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Topic: any one live in Connecticut???
Hi everyone. I am wondering if any one in ct has community health network (husky) insurance??? Has anyone been approved denied for surgery? I really want to have the vbg done but i dont think they will cover that specific procedure... anyone else have any problems?
Topic: RE: Update: Approved! (Anthem is giving me hissy fits)
Congratluations on your approval =) Sounds like you had a fairly easy time--as it should be!
And hey, I'm originally from Westfield! (You probably just refer to it as "North Carmel" ;) )
Best wishes,
Jonathan
And hey, I'm originally from Westfield! (You probably just refer to it as "North Carmel" ;) )
Best wishes,
Jonathan
Topic: RE: 12 month program
BC/BS wouldn't use the notes from my PCP, but they weren't good notes (they weren't intended to be, so I don't blame my PCP) and I had to start my program over w/ my surgeon; however, it was only a 3 month program.
I hate that some insurance companies have gone to a 12 month weight management program. Do they really think we've never tried to lose weight before? Or even better, do they really think we've never LOST weight before, just to gain it back, like 95% of everyone else?
I will tell you this, even if you don't believe me. The time will pass, and it will pass quickly. Don't give up. That's what they want you to do. That's the ONLY reason I can see them requiring an entire year of weight loss program before approving.
Good luck, and God bless.
I hate that some insurance companies have gone to a 12 month weight management program. Do they really think we've never tried to lose weight before? Or even better, do they really think we've never LOST weight before, just to gain it back, like 95% of everyone else?
I will tell you this, even if you don't believe me. The time will pass, and it will pass quickly. Don't give up. That's what they want you to do. That's the ONLY reason I can see them requiring an entire year of weight loss program before approving.
Good luck, and God bless.
Topic: RE: Psych Eval?
My psych eval result wasn't exactly a glowing recommendation. They asked me to fill out over 25 pages of paperwork before they saw me, in which they asked for the same information over and over again. I quit filling out forms that were clearly repetitive, and when he wrote my evaluation, he said something to the effec that I "don't follow directions well," and that may have an impact on my success with weight loss surgery. He wrote that if the doctor's office put a high priority on motivating me, I might do ok.
Pretty arrogant, I thought, considering he based that on me not wanting to write my social security, address, and health insurance information in 20 different places.
Anyway, I did have a point here.. =) BC/BS IL approved my surgery, and never mentioned the psych eval.
But, if you're asked to fill out 25 pages of paperwork.. do it. =)
Peace,
Jonathan
Pretty arrogant, I thought, considering he based that on me not wanting to write my social security, address, and health insurance information in 20 different places.
Anyway, I did have a point here.. =) BC/BS IL approved my surgery, and never mentioned the psych eval.
But, if you're asked to fill out 25 pages of paperwork.. do it. =)
Peace,
Jonathan
Topic: RE: Approved!
On December 15, 2010 at 2:15 PM Pacific Time, Saintsfan1 wrote:
"... just got my denial once again ..."
Amazing. That's my same story. BCBS/IL. Deny, deny, deny. We asked them EXACTLY what they needed to see, and it was information the doctor had ALREADY sent them. I said, "Look at page 17." They said, "We''ve denied the claim, and we're not looking at it anymore." I tried to explain that they denied it saying there wasn't documentation that clearly existed. It was like talking to a brick wall.
I found an advocate within the system (through my employer ) who wouldn't give up, and they FINALLY approved it.
I wish you the best of luck w/ your battle w/ BC/BS IL. They've been great about ever medical need I've ever had, except for this surgery. But, in the end, they finally came through. I'll be having surgery in 6 days.
Sorry for your struggle. Keep the faith.
Jonathan
"... just got my denial once again ..."
Amazing. That's my same story. BCBS/IL. Deny, deny, deny. We asked them EXACTLY what they needed to see, and it was information the doctor had ALREADY sent them. I said, "Look at page 17." They said, "We''ve denied the claim, and we're not looking at it anymore." I tried to explain that they denied it saying there wasn't documentation that clearly existed. It was like talking to a brick wall.
I found an advocate within the system (through my employer ) who wouldn't give up, and they FINALLY approved it.
I wish you the best of luck w/ your battle w/ BC/BS IL. They've been great about ever medical need I've ever had, except for this surgery. But, in the end, they finally came through. I'll be having surgery in 6 days.
Sorry for your struggle. Keep the faith.
Jonathan
Topic: can anyone approved by Aetna answer a couple questions for me?1
My main question is who/what qualifies for the exercise consult part if I'm doing the 3-month. A trainer? If so, do they just do a write-up to include with the approval packet? Or do their notes go to the PCP?
