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Topic: RE: Tricare ins
I still have alot of questions too. I did go to a seminar in Mobile, The dr said Tricare only pays for Lapband and the gastric bypass. They dod not cover the sleeve.
cookies4pennies
on 12/4/10 3:23 am
on 12/4/10 3:23 am
Topic: RE: Tricare ins
I'm excited to see tricare approves wls.
my husband is retired military and tricare is all we have.
i wonder if they are specific on what they cover. for instance, only lapband or only gastric sleeve etc. or does your bmi make the difference?
i have so many questions as i am just recently considering all of this.
my husband is retired military and tricare is all we have.
i wonder if they are specific on what they cover. for instance, only lapband or only gastric sleeve etc. or does your bmi make the difference?
i have so many questions as i am just recently considering all of this.
Topic: RE: Tricare ins
Hi, Congratulations!
Was it hard to get approved ? How long did it take to get approved?
Was it hard to get approved ? How long did it take to get approved?
Topic: RE: UHC (united) billing weirdness and lagging on approval...
thanks for your super detailed and thoughtful reply! 
the latest news is that they sent a denial to my surgeon this morning. my surgeon got on the phone w/the medical director and had a peer review. turns out the denial was because UHC overlooked some paperwork that they already had and tried to deny me for not sending it in. nice. so according to my surgeon's office, they're going to overturn it and approve by next week. i'll believe it when i see it, at this point.
as for the rest -- i'm definitely going to appeal it ALL if they don't fix the billing mistakes. i can't afford the added expense right now, plus it's just lame for them to think they can rip people off.
the latest news is that they sent a denial to my surgeon this morning. my surgeon got on the phone w/the medical director and had a peer review. turns out the denial was because UHC overlooked some paperwork that they already had and tried to deny me for not sending it in. nice. so according to my surgeon's office, they're going to overturn it and approve by next week. i'll believe it when i see it, at this point.
as for the rest -- i'm definitely going to appeal it ALL if they don't fix the billing mistakes. i can't afford the added expense right now, plus it's just lame for them to think they can rip people off.
Topic: anyone have success appealing denial from Para Adv?
Wondering if anyone out there has had success in appealing denial from Paramount Advantage? They denied due to my BMI was not over 35 for the entire past five years. I do however, have what I think is considered four comorbidities: diabetes type 2, high blood pressure, high cholesterol, and just diagnosed with sleep apnea. I am also on prilosec for what I think is considered "gerd" but my doctor has not actually called it that. Any help or advise would be appreciated!
Wondering if anyone out there has had success in appealing denial from Paramount Advantage? They denied due to my BMI was not over 35 for the entire past five years. I do however, have what I think is considered four comorbidities: diabetes type 2, high blood pressure, high cholesterol, and just diagnosed with sleep apnea. I am also on prilosec for what I think is considered "gerd" but my doctor has not actually called it that. Any help or advise would be appreciated!
JillinWarren
on 12/1/10 12:27 am - Warren, NJ
on 12/1/10 12:27 am - Warren, NJ
Topic: RE: Insurance Denied by Dr Bertha with 2 weeks to surgery date
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.
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.
JillinWarren
on 12/1/10 12:11 am - Warren, NJ
on 12/1/10 12:11 am - Warren, NJ
Topic: RE: Insurance Denied by Dr Bertha with 2 weeks to surgery date
I found another surgeon, but Dr Bertha could have made an exception for an EXISTING PATIENT and HE DID NOT. United Healthcare didn't cause me any problems personally.
This was all about the dispute between Bertha and UNC, and I was just in his "pipeline" in case it was resolved. He wasn't going to get enough MONEY for my surgery, so he dropped me despite my compliance with his instructions. His only interest in me was his fee, not patient care.
This has cost me HOURS and DAYS and money to get another surgery lined up, and isn't final yet. It will cost me THOUSANDS MORE if it is pushed into 2011.
His office did not provide my medical records to other doctors in a timely fashion, so cost me another few weeks!
BEWARE BERTHA!!!!!!!!!!!!!!!!!!!!
Jill
This was all about the dispute between Bertha and UNC, and I was just in his "pipeline" in case it was resolved. He wasn't going to get enough MONEY for my surgery, so he dropped me despite my compliance with his instructions. His only interest in me was his fee, not patient care.
This has cost me HOURS and DAYS and money to get another surgery lined up, and isn't final yet. It will cost me THOUSANDS MORE if it is pushed into 2011.
His office did not provide my medical records to other doctors in a timely fashion, so cost me another few weeks!
BEWARE BERTHA!!!!!!!!!!!!!!!!!!!!
Jill
Topic: Can't get insurance after wls?
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?
Has anyone else had trouble getting health insurance after weight loss surgery? How did you handle it?
Topic: RE: UHC (united) billing weirdness and lagging on approval...
I definately understand your frustration.
1. Since the file is with the medical director, call UHC and tell them that you would like to speak to someone in the Medical Director's office. DO NOT TAKE NO FOR AN ANSWER. (However, you may have to agree to a call back for this). Once you get to the office, explain to them that your file has been with UHC for 3.5 weeks and you would like to know when you can expect a decision. The fact that it is with a medical director is not necessarily a bad thing.
2. Pull a copy of your policy. (If you dont have one, you can get it from your employer. The law requires that you be able to obtain a copy) Does your policy limit the nutrition visits? if it doesn't specifically say anything, then APPEAL and reference your policy. Even if it does limit them, appeal but then reference the fact that the nutrition classes are their prerequestite for WLS. As for being told that "all pre-op visits would be covered", some insurance plans does not consider nutrition plans to be a pre-op visit since you are usually not meeting with a physician or a PA. (Yes this is stupid)
3. APPEAL the radiology tests. Most companies do require their appeals in writing. In this appeal, cite your policy. It will strengthen your case.
4. My psych eval took 4 weeks to pay. As long as your are sure that it was billed, you need to wait to see if they pay. While you are waiting, look at your policy and see if there is an exclusion for mental health. If their isn't, you have an appeal if they do deny.
I know that having to appeal is a hassle and they do tend to take about 30 days. However, it is much better than having to come out of pocket for costs that should be paid. I hope it all resolves quickly and that you have your approval.
GOOD LUCK!!!
1. Since the file is with the medical director, call UHC and tell them that you would like to speak to someone in the Medical Director's office. DO NOT TAKE NO FOR AN ANSWER. (However, you may have to agree to a call back for this). Once you get to the office, explain to them that your file has been with UHC for 3.5 weeks and you would like to know when you can expect a decision. The fact that it is with a medical director is not necessarily a bad thing.
2. Pull a copy of your policy. (If you dont have one, you can get it from your employer. The law requires that you be able to obtain a copy) Does your policy limit the nutrition visits? if it doesn't specifically say anything, then APPEAL and reference your policy. Even if it does limit them, appeal but then reference the fact that the nutrition classes are their prerequestite for WLS. As for being told that "all pre-op visits would be covered", some insurance plans does not consider nutrition plans to be a pre-op visit since you are usually not meeting with a physician or a PA. (Yes this is stupid)
3. APPEAL the radiology tests. Most companies do require their appeals in writing. In this appeal, cite your policy. It will strengthen your case.
4. My psych eval took 4 weeks to pay. As long as your are sure that it was billed, you need to wait to see if they pay. While you are waiting, look at your policy and see if there is an exclusion for mental health. If their isn't, you have an appeal if they do deny.
I know that having to appeal is a hassle and they do tend to take about 30 days. However, it is much better than having to come out of pocket for costs that should be paid. I hope it all resolves quickly and that you have your approval.
GOOD LUCK!!!
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