Insurance

[Guest guest]

cjvaillan@... wrote:

>

> Hi,

>

> Can anyone tell me if the MGB can be considered outpatient surgery?

> When I spoke to my insurance company(BCBS of RI) they asked if the

> surgery was inpatient or outpatient. I wasn't sure how to answer the

> question since I knew that the surgery time was so short and the

> hospital stay was usually only one night.

>

> After I told her the estimated surgery time and that there should only

> be a one night stay, she said that it sounded like the one night was

> just for observation and that it sounded like it could be considered

> outpatient surgery. In which case, I shouldn't have a problem with

> the surgery being covered. I asked for that in writing and she told

> me should would send me a copy of my insurance contract. I'm waiting

> to see what it says. In the mean time I'd like to find out is the

> surgery is considered outpatient or inpatient.

>

> Thank you for your help!

>

> Carol in MA.

You get a room charge from the hospital no matter how short of a time

you are there, and that seems to be one of the distinctions between

" in-patient " and " out-patient " surgery.

Some policies make a distinction that if you are in under 23 hours or if

it is " out-patient surgery " it does not need to be pre-certified, and

maybe that is the issue (pre-certification?)

Precertification is required for most hospitalizations that are

" in-patient " and it depends on how your insurance company defines it.

Kind regards,

[Guest guest]

Outpatient surgery is considered when you do not spend 24 hours or

more in the hospital you can stay 23 hours and 59 min and not one

min. more.

that is how my insurance company explained it to me

> Hi,

>

> Can anyone tell me if the MGB can be considered outpatient

surgery? When I spoke to my insurance company(BCBS of RI) they asked

if the surgery was inpatient or outpatient. I wasn't sure how to

answer the question since I knew that the surgery time was so short

and the hospital stay was usually only one night.

>

> After I told her the estimated surgery time and that there should

only be a one night stay, she said that it sounded like the one night

was just for observation and that it sounded like it could be

considered outpatient surgery. In which case, I shouldn't have a

problem with the surgery being covered. I asked for that in writing

and she told me should would send me a copy of my insurance

contract. I'm waiting to see what it says. In the mean time I'd

like to find out is the surgery is considered outpatient or inpatient.

>

> Thank you for your help!

>

> Carol in MA.

[Guest guest]

I was trying to access the site about insurance but couldn't find a link from the DS site.

[Guest guest]

Since I am newly employed, how long after one gets insurance can one start

looking into this? Does the insurance company balk at having a newly insured

go for this expensive surgery right away?

Carole

[Guest guest]

In a message dated 6/15/2001 1:54:10 AM Pacific Daylight Time,

MsMystic1@... writes:

<< Since I am newly employed, how long after one gets insurance can one start

looking into this? Does the insurance company balk at having a newly

insured

go for this expensive surgery right away?

Carole >>

Carole, I got my insurance in January of this year through my employer, and

started procedings in February. Everything went great. My insurance company

was awesome.

Kim B.

Dr. Anthone 4/18/01

-56lbs.

[Guest guest]

In a message dated 6/16/01 1:27:40 AM Eastern Daylight Time, susan4541@...

writes:

<<

Carole, I got my insurance in January of this year through my employer, and

started procedings in February. Everything went great. My insurance company

was awesome.

Kim B.

Dr. Anthone 4/18/01

-56lbs.

>>

Kim,

Who was your insurance company and what state are you in? (besides being in a

happy state. )

Lee

[Guest guest]

I have learned so much about this surgery and how it works! I just read Dr.

Hess' brochure, very informative. I am wondering if there is a website that

lists which insurance companies have approved this surgery. I know there is

one like that for the RNY, but I was wondering if there is one for this

surgery. If not, maybe we can make one and everyone can list which insurance

company there were with and whether or not it was a PPO, etc. which approved

the surgery?

Thanks guys! :-)

Carole

[Guest guest]

Carole,

Heidi has a partial list on http://www.mywls.com, but keep in mind, it really

depends on the individual exclusions in your policy/the type of policy your

company buys and even the size of the company you work for!

Anita

Pre-op in Denver

> I have learned so much about this surgery and how it works! I just read Dr.

> Hess' brochure, very informative. I am wondering if there is a website that

> lists which insurance companies have approved this surgery. I know there is

> one like that for the RNY, but I was wondering if there is one for this

> surgery. If not, maybe we can make one and everyone can list which insurance

> company there were with and whether or not it was a PPO, etc. which approved

> the surgery?

