are comorbidities). 

I would go for a consult and see what a WLS clinic has to say.  They are the ones that might know how to submit to your insurance correctly.  It all comes down to what your physical insurance policy says.  I have never had to deal with my insurance company - my surgeon did it all for me.

HW: 274 | SW: 232 | CW: 137 | Goal: 145 (ticker includes a 42 pound loss pre-op) | Height: 5'4"

M1: -24 (205) | M2: -14 (191) | M3: -11 (180) | M4: -7 (173) | M5: -7 (166) | M6: -8 (158) | M7: -11 (147) | M8: -2 (145) | M9: -3 (142) | M10: -2 (140) | M11: -4 (136) | M12: -2 (134) | M13: -0 (134) | M14: -3 (131) | M15: +4 (135) | M16: +2 (137)

SickofBeingThisWay
on 12/6/12 6:40 am - Dallas, TX
Topic: RE: Keep Getting Denials for Insurance

I haven't had a consult yet...I do have high blood pressure and my PCP thinks I may be a diabetic. It wouldn't be any use of submitting if I keep getting denials to have any insurance. Blue Cross Blue Shield will deny you insurance based on your height and weight, and there are other companies who will do the same. Self Pay is basically taking out a loan and paying back on it. My credit isn't decent enough for me to take out any more loans.

deedee1969
on 12/6/12 5:31 am - Milton, FL
Topic: Cigna insurance

Does anyone know how good Cigna PPO insurance is and also how hard is it to get approved for surgery with them? Did they require anything crazy?

noftessa0401
on 12/6/12 2:39 am - San Diego, CA
RNY on 12/27/12
Topic: RE: BCBS of Alabama

Congratulations!  It is exciting, isn't it?  :)

HW: 274 | SW: 232 | CW: 137 | Goal: 145 (ticker includes a 42 pound loss pre-op) | Height: 5'4"

M1: -24 (205) | M2: -14 (191) | M3: -11 (180) | M4: -7 (173) | M5: -7 (166) | M6: -8 (158) | M7: -11 (147) | M8: -2 (145) | M9: -3 (142) | M10: -2 (140) | M11: -4 (136) | M12: -2 (134) | M13: -0 (134) | M14: -3 (131) | M15: +4 (135) | M16: +2 (137)

noftessa0401
on 12/6/12 2:39 am - San Diego, CA
RNY on 12/27/12
Topic: RE: revision

Sorry no one has answered you yet.  It really depends on your insurance.  Did they pay for the first one?  Some policies exclude any and all WLS, and some are a once-per-lifetime type of policy.  Some cover revisions if medically necessary.  And it will depend on the reason for the revision - you might have to show that the revision is needed NOT due to your failure to follow post-surgery instructions.

HW: 274 | SW: 232 | CW: 137 | Goal: 145 (ticker includes a 42 pound loss pre-op) | Height: 5'4"

M1: -24 (205) | M2: -14 (191) | M3: -11 (180) | M4: -7 (173) | M5: -7 (166) | M6: -8 (158) | M7: -11 (147) | M8: -2 (145) | M9: -3 (142) | M10: -2 (140) | M11: -4 (136) | M12: -2 (134) | M13: -0 (134) | M14: -3 (131) | M15: +4 (135) | M16: +2 (137)

noftessa0401
on 12/6/12 2:36 am - San Diego, CA
RNY on 12/27/12
Topic: RE: Keep Getting Denials for Insurance

Meaning that your BMI is not high enough?  Can I ask what it is?  Do you have co-morbidities?   Have you submitted for pre-approval, or has your surgeon's office submitted?  Have you had a consult with a surgeon yet? 

HW: 274 | SW: 232 | CW: 137 | Goal: 145 (ticker includes a 42 pound loss pre-op) | Height: 5'4"

M1: -24 (205) | M2: -14 (191) | M3: -11 (180) | M4: -7 (173) | M5: -7 (166) | M6: -8 (158) | M7: -11 (147) | M8: -2 (145) | M9: -3 (142) | M10: -2 (140) | M11: -4 (136) | M12: -2 (134) | M13: -0 (134) | M14: -3 (131) | M15: +4 (135) | M16: +2 (137)

RNfatty
on 12/3/12 12:04 pm
Topic: RE: best insurance company

I own my own small business and have been told by my insurance agent that none of the individual or small business plans will cover it. I'm not willing to give up that easily. I know that BC/BS of LA will not cover ANYTHING related to obesity (as I see patients and have been denied payment if I write obesity on the bill). But I also have patients with UHC, Aetna, Humana, to name a few who have been able to get bariatric surgery.  So keep looking and keep asking, I know I will.

SickofBeingThisWay
on 12/3/12 10:16 am - Dallas, TX
Topic: Keep Getting Denials for Insurance

Hi everyone. I am new to ObesityHelp. I have been denied insurance over and over and over again because of my weight and height. It is IMPOSSIBLE to pay for WLS out of my pocket, and now i'm at the point of not knowing what to do or just giving up? Have anyone ever felt this way or ever had this happened to them? cool

 

 

Signed

 

Angry and Upset Obese Diva

ChelseyKay
on 12/3/12 6:30 am - NE
Topic: best insurance company

Im looking VERY hard for an insurance company that I can get as an individual, not through my employer, to cover the DS. I am eager, but frustrated with this process, as im NOT winning....anybody have any imput or experiences? PLEASE?!?!

serenity1959
on 12/3/12 4:33 am
VSG on 08/05/13
Topic: RE: Insurance won't cover so I need $25,000

Is that a Bariatric Center of Excellence?

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