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Topic: Aetna diet
My agent told me Aetna does not require a diet in order to be qualified for surgery. Does anyone know if this is true?
Topic: Insurance wording
I have BCBS of TX PPO I have been reading my Benefits book and it has this listed for wieght loss:
Any servicesAny services or supplies provided for reduction of obesity or weight, including surgical
procedures,
even if the Participant has other health conditions which might be helped by a reduction of obesity or
weight. or supplies provided for reduction of obesity or weight, including surgical procedures,
even if the Participant has other health conditions which might be helped by a reduction of obesity or
weight.
But it also states exculsions:
Any services or supplies which are not Medically Necessary and essential to the diagnosis or direct care
and treatment of a sickness, injury, condition, disease, or bodily malfunction
If the DR states this medically necesasry do you think it may cover weight loss surgery.
Any comments welcomed.
Thanks
Any servicesAny services or supplies provided for reduction of obesity or weight, including surgical
procedures,
even if the Participant has other health conditions which might be helped by a reduction of obesity or
weight. or supplies provided for reduction of obesity or weight, including surgical procedures,
even if the Participant has other health conditions which might be helped by a reduction of obesity or
weight.
But it also states exculsions:
Any services or supplies which are not Medically Necessary and essential to the diagnosis or direct care
and treatment of a sickness, injury, condition, disease, or bodily malfunction
If the DR states this medically necesasry do you think it may cover weight loss surgery.
Any comments welcomed.
Thanks
Topic: RE: Question on 3 month option with aetna
Ok well then I am heading in the right direction. I joined a gym and the trainer there agreed to document my progress. Thank you that helped clear my confusion. How long did it take for yr approval?
Mrs. Glow 
Topic: Medicaid
Hey I'm a newbie. I haven't had a procedure done yet. My question is....I have been approved for Medicaid now what do I do. Please help. Thanks in advance.
Topic: RE: Question on 3 month option with aetna
Aetna just approved me after the 3-month regimen. I enrolled in an all-inclusive program where I met with a nurse, doctor, and dietician weekly. I just had to keep track of my physical activity - no one had to sign me in, watch me exercise, or anything else like that. I just tried to burn 2,000 calories a week. I was most nervous about the exercise portion of the regimen, however.
I have heard of people fulfilling this requirement by going to the gym and asking the front-desk people to sign that they were there. Alternatively, you can keep a log of exactly what you do, daily, and then talk to your doctor and nutritionist about it at each visit.
Good luck. That was the most nerve-wracking part about this whole thing.
I have heard of people fulfilling this requirement by going to the gym and asking the front-desk people to sign that they were there. Alternatively, you can keep a log of exactly what you do, daily, and then talk to your doctor and nutritionist about it at each visit.
Good luck. That was the most nerve-wracking part about this whole thing.
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)
Topic: Question on 3 month option with aetna
I choose the three month option. I had my first appointment with the Doctor, I go see the nutritionist tomorrow. My question is: What is an excercise therapist. What or my options for this requirement? I looked unto getting a personal trainer, but that is to expensive. What did you guys do to meet that requirement?
Mrs. Glow
Topic: RE: BCBS of ND. Frustrated!
Your thinking sounds right to me. Have you called your insurance company to specifically ask them why you have a bill for $900? Have you called the hospital? I would ask them those questions. Insurance is so crazy and confusing. It is quite possible something was charged as being out-of-network, or there was a coding error somewhere.
Good luck!
Good luck!
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)
Topic: BCBS of ND. Frustrated!
Ok, I have never had so many problems understanding an insurance companies break down of pay in my life. In FL with United Health it was clear cut and understood and no problems. I thought I had a handle on how BCBS did things but now I sit here looking at my hospital bill and it is a few hundred higher than I expected and what the hospital told me should be my final bill after calling insurance before surgery. If someone can help me out in understanding where my thinking is wrong I would greatly appreciate it.
My Maximum out of pocket according to the insurance company between Insurance and Co-Insurance is $1250.00.
My Insurance Deductable is $250.00/per family member (this only had 23.00 left to meet it when I paid my surgeons fee, then the co-insurance kicked in and I had to pay 10% of whatever the $3000 fee that was left which was $300.00 which I was told would go towards my co-insurance deductable and it did)
My Co-insurance deductable is $1,000.00/per family member (or no more than $2000.00 for the whole family). So the surgeons fee that I paid the rest of is supposed to go towards the thousand, now making the deductable I have left to cover before I have met my maximum out of pocket $700.00)
Now in this time between scheduling my surgery and having my surgery I have also been to my GP and had the battery of tests that my surgeon required before hand done, which I have recieved and paid bills for and in benefit explination notices from BCBS was told some of this also went towards my deductable making it even less to finish having to pay (totals about $75.00 more paid towardds co-insurance deductable.)
