Recent Posts

Member Services
on 10/9/13 8:06 am - Irvine, CA
Topic: Patient Bariatric Surgeon's Reunion

Staff and attendees had a great celebration at our recent 2013 ObesityHelp Conference.  It is so much fun to be with other pre-op and post op WLS'ers.  

 Bariatric surgeons regularly hold patient reunions for their patients.  If your bariatric surgeon has an upcoming Patient Reunion, please reply to this post with the surgeon's name, date and details so other patients of your surgeon can be aware of the upcoming get-together.  
 

Thanks!!
Member Services Team
  View more of my photos at ObesityHelp.com

GigiT
on 10/9/13 3:13 am - TX
Topic: Need help on how to appeal Cigna's denial _HELP!!!

I have been denied twice by Cigna. First was because the In-Network doctor submitted a claim to a non network facility.  We got that straighten out.  Now Cigna has come back again to say I was denied me for the sleeve for the following reasons:

They say medical necessity has not been established because:

1. The documentation submitted does not confirm that technical failure has been demonstrated on upper GI and EGD.

2. the documentation submitted does not confirm that due to technical failure of the original bariatric surgical procedure you have failed to achieve adequate weight loss as defined above at the least 2 years following original surgery (I had the lapband surgery that never worked for me)

3. The documentation submitted does not confirm that you have remained fully compliant with the medically prescribed postoperative nutrition and exercise program.

The doctor is going to attempt a peer to peer review, should I do anything else?  The lapband didn't work for me.  I have high blood pressure, my PCP submitted a report showing my heart is affected by the high blood pressure.  I have tried everything imaginable to try to lose weight and I can't keep it off.  I even bought a dog to walk only to find that I could walk about couple of blocks before hip started to hurt and feet went numb.  I just don't know what to do at this point.

If someone could guide me so I can get approved.

 

Thank you!

 

Gigi

    

        
rivieramaya05
on 10/8/13 7:22 am - TX
VSG on 12/16/13
Topic: RE: Longshot Question about insurance
Thanks for the reply! Hoping for the best









 

noftessa0401
on 10/8/13 7:18 am - San Diego, CA
RNY on 12/27/12
Topic: RE: Longshot Question about insurance

I'm sorry no one replied to this.  It really depends on each insurance company.  For example, Aetna requires that the 6-month supervised happen within 2 years prior to the surgery.  They have a 3-month option that they require happen within the 6 months prior to the surgery.  It appears that BCBS's medical policy bulletin is silent as to the timing, so, you might make it.

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)

Member Services
on 10/8/13 3:21 am - Irvine, CA
Topic: Non-Scale Victories (NSVs) for pre-ops, post-ops and non-ops

We LOVE NSVs.  Check out this video on NSVs that contains some of our fellow OH members and speakers from the 2013 ObesityHelp Conference, courtesy of OH Member, Beth Sheldon-Badore.  Inspiration for all of us as we live our healthy lifestyles every day. 

What are some of YOUR NSVs?

DeeDeeLynne60
on 10/7/13 10:03 am - Massillon, OH
Topic: Medical Mutual Coverage
Anyone out there have experience with Medical Mutual paying for a revision/wls?? My insurance (medical Mutual Plus) said they do not cover weight loss surgery of any kind! But what if I am having secondary problems from my original surgery? Anyone know?? Thanks!
DeeDeeLynne60
on 10/7/13 9:56 am - Massillon, OH
Topic: Medical Mutual Coverage
Anyone out there have experience with Medical Mutual paying for a revision/wls?? My insurance (medical Mutual Plus) said they do not cover weight loss surgery of any kind! But what if I am having secondary problems from my original surgery? Anyone know?? Thanks!
KristenRB82
on 10/6/13 1:29 pm
Topic: RE: Five year documented weight history question
I'm right there with you on that one. I only have two of the five years documented. My surgeons office coordinator doesn't seem like she has a lot of hope. At this point I am still pressing onward with all my appointments and pre-op tests. and if it means a medical loan, then so be it.

I'd be broke with bills than live another year like this.

Lots of luck to you!
(deactivated member)
on 10/6/13 11:53 am
Topic: RE: Surgery next year after Obamacare starts...

I will have a revision in February, too.I wondered about this as well, but I will still have my private insurance, so I think I will be ok. I need to get everything and anything done before things change.

mollymcb
on 10/6/13 3:26 am - TX
Topic: RE: Five year documented weight history question
I'm not sure which insurance you have but don't give up hope my insurance really took a statement from me and my surgeons office of what diets I had been on in the past 5 years.. I had a horrible time when I first started trying to get approval due to me having 2 insurance policies at that time it took me few months to figure out what needed to be done and now I'm approved with a December date... Have faith
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