Recent Posts
Topic: RE: 6 month diet/gained weight!?
Just wanted to follow up and answer my own question...YEP they approved me! My RNY is scheduled for Jan 17. Approved on the first try. Apparently they looked at my overall not just a one month gain (you know how paranoid you get with this experience!)
Good luck to all!
Jennie
Good luck to all!
Jennie
Topic: Employer Changed Insurance ughhh
I am so upset right now. The hospital I work at used to have Cigna and now they changed it to Aetna and they didnt add weight loss surgery to the insurance so now if I wanted to get weight loss surgery i would have to either get my own insurance or do self pay. I am so mad. I just had to vent yall sorry.
Nekeya B.
Topic: RE: Can't get insurance after wls?
I may have to opt for a "real" job, just to get insurance (hubby is self-employed, thus the insurance issue!)
Can I just say that the insurance industry sucks balls? There, said it anyway. It doesn't matter that we've paid thousands and thousands of dollars with few claims, since we're all basically healthy. Our premium for family coverage is over $1000/mo. with high deductibles, and we can't switch to new insurance because a) Two family members are obese; and b) I had surgery to *not* be obese.
Tami
Maybe not. I believe starting 1/1/11 each state has to come up with high risk ins for people like us and it's supposed to be affordable. Likely it won't cover much but it's better than nothing. I know absolutely nothing about this but there is a lady asking about it on the insurance board. She is looking to see if her state ins (not medicaid) will cover WLS. She might have more info for you.
On December 6, 2010 at 4:00 PM Pacific Time, TamiFromAL wrote:
Well, on the "plus" side, it looks like it's going to be just as difficult for my son and hubby, since they are both obese :-( I may have to opt for a "real" job, just to get insurance (hubby is self-employed, thus the insurance issue!)
Can I just say that the insurance industry sucks balls? There, said it anyway. It doesn't matter that we've paid thousands and thousands of dollars with few claims, since we're all basically healthy. Our premium for family coverage is over $1000/mo. with high deductibles, and we can't switch to new insurance because a) Two family members are obese; and b) I had surgery to *not* be obese.
Tami
Maybe not. I believe starting 1/1/11 each state has to come up with high risk ins for people like us and it's supposed to be affordable. Likely it won't cover much but it's better than nothing. I know absolutely nothing about this but there is a lady asking about it on the insurance board. She is looking to see if her state ins (not medicaid) will cover WLS. She might have more info for you.
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: Can't get insurance after wls?
Well, on the "plus" side, it looks like it's going to be just as difficult for my son and hubby, since they are both obese :-(
I may have to opt for a "real" job, just to get insurance (hubby is self-employed, thus the insurance issue!)
Can I just say that the insurance industry sucks balls? There, said it anyway. It doesn't matter that we've paid thousands and thousands of dollars with few claims, since we're all basically healthy. Our premium for family coverage is over $1000/mo. with high deductibles, and we can't switch to new insurance because a) Two family members are obese; and b) I had surgery to *not* be obese.
Tami
I may have to opt for a "real" job, just to get insurance (hubby is self-employed, thus the insurance issue!)
Can I just say that the insurance industry sucks balls? There, said it anyway. It doesn't matter that we've paid thousands and thousands of dollars with few claims, since we're all basically healthy. Our premium for family coverage is over $1000/mo. with high deductibles, and we can't switch to new insurance because a) Two family members are obese; and b) I had surgery to *not* be obese.
Tami
Topic: RE: My Empoyer's Plan vs my stoma
Has anyone had any experience appealing for an exception/waiver to the Empoyer's Plan???
A lot of ins co's are going to the one WLS in a lifetime and honestly, I can't blame them. Look at the band board, you can often see someone basically explaining that they know the band has horrible results, awful stats, and lots of complications but they will get it anyway and just revise if it doesn't work. I wouldn't want to pay for additional surgeries for someone like that either. I think it is that population (those that knowingly get procedures they know are not likely to work) that caused ins co's to adopt the one WLS in a lifetime rule.
Sadly they have every right not to cover a revision. Putting a band over your bypass is not a correction to the stoma, it is a band over your bypass. Correcting the stoma, unfortunately, would be something like Stomaphyx that does not work either.
Also, if you end up self pay I certainly wouldn't get a band over your bypass, it's quite unlikely to work.
On November 29, 2010 at 6:31 AM Pacific Time, Jayne wrote:
My employer's healthcare plan specifically states one bariatric procedure per lifetime. However, my surgeon has stated that I require a Band Over Bypass to correct a dilated stoma (staples came out of place ).... The insurance rules this BOB a second bariatric procedure not a correction to the RNY....Has anyone had any experience appealing for an exception/waiver to the Empoyer's Plan???
A lot of ins co's are going to the one WLS in a lifetime and honestly, I can't blame them. Look at the band board, you can often see someone basically explaining that they know the band has horrible results, awful stats, and lots of complications but they will get it anyway and just revise if it doesn't work. I wouldn't want to pay for additional surgeries for someone like that either. I think it is that population (those that knowingly get procedures they know are not likely to work) that caused ins co's to adopt the one WLS in a lifetime rule.
Sadly they have every right not to cover a revision. Putting a band over your bypass is not a correction to the stoma, it is a band over your bypass. Correcting the stoma, unfortunately, would be something like Stomaphyx that does not work either.
