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I realize that. I was asking for experiences.
I'll be sure to post my experience to help other's in the same situation.
on 6/9/13 10:35 am
Hi! Does anyone have the 1 surgery per lifetime clause on their insurance? Have you been able to get around that to get a revision? what was your experience?
I'm hoping there are people who have been approved and can maybe give me some insight into getting an appeal approved!
Thanks in advance!
You can pay a lawyer a grand or so but the reality is, those are the contract requirements and they have the right to decline payment.
I would contact Lindstrom Obesity Advocacy.
http://wlsappeals.com/common-bariatric-denials/denials-revisions-and-conversions/
Hi! Does anyone have the 1 surgery per lifetime clause on their insurance? Have you been able to get around that to get a revision? what was your experience?
I'm hoping there are people who have been approved and can maybe give me some insight into getting an appeal approved!
Thanks in advance!
In 2010 I shared My Story in support of The Lymphedema Treatment Act. The bill did not make it through the congressional process at that time and must be re-introduced. I am committed to using my newly acquired advocacy skills to help make this act a LAW.
WHY THIS LEGISLATION IS NEEDED:
- Lymphedema is a non-curable but treatable medical condition that results in an accumulation of lymph fluid swelling in parts of the body where lymphatic vessels and/or lymph nodes are damaged, nonfunctional or inadequate. Lymphedema affects an estimated 5-6 million Americans, with the majority of cases caused by cancer treatment.
- Untreated, or under-treated, lymphedema is progressive and leads to increased morbidity. Complete Decongestive Therapy (CDT) is the gold standard and only known course of treatment for lymphedema. CDT is a multi-modal treatment that is only effective when used in its entirety.
- Medicare currently covers all but the most critical component, the medically necessary compression supplies used daily in lymphedema treatment, citing they do not fit under any existing benefit category. As a result, many patients suffer from recurrent infections, progressive degradation in their condition and eventual disability because they cannot afford the compression supplies required to maintain their condition.
WHAT THIS LEGISLATION WILL DO:
Although this legislation relates specifically to a change in Medicare law, it would set a precedent for Medicaid and private insurers to follow.
Specific goals of the Act are:
- Provide comprehensive lymphedema treatment coverage, according to current medical treatment standards;
- Enable patient self-treatment plan adherence by providing necessary medical supplies for use at home, as prescribed for each patient (including gradient compression garments, bandages, and other compression devices);
- Allow for new treatment modalities to be considered for coverage as they become available and are approved;
- Reduce the total healthcare costs associated with this disease by decreasing the incidence of complications, co-morbidities and disabilities resulting from this medical condition.
A quick one-page reference on the Lymphedema Treatment Act. To get involved visit: http://lymphedematreatmentact.org/
I have Lipedema and Lymphedema. I also have a passion for Obesity and Health Insurance Advocacy.
Blog: born2lbfat.com Facebook: Born2lbFat Twitter: @born2lbfat
I know this post is almost 3 years old, but thank you. I am a month shy of being 6 years out from surgery and have maintained my weight all 6 of them. I am just so so sick of dealing with the rashes and belly button fungal issues etc from the excess skin. I have an appointment with my PCP tomorrow and I am going to address it with her. I am 80% SC.
Try Emory bariatrics that's who I'm using! ;) they have a very straight forward program keep me posted!! ;)
I also have straight medicaid and I have to pick a specific carrier am seeking bariatric surgery, here in Georgia what were the other requirements for Amerigroup? Ive been in contact with Peachtree Bariatrics and i spoke to one of their insurance reps they told me Wellcare is very lenient as far as approvals, but peachstate has denied alot of people.So thats why i chose in my head wellcare but if Amerigroup has a 3 month supervised diet i would choose them first. To get this ball rolling or in other words this fat rolling off.