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Topic: RE: surgery codes
if you google the surgery, say VSG CPT Code, you should be able to locate the codes. Most insurance companies will also have the Codes listed on their medical policy that they cover.
Keep a smile on your face....it makes people wonder what you are up to!
Topic: RE: Updates on Aetna Appeal Denial/Peer to Peer question
they are upholding the lack of six month documentation, even though I had 6 visits with a physician and two pages of notes per visits... very confusing.... the worst part is they will not tell me why they are not accepting the documentation
Topic: RE: Is the deductible pd to hosptial or surgeon?
It depends on the hospital or the surgeon. When I had my surgery, they did not collect anything up front other than a very small co pay. But my out of pocket amount, which was about $1800, I received bills for after I had my surgery from different people (hospital, anesthesiologist, surgeon).
When my daughter had surgery, about a year after me, same bariatric center, same hospital, they collected the co pay (approx $1,800) upfront. Apparently they changed their policy from the time when I had it.
You would need to check with your surgeon to see what his policy is on that.
Nan
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
Topic: RE: Are nut & psych evals covered by Cigna?
My physician supervised diet was paid for by my insurance. I had to go to my pcp for 'weight management' and all's I had to pay was the $20 co pay. The remainder of the bill was paid by insurance.
Also, my psych eval (as well as my kids, all of which have been approved for or are going through the approval process) was covered by insurance. Again, I had to pay the co-pay, the the rest was covered.
As far as the dietician, where I work we have a registered dietician on site and I was able to go to her. Her service is free of charge to employees, so I lucked out there. I know when my son went to a dietician a few years back, the insurance did not cover that visit.
Hope this helps,
Nan
Also, my psych eval (as well as my kids, all of which have been approved for or are going through the approval process) was covered by insurance. Again, I had to pay the co-pay, the the rest was covered.
As far as the dietician, where I work we have a registered dietician on site and I was able to go to her. Her service is free of charge to employees, so I lucked out there. I know when my son went to a dietician a few years back, the insurance did not cover that visit.
Hope this helps,
Nan
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
Topic: Is the deductible pd to hosptial or surgeon?
I keep reading conflicting things. Is the deductible paid to hosptial or surgeon? Does it have to be paid in full prior to surgery?
Topic: RE: AETNA approved then denied. any help appreciated
thanks Nan.. I appreciate your reply & help :)
Topic: RE: AETNA approved then denied. any help appreciated
Hi
I sent you a PM. If I'm reading it right, you were denied because you did not complete their 3 month Multidisciplinary or the 6 month physician supervised diet. I'm thinking that besides the Revision requirements, you also have to meet the requirements for bariatric surgery which would include a physician supervised diet, along with BMI >40 or >35 with 2 co-morbidies, and proof of 2 year history of obesity.
Check out the PM's I sent you!
Nan
I sent you a PM. If I'm reading it right, you were denied because you did not complete their 3 month Multidisciplinary or the 6 month physician supervised diet. I'm thinking that besides the Revision requirements, you also have to meet the requirements for bariatric surgery which would include a physician supervised diet, along with BMI >40 or >35 with 2 co-morbidies, and proof of 2 year history of obesity.
Check out the PM's I sent you!
Nan
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
Topic: Are nut & psych evals covered by Cigna?
I know I will find out "soon enough" and could probably (gasp!) call them to find this out but does anyone know offhand if the nut and psych evals required by insurance covered by insurance? I know the 6 month of diet documentation wasn't but I keep hearing that those are both EXPENSIVE ($500+) for one time visits(?)
Topic: RE: How did you do your 6 mo. of medically supervised WL if your insurance required it?
My insurance required it as well and it wasn't covered (I find that ironic but anyway...)
I, too, had to pay out of pocket for visits with the exception of blood work that was also required. My insurance paid for that.
I, too, had to pay out of pocket for visits with the exception of blood work that was also required. My insurance paid for that.
Topic: RE: Insurance Reform Resources FYI
Is it easier to get insurance coverage if one's BMI is over 48 ?
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