> Thanks guys! :-)

> Carole

[Guest guest]

joann..i don't post here very much but thought i should let you know what i

know about this bc/bs mess..someone who attended the asbs conference told me

that there was much talk there about a recently instituted nationwide ban by

bc/bs on approval for bpd/ds..resulting from an investigation into errors

made during the surgery by a bc contracted doctor on a bc patient..it was

supposedly a hot topic of conversation among the docs..as i am pre-op and

have bc, i started to look into it..my state bc said they don't know..the

only way to find out is submit lomn..if it is approved, then you will know

there is no ban..i tried to speak to the president of the company..no

luck..tried to contact national office..no luck..cannot get a number..my

surgeon's office insurance person is too busy to deal with it..said he

doesn't know and doesn't care until he gets to my file..which will not be

until the week or two before surgery..all if this is very unbelievable to

me..nightmarish..have heard recently of some folks who have had denial from

bc..also one who had approval and received retraction right before

surgery..and some surgeons have told their patients that there is a ban..i

know that all of you out there who had no difficulty with bc will now

respond with that info..but unless you have been approved through bc in

june, it doesn't apply..the ban supposedly began somewhere around the end of

may or beginning of june..would certainly like to hear from anyone who has

been approved since that time..hoping that there are some of you out there

to put our minds at ease..in the meantime, i have made alternate

arrangements to self-pay with dr. baltasar..now am playing the waiting

game..please let me know if you get any additional info, and i will do the

same..best regards..nancy

nancy fissel

dr. gagner 7/26/01 OR dr. baltasar??

age and bmi are both 54!

>From: joannm@...

>Reply-To: duodenalswitch

>To: duodenalswitch

>Subject: Insurance

>Date: Tue, 19 Jun 2001 14:39:23 -0000

>

>Has anyone been denied by Blue Cross for the DS surgery lately? At first I

>heard they were one of the better insurances. Last Tues. I went to a

>support meeting and the Dr. office informed my that Blue Cross all of a

>sudden started dening.(sp?)Help!! Scheduled for surgery 7/27/01.

>Jo Ann

>

>

>----------------------------------------------------------------------

>

[Guest guest]

At 14:39 +0000 6/19/01, joannm@... wrote:

>Has anyone been denied by Blue Cross for the DS surgery lately? At

>first I heard they were one of the better insurances. Last Tues. I

>went to a support meeting and the Dr. office informed my that Blue

>Cross all of a sudden started dening.(sp?)Help!! Scheduled for

>surgery 7/27/01. Jo Ann

I received my denial letter last week; the reason was that this

surgery is considered 'investigational' (their word, not mine). The

letter also didn't say 'morbid' when referring to my obesity. The

appeal wheels are in motion via Dr. Booth's office...

--stella

[Guest guest]

I am also concerned about this supposed ban by bc/bs on the DS. MY SO is

considering

the DS and we have been looking at options. However, I don't plan to alert

anyone in the state bc/bs office that there may be such a " ban " because if they

don't know, why tell them????

I had Fed bc/bs and they did pay for it-- that was in Jan 2001.

in Seattle

>joann..i don't post here very much but thought i should let you know what i

>know about this bc/bs mess..someone who attended the asbs conference told me

>that there was much talk there about a recently instituted nationwide ban by

>bc/bs on approval for bpd/ds..resulting from an investigation into errors

>made during the surgery by a bc contracted doctor on a bc patient..it was

>supposedly a hot topic of conversation among the docs..as i am pre-op and

>have bc, i started to look into it..my state bc said they don't know..the

>only way to find out is submit lomn..if it is approved, then you will know

>there is no ban..i tried to speak to the president of the company..no

>luck..tried to contact national office..no luck..cannot get a number..my

>surgeon's office insurance person is too busy to deal with it..said he

>doesn't know and doesn't care until he gets to my file..which will not be

>until the week or two before surgery..all if this is very unbelievable to

>me..nightmarish..have heard recently of some folks who have had denial from

>bc..also one who had approval and received retraction right before

>surgery..and some surgeons have told their patients that there is a ban..i

>know that all of you out there who had no difficulty with bc will now

>respond with that info..but unless you have been approved through bc in

>june, it doesn't apply..the ban supposedly began somewhere around the end of

>may or beginning of june..would certainly like to hear from anyone who has

>been approved since that time..hoping that there are some of you out there

>to put our minds at ease..in the meantime, i have made alternate

.nancy

>

Web Mail services provided by http://www.aa.net

[Guest guest]

I have been trying to find insurance to buy for myself since I don't have any

right now. While looking around the internet, I found a site that suggested

joining an organization and getting on their group plans - such as alumni

associations, etc. So I am going to check into my alumni assoc. and see what

they have.

