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Topic: RE: I LOVE BCBSAL!!
Hi Channel --
I also have BCBS AL and I just got denied for RNY. They said that my 6month medically supervised diet didn't meet their requirements. I've been seeing a registered dietician for 6 consecutive months where they weigh me each month and we go over goals, etc. I'm so disgusted. I'm waiting for the denial letter to come in the mail so that we can appeal this decision. I've spent almost 8 months preparing for this surgery...which was supposed to be tomorrow!
I also have BCBS AL and I just got denied for RNY. They said that my 6month medically supervised diet didn't meet their requirements. I've been seeing a registered dietician for 6 consecutive months where they weigh me each month and we go over goals, etc. I'm so disgusted. I'm waiting for the denial letter to come in the mail so that we can appeal this decision. I've spent almost 8 months preparing for this surgery...which was supposed to be tomorrow!
Topic: RE: How did you do your 6 mo. of medically supervised WL if your insurance required it?
Karen- who is your insurer... I am going through the same type of thing with aetna right now...
Topic: RE: How did you do your 6 mo. of medically supervised WL if your insurance required it?
I was scheduled for surgery tomorrow and just found out that my insurance is denying coverage. I've been going thru a 6 month nutrition program with a registered dietician and the insurance company said that the registered dietician didn't count as "medically supervised" because notes of my progress have to me contained within my medical history with an MD and that can't include my bariatric surgeon. I'm just disgusted!!! I hope your insurance isn't as strict or has loop holes. I'm going to appeal the decision, but I've been working toward this day for over 8 months only to be denied. Ugh.
(deactivated member)
on 10/5/10 1:27 am - Vacaytown, HI
on 10/5/10 1:27 am - Vacaytown, HI
Topic: RE: DENIED BY AETNA ON APPEAL
Id add to get a copy of the insurance criteria from the Aetna website. If each criteria is met and they denied you may have legal recourse. Hang in there I went through it 5 years ago but got my surgery and am still doing well.... its worth the fight :)
(deactivated member)
on 10/5/10 1:04 am - GA
on 10/5/10 1:04 am - GA
(deactivated member)
on 10/4/10 5:25 pm - Vacaytown, HI
on 10/4/10 5:25 pm - Vacaytown, HI
Topic: RE: Insurance Reform Resources FYI
Well one thing I would say is see another MD for a second opinion. When I started the wls process my primary MD was opposed so I found a new one who had a fundamental belief in it and had close ties to the surgeons.
In my experience keeping a daily documentation on food intake and exercise will help with justification for any procedure. Also statsical analysis comparing the two procedures and how it applies to your case.
The new laws are helping with pre exsisting condition issues and more things are developing. But stay tuned on any changes that might apply in the bariatric world.
You are not going crazy... but it is very frustrating. At 5 yrs out i lost all the weight but my mind is still of the "fat girl" I still like food and want to eat. Boo hiss lol.....
And on a positive note... its great u lost 80!
In my experience keeping a daily documentation on food intake and exercise will help with justification for any procedure. Also statsical analysis comparing the two procedures and how it applies to your case.
The new laws are helping with pre exsisting condition issues and more things are developing. But stay tuned on any changes that might apply in the bariatric world.
You are not going crazy... but it is very frustrating. At 5 yrs out i lost all the weight but my mind is still of the "fat girl" I still like food and want to eat. Boo hiss lol.....
And on a positive note... its great u lost 80!
Topic: RE: How did you do your 6 mo. of medically supervised WL if your insurance required it?
My insurance company covers non-surgical weight loss programs. I see a dietician at a local hospital. My lazy PCP is making my dietician fill out the 6 months of visits and progress notes and then she is gonna sign them. My surgeon's office sent me in the info package about their program, 6 months worth of blank forms for the PCP to fill out plus a sample sheet of how to fill it out.
When it comes time to send the stuff to the Ins. company for auth., the surgeons office sends that stuff in, they deal with it all the time and should know what to do.
Do you have a surgeon picked out, if so contact them and ask for info on their program and they may be able to answer some of your questions on that, mine was very helpful. Now some of the hospitals in my area won't even see you for a consultation till you have finshed your 6 months of diet supervision.
When it comes time to send the stuff to the Ins. company for auth., the surgeons office sends that stuff in, they deal with it all the time and should know what to do.
Do you have a surgeon picked out, if so contact them and ask for info on their program and they may be able to answer some of your questions on that, mine was very helpful. Now some of the hospitals in my area won't even see you for a consultation till you have finshed your 6 months of diet supervision.
Topic: RE: Insurance Reform Resources FYI
Hi, I was wondering if you can help me with this. I had VG done last year in November. My weight loss slowed down within 4 months of the surgery, and its been an uphill battle with losing weight. I have managed to lose about 80 pounds, putting me at 195 @ 5'5'. According to my surgeon is this very good, but I have repeatedly told him that I'm always hungry, basically dieting and at the gym 1.5-2 hr/day, five days a week to lose the weight. During the summer, I hit the gym very hard, and was spending 2 hours working out, in addition to walking everywhere, and keeping my caloric intake to around 1200-1500. For all my efforts I lost only 15 pounds in 4 months...and my surgeon suggested to increase the caloric intake to make-up the difference for the workouts. I have done just that, working with a dietitian and a personal trainer. I am living my life with all these rules to follow, yet my body is refusing to lose any more weight.
