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Topic: RE: Super Freaked out and nervous!
Open yourself to possibility and possibility will present itself.
It is, but I need you all to remind me too (Nan, I PMd you).
I'm trying to have a DS at GHP, but I live in Indiana and Grand Rapids is a three hour trip each way, so their 90 day/weekly program is not an option for me, and they told me today that if I can't do their 90 day program I have to do the six months.
Tomorrow I'll get back on the horse. Tonight I am angry and sad.
I'm trying to have a DS at GHP, but I live in Indiana and Grand Rapids is a three hour trip each way, so their 90 day/weekly program is not an option for me, and they told me today that if I can't do their 90 day program I have to do the six months.
Tomorrow I'll get back on the horse. Tonight I am angry and sad.
Open yourself to possibility and possibility will present itself.
Topic: RE: A whole lotta questions
Thanks for the info. I guess my choice is clear...switch to Med Mutual because they only require weight at 12 months of >40 bmi before application date and if I have a comorbidity after testing I can apply for surgery after 6 months of diet and if I not I can apply a few months later.
Topic: RE: A whole lotta questions
I am pretty sure they mean 24 months. For example if you weigh in in Oct 2010 at >40 and then expect surgery in 2011 after doing the 6 month supervised diet, they will want to see a weight from 2009. My daughter's exact denial letter read 'denied due to lack of proof of obesity present for 2 years'. We went back to 2007 and proved weights from 2007, 2008, 2009 and 2010 of her BMI >40 in the appeal and won.
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
Topic: RE: A whole lotta questions
Ok I did not realize the comorbidities had to be for the 2 years....talking to others who have had surgery they didn't mention this. What constitutes 2 years? Do they use months and years or just years? Like if I have a weight for 2010 at >40 and then at the end of my 6 month diet have a 2011 bmi of >40 is that all they look at? I ask because my friend that has Med Mutual had a baby in Jan of 2008 had her first weight of bmi>40 (previous to baby she was around 35 bmi) in the summer of 2008 then had surgery Oct 2009 and was approved.....this was only a period of about 14 months not 24 months...they just wanted a 2008 weight and 2009 weight.
Topic: RE: surgery codes
I SURE COULD HAVE USED SOME HELP WITH SURGERY CODES WHEN PRICING SURGERY AT LOCAL HOSPITAL THEY DO GASTRIC BY -PASS BUT MY SURGEAN HAS NEVER DONE REVISION SURGERY SO WHAT COULD HAVE COST 22,000 BECAME 65- 95 & PLEASE PAY IN ADVANCE SINCE I HAVEN'T ANY INSURANCE. SINCE IT IS MEDICALLY NEEDED NOT A OBTION I STARTED SEACHING DIFFERENT COUNTRIES. THEN I HAD TO WAIT FOR PASSPORT. NOW I'M SET WISH I WOULD HAVE KNOWN ABOUT THIS WEB SITE SOONER.
Topic: surgery codes
anyone know the surgery codes used for different types of surgery? I found this on OH:
http://www.obesityhelp.com/content/callingyourinsurer.html
are there more?
My insurance rep just found out Id be approved for the band but I dont want the band. I want the VSG or the D switch(something permanent).
http://www.obesityhelp.com/content/callingyourinsurer.html
are there more?
My insurance rep just found out Id be approved for the band but I dont want the band. I want the VSG or the D switch(something permanent).
Topic: RE: A whole lotta questions
Hi,
I have Aetna insurance also. I don't want to discourage you by all means, but you will not get approved with a BMI of under 40 and no documented co-morbidies. Even if you go for the sleep apnea test, the co-morbidies have to be present for the two years that your BMI was between 35-39.9. Otherwise, you have to show a BMI of over 40 for at least 2 years.
There are three of us so far in my family that were approved with Aetna. Myself and my daughter were approved on the 3 month multidisciplinary program and my son was approved by doing the 6 month physician supervised diet.
It is my understanding you must be seeing your PCP each month and it documented in office notes. If you are going going to the gym and seeing a personal trainer you must get it documented with your PCP in order for it to count toward the 6 month physician supervised diet. Aetna will not recognize it if it is not documented that you went 6 consecutive months to their office. I was denied at first for that exact same reason before completing the 3 month multidisciplinary program., My daughter was also denied, but we appealed on both of us and each time the denial was reversed.