But every policy I have gotten referred to as individual has openly stated

that they don't pay for treatment of obesity and specifically stated weight

loss surgery. some of them categorize this under cosmetic surgery. Only

Cigna seemed to not have this specific wording, but I don't think they have

individual plans, just organization or employment group benefits.

I did get some information from Anthem Blue Cross here in OH for an

individual plan. It says it doesn't pay for " treatment of obesity, including

any care which is primarily diet or exercise. " This one does not name

specifically weight loss surgery like the others do, but I wonder if this is

categorically NOTHING to do with obesity. Of course, once I sign up, then I

get all the rest of the details of what they exclude.

I know Tom (I think) is self-insured through Blue Cross. How did you manage

this?

I might as well pay for my own insurance unless I get a better job with good

insurance, but I want to make sure I am not buying something that won't cover

this.

They also say they will not cover " pre-existing " things, so is being

overweight considered " pre-existing " ? Seems to me like they are all wanting

to opt out of paying for this now and are starting to specifically exclude it

from their policies.

Carole

[Guest guest]

What about Kaiser Permanente. Is there one near you? I had them in Southern

California for years. They did a lap gallbladder,it was a breeze. I had my

eight year old and my twins with them also.

[Guest guest]

> I know Tom (I think) is self-insured through

> Blue Cross. How did you manage this?

Hi Carol:

I'm insured through a joint Blue Cross / State of California program

called Major Risk Medical Insurance Program, which is for people with

pre-existing conditions. Unfortunately, it only exists in

California.

Even more unfortunate if it turns out to be 100% true, is that I keep

hearing lately that Blue Cross is now automatically turning down all

requests for the DS, claiming it is " investigational " or some such

crap.

Note to fellow Californians: Blue Cross is not the ONLY insurer

involved in the MRMIPS program, so if you need to privately insure,

don't give up all hope quite yet.

Sorry I couldn't give you better news Carol,

Tom

[Guest guest]

As many of you may know, I am in the process of checking for new insurance.

The company I joined as Blue Cross and since they no longer pay for this

surgery, I don't want to join their insurance if I can find one that will pay

for it.

In checking, I was led to check out associations that have insurance for

their members. Something to think about. Alumni associations, trade

associations, etc.

It might be worth it to pay the membership fee to get good insurance at group

rates.

I also found out that United Health Care has open enrollment in August, from

August 1st - the end of the month. They don't have fees decided yet, so

can't get that, but someone on the list got approval from them in one day

with UHC Select PPO. I am not sure if this is one that you can join as an

individual, but I thought I'd pass this information on, in case anyone else

is interested.

Carole

[Guest guest]

Well, I decided to take the bull by the horns, so to speak today. I had

gotten information on Aetna BC here in Oh, for an individual policy. They

stated they do not cover anything to do with obesity. Anyways, I got an

email from the girl who sent me the stuff asking me did I get it and did I

have any questions. So, I figured, I might as well ask my question before I

put my money down. So I asked about the obesity exclusions. I asked also

specifically about MO. I said I would like to read the exclusions before I

buy the policy. I got back this email:

Carole,

Without your exact height and weight it would be impossible to see if you

even qualify for coverage. if you would like to give me that information I

would be happy to see what coverage we may be able to offer you. The

certificate of coverage is a thick book that comes to you once you are a

member. We do not send them out until you qualify for the plan.

so, I guess they are already thinking of not covering me? Ya know, sometimes

it just gets to me the way people who work for an organization act like its

their money that would be paid (like when you return something and the

salesperson doesn't want to give a refund and acts like she is giving you her

own money).

Oh well, we shall see.

I did get information on Kaiser - someone mentioned them. Now, does anyone

know if Kaiser covers ANY of this? If I go out of the system, do they cover

70%?

Has anyone had Kaiser and had this surgery covered?

Carole

[Guest guest]

Carole,

I do know of a couple of gals who had surgery thru Kaiser in san

diego....they were referred to pacific bariatrics for their surgeries but I

think Kaiser is beginning to do their own now.....check into it, you might

be suprised!

