XP-Primary Ins -- WISH ME LUCK!!!!!!
**Still waiting on appeal decision from secondary insurance**
I have thought this whole time (going on 2 1/2 years) and been told that my primary insurance will not cover bariactric surgery..... Well, I was reading through my old posts from April of 2009 and also had been given an updated copy of my new insurance plan last week.
I decided to e-mail my primary insurance for a clairification, here is my question:
Question: I just received a copy of my updated Group Health Plan last
week, and the plan says to contact ******** prior to
treatment..... Inpatient surgeries relating to, but not limited to,
hyesterectomies, back surgery, or bariatric surgery (if applicable under
this plan). How do I find out if a revision to my bariatric surgery
from over 9 years ago is covered?
Can you help me, please?
And here is their reply I just got back:
Jamie,
Thank you for your inquiry. Your plan states that medical necessary
bariatric surgery is considered eligible if you meet the definition of
morbidly obese. Your plan defines morbidly obese as a BMI of 40+. If
you meet that definition, then a letter of medical necessity from your
referring doctor and the supporting medical records need to be sent to ************
WOOHHHHOOOOOOO!!!!!!!!!!!!!!!!! Yes, I have had a BMI over 40.
There is PROMISE yet, for my PRIMARY!!!!!
GOD is looking out for me!!!
-Jamie
RNY 2/26/2002 DS 12/29/2011
HW 317 SW 263 BMI 45.1
SW 298 CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003
Normal BMI 24.8 is my GOAL!!!
GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**
Thank YOU, Holly!!!!!
MEEEEEEEEEEEEEE TO!!!!!!
-Jamie
RNY 2/26/2002 DS 12/29/2011
HW 317 SW 263 BMI 45.1
SW 298 CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003
Normal BMI 24.8 is my GOAL!!!
GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**
What's next...... is to just wait & see. For both insurance companies at this point.
You would think I would be "used" to waiting after so much hoop jumping.
I will keep everyone updated when I hear something~
-Jamie
RNY 2/26/2002 DS 12/29/2011
HW 317 SW 263 BMI 45.1
SW 298 CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003
Normal BMI 24.8 is my GOAL!!!
GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**
Frankie-
Everything was e-mailed into the primary that evening. Dr. K's office is SOOOO AWSOME!!!!!
Now, I wait.....
-Jamie
RNY 2/26/2002 DS 12/29/2011
HW 317 SW 263 BMI 45.1
SW 298 CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003
Normal BMI 24.8 is my GOAL!!!
GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**