Long story short, I honestly believe at this point it is back to fighting with my body again trying to lose the weight. I'm so depressed, trying to hold back tears as I write this. You have to understand that I had fought for VG with two different insurance providers before I was approved, and I believed that with my hard work and determination, VG would work for me. It has been soul crashing to see my efforts bringing in almost no results. In my guts I knew something was wrong when 4 months out, my weight loss slowed down greatly. And since then, its been just such a battle with this body trying to lose the weight. At the time I did not know about DS, which I now believe would have been the better surgery for me. Given my starting weight of 300+, VG was not appropriate. I emailed my surgeon at Kaiser, and he replied in bold letters that any WLS surgery is NOT an option for me anymore.
What can I do now, can I make an appeal to have Kaiser pay for me to get the DS done elsewhere...do I even have a strong case? I know I'm not a year out yet, but believe me, I'm back to dieting and working out because my body is just fighting me at every chance to not lose anymore. Believe me guys, I know, I just know I am going to lose this battle. Every time I write on VG forum for support or feedback, I'm questioned on my eating habits, and told to try this or that. This is not magic, I know what I am eating, and how much, and the efforts I'm putting at the gym. I have given it my all, just to start back right where I was a year ago. I'm so depressed, I've know for months this surgery was not working, but the fear of failure kept me working out and dieting, and just been hungry all the time. I kept telling myself, I have to do this, or try that with this...but really, the reality is this is just not working. Something is very wrong, and I know it in my gut.
Since I lost 80 pounds, everyone thought I was doing great. I've been struggling, because I'm hungry, yet I try to stay within the caloric range, and I work out...I'm following all the rules, but my weight has not moved from 195. I feel like no one wants to valid this reality for me..from the VG forum, to my surgeon, and my family and friends. I'm telling everyone I'm struggling, but I feel like no one wants to acknowledge it. AM I JUST GOING CRAZY? Do I have any hope for petitioning for DS with a surgeon that flat out said NO! And I have Kaiser, which means I have a better chance of winning the lottery to pay for it. What can I do here? Will the new healthcare laws enacted help me out in anyway. As you can tell, I'm very heartbroken about my weight loss journey, its not been easy at all. If you have any ideas, suggestions, or insight to help, please let me know.
Long story short, I honestly believe at this point it is back to fighting with my body again trying to lose the weight. I'm so depressed, trying to hold back tears as I write this. You have to understand that I had fought for VG with two different insurance providers before I was approved, and I believed that with my hard work and determination, VG would work for me. It has been soul crashing to see my efforts bringing in almost no results. In my guts I knew something was wrong when 4 months out, my weight loss slowed down greatly. And since then, its been just such a battle with this body trying to lose the weight. At the time I did not know about DS, which I now believe would have been the better surgery for me. Given my starting weight of 300+, VG was not appropriate. I emailed my surgeon at Kaiser, and he replied in bold letters that any WLS surgery is NOT an option for me anymore.
What can I do now, can I make an appeal to have Kaiser pay for me to get the DS done elsewhere...do I even have a strong case? I know I'm not a year out yet, but believe me, I'm back to dieting and working out because my body is just fighting me at every chance to not lose anymore. Believe me guys, I know, I just know I am going to lose this battle. Every time I write on VG forum for support or feedback, I'm questioned on my eating habits, and told to try this or that. This is not magic, I know what I am eating, and how much, and the efforts I'm putting at the gym. I have given it my all, just to start back right where I was a year ago. I'm so depressed, I've know for months this surgery was not working, but the fear of failure kept me working out and dieting, and just been hungry all the time. I kept telling myself, I have to do this, or try that with this...but really, the reality is this is just not working. Something is very wrong, and I know it in my gut.
Since I lost 80 pounds, everyone thought I was doing great. I've been struggling, because I'm hungry, yet I try to stay within the caloric range, and I work out...I'm following all the rules, but my weight has not moved from 195. I feel like no one wants to valid this reality for me..from the VG forum, to my surgeon, and my family and friends. I'm telling everyone I'm struggling, but I feel like no one wants to acknowledge it. AM I JUST GOING CRAZY? Do I have any hope for petitioning for DS with a surgeon that flat out said NO! And I have Kaiser, which means I have a better chance of winning the lottery to pay for it. What can I do here? Will the new healthcare laws enacted help me out in anyway. As you can tell, I'm very heartbroken about my weight loss journey, its not been easy at all. If you have any ideas, suggestions, or insight to help, please let me know.
Topic: RE: How did you do your 6 mo. of medically supervised WL if your insurance required it?
Did you do it with your PCP?
On October 4, 2010 at 7:42 PM Pacific Time, kurn07 wrote:
Insurance did not cover. 60 bucks a pop.
Topic: RE: How did you do your 6 mo. of medically supervised WL if your insurance required it?
Insurance did not cover. 60 bucks a pop.
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