Recent Posts
Topic: RE: HELP! A little complicated insurance problem
Oh thank you, thank you, thank you! Dr. Scott and the Center for Bariatrics are a Center of Excellence. I just got off the phone with the nurse, and she told me that I needed to get my CPAK. I think that's what it's called 
. I found out last year after a sleep study that I have sleep apnea. However, I did not get fitted for the mask because it terrified me 
. Now I find out that my surgeon won't perform unless I have used this machine or mask thing. She said it is because during anesthesia, not using it could cause a problem. So now I am waiting on Respiratory Consultants to call me and let me know if I have to redo the process or if they can just fit me. I am hoping they can just fit me and it won't be expensive(remember this was the insurance my husband had before he was laid off). I will go ahead a schedule my pap and I don't think I can get a mammogram, I am 29 ( I don't know), is it required, if so I'll schedule it too.
. I found out last year after a sleep study that I have sleep apnea. However, I did not get fitted for the mask because it terrified me . Now I find out that my surgeon won't perform unless I have used this machine or mask thing. She said it is because during anesthesia, not using it could cause a problem. So now I am waiting on Respiratory Consultants to call me and let me know if I have to redo the process or if they can just fit me. I am hoping they can just fit me and it won't be expensive(remember this was the insurance my husband had before he was laid off). I will go ahead a schedule my pap and I don't think I can get a mammogram, I am 29 ( I don't know), is it required, if so I'll schedule it too. 
Topic: RE: HELP! A little complicated insurance problem
Congratulations on the new job!
First, since this is a work plan, usally there is NO pre-existing condition clause. Which means, once your policy goes into effect (and provided WLS is NOT excluded) you can start the process (or continue in your case). On March 1st, call UHC and asked to speak with the Baratric Resource Service. The department specializes in WLS and what is needed to get approved so you will know what you still need as far as pre-op testing. They will provide you with MUCH better information that you will recieve through regular customer service.
Second, most UHC plans only allow surgery at a Center of Excellence. So make sure your surgeon and hospital are on their approved list. If they aren't on the list, look into some that are so that your approval process goes through quicker.
Third, pull out a copy of your policy. Since this is a HDHP, make sure you know what your deductible is as you will have a portion to pay before the insurance kicks in (hopefully your company provides some asistance with this through a HSA). Also, make sure there is no max that they will pay for WLS. (it is best to be prepared before surgery)
As for "fast-forwarding" the process, the only things I can think of would be to schedule your appointment with your surgeon for as close to that date (after Mar 1) as possible. And make sure you are up to date on your annual pap and mammograms (if your not, scheduled these now for right AFTER Mar 1st so they will count toward your deductible)
Good luck!
First, since this is a work plan, usally there is NO pre-existing condition clause. Which means, once your policy goes into effect (and provided WLS is NOT excluded) you can start the process (or continue in your case). On March 1st, call UHC and asked to speak with the Baratric Resource Service. The department specializes in WLS and what is needed to get approved so you will know what you still need as far as pre-op testing. They will provide you with MUCH better information that you will recieve through regular customer service.
Second, most UHC plans only allow surgery at a Center of Excellence. So make sure your surgeon and hospital are on their approved list. If they aren't on the list, look into some that are so that your approval process goes through quicker.
Third, pull out a copy of your policy. Since this is a HDHP, make sure you know what your deductible is as you will have a portion to pay before the insurance kicks in (hopefully your company provides some asistance with this through a HSA). Also, make sure there is no max that they will pay for WLS. (it is best to be prepared before surgery)
As for "fast-forwarding" the process, the only things I can think of would be to schedule your appointment with your surgeon for as close to that date (after Mar 1) as possible. And make sure you are up to date on your annual pap and mammograms (if your not, scheduled these now for right AFTER Mar 1st so they will count toward your deductible)
Good luck!
Top is my progress, Bottom is to Surgeon's Goal
Topic: HELP! A little complicated insurance problem
Hi everyone, I need help. I just started working for a new company and I enrolled with UHC in their HDHP plan. My coverage won't start until March 1st. I know they cover VGS and bariatric surgery. However I am concerned with me not being enrolled until now they will deny me. I had UHC under my husband's employer last year and it was the Choice Plus Plan and I was told that they would not cover any obesity proceedures surgerical or not, this was after my PCP referral, seminar, and diet plan. Long story short my husband was laid off and I became employed. Has anyone filed to have WLS done so early in changing plans? 
Is there anything I can do to fastfoward the process befor March 1st gets here. I have been on the waiting bench for about 8 months now and if there is anything that I can do or shouldn't do to speed up my process, I would LOVE to know.
Tora
Is there anything I can do to fastfoward the process befor March 1st gets here. I have been on the waiting bench for about 8 months now and if there is anything that I can do or shouldn't do to speed up my process, I would LOVE to know.Tora
Topic: RE: Help with insurance lingo
Thank you so much for your response and insight. This was very useful information. I do know that once my deductible is paid that I don't have any copay, and everything would be covered 100%. I just have to come up with a way to pay the deductible.
Topic: RE: Help with insurance lingo
It is definately is not a stupid question. You will not have to pay this to BC/BS. It will have to be paid to your providers. Since you are still early in the process, my guess is that it will be paid to the providers that do your pro-op testing, i.e. psych, labs, your surgeon, as well as some for your actual surgery. The providers MAY require that you pay it before you have the procedure since it is such as large amount.
If you don't already have a copy of the plan, get one ASAP (his employer has to provide this). Then, take a GOOD look at your policy so you can determine the following:
Is it a HDHP (high dedcutible health plan)? If so, does your hubby's employer help to cover some of the deductible through an HSA (health savings account)?
