Re: Which insurance companies are approaving now?

[Guest guest]

Hi There ....

I know BC BS PPO covers the surgery with a letter os nessessity

good luck

Which insurance companies are approaving now?

> Hello,

> I am just wondering...if all of the insurance compaies are turning this

> surgery down...WHO IS ACCEPTING IT? Does anybody know?

> I am confused as to who CAN get this surgery done and through what

insurance

> company that is open to everyone and not just poeple within the confinds

of a

> specfic state, fedreal or large company?

> I heard someone say UNC? Is that right? And what does that stand for? Who

are

> they again?

> I am desperately trying to sort this all out again becasue of all the new

WLS

> exclusions instated in come more policies this past July.

> Spain is still an option but frankly I dont have the money up front, being

on

> disablilty. My ability to gather the money to do this is so limited right

now.

> Please let me know which companies have approaved this DS/BPD surgery

within

> the last month or so?

>

> Thanks sincerely,

> Lee H.

>

> <<

> Carole, What you are experiencing is totally normal. I think whether you

are

> 15, or 65, most people go through a stage when they wonder if this is

really

> worth it. Although I am only 30, I asked myself this one very important

> question....

>

> What quality of life do I want to have for the rest of my years?

>

> The answer for me was a good, mobile, healthy quality of life, and I was

at

> the point where I was getting very unhealthy, and it was difficult to get

> around. Don't get me wrong, I was terrified, but in the end I was willing

to

> take the risk. If I didn't I was sure to die before I was 35!

>

> What helped me get through it was lots of prayer and support from family

and

> friends. I was/am very lucky to have so much support. Just remember you

have

> to do what is right for you. If you don't think you are ready, you can

hold

> off.... I think you will be okay. Hang in there!

>

> Kim B. >>

>

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

>

[Guest guest]

Lee H.

Are you on a permanent disability? Do you have Medicare? That is what I have

and had no problem with them accepting. You just had to have a co-morbidity.

Rita Black

<frankly I dont have the money up front, being on

disablilty. My ability to gather the money to do this is so limited right now.

Please let me know which companies have approaved this DS/BPD surgery within

the last month or so?

[Guest guest]

> I am just wondering...if all of the insurance compaies are turning this

> surgery down...WHO IS ACCEPTING IT? Does anybody know?>>>>

Medicare accepts it....so does medicaid.....cigna on some......

Which insurance companies are approaving now?

>

>

> > Hello,

> > I am just wondering...if all of the insurance compaies are turning this

> > surgery down...WHO IS ACCEPTING IT? Does anybody know?

>

> Cigna is still approving it, but you have to prove " medical necessity. "

How

> one defines that term exactly, I have yet to figure out.

>

> alyssa

>

>

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

>

[Guest guest]

Rita ,

yes I am on SSI but with medicaide and they turned it down.

I do have co - morbidities and I asked my DR to appeal it but he seemed to

think it was futile.

Medicaid in WV will not accept it..not even the RNY..lol which they are very

much for.

I will have to look into other companies and ways.

But I have heard the AETNA just slammed the door on DS/BPD surgery on all

claims..so now I am wondering which companies are even still within mean of

getting this approaved?

Thanks,

Lee H.

Are you on a permanent disability? Do you have Medicare? That is what I

have and had no problem with them accepting. You just had to have a

co-morbidity.

Rita Black >>

[Guest guest]

Which state are you in Judie? Here in WV they wouldnt approave even an RNY

with Medicaid.....

Lee h>

<<

> surgery down...WHO IS ACCEPTING IT? Does anybody know?>>>>

Medicare accepts it....so does medicaid.....cigna on some...... >>

[Guest guest]

I was originally approved by Cigna (Traditional/PPO), but when my school

system switched over to Horizon BC/BS of NJ. they picked it up as well.

Where I got lucky was that NYU (Dr. Ren) is out of network for Cigna but IN

network for BC/BS. Boy, if ever a postponed surgery was a lucky stroke, this

was it (my surgery was scheduled for 6/26, rescheduled 7/13 and insurance

changed over on 7/1)!

Marcia

Dr. Ren, NYU

first consult 3/26/01-280 lb./BMI 52

surgery-266lb.

8/29 -227/BMI 43

>

>

>

> > Hello,

> > I am just wondering...if all of the insurance compaies are turning this

> > surgery down...WHO IS ACCEPTING IT? Does anybody know?

>

> Cigna is still approving it, but you have to prove " medical

> necessity. " How

> one defines that term exactly, I have yet to figure out.

>

> alyssa

>

>

>

>

[Guest guest]

In a message dated 8/29/01 12:12:05 PM Central Daylight Time,

chull1@... writes:

> Lee,

>

> This is really a more compliated topic than you may realize. Some

> Aetna and BC/BS patients do get covered and some do not. There are a

> number of variables with any insurance company. Some key variables

>

> 1. State you live in

> 2. Employer fully-insured or self-insured, or personal policy

> 3. PPO vs. HMO

> 4. You willingness to be persistant

> 5. Just plain luck

>

> Your chances are probably best if your employer is self-insured

> (usualy large companies with 1000+ employees) since the insurance

> company is not out of pocket. You chances are probably worst with a

> personal policy since almost all of them have pre-existing clauses

> and WLS exclusion. If you have a small employer that is fully-insured

> than your chances are moderate.

>

> You chances are better with a PPO than an HMO since the network is

> much bigger and you can go directly to any in-network suregon. If you

> have an HMO then you will need a referal from you PCP to an in-

> netwrok suregon (who most likely does RNY ).

>

> Persistance pays off. About 1/2 of those initally denied are able to

> win on appeal.

>

> Hull

>

>

I would also add that since there is not a unique code for the DS that it

depends on how the surgeon words the predetermination letter.

Dawn

Dr. Hess

4/27/00

265 to 165

size 22 to size 10

[Guest guest]

Lee,

This is really a more compliated topic than you may realize. Some

Aetna and BC/BS patients do get covered and some do not. There are a

number of variables with any insurance company. Some key variables

1. State you live in

2. Employer fully-insured or self-insured, or personal policy

3. PPO vs. HMO

4. You willingness to be persistant

5. Just plain luck

Your chances are probably best if your employer is self-insured

(usualy large companies with 1000+ employees) since the insurance

company is not out of pocket. You chances are probably worst with a

personal policy since almost all of them have pre-existing clauses

and WLS exclusion. If you have a small employer that is fully-insured

than your chances are moderate.

You chances are better with a PPO than an HMO since the network is

much bigger and you can go directly to any in-network suregon. If you

have an HMO then you will need a referal from you PCP to an in-

netwrok suregon (who most likely does RNY ).

Persistance pays off. About 1/2 of those initally denied are able to

win on appeal.

Hull