Recent Posts
Hello I'm looking to have surgery and I've been denied twice. My bmi is 43 and I did the physicians path and I have sever sleep Apnea and prediabetic but they said it's not a medical necessity. Would you be willing to help me too...
Hi how did it go.. did you get approved???? without having to submit the 5 year documentation. I just finished my 6 months today. And tomorrow my Pcp is going to submit the referral.
on 12/28/16 9:08 am
Does anyone know what percentage or amount of weightloss is considered "compliant" in order to get a revision? I was non-compliant and am working on weightloss with the band although I have never had any significant success with it. I have been denied for a revision due to non-compliance
Hello, I have BCBS of MN and I am jumping thru the hoops for insurance now. I made my own appt with a bariatric surgeon on Sept 21, at that appointment I spoke with the surgeon's nurse, the surgeon, and I was also introduced to a patient advocate who takes care of everything. My insurance requires the same thing as yours and this is what I had to do.
I had to have an Appt with a nutritionist and a psych evaluation (both set up by the advocate) both have to approve you for surgery.
I had to make an appointment every month for 6 months with my primary care physician and weigh in and talk about dieting, exercise etc. Because I had met with my PCP in August and we spoke about diet and exercise and she put it in my chart this counted as my first monthly session. I have my last session on Jan 5 and after that they ( bariatric nurse or advocate) will send paperwork to insurance and I wait for approval.
Once I am approved I then have to take some nutrition classes (3) and then they can schedule my surgery.
If you have any questions feel free to ask I will help if I can.
Tammy
HW: (9/28/16) 369.8 / SW: (3/13/17) 285 / CW: 162.8
Pre-op loss (6 1/2 Months) - 84.8 pounds
M1 - 17.2, M2 - 17.2, M3 - 13.4, M4 - 15.4, M5 - 13.8, M6 - 13.6, M7 - 10.8, M8 - 9.6, M9 - 5.0, M10 - 2.4, M11 - 3.8
Hi everyone,
This is the answer I received from my insurance company. Is there any point in appealing this? I feel it is a pretty solid answer. Anyone run into this and then got approved? I did a search and they are all a couple of years old. I have Anthem BCBS.
Nope nothing. someone at the surgeon office is going to look into it after I see my new pcp and get some paper work turned in to her. ill let you know if anything is clarified!
Hi - curious if you got your answer? I have my appointment with my surgeon in mid January - my dr knows I have been trying to lose weight and have been up and down since I met her - I would just HATE to have to wait 6 months to prove I cannot lose weight!!
267/258/223.9 Turkey Day Challenge 15 pounds minus 2.1lbs
Highest/Surgery/Current
Hi, Does anyone know the requirements for RNY surgery under Molina healthcare of Illinois Medicaid? Please help. Thanks.
Years ago (2011) when i first started the process for bariatric surgery (got talked out of it, long story) the wording of my insurance policy was "doctor supervised diet".
I have a different insurance now, BCBS of TN and the wording is alot different.
-
Attending physician documents adherence to a non-surgical weight loss program (e.g. dietary management, behavior modification, and/or exercise) with ALL of the following:
-
-
Most recent attempt was within 2 years of request for surgery
-
Participation was for a minimum of 6 months.
-
Can anyone tell me if this is the same thing, or if they just have to say yeah they have done this this this and blah of # months.
I tried asking the nice BCBS service rep for clarification, but she said that's all it said. I have my consult in december. But I have had some hiccups with my PCP retiring our of no where, and the area I live in has a doc shortage, so it's been one thing after another.
I had read a few places that some BCBS networks had changed to not needing a "supervised diet" and just wondered if this was the wording for that.
Thanks for any help
does anyone know if it's possible to get insurance that covers complications for surgery in Brazil? I have seen it for surgery in Mexico but nowhere else
Hockeymom87 · 0 replies · 603 views
