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(deactivated member)
on 1/23/16 2:08 pm
Topic: MVP EPO insurance plan and getting approved

Just wondering how many of you have had your surgery approved through MVP insurance.  They are based in New York. I live in Florida and have the EPO plan. Are they more likely to deny or approve WLS?

they told me I need to have proof that my weight has been an issue for 2 years, documented proof that I've tried a medically monitored diet plan for at least 6 months, and have a BMI of 40+ (35+ with weight related health issue). 

I've had weight issues my whole life. Not sure where to start with documenting this. 

hollykim
on 1/22/16 3:56 pm - Nashville, TN
Revision on 03/18/15
Topic: RE: BCBS any hope? Weightloss surgery excluded
On January 22, 2016 at 9:23 PM Pacific Time, Aleena wrote:

That is what I figured. I was mostly just wondering if there would actually be a possibility of finding another insurance or if I am most likely going to be marked as "uninsurable" now as there are records of morbid obesity and my wanting to have bariatric surgery.

no,it is now illegal for insurance companies to deny coverage to ppl for pre existing conditions.

 


          

 

Aleena
on 1/22/16 1:23 pm
Topic: RE: BCBS any hope? Weightloss surgery excluded

That is what I figured. I was mostly just wondering if there would actually be a possibility of finding another insurance or if I am most likely going to be marked as "uninsurable" now as there are records of morbid obesity and my wanting to have bariatric surgery.

hollykim
on 1/22/16 1:15 pm - Nashville, TN
Revision on 03/18/15
Topic: RE: BCBS any hope? Weightloss surgery excluded
On January 22, 2016 at 4:46 PM Pacific Time, Aleena wrote:

I desperately need this surgery. I have Blue Cross/Blue Shield in Montana. I was just told that BC/BS will not cover any medical anything to treat obesity...that they would cover appointments at the metabolic center if I had a comorbidity (I do not, I am just obese.), but they won't cover the surgery at all, for any reason.

 

Is there any hope? Doctors agree that I need this surgery but insurance doesn't care. Would I be able to get on another insurance now that I have started the process and there are records of my obesity and need for surgery? I mean, would other insurances pretty much consider me "uninsurable"? We went through a process to find an insurance in the first place because of my weight.

 

btw we pay for our insurance ourselves, it is not through work.

 

 

Thanks in advance for any help you can give me!

no,if it is excluded on your policy,it. Means that you are not paying for bariatric coverage in your premiums. 

All you can do is get new insurance that covers it or self pay. Sorry to bear bad news.

 


          

 

Aleena
on 1/22/16 8:46 am
Topic: BCBS any hope? Weightloss surgery excluded

I desperately need this surgery. I have Blue Cross/Blue Shield in Montana. I was just told that BC/BS will not cover any medical anything to treat obesity...that they would cover appointments at the metabolic center if I had a comorbidity (I do not, I am just obese.), but they won't cover the surgery at all, for any reason.

 

Is there any hope? Doctors agree that I need this surgery but insurance doesn't care. Would I be able to get on another insurance now that I have started the process and there are records of my obesity and need for surgery? I mean, would other insurances pretty much consider me "uninsurable"? We went through a process to find an insurance in the first place because of my weight.

 

btw we pay for our insurance ourselves, it is not through work.

 

 

Thanks in advance for any help you can give me!

VegasShmitty
on 1/16/16 1:09 pm
Topic: RE: Getting approved through Amerigroup/Medicaid?
On January 16, 2016 at 8:59 PM Pacific Time, scoates0 wrote:

I work for Amerigroup and I process a lot of claims for WLS. From everything I have seen it seems that you have to do 6 months nutrition counseling and all the other standard tests. It also depends on what state you live in because each state has it own plans and rules. 

I thought they changed it to 3 months?  But thats just what they  told me over the phone. I'm hoping to switch to Health Plan of Nevada since they are easier to deal with.  

scoates0
on 1/16/16 12:59 pm
RNY on 01/29/16
Topic: RE: Getting approved through Amerigroup/Medicaid?

I work for Amerigroup and I process a lot of claims for WLS. From everything I have seen it seems that you have to do 6 months nutrition counseling and all the other standard tests. It also depends on what state you live in because each state has it own plans and rules. 

DEBGG
on 1/14/16 2:15 am
Topic: RE: United Healthcare Requirements

I also have UHC. I got online and searched our benefits. I also needed a 6 mth supervised diet. I began seeing my pcp for 6 mth, every month on time. I googled meds that help with weight loss, then searched my benefits  in through express scripts to find out the cost. Once we decided on a med (topomax) I wrote down everything I put in my mouth and how many calories I was eating. I found my surgeon at Cleveland Clinic and began the process. When I began the process I was already done with my supervised diet. Good luck! It's a lot of work :(

DEBGG
on 1/14/16 2:07 am
Topic: RE: Insurance Appeal letters ~ please help!

Ive had to do all this before. It's quite the pain in the butt. I had a different ins co also. I googled how to write an insurance appeal letter, got every type of record from every dr I have ever seen, a letter from my pcp and  mailed it in with delivery signature confirmation. Make sure you do that because they will say they never received it. After they got it, I have them 5 business days, then I grabbed my copies and called them every other day until they approved it! Unfortunetly I had a bad experience with the band, after all that trouble, and had to have it taken out a month after getting it :(.  That was in 2008 and since then my health had declined, I have diabetes and am in the process of RNY. It's a long hard process for an appeal but stay on them!!! That's the key! Good luck!!

megan G.
on 1/7/16 10:42 pm
RNY on 01/05/16 with
Topic: RE: IEHP Approved me! I have a date

You're welcome  feel free to look up my facebook surgical page https://m.facebook.com/Megans-roux-en-y-570321976511408/ and if you have any questions about iehp or anything let me know, I also know several others who got approved by iehp. :)

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