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I have seen so many post about can someone tell me if BCBS covers this or Aetna covers this or if Cigna covers this, oh yes mine covered it, oh no mine didnt etc. you really have to understand asking this question this way will have no answer or at least the wrong answer.
1. it is not your insurance carrier but your specific policy
2. it is your responsibility to have and know what is in your subscriber agreement
3. everyone should have an updated copy of their subscriber agreement, going in for bariatric surgery especially, revision or conversions double yes-wow the lamb going into slaughter wihout it
4. A busy drs office will not be able to appeal everyone, they do this but it really is not their responsiblity is it the member's yes you.
5. the insurance company will count on you not having a clue, and you not having and knowing your right via your subscriber agreement they surely are correct, you make it easy to deny you.
6. you have to be proactive and not wait for others to do the work for you, you really have more power than you know, but ignorance is bliss.
7. You agreed to that policy, when you have your annual enrollment, you should know what you are buying, ahhh buyer beware.
Now go out and make sure you know what is in your subsciber agreement, then ask specific questions about your particular policy and how/why you are being denied, and know this BEFORE you even pre-cert for surgery, you should know you will be denied or approved before your pre-cert goes out. Ask the correct questions then you will get correct responses to your denials any other way will just be a waste of time.
in order to change your policy, your policy would have to change, it is just that what hollykim said. it was put in there intentionally, if drafted correctly that exclusion is binding and you cant do anything about it. you did pick the insurance either by one of the choices your employer offers or by picking that employer, it is really that simple. Get another insurance plan, get another job. those are essentially your 2 options.
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you can't get it changed. An exclusion means your employer didn't buy the coverage that includes Wls for its employees. Unless they decide to buy the coverage,the insurance will not pay for it.
greetings.....So I was wondering how to get my policy changed to including bariatric surgery! My job provides us with insurance but it has bariatric surgery as an exclusion. I really want to have surgery but do not know where to start! Id appreciate any help you guys can provide me in getting started on the right track!
I start my post -op diet tomorrow, but i've been working on it all weekend ... I got my protein powder today... and off I go. I still have to pass the meeting with the surgeon thursday and have pre- op testing tomorrow so I still have my fingers crossed... thanks
Here they are.....the Holidays. With the challenges of Holiday foods and get-togethers, cold temperatures making it difficult for exercise, along with other stressors, it can be difficult to stay on track.
Let's support each other in this thread by sharing any tips and strategies you use to stay on track with your healthy lifestyle.
(We will make this topic into an OH blog post with some of your helpful tips so we can share with more people and help the OH Community on their journey. OH Blog posts are shared on various social media outlets.)
YaY, She called and I have been approved for a VSG Procedure. My surgery date is Dec.1st.
first doesnt matter what your other insurance company approved unless you had surgery in that timeframe forget that one, this is a new contract YOU accepted when it changed over, so you have to use the contract that is in place at time of surgery.
so you have obesity surgery covered, but VSG they are saying no let me guess experimental?, well this is an such an easy appeal to win, since the vsg is now a covered standard of care for obesity. good luck on your next surgery
Hockeymom87 · 0 replies · 630 views
