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Recent Posts

Kristiemarie060504
on 9/10/12 2:17 pm - MD
Topic: Uhc revision questions
Hi everyone my question is the following .... I am almost at the end of all my testing I need done to try to have my lapband removed and get the sleeve . I have united health I was just looking for people who have been in my shoes and what they went threw with the whole insurance process
Trish06
on 9/8/12 5:01 pm
DS on 12/06/12
Topic: RE: Need to qualify!
 Hi,
I know most insurance companies won't consider you for WLS unless you have 35 to 39 bmi with comorbidies or 40+ bmi with no comorbidies. You should be able to call your insurance company and they can tell you exactly what your policy is. 

Good luck,
Trish
Member Services
on 9/8/12 1:46 pm - Irvine, CA
Topic: Meet Our Speakers: Colleen M. Cook

Meet Our Speakers: Colleen M. Cook

 

Hope & Help for the Pain of Regain

Join 17 year WLS veteran Colleen M. Cook for both a shot in the arm and a kick in the seat as she shares lessons from long-term losers and imparts insight, inspiration, and hope for WLS patients struggling with extended plateaus or weight regain. Her thoughts, stories, and personal experiences will inspire and motivate you to reach and maintain your optimum weight loss.

Also, don't miss her Keynote on Friday: Nothing Succeeds Like Success

We hope to see you in Atlanta, GA October 5th and 6th! Click here to book your ticket today!

Fast Facts About Colleen

-Colleen is the author of The Success Habits of Weight Loss Surgery Patients.
- She is the president or Bariatric Support Centers International, a company that specializes in providing education and support services for weight loss surgery patients and the professionals who serve them.
- Colleen currently serves on the National Advisory board for the Walk From Obesity.
-Known as Ms. Enthusiasm, Colleen helps men and women from all walks of life recognize their extraordinary potential and then inspires then to aspire.

groovykg
on 9/7/12 7:59 pm - VA
RNY on 02/27/13
Topic: Need to qualify!
Can anyone advise on the order of the steps I should take to get approval for RNY?

I have a current BMI of 37 with no comorbidiies.  I am not a candidate for lap band because of esophageal problems.  I actually have Barrett's Esophagus, which is life threatening and considered to be precancerous, but the surgeons I saw previously didn't seem to think that would be a comorbidity.

In May and June of this year, I talked to my PCP and consulted with one group of surgeons, and then we were traveling for the summer.  In the spring, I had a sleep apnea test, which  was normal, bloodwork, which was mostly normal, just borderline cholesterol.

My insurance (Carefirst in VA) actually has some weight charts from MetLife that show a range of weights and the policy online states if more than 100 lbs above weight range.  So the medium build range has a high weight of 147, meaning that if I were 247 I would qualify, right?  No one has ever declared me small, medium, or large, but whatever.  247 is a bmi of like 38.  So then I'm there?

Anyhow, I don't know if I should pursue this at current weight, or just forget about this for now and revisit if I develop comorbids or gain 20 lbs?   I have an appt with PCP next wed to begin medically supervised diet just in case, but again, I don't really qualify (I *think*) at this weight.  If a surgeon would fight for me, it might happen, but I wanted to get the ball rolling on this.

I would consult with another surgeon, and don't think I could get an appt until October. In the meantime, I don't know what I should do about my weight/eating.  When I'm restrained, I hang out in the 230s.  If I don't give a darn, I can easily go up to the 240s and hit the 247 I'm seeing in my insurance info (although I have NEVER read anyone being approved from a chart and not BMI).

Sorry for the rambling, but I guess my question is this: What would you do at this point?  

-Proceed at current BMI and do supervised diet?  
-Forget this all for awhile and do what I need to do to get up to a higher weight before I begin supervised diet?
-See surgeon first at current weight before beginning diet?
-See surgeon at higher weight before beginning diet?

If my PCP documents a higher weight and I am able to lose some on supervised diet, hence knocking me out of qualifying range, is this a problem?  Do I need SURGEON to document highest weight or PCP to do so?




nicolejohansen
on 9/5/12 6:53 pm
Topic: One surgery, per lifetime HELP!
Would like your guidance…will try to make this long story short, but want to give you some background info. In 2010 I had Lapband surgery lost 90 lbs and committed to a healthy lifestyle. In 2011, I had the surgery reversed because of the procedure failing and causing major medical issues due to erosion. I am trying to have my surgery to fix the procedure, but they can’t do the same procedure because of the same complications so they want to use the gastric sleeve.