Judie

Re:insurance

> Well, I decided to take the bull by the horns, so to speak today. I had

> gotten information on Aetna BC here in Oh, for an individual policy. They

> stated they do not cover anything to do with obesity. Anyways, I got an

> email from the girl who sent me the stuff asking me did I get it and did I

> have any questions. So, I figured, I might as well ask my question before

I

> put my money down. So I asked about the obesity exclusions. I asked also

> specifically about MO. I said I would like to read the exclusions before

I

> buy the policy. I got back this email:

>

> Carole,

> Without your exact height and weight it would be impossible to see if you

> even qualify for coverage. if you would like to give me that information

I

> would be happy to see what coverage we may be able to offer you. The

> certificate of coverage is a thick book that comes to you once you are a

> member. We do not send them out until you qualify for the plan.

>

>

> so, I guess they are already thinking of not covering me? Ya know,

sometimes

> it just gets to me the way people who work for an organization act like

its

> their money that would be paid (like when you return something and the

> salesperson doesn't want to give a refund and acts like she is giving you

her

> own money).

> Oh well, we shall see.

>

> I did get information on Kaiser - someone mentioned them. Now, does

anyone

> know if Kaiser covers ANY of this? If I go out of the system, do they

cover

> 70%?

> Has anyone had Kaiser and had this surgery covered?

> Carole

>

> ----------------------------------------------------------------------

>

[Guest guest]

Youre right, Shirley......they only do the RNY. I mentioned it without

thinking about that but I wonder if Kaiser will send you to someone who does

the DS if you can convince them youve done your homework and know what you

want......just a thought. Sometimes we need to teach the doctors who are

clueless about all these procedures and I know sometimes they feel

threatened by our knowledge.

judie

Re:insurance

> Does Pacific Bariatrics have a surgion who does the DS?

> I met with the dietitan at Kaiser last week and she said that some of

> the patients are being sent to Pacific Bariatrics in San Diego, but I

> thought they only did the RNY.

> Do you know the name of the doctor that does the DS at Pacific

> Bariatrics.

> Shirley

>

>

>

> > Carole,

> > I do know of a couple of gals who had surgery thru Kaiser in san

> > diego....they were referred to pacific bariatrics for their

> surgeries but I

> > think Kaiser is beginning to do their own now.....check into it,

> you might

> > be suprised!

> >

> > Judie

> >

> >

>

>

> ----------------------------------------------------------------------

>

[Guest guest]

Does Pacific Bariatrics have a surgion who does the DS?

I met with the dietitan at Kaiser last week and she said that some of

the patients are being sent to Pacific Bariatrics in San Diego, but I

thought they only did the RNY.

Do you know the name of the doctor that does the DS at Pacific

Bariatrics.

Shirley

> Carole,

> I do know of a couple of gals who had surgery thru Kaiser in san

> diego....they were referred to pacific bariatrics for their

surgeries but I

> think Kaiser is beginning to do their own now.....check into it,

you might

> be suprised!

>

> Judie

>

>

[Guest guest]

--I am hoping to convince them to let me have the DS. She said that

it is the surgeon who decides what surgery you have, so I am having

to wait until I get to meet with him. She said that they send us to

San Francisco, (they have Kaiser doctors doing RNY in SF) but that

they get so back logged that sometimes they sent people to San

Diego. I figure that if they are willing to send me out of network,

they should be willing let me have the one that I feel will work best

for me. If they won't I will have to self pay, but I have to at

least try with them.

Shirley

- In duodenalswitch@y..., " Judie Hensel " wrote:

> Youre right, Shirley......they only do the RNY. I mentioned it

without

> thinking about that but I wonder if Kaiser will send you to someone

who does

> the DS if you can convince them youve done your homework and know

what you

> want......just a thought. Sometimes we need to teach the doctors

who are

> clueless about all these procedures and I know sometimes they feel

> threatened by our knowledge.

>

> judie

>

>

> Re:insurance

>

>

> > Does Pacific Bariatrics have a surgion who does the DS?

> > I met with the dietitan at Kaiser last week and she said that

some of

> > the patients are being sent to Pacific Bariatrics in San Diego,

but I

> > thought they only did the RNY.

> > Do you know the name of the doctor that does the DS at Pacific

> > Bariatrics.

> > Shirley

> >

> >

> >

> > > Carole,

> > > I do know of a couple of gals who had surgery thru Kaiser in san

> > > diego....they were referred to pacific bariatrics for their

> > surgeries but I

> > > think Kaiser is beginning to do their own now.....check into it,

> > you might

> > > be suprised!

