Recent Posts

Dial_M.
on 10/16/10 4:20 am - Los Angeles-ish, CA
Topic: RE: I am Approved
Congrats!
Be sure to update us when you get your date!
Best wishes!

~Michelle

"Everything I did in my life that was worthwhile I caught hell for." ~Earl Warren
 
Dial_M.
on 10/16/10 4:17 am - Los Angeles-ish, CA
Topic: DS denied because of BMI under 50
Blue Shield (HMO) denied me because they require a BMI of 50 or greater and because there is not a DS surgeon in the network.

Has anyone with a BMI under 50 been able to win an approval for the DS when the insurance company requires a BMI of 50 or greater?

~Michelle

"Everything I did in my life that was worthwhile I caught hell for." ~Earl Warren
 
April Greer
on 10/16/10 4:17 am - Springfield, MO
Topic: RE: aetna - peer to peer APPROVED
     What exactly did you find out regarding their diet requirements for a revision?  My PCP is getting ready to sign off on my six months did with WW.  However, I started this before I decided to check back on getting a revision so everything I've done was online at home.  Any insight would be helpful.  Thank you.
April     
Dial_M.
on 10/16/10 4:03 am - Los Angeles-ish, CA
Topic: RE: surgery codes
I have seen 43843 for the VSG and 43845 for the DS. When you call ask what are their medical requirements (such as BMI) for each surgery.

~Michelle

"Everything I did in my life that was worthwhile I caught hell for." ~Earl Warren
 
yourstruly
on 10/15/10 2:22 pm
Topic: MN GAMC? anyone?
 I have inquired on the MN forum, and the Duodenal Switch forum, so I thought I would try here too. (Can't hurt, right?)

I live in Duluth MN, and have GAMC (General Assistance Medical Care). It's just a straight Medicaid. I have no HMO. Anyone in here have the same insurance and successfully got the Duodenal Switch?

I know it pays for Lap Band, RNY.. I called the insurance and they told me that Bariatric Surgery IS covered, as long as it's medically necessary. I asked the lady specifically what was covered, and all she said was Bariatric Surgery, so I asked her if Duodenal Switch was covered, and she said she didn't know. (Wow.. the people they hire to work for these companies...) 
I asked her to check, and she wouldn't. I told her I was not going to try to go through all the requirements for surgery, and then be denied because the surgery of my choice was not covered. She told me it should be as long as it's medically necessary. 

It took me a long time to get through to these people, as every time I called, I was told there was a high call volume and I would have to call back later, and it hangs up on me. 

Do you think I have a good chance of getting Duodenal Switch covered?
It's not offered in my area, so I will be traveling to Twin Cities to get it done. 

Thank you for you time 
deedee21573
on 10/15/10 10:35 am - Oklahoma City, OK
Topic: Aetna PPO - Thyroid Condition exclusion - Help?
I am hoping to have surgery soon after the new year. I currently have an HMO that does not cover WLS at all and am switching to the Aetna PPO plan which does offer it with all the hoops to jump through. I was pretty excited until I read today in the policy that you can not have an endocrine or thyroid condition.

Well...2 months ago I was diagnosed with Hoshimoto's Thyroiditis. Given meds and will go back to see the Dr. in 3 months. I have been morbidly obese since at least 17 when at my lowest remembered weight of 217. In 20 years I have gained 200 lbs. I am certain it has nothing to do with my thyroid but now I am super freaked out wondering if they are going to deny me based on this. What can I do? I can't convince my Dr. I don't have this condition...

Has anyone else had to face this hurdle?
amyskieblu09
on 10/15/10 5:10 am - Hillsboro, OH
Topic: RE: I am Approved
Thanks so much !!!!!! I sure do hope time flies by I was told that usally when i go to this physical and history appt  and get my date, that is usally scheduled 1 or 2 weeks after that but the person who told me that has never had surgery like this but i really pray she is right  I am ready to be on the looser's bench with everyone living a healthier life!!!!!
Nan2008
on 10/13/10 10:46 pm - Midland, MI
Topic: RE: I am Approved
CONGRATULATIONS!!!!  I still remember the day I got the phone call that I was approved!  The time will fly by til surgery!

Good Luck to you,
Nan

Nan

HW 300
/ SW 280 / CW 138 /
GW 140
Hit Goal 4/2/2010

        
amyskieblu09
on 10/13/10 9:01 am - Hillsboro, OH
Topic: RE: paying for bariatric protein shakes and vitamins
you say you get food stamps... there are some protein shakes that you can get on food stamps  if you go to the USDA web site it clearly explains as long it has a nutrition label and not a  supplement label you can get the protein powder on your food stamps! I found mine at krogers  it is designer whey  protein it has 18g of protein  200 mg of calcium and only 2 g of fat i by mine at krogers it rings up as a cash purchase but if you print the statement from the usda website and show it to a manager they have to give it to you on your stamps that is how i get mine As far as the vitamins I am still working on that myself i usally get some when the drugstores have them onsale buy 1 get 1 free. Hope that helps.
amyskieblu09
on 10/13/10 8:51 am - Hillsboro, OH
Topic: I am Approved
Oh my gosh I called my insurance today to check the status of the authorization request for the surgery and the woman at Molina said congratulations! you are approved !!!!!! I was so happy i just couldnt stop thanking her. lol! I go to see my surgeon on the 29th of October for my History and physical and Nicole from Dr. Schumacher's office said I will get my surgery date then . I am just so excited and had to share my news with everyone!
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