The request to the insurance company and my benefits department at my actual company were denied as were my two appeal due to “One surgery per person per lifetime". They said I've exhausted my two appeals and the corporate benefits people keep referering back to United Healthcare's one surgery per person per lifetime.

I'm at a loss here trying to get them to understand that this is a very different situation, and while I understand the need for the policy due to people trying to use multiple surgeries as a “quick fix", this really an exception to the rule…I’m not trying to have a second procedure, I’m trying to correct the one surgery (procedure) that failed. Had my “one" procedure not failed me, I would still have it and still be doing incredibly exceptional. I'm also at a loss as to who I should be fighting this with....

Just wanted to get your thoughts on who I should appeal to or what help is out there? I can't afford a lawyer and with my company telling me there isn't anything else I can do, I'm not sure where to go
montana28
on 9/5/12 6:42 pm - FL
Topic: RE: BCBS FL State changed policy!!!!!
Thanks Walter. I just found out thru a mutual friend. My Dr. office heard it from a drug rep. Guess BCBS doesn't want to get flooded with requests just yet. The timing didn't make any difference, my Dr was out of town last week and I've been out of town for the last month. Dr. office submitted forms today and BCBS returns denial/acceptance w/in 72 hrs, so it's all good.
Jules
Jules
Jodi_wantstoliveagain
65

on 9/5/12 1:45 pm - Onancock, VA
Topic: Insurance
Post Date: 9/5/12 1:38 pm
Hi All! My name is Jodi I am morbidly obese and have a letter stating surgery is life threatening and is a medical nessesity. I have Anthem HealthKeepers With NO Rider/ Exclusion. It states
OBESITY: Services and supplies related to weight loss of dietary control, including complications that directly result from such surgeries and / or procedures. This includes weight loss reduction therapies / activities, even if there is a related medical problem.  Notwithstanding provisions of other exclusions involving cosmedic surgery to the contrary, services tendered to improve appearence (such as abdominoplasties, panniculectomies, and lipectomies), are not covered services even though the services may be required to correct deformity after a previous therapeutic process involving Gastric Bypass Surgery.

I have sleep apnea
High Blood pressure
Stents in my heart
uncontrolabl diabetes
edema
depression
p.a.d
Sciatica
dyspnea
very high cholestrol
BMI is 51
and a few more issues


My question is does anyone understand this policy and can i get my insurance comp. to pay for my surgery? PLEASE help me. I want to live... Thank you so much in advance
12Rowrena
on 9/5/12 5:36 am - Reinbeck, IA
Topic: RE: Anyone from Iowa with UnitedHealthCare and fighting
I am telling you now that they told me the same thing but as I talking with  Dr. Glas****'s Insurance ClerK, Kim, she can tell you how to get around it and have your surgery closer to home where it should be done.  I had my surgery at Satori with Dr. Glas**** and she got it approved.  So if you are still interested in having somewhere closer to your home it can be done.  Call Dr. Glas****'s office and ask for Kim and she will explain to you what needs to be done to get you approved to have it done somewhere that is not a provider.  I don't know what type of surgery you are wanting but you can go to their page and take a look at what they do http://www.wheatoniowa.org/programs-services/weight-loss-sur gery/about/default.aspx

I had a more involved surgery as I had a previous VBG done in 1999 so I had a revision from a VBG to an RNY and I had many medical problems and my surgery was tough and lasted close to 5 hours give or take a fewe minutes from what I am told.  I was in the hospital 10 days and back to the ER twice with another admision for acute renal failure which means I got very dehydrated because my feeding tube plugged up for the second time.  I hope you all the luck in the world but if I had to do it over again I woldn't have changed a thing.  I still have my feeding tube in till 9-11-12, at my next appointment and then I will be worried about getting in the liquid and protein after that.  I have found a couple items I should never have eaten and will never eat again.  I have different forms of the dumping symdrome depending on what I've done wrong and I'm learned fast as it is no fun. 

Good Luck!

Rowrena Tichy

Walter Lindstrom
on 9/4/12 8:58 pm - Chula Vista, CA
Topic: RE: BCBS FL State changed policy!!!!!
www.obesityhelp.com/forums/amos/4562150/Blue-Cross-Blue-Shie ld-of-Florida/

I posted on this a couple weeks ago - I sure wish you had seen it or known about it sooner but hopefully that delay didn't really impact your approval.  Good luck!
(deactivated member)
on 9/3/12 9:39 pm - Lawrenceville, GA
VSG on 12/15/12 with
Topic: RE: BCBS FL State changed policy!!!!!
Now that is some good news! Thanks for sharing.
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