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on 12/6/13 3:22 am
~~In addition, it was also noted that I was not in compliance with my 2 previous weight loss surgeries as far as dieting and exercising.~~
This is the one that is going to be tricky for you. The Nut appts are easy enough to take care of.
Ins co's are really cracking down on wls folks who have surgery after surgery. Most ins co's are going to a "one wls per lifetime" rule and they are being hard nosed about it as well. Even if someone was self pay for their surgery and they want a revision... the ins co's are looking at that self pay surgery as their once in a lifetime surgery.
They just aren't paying for repeated surgeries anymore. I would jump through whatever hoops are necessary to get your revision before your ins co follows the standard policy most are today... one per lifetime. Make this one right, follow the diet, cut out the white carbs, get to a gym. It is unlikely they will pay for a 4th surgery down the road.
on 12/6/13 3:16 am
Hi everyone question my plan says I' am covered for weight loss surgey. Under the plan Aetna has a lifetime cap of 10,000 is there a way around this? what are my options? Thanks hoping to be a future weightloss grad.I didnt the 3 month visit everything aetna ask but there a cap my wife job place a cap on the procedure.
No, there isn't. That is the cap, period.
Does it say who you have to go to? Some BC/BS plans allow you to go to Mexico where surgery in full would be cheaper than the $10K limit you have. MOST self pays go to MX, about 1% have insurance that will pay for them to go to MX.
Hi everyone question my plan says I' am covered for weight loss surgey. Under the plan Aetna has a lifetime cap of 10,000 is there a way around this? what are my options? Thanks hoping to be a future weightloss grad.I didnt the 3 month visit everything aetna ask but there a cap my wife job place a cap on the procedure.
Hi there-
I was denied for no evidence of mechnical failure of the original procedure. All my EGD and barium swallow tests keep coming back normal but Ive been in agony off and on for the past 2 years with a 10 year old band. It feels like the band and port are both pulling. Ive had to go on strong pain meds for it and yet there is no evidence of mechanical band failure. They also denied saying that weight loss surgery to treat diabetes with a BMI under 35 is considered experimental. Problem is the insurance person put the wrong weight and Im not even DIABETIC!! I have a BMI of exactly 35 right now. I got a letter from the surgeon saying that a mistake had been made and that my correct weight is 230 and BMI is 35. He also corrected the diabetes diagnosis. I have a bunch of other co-morbidities and take 7 meds a day. Ironically, diabetes is the only thing I dont have. The whole thing has been a nightmare. I thought it would be easy with all the problems that I already have. Congrats on getting your surgery done!
Why did Cigna deny you? I have Cigna was denied as well and I appealed and won.
VSG on 1/14/14 with Dr. Samuel Wasser
I received a notification from Cigna today that my request for an independent review of their denial was being sent to a company called MCMC which I think stands for medical care management corporation. Has anyone else had any contact or experience with these guys before?
My appeal was approved and my surgery date is January 14th! I didn't think would ever happen.
VSG on 1/14/14 with Dr. Samuel Wasser
My first appt was July 12 then August 12th, Sept 13th and October 11th! I thought that Sept 13th was going to be the last but it was 3 months from the first visit.
Your two appt. you had in Oct wasn't a good idea! Remember 30 days from the last appt. Good luck!
VSG on 1/14/14 with Dr. Samuel Wasser
HW: 274 | SW: 232 | CW: 137 | Goal: 145 (ticker includes a 42 pound loss pre-op) | Height: 5'4"
M1: -24 (205) | M2: -14 (191) | M3: -11 (180) | M4: -7 (173) | M5: -7 (166) | M6: -8 (158) | M7: -11 (147) | M8: -2 (145) | M9: -3 (142) | M10: -2 (140) | M11: -4 (136) | M12: -2 (134) | M13: -0 (134) | M14: -3 (131) | M15: +4 (135) | M16: +2 (137)
I appreciate you chiming in. My first consultation appt. with the dietician was Oct 16 she said we could meet again the next appt on Oct 30. Next visit was Nov 22. My next appointment is Dec 11. I suppose I will have to do another visit to make it 4. But the days between the visits are too early. I was trying to get my visits done as soon as possible so I could get the surgery done before January.
Looks like i scheduled all these appts wrong. I bet that I will have to start all over again. I am going to call BCBS tomorrow to confirm that.
So did you have to do your appoints all over again since it was not 90 days?
Virgie Tschirhart
Lap Band - 2008, Sleeve - 2009, RYN - 2017
Started Program Weight July 13, 2017 - 194.2
Before Surgery Weight December 27, 2017 - 185.0
Current Weight - February 2018 - 161.0
Hockeymom87 · 0 replies · 617 views
