Recent Posts
Topic: RE: FIGHTING! MORE DOCUMENTS?
Hi,
For me, I had to have documented that the CPAP was not controlling my sleep apnea. From the time I found out I had sleep apnea (last July), it took me until April of this year to get my approval. I assumed that just because I was diagnosed with sleep apnea, I was covered. That was not the case for BCBS with me.
I had struggled with the CPAP since I got it. I still had symptoms of uncontrolled sleep apnea, so a visit to the sleep doctor and a letter documenting my CPAP was not controlling my sleep apnea is what it took for my insurance to cover.
Basically, after my initial denial and appeal and subsequent denial, I let it sit for a while. I didn't start pursuing again until March. What I found then when I read between the lines of my denial letter was that any qualifying comorbidity didn't count if it were controlled by medication or CPAP.
Good Luck.
Lori
248/137/140
Lap RNY 7/2/07
To the world you are just one person, but to one person you are the world.
Topic: FIGHTING! MORE DOCUMENTS?
Hello All,
Well here I go again.
I just received a letter from BCBS stating my benefit elig. cannot be determined because they want chart notes documenting the asthma and sleep apnea that is not controlled even with the use of conventional therapy.
What does that mean?
I get the feeling they are trying any thing to denie me?
I have been on a cpap for a short time for sleep apnea.
Now what?
Thanks for listening
Topic: RE: Merit Care WLS Clinic
and the answer is.....check, cash, or credit card. I had my preop and they faxed my menu to the nurtrition place, which I totally didn't find the first time and had to ask directions. Once I got there they gave me a sheet I had to take to the pharmacy and pay for the meals and vitamins. After I paid they stapled the receipt to the piece of paper and I went back to the nurtion office and showed them I paid and they gave me the food and vitamins. That's pretty much it in a nutshell. I did ask if I could come back to get some more meals if I'm leary about eating my own creations and she said yes.
Danni
Topic: RE: North Dakota Bariatric Doctors
I had my surgery done with Dr. Monson at Meritcare in Fargo. I am 2 1/2 years out & doing good. He is a fantastic doctor!
Heather
Topic: RE: new and kinda scared
Gotcha...I wonder how many of the lap bands he does. They sure seem to talk alot of people out of them. I know when Cindy did her speech she made it sound like it didn't work well and that there was a lot of slippage, etc... I liked that it was less invassive and that whole "death" risk was supposedly taken out. I LOVED Cora, she has been the nicest person in this long process. Even though I wasn't Dr. Monson's pt. anymore she still called me when the approval went through, SUPER nice nurse!! Good Luck!
Danni
Topic: RE: new and kinda scared
I was planning on having the lapband but changed my mind to the LapRNY. I think i have to drink that Optisource for two weeks...euuww. I am going to call Cora (Dr. Monson's nurse) and see if there's a date in September that would work for me...I've decided I don't want to wait until November. You are smart to be doing this at your age...I've waited WAY too long.
Topic: RE: new and kinda scared
None of that yuck for me, thats only if you have your sugery done laproscopically. September sounds good, gives you time to research and get oriented on the surgeries befores and afters. From what I've read the band goes pretty slick with recovery so I would think you would be fine for travel by Oct. 15th...heehee, thats my Birthday- I'll be the big 35. I told myself I had until I was 35 to get my weight under control and after that I was going to have the surgery. Yah, so I didn't get it under control and now I'm having the surgery :)
hmm... I guess the only thing you would have to work around is your fills? I'm not sure how often that is, I kind of erased that info from memory once I found out I couldn't have it...
Good Luck!
Danni
Topic: RE: new and kinda scared
Do you have to do two weeks of OptiSource before your surgery? That's what I have to do with Dr. Monson (yuck, cuz that stuff is gross). I am thinking of rescheduling my surgery to September 15th. I have to do some traveling on October 15th through the 21st but I should be good to go by then ( I would hope). But why wait until November and waste two months of losing? There are always going to be occasions and reasons to wait, but I really don't want to waste time.
I hope your surgery goes really well and you get the results you are looking for!
Topic: RE: new and kinda scared
I have my pre-op appt. on Wednesday and my surgery with Doc Howell is July 24th. It's getting close now, I think it will really set in when I have my pre-op done. I started this "journey" with thoughts of getting the lap band, after I went to the first mtg. I was basically talked out of it, and then I went online and saw that quite a few people that had it went back and had the gastric bypass anyways. Of course you never know their story, and I think Sharon Osbourne had the lap band and she looks awesome!! As it turns out because of my previous Nissen procedure I couldn't have the lap band anyways so it was good I talked myself out of it...lol
Danni
Topic: RE: Merit Care WLS Clinic
Loretta, I have my pre-op Wednesday so I can tell you then. I would think you can pay credit card or cash, but I'll know for sure on Wednesday. You can call the receptionist and they should be able to tell you when he's booked out to. I think he also is the surgeon that goes to Wahpeton's MeritCare so I don't know if that affects anything. I would just call and ask, "as of today" where is he booked out to, and tell them "I know it will change by the time I get approved"- sometimes they don't want to tell you because they think you will then "count" on that time. He could have 10 approvals come in between now and your date but at least you would know when the soonest is for now. Good Luck and I'm glad you appealed!!
Danni