> > >

> > > Judie

> > >

> > >

> >

> >

> > ------------------------------------------------------------------

----

> >

[Guest guest]

This list is full of folks who decided which surgery they would have and

found the surgeon to do it.

in Seattle

DS 1/5/01 295# BMI 47.6

6/5/01 220# BMI 35.5

Dr Welker - OHSU

----- Original Message -----

She said that

> it is the surgeon who decides what surgery you have, > Shirley

[Guest guest]

Recently a good friend of mine who was at that time about the same weight as

me (around 340) could not get insurance anywhere. He had the money but they

simply would not write him an individual policy because of his weight. This

is just absurd!

Nahodil

Woodbridge, VA

Pre-Op Dr. Elariny

Fairfax INOVA Hospital

BPD/DS Part 1 Version 1

Date: TBA

Re:insurance

Well, I decided to take the bull by the horns, so to speak today. I had

gotten information on Aetna BC here in Oh, for an individual policy. They

stated they do not cover anything to do with obesity. Anyways, I got an

email from the girl who sent me the stuff asking me did I get it and did I

have any questions. So, I figured, I might as well ask my question before I

put my money down. So I asked about the obesity exclusions. I asked also

specifically about MO. I said I would like to read the exclusions before I

buy the policy. I got back this email:

Carole,

Without your exact height and weight it would be impossible to see if you

even qualify for coverage. if you would like to give me that information I

would be happy to see what coverage we may be able to offer you. The

certificate of coverage is a thick book that comes to you once you are a

member. We do not send them out until you qualify for the plan.

so, I guess they are already thinking of not covering me? Ya know,

sometimes

it just gets to me the way people who work for an organization act like its

their money that would be paid (like when you return something and the

salesperson doesn't want to give a refund and acts like she is giving you

her

own money).

Oh well, we shall see.

I did get information on Kaiser - someone mentioned them. Now, does anyone

know if Kaiser covers ANY of this? If I go out of the system, do they cover

70%?

Has anyone had Kaiser and had this surgery covered?

Carole

----------------------------------------------------------------------

[Guest guest]

Well, I am not sure if any of you can remember that I wrote back to the Aetna

BC girl and asked about the obesity and morbid obestity exclusions and she

said I might not even qualify for the insurance? Well, after telling her my

stats, she said I don't qualify. Looks to me like maybe they are just

disqualifying anyone who would qualify for the wls just to not have to deal

with it. Now, this is for an individual policy.

I am 5 ft 5 1/2 inches and about 255 lbs, which is not in the upper category

of weight, but enough to qualify for the surgery.

Anyway, I got some information on insurance carried through my college alumni

association. They just say they don't cover " weight loss programs or diets " .

Now, I would take that to mean, they won't pay for weight watchers or some

other such program, right? but it doesn't say anything about weight loss

surgery.

so what do you guys think? Also they have a PPO or 80/20 plan. Would I be

better off not doing the PPO and going with the other plan?

the insurance is call Alumni Med Choice through World Insurance.

I think this company does alumni insurance for colleges all over the country.

Maybe this is a way to get insurance that will cover this??

Anyone have any comments or ideas on this?

Carole

[Guest guest]

Believe it or not, I found out yesterday that I will not be having my

surgery tomorrow as scheduled. There's this big fiasco between my

divorced parents' insurance companies (fighting over which one will

pay for the surgery) and neither insurance has pre-approved my

surgery yet. It's so absolutely ridiculous, and I'm kind of mad

because I want to get this thing over with. There's a new tenative

date of June 22nd, but that's only if the surgery is pre-approved

before then. It's just a big mess.

[Guest guest]

valerie,

I'm sorry for you that you're surgery has been postponed. As you

know from reading this forum, insurance can be one of the worst

parts about this whole process. Spend the next week fighting the

insurance monster daily so you can insure you'll meet the 6/22

date. Gee, 6/22... That date is familiar... ;-)

Dammit

> Believe it or not, I found out yesterday that I will not be having

my

> surgery tomorrow as scheduled. There's this big fiasco between my

> divorced parents' insurance companies (fighting over which one

will

> pay for the surgery) and neither insurance has pre-approved my

> surgery yet. It's so absolutely ridiculous, and I'm kind of mad

> because I want to get this thing over with. There's a new tenative

> date of June 22nd, but that's only if the surgery is pre-approved

> before then. It's just a big mess.

>

>