Also, if you end up self pay I certainly wouldn't get a band over your bypass, it's quite unlikely to work.
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: Can't get insurance after wls?
Has anyone else had trouble getting health insurance after weight loss surgery? How did you handle it?
Oh yeah! Medical and life ins are almost impossible to get for a few years after WLS.
The port was not a complication, don't even tell them about it. Gallbladder surgery could have been necessary without WLS, I wouldn't permit them to call that a complication either.
On December 1, 2010 at 7:44 AM Pacific Time, TamiFromAL wrote:
I had lap band surgery, self-pay, a little over four years ago. I moved out of state, and need to get new insurance. We currently have BCBS of AL, and they only cover if we are in the state. We can transfer the policy to BCBS of FL, but for some reason, our premiums will jump by a third to keep basically the same policy (which, of course, excludes anything related to the lap band, since I was self-pay). We inquired about getting an entirely new policy, which would actually cost less, but they said I cannot get a new policy until I am five years out from surgery, without complications. The only "complications" I have had were port replacement for cosmetic reasons (old style port was visible and replaced with low-profile port), and gall bladder removal. I don't know if either of those will impact my ability to get insurance after my five year anniversary in Sept. '11. Has anyone else had trouble getting health insurance after weight loss surgery? How did you handle it?
Oh yeah! Medical and life ins are almost impossible to get for a few years after WLS.
The port was not a complication, don't even tell them about it. Gallbladder surgery could have been necessary without WLS, I wouldn't permit them to call that a complication either.
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: Insurance Denied by Dr Bertha with 2 weeks to surgery date
It is clear that BERTHA IS ONLY IN IT FOR THE MONEY OR WOULD TREAT EXISTING PATIENTS WITH MORE CARE. All the other insurance and legal issues are a screen to deflect his actions.
Doctors are supposed to "do no harm"--and I WAS harmed.
Of course he is in it for the money. Do you go to work for money? All of us do.
On December 1, 2010 at 8:27 AM Pacific Time, JillinWarren wrote:
I did verify with UNC the he was in network and I was approved, several times up to and including the day I was in his office to try to get him to change his mind. I did EVERYTHING I was supposed to do up to the date I was told my surgery was cancelled because Dr Bertha would not get enough money for my operation. He did not care about me or what I had done to follow his instructions.It is clear that BERTHA IS ONLY IN IT FOR THE MONEY OR WOULD TREAT EXISTING PATIENTS WITH MORE CARE. All the other insurance and legal issues are a screen to deflect his actions.
Doctors are supposed to "do no harm"--and I WAS harmed.
Of course he is in it for the money. Do you go to work for money? All of us do.
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: Does ins pay for revision
So, just wondering if i should have a revision and if my insurance company will pay.
As i told you on another board, you won't necessarily gain weight after surgery. We don't lose because of exercise, we lose because of diet. Just don't eat the wrong things or large quantity.
Ins will not pay for a revision unless you meet the basic qualifications and if they do not have a 'one WLS in a lifetime' exclusion.
On December 4, 2010 at 7:56 PM Pacific Time, Debbie R. wrote:
I have the lap band and have only lost 65 pounds, i am still considered obese with a bmi of 32. i am going to have spinal fusion surgery next month and i wont be able to move around much and i'm sure i will gain more weight. My back surgeon told me i needed to lose weight...I didn't think I would ever hear those words again.So, just wondering if i should have a revision and if my insurance company will pay.
As i told you on another board, you won't necessarily gain weight after surgery. We don't lose because of exercise, we lose because of diet. Just don't eat the wrong things or large quantity.
Ins will not pay for a revision unless you meet the basic qualifications and if they do not have a 'one WLS in a lifetime' exclusion.
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 ins
The gastric sleeve is only covered if you have the surgery in a MTF - otherwise you are correct....tricare only covers GBP or the LB. My start to finish (granted I finish a week from today) took about 6 months. It would have been sooner but....when I first asked for a referral, I was referred to Keesler - well the bariatric program shut down after Katrina and they were in the process of re-establising it. My first appt was in June, but the surgeon wasn't going to be here until August. During those months, I had many visits to the nutritionist and I had my Psch evail. At the end of August they did a mandatory seminar. Because the program was just starting to get up and running, the surgeon said that he will not perfom any surgeries until he has all the equipment that he prefers to use.....once everything was in order...he started doing the surgies. There was a waiting list and the most "critical" went first. I am a light weight with out any health issues other then being "fat". Because my surgery is being done at the MTF here at Keesler, I also don't have to go through the regular "TRICARE" approvals process. If I have the surgeons approval, then my surgery is a go.
I'm 5.5, my starting weight was 243....my weight right now (I'm on the pre-op diet...keep that in mind) is 224.
I'm 5.5, my starting weight was 243....my weight right now (I'm on the pre-op diet...keep that in mind) is 224.
Rhie
Topic: Does ins pay for revision
I have the lap band and have only lost 65 pounds, i am still considered obese with a bmi of 32. i am going to have spinal fusion surgery next month and i wont be able to move around much and i'm sure i will gain more weight. My back surgeon told me i needed to lose weight...I didn't think I would ever hear those words again.
So, just wondering if i should have a revision and if my insurance company will pay.
So, just wondering if i should have a revision and if my insurance company will pay.
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