Are there some services covered before the deductible (this could be possible with several types of plans)? Also, do you have to pay a percentage after the deductible is met?
Is there a limit as to how much the insurance company will pay towards WLS (aka WLS Cap)?
Is there a MOOP (maximum out of pocket) for the policy and how much is it?
You definately need to read all services so you know exactly what to expect so you can be prepared.
Good luck!!!
If you don't already have a copy of the plan, get one ASAP (his employer has to provide this). Then, take a GOOD look at your policy so you can determine the following:
Is it a HDHP (high dedcutible health plan)? If so, does your hubby's employer help to cover some of the deductible through an HSA (health savings account)?
Are there some services covered before the deductible (this could be possible with several types of plans)? Also, do you have to pay a percentage after the deductible is met?
Is there a limit as to how much the insurance company will pay towards WLS (aka WLS Cap)?
Is there a MOOP (maximum out of pocket) for the policy and how much is it?
You definately need to read all services so you know exactly what to expect so you can be prepared.
Good luck!!!
Top is my progress, Bottom is to Surgeon's Goal
Topic: Help with insurance lingo
Hello all!
I am interested in having gastric bypass surgery, but I am confused with the way my insurance works. My hubby's insurance has recently changed, and now our deductible is $10,000! Well the good thing is that it does cover weight loss sugery. My question is this (and I'm sure it may be a stupid question): When will I have to pay this, and who do I pay? Is this an amount that I will have to pay BCBS, the hospital, or my surgeon? Can I be billed this amount after surgery, because I don't have this kind of money. I'm so completely loss. Any and all answers will be greatly appreciated, but please explain it to me like i"m a 2 yr. old, lol.
Thanks!!!
I am interested in having gastric bypass surgery, but I am confused with the way my insurance works. My hubby's insurance has recently changed, and now our deductible is $10,000! Well the good thing is that it does cover weight loss sugery. My question is this (and I'm sure it may be a stupid question): When will I have to pay this, and who do I pay? Is this an amount that I will have to pay BCBS, the hospital, or my surgeon? Can I be billed this amount after surgery, because I don't have this kind of money. I'm so completely loss. Any and all answers will be greatly appreciated, but please explain it to me like i"m a 2 yr. old, lol.
Thanks!!!
Topic: RE: Tricare Prime North question
I did not know there was any way to appeal a surgery choice. Have you heard of Tricare Prime insurance letting someone who appealed the RNY choice to a DS?
The doctor I am thinking about does the DS but they said he only does it if you are 600 pounds or over and thank God, I don't qualify for that weight.
If you have information as to how to appeal Tricare Prime and have them approve a DS, please advise.
Also, I was told a couple of years ago via an endoscopy that I had a duodenal ulcer. Not sure if that would mean anything as far as getting a DS?
Thanks for your help and advice.
I'm sorry, TriCare and Medicaid are the two ins co's where appeals do no good. :o(
On January 15, 2011 at 10:49 PM Pacific Time, wynter57 wrote:
Hello there. I've seen many of your post advocating DS surgery. I've read a lot of good things about it and I was considering having the DS. I'd be a revision FROM a VBG done 22 years ago. Anyway, like Jess said, TriCare does not cover the DS.I did not know there was any way to appeal a surgery choice. Have you heard of Tricare Prime insurance letting someone who appealed the RNY choice to a DS?
The doctor I am thinking about does the DS but they said he only does it if you are 600 pounds or over and thank God, I don't qualify for that weight.
If you have information as to how to appeal Tricare Prime and have them approve a DS, please advise.
Also, I was told a couple of years ago via an endoscopy that I had a duodenal ulcer. Not sure if that would mean anything as far as getting a DS?
Thanks for your help and advice.
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/
Topic: RE: Tricare Prime North question
Hello there. I've seen many of your post advocating DS surgery. I've read a lot of good things about it and I was considering having the DS. I'd be a revision FROM a VBG done 22 years ago. Anyway, like Jess said, TriCare does not cover the DS.
I did not know there was any way to appeal a surgery choice. Have you heard of Tricare Prime insurance letting someone who appealed the RNY choice to a DS?
The doctor I am thinking about does the DS but they said he only does it if you are 600 pounds or over and thank God, I don't qualify for that weight.
If you have information as to how to appeal Tricare Prime and have them approve a DS, please advise.
Also, I was told a couple of years ago via an endoscopy that I had a duodenal ulcer. Not sure if that would mean anything as far as getting a DS?
Thanks for your help and advice.
I did not know there was any way to appeal a surgery choice. Have you heard of Tricare Prime insurance letting someone who appealed the RNY choice to a DS?
The doctor I am thinking about does the DS but they said he only does it if you are 600 pounds or over and thank God, I don't qualify for that weight.
If you have information as to how to appeal Tricare Prime and have them approve a DS, please advise.
Also, I was told a couple of years ago via an endoscopy that I had a duodenal ulcer. Not sure if that would mean anything as far as getting a DS?
Thanks for your help and advice.
Topic: RE: upfront cost bcbs trs activecare 2???
Your policy likely changes a bit from year to year so it's hard telling if you are comparing to your coworker. Also, someone else may have the same ins as you but through a different employer so the policy would again be different.
There is really no way to tell you your up front fees because you'll likely have a program fee through your surgeon that ins will not cover.
There is really no way to tell you your up front fees because you'll likely have a program fee through your surgeon that ins will not cover.
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/
Topic: RE: UNITED HEALTHCARE PPO 90 PLAN???!!!
It's a group policy so you shouldn't have to deal with pre existing conditions. Go for it!
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/
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
