nhandy

Those of you who submitted pictures in lieu of weight history, what insurance do you have that accepted the pictures?

Hi all, I am cross posting this here as well as in insurance to get as many opinions as possible. Hope you don't mind. I'm so disappointed right now. I had my consult appointment scheduled for Friday and today the insurance/billing person called me to discuss my insurance with me and what would be due at the consultation. I was expecting it to be $100 because that's what my co-worker (same employer, insurance and surgeon) had to pay for each of her co-pays since the surgery center is at the hospital. So it came as a huge surprise to me when the last said i would be responsible for $508 on Friday! She said I need to meet my entire deductible for the year that day. I asked why, when I had no assurance I would be approved for surgery would I pay my entire deductible at a consultation and she just said after contacting my insurance, it was necessary. I was so upset and angry and disappointed I just told her to cancel my appt for Friday. Here's the thing; $500 is a lot of money for me. Do I have it? Yeah, but I wasn't planning on dropping that kind of money until I had some confidence I would be able to get approved through my insurance (Aetna). I don't have the 2 year medical history of my BMI. I have one year medically documented and then I have other means of documenting my weight from 2 years ago from a weight loss blog. But I have no clue if that's something I could even use so I was looking forward to my appt Friday when I could talk to the insurance specialist. I know my Dr would write a letter of necessity and I'm sure I could put together a pretty submittal to Aetna but that may not be enough. So I'm asking for opinions. What would you do if you were me? The idea of staying fat and unhappy for a whole other year makes me feel so depressed. But if I wait until next year, I will have the two years documented and I know I could get approved with no problem. So do you think I should just hold out another year and try next year? Or roll the dice and pay the $500 and take a chance that I may be able to get it done this year?

Thanks all. I did call my insurance company for clarification and they said since they are billing as a hospital, they do collect the entire deductible upfront but then after the insurance company received the explanation of benefits, they will let the hospital/dr office know how much to refund me. So if it never goes past the consultation, I'll get the bulk of that money back. I don't love the idea of doing it, but now that I know they aren't going to keep the whole thing, I may be ok with it.

Thanks all. I did call my insurance company for clarification and they said since they are billing as a hospital, they do collect the entire deductible upfront but then after the insurance company received the explanation of benefits, they will let the hospital/dr office know how much to refund me. So if it never goes past the consultation, I'll get the bulk of that money back. I don't love the idea of doing it, but now that I know they aren't going to keep the whole thing, I may be ok with it.

I'm so disappointed right now. I had my consult appointment scheduled for Friday and today the insurance/billing person called me to discuss my insurance with me and what would be due at the consultation. I was expecting it to be $100 because that's what my co-worker (same employer, insurance and surgeon) had to pay for each of her co-pays since the surgery center is at the hospital. So it came as a huge surprise to me when the last said i would be responsible for $508 on Friday! She said I need to meet my entire deductible for the year that day. I asked why, when I had no assurance I would be approved for surgery would I pay my entire deductible at a consultation and she just said after contacting my insurance, it was necessary. I was so upset and angry and disappointed I just told her to cancel my appt for Friday. Here's the thing; $500 is a lot of money for me. Do I have it? Yeah, but I wasn't planning on dropping that kind of money until I had some confidence I would be able to get approved through my insurance (Aetna). I don't have the 2 year medical history of my BMI. I have one year medically documented and then I have other means of documenting my weight from 2 years ago from a weight loss blog. But I have no clue if that's something I could even use so I was looking forward to my appt Friday when I could talk to the insurance specialist. I know my Dr would write a letter of necessity and I'm sure I could put together a pretty submittal to Aetna but that may not be enough. So I'm asking for opinions. What would you do if you were me? The idea of staying fat and unhappy for a whole other year makes me feel so depressed. But if I wait until next year, I will have the two years documented and I know I could get approved with no problem. So do you think I should just hold out another year and try next year? Or roll the dice and pay the $500 and take a chance that I may be able to get it done this year?

A consultation doesn't count from what I've heard.

Ladies, I would call Aetna to ask if WW is allowed. Based on their bulletin 157, weight watchers does not qualify. Read below. http://www.aetna.com/cpb/medical/data/100_199/0157.html

How much time did you take off work after being sleeved?

Hey all! I am new here and am just getting started on this journey. I have been the a seminar and have my first appointment withe the surgeon and next Friday. I'm looking for advice and info regarding one of the requirements of my insurance company, Aetna. They require a 2 year history of a BMI over 40. I have had a BMI over 40 for well over 2 years now. It currently is something like 48.6. My issue is, after my son was born in 2009, I didn't see a doctor until early 2013. My PCP moved to another practice and I couldn't get in to see her for a few years and I just wasn't sick at all so no need for an urgent care or anything. So I don't have a medically documented history of my BMI for the last 24 months. I have it documented from January 2013 till current, so 13 months. Are there any records they will take in lieu of the medical history? I can submit photos and a link to a blog I created in 2012 when my weight was documented with photos of my weight on a scale. I can provide photos of my body for the last several years where I am clearly obese. I can provide a letter from my PCP stating that I've been obese for the entire time I've been her patient (10+ years). I just don't have that medically documented BMI history for the year 2012. I guess the worst case scenario is I wait another year and try to get approved then, but I would hate to stay fat for a whole other year. I want this surgery so bad! Does anyone have any advice? Has anyone ever gotten approved through Aetna with missing this specific criteria?

That's exactly what I'm thinking too. Thanks for the feedback.

I didn't have any weigh ins at all, anywhere, other than my scale at home. I don't really want to call the insurance company cause I have a feeling they will just flat out tell me no. They don't want to have to fork over the money for this surgery so I'm sure they would tell me I had to wait a year. I'm just hoping the surgeon I meet with has some sort of creative way of getting past this.

** sorry for all the typos lol. I'm posting from my phone.