Recent Posts

lovemyhorse
on 2/15/14 4:13 am, edited 2/15/14 4:30 am
Topic: RE: Denial due to non compliance??? Really!!

I am going through the same crap. I had my band placed in 2003 and only lost about 20 lbs.. I had fills and unfills and never could get it right. it was either everything went down with no obstruction or completely nothing for the first 3 years with the band. Then, Went through lots of IVF treatments and had 2 kids then nursed both so for 6 years I couldnt have a fill in my band anyway. Went to the original surgeon who placed the band. (HIS OFFICE LOST MY ENTIRE ORIGINAL FILE!) Last 2 years started trying again to see if I could get the right fills level. This time the band started causing loads of pain. Turns out trying to get it filled the last 2 years caused a severe slip and it i****ting my diaphragm. So, fought Cigna for the past year and they finally agreed to pay for band removal but will not pay for revision to sleeve due to non-compliance. So Cigna is saying that I meet all the other criteria but until I produce that now non-existant record, they will not pay for sleeve. How are we supposed to argue with that? To say we were not compliant is an opinion, not a fact. I would saying trying for years and years to avoid surgery again and work with a sleeve that isnt helping, is compliance. 

SunnyGal14
on 2/13/14 3:56 am
VSG on 08/06/14
Topic: RE: So Frustrated with Insurance

Ugh, that stinks! Dealing with insurance is difficult. 

Colleen O.
on 2/11/14 9:12 pm
VSG on 04/09/14
Topic: RE: So Frustrated with Insurance

Thank you!  I did exactly what you suggested over a week ago.  I waited a couple of days and then called and left a voicemail with the insurance company asking if they had received anything.  No response.  I left another message on Monday.  No response.  I emailed the insurance company to ask how to escalate customer service issues and was told a supervisor would contact me.  No contact.  Grrrrrr....

  

HW: 387 (12/13)  ConsultW: 383 (12/13)  SW: 321 (4/9/14)  CW: 234.6 (10/19/14)

SunnyGal14
on 2/11/14 1:01 pm
VSG on 08/06/14
Topic: RE: So Frustrated with Insurance

No, you are not being unreasonable.  Sorry you are having such a hard time. Maybe get the exact number from the insurance company of where to send the paperwork to then give that to the bariatric office and ask them to resubmit.  Good luck!

Colleen O.
on 2/11/14 3:23 am
VSG on 04/09/14
Topic: So Frustrated with Insurance

I went to my initial seminar for WLS the first week of December.  BEFORE I went, I contacted my insurance company and found out their requirements just so I knew what was in my future.  At the seminar, the nurse said we could go ahead and do any of the requirements that were possible before our initial consult with the surgeon.  In December, I saw my PCP, the NUT, and had my pych evaluation to get ahead of schedule.  When I met my surgeon for the first time on January 17th, I received the list of what was left to process (sleep study, pysch eval sent to office, and endoscopy).  I was told that the sleep study and endoscopy would not hold up scheduling a surgery date.  I called the psychologist that day and had him fax the evaluation right away.  All of my info was received and sent for approval at least two weeks ago according to the bariatric center (nurse and insurance coordinator).  I contacted my insurance company to ensure they had received everything.  I was told nothing was received.  I then called the bariatric center and was told that a lot of times the customer service people at the insurance company don't have access to the right information.  So, I called the insurance company back and was given another phone number to called that was specifically for bariatric surgery claims/approvals.  I called that number and the ONLY option you have is to leave a voicemail for a callback.  I received a callback over 24hrs later which said that the center needed to fax the submission to a specific number and nothing had been received yet.  I call the center back and they insist everything has been submitted and is "pending".  A week later, I still have not heard anything.  I called the insurance and left two more voicemails (one on Friday and one yesterday) and have not received a callback.  I am not expecting a 24hr approval - I just want to know that everything has been received!  I'm so frustrated that I 1. can't talk to a live person when I call, and 2. have no idea where my personal medical information is floating around within the insurance company.  Am I being unreasonable to expect a callback with SOME kind of information (even if it's that they haven't received anything) after 48hrs??

  

HW: 387 (12/13)  ConsultW: 383 (12/13)  SW: 321 (4/9/14)  CW: 234.6 (10/19/14)

Member Services
on 2/11/14 2:33 am - Irvine, CA
Topic: The latest from Dr. Alvarez

We have a new Obesity Chat from Dr. A.  The new episode can be uploaded at www.obesitychat.com or the latest episode's direct link is:  http://guillermoalvarez.podomatic.com/entry/2014-02-11T08_42 _07-08_00

Thanks Dr. Alvarez!

SunnyGal14
on 2/9/14 12:59 pm
VSG on 08/06/14
Topic: RE: Did you get this info. In writing?

Yes, my insurance referred me to the correct policy number to look up online when I called.  I printed it online. I too have to do the six months, etc. I have my first appointment this month. I am still confused about some of my requirements though which hopefully the bariatric office staff will help with, since I'm getting conflicting answers from my insurance company and the policy about weight loss surgery is vague.

SunnyGal14
on 2/9/14 12:52 pm
VSG on 08/06/14
Topic: RE: insurance approval

Do you know if in fact your insurance requires the bmi of 40? Most insurance companies will take a bmi of 35-39.9 with co morbidities.  I would call the insurance company. Good luck!

HKFandora
on 2/6/14 10:15 pm
Topic: Did you get this info. In writing?

I called my insurance and I'm waiting for them to send me the handbook where hopefully I can get specific info regarding coverage and bariatric surgery.

 

On the rep's end she didn't see a specific amount of time needed (I was told six months before.) I was then put on hold and she spoke to someone in the authorization department and in short I was told it doesn't hurt to have the surgeons office put the claim in early and at least I will know what else might be needed. I found this interesting. I'm a revision or a completion to the DS. 

 

Anyone who need or needed to do a six month consecutive visit with your doctor, did you ever see it in writing from your insurance? 

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