Now this is where I get confused on the situation. I bill from the hospital was $900.00, don't get me wrong I know that compared to what others have had to pay or are paying that this is great, however it is not what I expected nor what I was told to expect. According to what I was lead to believe is that once co-insurance kicks in I am required to pay 10% of my bills UNTIL I HAVE MET MY MAXIMUM OUT OF POCKET, which even though my math isn't fantastic (I am just doing the co-insurance here because reg. insurance deductable has been met) $1,000.00 - 300.00 - 75.00 = $625.00 of a deductable left to pay, so even though my 10% of my hospital stay is $900.00, shouldn't I only have to pay the $625.00 left to cover my deductable which would then have met my max out of pocket making everything else covered 100%? And on top of it I was just told by insurance that yes max out of pocket was met on both ends of insurance and co-insurance the dates of surgery and days of stay but my er visit 7 days later for what they thought was a blood clot is going to cost me $117.00.
So if someone can please explain where my thinking is wrong I would greatly appreciate it.
My Maximum out of pocket according to the insurance company between Insurance and Co-Insurance is $1250.00.
My Insurance Deductable is $250.00/per family member (this only had 23.00 left to meet it when I paid my surgeons fee, then the co-insurance kicked in and I had to pay 10% of whatever the $3000 fee that was left which was $300.00 which I was told would go towards my co-insurance deductable and it did)
My Co-insurance deductable is $1,000.00/per family member (or no more than $2000.00 for the whole family). So the surgeons fee that I paid the rest of is supposed to go towards the thousand, now making the deductable I have left to cover before I have met my maximum out of pocket $700.00)
Now in this time between scheduling my surgery and having my surgery I have also been to my GP and had the battery of tests that my surgeon required before hand done, which I have recieved and paid bills for and in benefit explination notices from BCBS was told some of this also went towards my deductable making it even less to finish having to pay (totals about $75.00 more paid towardds co-insurance deductable.)
Now this is where I get confused on the situation. I bill from the hospital was $900.00, don't get me wrong I know that compared to what others have had to pay or are paying that this is great, however it is not what I expected nor what I was told to expect. According to what I was lead to believe is that once co-insurance kicks in I am required to pay 10% of my bills UNTIL I HAVE MET MY MAXIMUM OUT OF POCKET, which even though my math isn't fantastic (I am just doing the co-insurance here because reg. insurance deductable has been met) $1,000.00 - 300.00 - 75.00 = $625.00 of a deductable left to pay, so even though my 10% of my hospital stay is $900.00, shouldn't I only have to pay the $625.00 left to cover my deductable which would then have met my max out of pocket making everything else covered 100%? And on top of it I was just told by insurance that yes max out of pocket was met on both ends of insurance and co-insurance the dates of surgery and days of stay but my er visit 7 days later for what they thought was a blood clot is going to cost me $117.00.
So if someone can please explain where my thinking is wrong I would greatly appreciate it.
Topic: Oxford United Health Care: 6 month documented diet?
Im in the process of doing all the requirements needed to have the duodenal switch surgery and I cant get a stright answer on the requiremetns for insurance to cover my procedure.
Here is the current PDF:
https://www.oxhp.com/secure/policy/bariatric_surgery.pdf
I have a BMI of 58 and Sleep Apnea, GERD, and a hatal hernia... when i call oxford twice asking about it and I am told that I do not need to do the 6 month documented medicly reviews diet(seems like just phone support reading off the same paper i linked) .... but from what I read around and what the surgons office has told me that its allmost allways required...
The document reads:
1 . Class III obesity (BMI > 40 kg/m2); OR
2. Class II obesity (BMI 35-39.9 kg/m2) in the presence of one or more of the following comorbidities...; AND
3. (part about 6 month diet)
Since my BMI is over 40 does that mean I am excluded from the 3rd part? Thats what the epresenatives have told me... and by boolian logic (TRUE or FALSE and FALSE) = TRUE....
I am hoping someone who has had oxford and a high BMI could tell if they had to get the 6 month documentation...
Here is the current PDF:
https://www.oxhp.com/secure/policy/bariatric_surgery.pdf
I have a BMI of 58 and Sleep Apnea, GERD, and a hatal hernia... when i call oxford twice asking about it and I am told that I do not need to do the 6 month documented medicly reviews diet(seems like just phone support reading off the same paper i linked) .... but from what I read around and what the surgons office has told me that its allmost allways required...
The document reads:
1 . Class III obesity (BMI > 40 kg/m2); OR
2. Class II obesity (BMI 35-39.9 kg/m2) in the presence of one or more of the following comorbidities...; AND
3. (part about 6 month diet)
Since my BMI is over 40 does that mean I am excluded from the 3rd part? Thats what the epresenatives have told me... and by boolian logic (TRUE or FALSE and FALSE) = TRUE....
I am hoping someone who has had oxford and a high BMI could tell if they had to get the 6 month documentation...
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