Insurance, Cash Pay and Financing

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moving-on
on 9/19/10 2:25 am - Rimrock, AZ

Topic: RE: NAN2008!!! YOUR LETTER GOT ME APPROVED!! BY CIGNA!

Wow that is so exciting. I am going to try this letter as well. I got approved on Aug 31 and started the whole process of testing and even was on the liquid diet for a week and boom get denied 2 weeks later. I have been just devastated. I wouldnt have been so depressed or upset if I got the declination first, I was prepared for a battle with the insurance company. I have been calling anybody and everybody and it looks like the long and short is they dont like that I started taking Zoloft in April of this year. Insurance company said they didnt like that i was being treated for Chronic depression..... What!!! since April. Gees, i am a single mom of two teenage boys (both of which are ADHD/ODD) and things have just become overwhelming. Between my declining health and raising kids I get very high anxiety and felt i needed some help for now... I know the insurance company is just looking for a way out, but I am looking for a way in and with this letter I hope to succeed just as you did. (sorry for the long post :) I am just frustrated and hope like you i will get an approval.

Moving on to better health

Amanda H.
on 9/17/10 2:18 am - Cooperstown, NY

VSG on 09/27/10

Topic: Not fat enough now....

My insurance just denied me during the "peer-to-peer" review with my surgeon because, get this, now I'm not fat enough.

In January of this year, I called to determine whether it was a covered benefit, and they said that my procedure (sleeve gastrectomy) was. They cover this procedure if your BMI is over 40, OR if it's 35-40 with two comorbidities. My BMI was 42 when I entered the bariatric program I eventually chose. However, the 10% pre-operative weight loss put me at a 38.2 with no comorbidities.

So I was declined. Twice. Now, I have to go through an internal appeal and an external (state insurance board) appeal process. This is SO unfair!!! I've become SO committed to this as a lifestyle choice that when my surgeon nudge-nudge, wink-wink hinted that he wouldn't hold me back from surgery if I regained the weight to get over a 40 BMI, the idea (if not the compassionate, sympathetic way it was presented) was distasteful to and angered me.

Anyone have any words of wisdom about fighting insurance companies?

M. DeVenney
on 9/16/10 11:03 am - Phoenxiville, PA

Topic: RE: BCBS Georgia

I am sorry you are having such issues. I worked in the medical insurance industry for years. Your parent's employer actually chooses the coverage. The insurance company only administers that coverage. So, it is possible that someone else, with the same insurance company (BCBS Georgia) who works for another employer/company is covered for bariatric surgery while you are not.

I know this is all crazy, but switching insurances won't help if the employer has rejected Bariatric surgery from the plan (because of cost) another insurance company with the same employer will most likely exclude the same benefit.

If one of your parents is employed with another company, it may be worth trying to see if that insurance company has Bariatric surgery covered. If it does, you can try switching to that parent;s plan. If not.....you need to get a job with insurance coverage yourself or start saving!! I hope this information helps. Good luck to you!

ambo424
on 9/16/10 12:04 am - berkeley heights, NJ

Topic: RE: looking for cigna approval

i haven't been approved yet (although everything's being sent to cigna this week!), but my cigna plan required me to do the 6 month diet, a nutrition apt, and a aquire psychiatric approval. my surgeon also made me have an edg. my only reccomendation is to get all of the other appointments overwith before the end of your 6 month diet, so that way when you're done with the 6 months, your PCP can write a letter and send it off. good luck :)

kjm92002
on 9/15/10 4:45 am - gastonia, NC

Topic: RE: Need help and/or advice

Thanks for the reply, I've recently began to look into finding another dr, I don't htink that financing would be to good of an option for me, so hopefully everything will work out for the best, thanks for the good luck wishes

Dorian

BeautyisherGODgiven
name
on 9/14/10 6:45 am

VSG on 06/28/11

Topic: RE: looking for cigna approval

my cigna plan also required 6 months. It started 8/31.. yeah, we are in it for the long haul

Follow my progress: www.youtube.com/user/livictori

BeautyisherGODgiven
name
on 9/14/10 6:42 am

VSG on 06/28/11

Topic: RE: NAN2008!!! YOUR LETTER GOT ME APPROVED!! BY CIGNA!

if is not to forward of me; may I ask why you were denied?

Follow my progress: www.youtube.com/user/livictori

ashtons07
on 9/14/10 4:18 am

Topic: BCBS Georgia

A little over 4 months ago, I went through the process of getting the lap-band surgery. I went to the meeting, got all the information and set up an appointment with the surgeon. The DAY OF my meeting with my surgeon, I get a phone call saying that my insurance does not cover Bariatrics. I have Blue Cross Blue Shield of Georgia. After the phone call, I called BCBS to ask them what the heck was going on. We have a HIGH premium, so I figured since we pay so much (my parents that is) that it would cover it. BCBS repeatidly told me that bariatrics is excluded from our plan and that there was nothing we could do about it.

I need some advice. I have put this off for long enough and I am ready to do something about it. If this means switching insurance companies then so be it.

Someone please tell me what to do!