My son did the 6 month physician supervised diet (he actually did 12 months) and was approved within 4 days.
Given the info you said in your post, I think it will be hard to get approved by Aetna, to be honest with you, only because you don't meet all of their requirements.
Nan
I have Aetna insurance also. I don't want to discourage you by all means, but you will not get approved with a BMI of under 40 and no documented co-morbidies. Even if you go for the sleep apnea test, the co-morbidies have to be present for the two years that your BMI was between 35-39.9. Otherwise, you have to show a BMI of over 40 for at least 2 years.
There are three of us so far in my family that were approved with Aetna. Myself and my daughter were approved on the 3 month multidisciplinary program and my son was approved by doing the 6 month physician supervised diet.
It is my understanding you must be seeing your PCP each month and it documented in office notes. If you are going going to the gym and seeing a personal trainer you must get it documented with your PCP in order for it to count toward the 6 month physician supervised diet. Aetna will not recognize it if it is not documented that you went 6 consecutive months to their office. I was denied at first for that exact same reason before completing the 3 month multidisciplinary program., My daughter was also denied, but we appealed on both of us and each time the denial was reversed.
My son did the 6 month physician supervised diet (he actually did 12 months) and was approved within 4 days.
Given the info you said in your post, I think it will be hard to get approved by Aetna, to be honest with you, only because you don't meet all of their requirements.
Nan
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
Topic: CareFirst of MD Insurance but living in VA
CareFirst of MD Insurance???????
Does your employer buy a ryder when they want to cover this surgery?
I'm working with our broker and trying to figure this out.
According to CareFirst policy:
CareFirst of MD Requirements for WeightLoss Surgury:
Virginia plan members only: must meet either of the above BMI criteria or the following:
Weight at least 45.5kg (100 lbs.) above or twice ideal body weight as specified in the
Metropolitan Life Insurance Tables. (see Tables Below)
http://notesnet.carefirst.com/ecommerce/medicalpolicy.nsf/vwwebtablex/59ce207e0f4213278525776500593437?OpenDocument#_Section4
I blow away the Met Life Tables:
6'4" Large Frame = 181-207.
I am 6'7" Large Frame 340lbs.
I gotta get this done. I want the VSG but if insurance will pay I'll do what ever they will pay for.
Any help would be appreciated.
Does your employer buy a ryder when they want to cover this surgery?
I'm working with our broker and trying to figure this out.
According to CareFirst policy:
CareFirst of MD Requirements for WeightLoss Surgury:
Virginia plan members only: must meet either of the above BMI criteria or the following:
Weight at least 45.5kg (100 lbs.) above or twice ideal body weight as specified in the
Metropolitan Life Insurance Tables. (see Tables Below)
http://notesnet.carefirst.com/ecommerce/medicalpolicy.nsf/vwwebtablex/59ce207e0f4213278525776500593437?OpenDocument#_Section4
I blow away the Met Life Tables:
6'4" Large Frame = 181-207.
I am 6'7" Large Frame 340lbs.
I gotta get this done. I want the VSG but if insurance will pay I'll do what ever they will pay for.
Any help would be appreciated.
Topic: RE: HOW DOES "SELF INSURED" affect approval
As long as your employeer hasn't excluded WLS from your policy the Aetna's medical policy guidelines will still apply. So as long as you meet their wls criteria, you'll get approved.
A l y s i a (pronounced like A l i c i a)
Total weight loss since HW of 475:
Pounds lost since band revision to DS
Total weight loss since HW of 475:
Pounds lost since band revision to DS
Topic: RE: A whole lotta questions
I also left out I have 6 weeks last Dec/Jan that I went to a doc and was prescibed phentermine and lost 10 lbs in first 2 weeks but then I quit because I didn't lose anymore weight for 4 weeks and it was costing me alot of money. I was at a 39 bmi then too so still not a weight of >40bmi from 2009. I went to Curves for 3 months also in 2009 (Oct-DEc) part of it while I was on phentermine and did not lose any weight besides the 10 lbs in those 2 weeks. I am still a member even though I have not been since Jan of last year since I signed a contract through work for a discount.
Just thought I would add...didn't know if this helps my case at all LOL
Just thought I would add...didn't know if this helps my case at all LOL
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