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(deactivated member)
on 10/12/10 4:14 pm
on 10/12/10 4:14 pm
Topic: RE: ? Medicare and seeing Dr.Nagle
I was wondering if you have an update on whether Medicare covered it?
(deactivated member)
on 10/12/10 3:40 pm
on 10/12/10 3:40 pm
Topic: RE: Illinois Medicaid - anyone w/ experience?
I would like to know this as well. If I find out, I'll let you know.
Topic: RE: aetna - peer to peer APPROVED
Congratulations!! I still remember the day I was called by Aetna and told my denial had been reversed! I think I started crying I was so happy! And the day my daughter got the call that her denial was reversed, I was so happy! It's a great fee It's a great feeling of relief! I think the whole insurance approval process is the most stressful part of this whole WLS journey!
Good Luck to you!
Nan
Good Luck to you!
Nan
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
Topic: RE: aetna - peer to peer APPROVED
Congratulations! I know you're probably doing the happy dance. 
Kim
5'0"
"In two decades I've lost a total of 789 pounds. I should be hanging from a charm bracelet." Erma Bombeck
5'0"
"In two decades I've lost a total of 789 pounds. I should be hanging from a charm bracelet." Erma Bombeck
Topic: RE: Are nut & psych evals covered by Cigna?
make sure you get referrals from your pcp. mine were both covered. my surgeon also required an egd, and that was covered too. just make sure to get a referral!
Topic: RE: Empire Blue Cross Blue Shield says VSG is still Experimental????
I got approved for VSG through BCBS North Dakota, PPO. I had to appeal an initial denial, and BCBS sent my appeal out for an external review on thier own. As usual the reason for denial was "investigational". I am almost 3 months out from surgery and including the 3 months prior to surgery that I was off my immunosuppressant meds, I have saved them more than $12,000 in prescription costs alone. The VSG is a much less expensive procedure than RNY, and way more effective than the band in most cases. I wish BCBS would embrace it instead of fighting it.
Do you have any comorbidities or health issues that could preclude you from the RNY or Band? I could send you a copy of my appeal letter if you want. PM me your email if you are interested. Good luck!
Do you have any comorbidities or health issues that could preclude you from the RNY or Band? I could send you a copy of my appeal letter if you want. PM me your email if you are interested. Good luck!
Topic: RE: HOW DOES "SELF INSURED" affect approval
The advantage to your company being self insured, is that if Aetna continues to deny you for surgery, you may be able to appeal to your company's HR department. I thought I was going to have to do that with BCBS, but they approved me on appeal.
Topic: aetna - peer to peer APPROVED
I am completely shocked. After being given a verbal approval, receving a denial letter, my surgeon did a peer to peer yesterday & the denial was overturned.. I AM APPROVED!
Topic: RE: How did you do your 6 mo. of medically supervised WL if your insurance required it?
No the way I typed that sounded like I did but I did the 3 month multidiscipline program for Aetna. I did have 8 months worth of WW and when I submitted my paperwork to the surgeon's office, they saw the 8 months of WW and submitted my paperwork, thinking that Aetna would recognize it as the 6 mo medically supervised diet.
At the time, I was about 2 1/2 months into the 3 mo multidiscipline program. I had no idea the surgeon's office was going to submit....I thought they knew I was still seeing my physician for the 3 mo MD program. The insurance specialist at the surgeon's office was new on the job and was going to 'surprise' me by getting me approved and sending in my paperwork. I was sick when I got the letter and heard the news that I was denied because I was still in the process of meeting the requirement of the 3 mo multidisciplinary program.
so what I did is finish up with the remainder of the 3 mo MD program and submitted my own appeal. And I won.
So long story short (LOL) no, I only did the 3 month MD program, not that plus 6 months physician supervised.
My daughter was also approved on the 3 mo MD program, and my son has just been approved by doing the 6 month physician supervised diet. I have one other son, who just finished his 3 mo MD program and we are submitting at the end of this week for approval!
Nan
At the time, I was about 2 1/2 months into the 3 mo multidiscipline program. I had no idea the surgeon's office was going to submit....I thought they knew I was still seeing my physician for the 3 mo MD program. The insurance specialist at the surgeon's office was new on the job and was going to 'surprise' me by getting me approved and sending in my paperwork. I was sick when I got the letter and heard the news that I was denied because I was still in the process of meeting the requirement of the 3 mo multidisciplinary program.
so what I did is finish up with the remainder of the 3 mo MD program and submitted my own appeal. And I won.
So long story short (LOL) no, I only did the 3 month MD program, not that plus 6 months physician supervised.
My daughter was also approved on the 3 mo MD program, and my son has just been approved by doing the 6 month physician supervised diet. I have one other son, who just finished his 3 mo MD program and we are submitting at the end of this week for approval!
Nan
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
Topic: RE: Updates on Aetna Appeal Denial/Peer to Peer question
i am so sorry this is happening to you. i went to this site: www.obesitylaw.com to see what services they offered in case i need them. i think they are worth a call. i dont understand how insurance company can get away with what they are doing. please keep me posted!
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