Recent Posts
Topic: RE: Does anyone have any experience with the approval process through Fidelis Care NY?
I cant answer ur question but i would like to know what did you find out so far and what have you done so far i was schedule for the lap band but do to some health issue with my lungs they had to cancel my surgery date in the time that happen i changed my mind now i want the vsg ! Btw if i do get surgery my doctor performs there st lukes right
Topic: RE: has anyone had their nutrional counseling or phsy eval done on base
thanks for getting back with me, so far, i am getting the psy evaluation done on base, so there is no co pay or anything like that. the nut counseling is what my surgeons office requires and tri care does not pay for that so that is going to be out of pocket, i am going to my cardio and EKG tomorrow afternoon, my psy eval is next thursday...
so things are moving quickly, i will just be out of pocket the $600 but that is not too bad compared to be self pay,
thanks and keep in touch there does not seem like there are too many military on this board.
have a great day
debby
so things are moving quickly, i will just be out of pocket the $600 but that is not too bad compared to be self pay,
thanks and keep in touch there does not seem like there are too many military on this board.
have a great day
debby
Topic: RE: has anyone had their nutrional counseling or phsy eval done on base
Hi Debby,
I don't know if anyone responded but Tricare doesn't require the nut just counseling. You can get that accomplished through your PCM. I argued this with my BS office and they kept saying it's a Tricare requirement...wrrong. Tricare doesn't require anything they don't or won't pay for.
I don't know if anyone responded but Tricare doesn't require the nut just counseling. You can get that accomplished through your PCM. I argued this with my BS office and they kept saying it's a Tricare requirement...wrrong. Tricare doesn't require anything they don't or won't pay for.
Topic: RE: appealing bcbs of delaware
There are a few people that have appeal letters on their page. If you haven't already post this on the VSG forum to see if someone can help you. I know of a few people that have appeal letters.
Also, google WLS appeal letters, there are few that come up.
I am actually about to post on the VSG forum to ask if any one had any appeal letter statistics on performing surgery on people with a BMI under 50.
Hope this helps.
Also, google WLS appeal letters, there are few that come up.
I am actually about to post on the VSG forum to ask if any one had any appeal letter statistics on performing surgery on people with a BMI under 50.
Hope this helps.
Topic: RE: Aetna Weight History
Yes, that should be perfect!
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
Topic: RE: Self Pay
I was self pay and my doctors office had several financing options; however, I just went to my credit union and took out a 3 year loan and decided to drive my Trailblazer for a few more years.
I had the RNY in Alabama and total (doctor, hospital, anesthesia) was right at $20,000.
Hope this helps...Good luck.
I had the RNY in Alabama and total (doctor, hospital, anesthesia) was right at $20,000.
Hope this helps...Good luck.
Topic: RE: Aetna Weight History
Thanks for responding! I have a documented weight from 2009 and I might have one from the beginning of 2010. I didn't see my PCP but I did have my weight checked at our Health Department. If I can get those records, should that be enough to qualify for the 2 year weight history?
Topic: RE: Aetna Weight History
They are looking for a 2 year history. I was approved as well as my 3 kids through Aetna. All 4 of us had to show a 2 year history. If you do not have anything from 2009, you will have to show a 2 year history from 2011. So that would be 2011, 2012, and 2013. Do you have anything that has your weight shown in 2010?? It doesn't have to be a dr visit? In both my daughter's cases, it was records from weigh****chers showing our weights because I had not been to the dr in a specific year, same as you, but I did have weigh****cher records that had my weight documented.
Nan
Nan
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
Topic: Aetna Weight History
Aetna insurance requires a 2 year weight history to be approved for weight loss surgery. In my case, I hadn't been to a doctor for a few years before my pregnancy in 2008. I believe I have a documented weight from a postpartum checkup in early 2009. However, I did not see a doctor at all in 2010 and have no weight history for that year. I do have a documented weight for 2011 but since Aetna requires two years of weight history, I'm afraid that I may not qualify. Would my weight for 2009 and 2011 count towards the weight history? Do I need to wait another year to have the surgery? I would appreciate any help or advice. Thanks!
Topic: RE: can anyone approved by Aetna answer a couple questions for me?1
I too was approved by Aetna, but it was after 2 appeals.
I agree with everything Nan says and used some of her letters to help get my approval through. I agree, get everything documented, take it to your PCP and get them to clearly document your efforts in each of the three areas in their notes. This would typically be sent with the surgeonsrequest for the actual surgery. I also sent the visit verification from the counselor I went to.
The 90 day vs 3 month or 180 days vs 6 months is very true and important. They will deny you over just this....
Good luck!
I had my surgery 12-21 and am down over 50 lbs already! ; )
I agree with everything Nan says and used some of her letters to help get my approval through. I agree, get everything documented, take it to your PCP and get them to clearly document your efforts in each of the three areas in their notes. This would typically be sent with the surgeonsrequest for the actual surgery. I also sent the visit verification from the counselor I went to.
The 90 day vs 3 month or 180 days vs 6 months is very true and important. They will deny you over just this....
Good luck!
I had my surgery 12-21 and am down over 50 lbs already! ; )
Most Active
Recent Topics
My insurance will not pay for my excess skin that hang down to my knees
Hockeymom87 · 0 replies · 605 views
Hockeymom87 · 0 replies · 605 views
