Recent Posts
Topic: RE: TEXAS MEDICAID
thank you so much for info on drs accepting medicaid i will try it out..im in webster ,tx,but i will go anywhere in tx if they will take me! great luck with your surgery
Topic: RE: New Insurance
You should call BC to verify that a pre-approval and reimbursement for a surgery is still covered even though you switched plans. Also, check with your employer to see if the termination date for Blue Cross is Dec. 31 or Jan 31. Some policies cancellation have a grace period which means you will be covered for an additional 30 days (Jan 31).
Topic: RE: denial from cigna?
Did CIGNA require a 3 or 6 month diet plan. If so that's what your missing from reading your post.
Topic: Approved!
So, after a long hard battle with BCBSIL PPO (9 months to be exact) and two previous denials, I finally got approved after I took control over my process. They approved me in 1 day after recieving 260 pages worth of documentation and one long nasty 9 page letter telling them that they are violating their medical policy. For the longest, the medical staff at the University of Chicago has been telling me to read the medical policy and so I finally read the entire WLS medical policy and used the sources in their lit. review against them to prove my case. AHAHA! They didnt have a choice with all of the evidence that I met their requirements of a 3 month diet and that I didnt have to do Medifast, Optifast, Weigh****chers, Jenny Craig, etc.
The most important things that I've learned from this appeal process
(1) DO NOT GIVE UP AND GO AWAY WITH DENIALS - denials means your missing information and you should harass as many people neccessary until questions are answered. (2) USE THE INSURANCE MEDICAL POLICY TO PROVE YOUR CASE - read everything and research everthing.
(3) BE YOUR OWN ADOVCATE - stay on top of things, stay on top of people, make sure your information is correct, make sure it is recieved/sent and just triple check everything.
If anyone else has BCBS and need help with appeals, I can assist. In fact, I'll send you my 9 page letter if need be. Its way toooooo long to post on here. LOL.
The most important things that I've learned from this appeal process
(1) DO NOT GIVE UP AND GO AWAY WITH DENIALS - denials means your missing information and you should harass as many people neccessary until questions are answered. (2) USE THE INSURANCE MEDICAL POLICY TO PROVE YOUR CASE - read everything and research everthing.
(3) BE YOUR OWN ADOVCATE - stay on top of things, stay on top of people, make sure your information is correct, make sure it is recieved/sent and just triple check everything.
If anyone else has BCBS and need help with appeals, I can assist. In fact, I'll send you my 9 page letter if need be. Its way toooooo long to post on here. LOL.
Topic: New Insurance
Hello,
My surgery date for the sleeve is set up for January 17, 2011. I find out today we are getting new insurance as of 1/1/2011 which is Amerihealth. Does anyone know if # 1 they cover the sleeve and number # 2 do I have to go thru all the work up and everything again? I have Blue Cross right now.
Thanks
My surgery date for the sleeve is set up for January 17, 2011. I find out today we are getting new insurance as of 1/1/2011 which is Amerihealth. Does anyone know if # 1 they cover the sleeve and number # 2 do I have to go thru all the work up and everything again? I have Blue Cross right now.
Thanks
Topic: RE: submitt everything but....
This was the question I needed help with too!
My insurance requries 6 months, first app tomorrow..woohoo..
So do I do all the other stuff required before that and then wait for insurance or what?
Oh and I also wondered, if you don't have surgeyr approved did you have to pay for all the labs and dietician stuff since they can't attach it as part of a non approved surgery?
My insurance requries 6 months, first app tomorrow..woohoo..
So do I do all the other stuff required before that and then wait for insurance or what?
Oh and I also wondered, if you don't have surgeyr approved did you have to pay for all the labs and dietician stuff since they can't attach it as part of a non approved surgery?
Topic: RE: submitt everything but....
No, You have to have everything in order and completed when it is submitted. Trust me Bev knows what she is doing. She is awesome and I got approval from my insurance within 3 business days. Trust her!
Topic: denial from cigna?
Tomorrow marks my 2nd week waiting for my approval.
I received a letter in the mail today from CIGNA saying I was denied. In the letter it states that I must be 18 years or older (I'm 27), a BMI over 40 (which I have), and must have at least one co-morb (mine is sleep apnea). I also followed thru with their requirement of 6 months of supervised diet and exercise.
I spent months going for all the necessary testing (sleep, pulminary, ultrasounds, egd, etc.). I even had my PCP write a note saying she's been seeing me since 1999 (I was a freshman in HS) and that I have struggled with obesity for years. It said that I had been seen for help regarding weight loss many times in the past and this was my last step.
I WAS EFFING DENIED?!? How in the world can people smaller than me be approved with one or ZERO co-morbs? Or people on Medicade??? I work hard and I pay for my insurance...I was even PRE-APPROVED at the beginning...
Obviously, being that its 8pm here, my surgeon's office is closed, what can I do? The insurance co-ordinator has a 98% success rate for approvals (or something crazy high), do I wait to talk to her? Do I have to dispute this? I want to cry. I'm just so upset. I've waited since last March for this, and now they're saying NO?!? Now that the holidays are here, I just know it's going to be even harder :( :( :(
I just want my life back. I want to walk up stairs without being winded, go shopping with my friends, be a "NORMAL" 27 year old.
My heart is broken. Suggestions?
I received a letter in the mail today from CIGNA saying I was denied. In the letter it states that I must be 18 years or older (I'm 27), a BMI over 40 (which I have), and must have at least one co-morb (mine is sleep apnea). I also followed thru with their requirement of 6 months of supervised diet and exercise.
I spent months going for all the necessary testing (sleep, pulminary, ultrasounds, egd, etc.). I even had my PCP write a note saying she's been seeing me since 1999 (I was a freshman in HS) and that I have struggled with obesity for years. It said that I had been seen for help regarding weight loss many times in the past and this was my last step.
I WAS EFFING DENIED?!? How in the world can people smaller than me be approved with one or ZERO co-morbs? Or people on Medicade??? I work hard and I pay for my insurance...I was even PRE-APPROVED at the beginning...
Obviously, being that its 8pm here, my surgeon's office is closed, what can I do? The insurance co-ordinator has a 98% success rate for approvals (or something crazy high), do I wait to talk to her? Do I have to dispute this? I want to cry. I'm just so upset. I've waited since last March for this, and now they're saying NO?!? Now that the holidays are here, I just know it's going to be even harder :( :( :(
I just want my life back. I want to walk up stairs without being winded, go shopping with my friends, be a "NORMAL" 27 year old.
My heart is broken. Suggestions?
Famous last words:
They say that the journey of 1000 miles begin with a single step, but the truth really is that the journey of like a million miles begin with a foot on the scale...--me.
View my website!
www.justxnikki.webs.com
They say that the journey of 1000 miles begin with a single step, but the truth really is that the journey of like a million miles begin with a foot on the scale...--me.
View my website!
www.justxnikki.webs.com 
Topic: RE: So upset with my PCP
Thanks so much I will be much more prepared for my next appointment. :)
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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