I'm just trying to fast-track this a bit. I have a consult with the surgeon on Feb. 22 (soonest I could get). I've had a nutritionist that I've seen occassionally for about a year, and I saw her this month, and saw my PCP this month, so I was thinking that if I can add the exercise part, I knock off the first and second month before I've even seen the surgeon.
The other option I suppose is to just wait and use only the people that the surgeon suggests, but then I don't get started until the end of February.
Also, I've been paying for a trainer at a gym that I haven't really been using :( It is still potentially a plan to get all of the stuff done for approval, but with exercising and following my nutritionist's plan, if I feel like I'm losing weight, I might just wait on the surgery. But I have done so much research on it already and I am somewhat desperate to lose weight.
I had a sleep study done a few months ago and I do have apnea (now have a CPAP machine). BMI is 43, and I have 5 year weight history (with BMI at or above 40) so at least those are covered.
My other question is regarding success vs. failure on the supervised weight loss. If I lose weight, will they deny me? Or am I supposed to lose weight to show that I can be successful after the operation?
Thanks for the help!
I'm just trying to fast-track this a bit. I have a consult with the surgeon on Feb. 22 (soonest I could get). I've had a nutritionist that I've seen occassionally for about a year, and I saw her this month, and saw my PCP this month, so I was thinking that if I can add the exercise part, I knock off the first and second month before I've even seen the surgeon.
The other option I suppose is to just wait and use only the people that the surgeon suggests, but then I don't get started until the end of February.
Also, I've been paying for a trainer at a gym that I haven't really been using :( It is still potentially a plan to get all of the stuff done for approval, but with exercising and following my nutritionist's plan, if I feel like I'm losing weight, I might just wait on the surgery. But I have done so much research on it already and I am somewhat desperate to lose weight.
I had a sleep study done a few months ago and I do have apnea (now have a CPAP machine). BMI is 43, and I have 5 year weight history (with BMI at or above 40) so at least those are covered.
My other question is regarding success vs. failure on the supervised weight loss. If I lose weight, will they deny me? Or am I supposed to lose weight to show that I can be successful after the operation?
Thanks for the help!
(deactivated member)
on 1/18/11 6:05 am - Vacaytown, HI
on 1/18/11 6:05 am - Vacaytown, HI
Topic: RE: Bummer - no obesity coverage AT ALL
Although I dont know which ones are good and which ones are not there are healthcare financing orgs...
http://www.carecredit.com/
http://healthcarecreditline.com/
Best of luck to you!!!
http://www.carecredit.com/
http://healthcarecreditline.com/
Best of luck to you!!!
(deactivated member)
on 1/18/11 6:01 am - Vacaytown, HI
on 1/18/11 6:01 am - Vacaytown, HI
Topic: RE: Help with insurance lingo
I had to pay a near 8k by the end of my surgery in co pays. However some of the funds were eventually refunded. The healthcare process is definately a maze these days. Keep in mind deducting expenses from your taxes as that was a help to me. Perhaps the facility or Dr. would consider a payment plan? Deductibles can be for any other health needs that can be applied to it per insurance specific regulations. Best of luck to you!!
(deactivated member)
on 1/18/11 5:55 am - Vacaytown, HI
on 1/18/11 5:55 am - Vacaytown, HI
Topic: Have an insurance relate question or tip?
Lets talk! I am 5 years post op and have been through it all. Id love to share and hear from you what your experiences have been!
One thing I learned is that to get the surgery approved is one hurdle, but also to remember the post op things to come. Make sure you make regular visits and address and out of the ordinary feelings or issues. I had gallbladder removal one year post op and have some Iron issues due to absorption at times. Luckily my insurance covers regular visits to keep a check on my iron levels and overall B12 etc. Remember its a lifetime, but I am sure that had I not had the surgery Id be going to to the Dr. for far more critical issues. I am thankful for that!
Take care!!
Jess
One thing I learned is that to get the surgery approved is one hurdle, but also to remember the post op things to come. Make sure you make regular visits and address and out of the ordinary feelings or issues. I had gallbladder removal one year post op and have some Iron issues due to absorption at times. Luckily my insurance covers regular visits to keep a check on my iron levels and overall B12 etc. Remember its a lifetime, but I am sure that had I not had the surgery Id be going to to the Dr. for far more critical issues. I am thankful for that!
Take care!!
Jess
Topic: RE: Help with insurance lingo
Wow.. and I thought my $5K ded was bad!
You know, if you don't have your heart set on bypass but a sleeve instead, it would actually be cheaper to go to Mexico. :o/
Sleeves ROCK!
You know, if you don't have your heart set on bypass but a sleeve instead, it would actually be cheaper to go to Mexico. :o/
Sleeves ROCK!
Previously Midwesterngirl
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
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