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Hello all,
My revision was denied due to an exclusion. All bariatric surgery is a non covered service. I want to appeal it, and I am wondering if it is even worth the effort. I could ask my HR to add it to our insurance package. However, I really was not planning to tell them about the surgery at all. We do not have an "official" HR person. I work for a non profit, and it is small. Has anyone had luck with appealing an insurance exclusion? Helpful advice only, as in ones with experience. I really do not want comments like "its standard for insurances" or other comments basically stating what I already know. I just really want to know if anyone had any success with this, or even failure.... Just dont wanna hear the ol "I told ya so".
On a much more positive note, I am in the non surgical weight loss program there. Its been two weeks and I have lost 4 pounds! I know it doesn't seem like much, but its a start! Consistency is key! If I can't get approved for the surgery, then I have no other choice but to work hard. These 4 pounds were extremely hard! But I did it!
I appeales my exclusion and had no luck.
it is excluded because the rider your employer can purchase from the insurance carrier is very expensive.
Most at small businesses won't buy the rider.
if the insurance co is not going to cover a surgery that the rider hasn't been purchased for.
Have you considered self pay on MX? That is what I did and my experience was great.
Yes, revision to the bypass. The technique that I am familiar with reduces the size of the pouch, tightens the stoma, and bypasses more intestine. I am wondering if it will correct digestive disorders that I have been suffering with for years and which nothing has been able to correct. And I was trying to understand how much weight is generally lost with the surgery.
I wonder, too, how much difference their is in the amount of intestine that is bypassed in the RNY revision versus the amount of intestine that is bypassed in the DS.
Living larger than ever,
My Bariatric Life
Hello all,
My revision was denied due to an exclusion. All bariatric surgery is a non covered service. I want to appeal it, and I am wondering if it is even worth the effort. I could ask my HR to add it to our insurance package. However, I really was not planning to tell them about the surgery at all. We do not have an "official" HR person. I work for a non profit, and it is small. Has anyone had luck with appealing an insurance exclusion? Helpful advice only, as in ones with experience. I really do not want comments like "its standard for insurances" or other comments basically stating what I already know. I just really want to know if anyone had any success with this, or even failure.... Just dont wanna hear the ol "I told ya so".
On a much more positive note, I am in the non surgical weight loss program there. Its been two weeks and I have lost 4 pounds! I know it doesn't seem like much, but its a start! Consistency is key! If I can't get approved for the surgery, then I have no other choice but to work hard. These 4 pounds were extremely hard! But I did it!
Are you asking about a revision to your gastric bypass or conversion of you gastric bypass to the DS?
tevision to you bypass, I believe is in the 20-30%.
Conversion to DS is closer to 60-80-%
Greetings All
I seek your advice and experience in trying to decide between the three options-VSG versus RNY versus DS.
Lap Band placed in 2004 and have lost and gained the same 30lbs. I have decided I need to do something about my 48.8 BMI and comorbidities before its too late. Male, 60 y.o.
Thanks in advance for your advice.
Bonvivant57
I have been told that there is a lot of competition for the gastric sleeve done by US surgeons competing with Mexico prices. The person who told me this works for a medical tourism company. He said that surgery has almost become a commodity because it is a rather easy surgery to do. If I recall correctly, he said $11k in the US. I wonder if you call Care Credit if you can ask them for a list of participating bariatric surgeons who accept their payment plan (if that's the way that you wanted to go). I think you also can look on RealSelf for surgeon's costs, although they are much more focused on plastic surgery than bariatric surgery. Otherwise, ask around on this forum and maybe try using the search feature. Or Google search may provide some figures.
I found this on BariatricSurgerySource: The total cost of gastric sleeve surgery without insurance averages just over $19,000, although you may be able to find local gastric sleeve surgery prices as low as $10,000 depending on your region. They got an interactive map that shows which states offer the lowest costs.
I hope this helps.
Living larger than ever,
My Bariatric Life
I have thought of self pay but have no idea how much that would be. Any idea?
I won't go to Mexico.... looked into it in the past but I just couldn't bring myself to do that.
I'm going for my lap band I just finished my requirements and the Office Coordinator says she's sending over my completed folder to the insurance for approval. I had RNY in 2005 I had an egd done and it showed that my pouch has stretched I did my research and decided to have the band done. yes I hear horror stories and I also hear good stories I discussed both with my surgeon and I decided on the lap band. So I hope to be hearing some good news soon that I was approved I'm so ready to get back on track!!!
I have Cigna and they do require 4 dietician Visit one each month and 1 psych evaluation. I just completed them both my Coordinator at the Dr. Office says she sending my folder over to Cigna.
I am so sorry to hear that insurance is so difficult... have you considered going to Mexico for surgery? It's about half the cost as far as I understand it. I am considering doing it myself IF it will heal the digestive disorders that I have been suffering for the past 4 years, because nothing else seems to work and I am desperate to heal.
I know self-pay sucks. I feel like why do I have insurance if they won't cover the medical care that I need... especially after peer review, OMG. But another option in case you have not thought of it is to take out a loan through CareCredit. Some surgeons even offer interest-free financing. So you can self-pay for the surgery in the USA over time.
All of the agonizing, and weight gain, and possibly the cost of therapy and other medical care potentially can be avoided if you just bite the bullet and self-pay is something to consider.
I wish you well with your decision and your approval.
Living larger than ever,
My Bariatric Life
