Sharon1964

I'm the office manager for a pain management doctors office. Trust me, we get more than our fair share of muffins, donuts, candy, etc. We started letting it be known that we were all trying to eat healthier, and now we get trays and baskets of fresh fruits and vegetables as well as meat and cheeses. It is VERY much appreciated!

You're so welcome. Keep up the good fight!

Here is the thread I was thinking of: http://www.bariatricpal.com/topic/334629-bcbs-carefirst-horror-story/

The reviewer has to have a specific reason to deny. It doesn't sound like there is a reason. Not to worry.

There is someone else on these forums who went thru the same situation. I'm not sure who their insurance carrier is. They successfully appealed citing the numerous instances of false information on the part of the insurance company. Cigna itself can cover it. It doesn't have to affect the employer's rating or costs. Appeal and keep appealing up the chain of command. Appeal to your state insurance commissioner if necessary.

Is there some reason why he can't keep his and add yours as a secondary? You can investigate to see if that would cover it.

It has nothing to do with it. Sorry.

Your best bet is to call United and ask them directly what the coverage is for vertical sleeve gastrectomy, including one or two days of hospital inpatient charges. For the surgeon: If they tell you they need a CPT or Procedure Code for the surgery, it is 43775. If they want an ICD9 diagnosis code, it is 278.01, morbid obesity. For the hospital: If they want an ICD9 hospital procedure code, it is 43.82. If they want a DRG or Diagnosis Related Group code it will be 619, 620, or 621 (depending on absence or presence of complications and/or comorbidities). Of course, there are no guarantees as your surgeon, for example, may have to change from lap to open surgery mid-procedure.

Call them again and ask them to send or fax you their medical policy for weight loss surgery. Also ask for a benefits booklet, and ask specifically what page of the benefits booklet covers weight loss surgery.

Here is a table by state of coverage for weight loss surgery under the Affordable Care Act: http://nofusa.org/news/health-insurance-cover-obesity-treatment/ There is also other information about financing and coverage. The state of NY offers bariatric surgery as part of the ACA. Perhaps a move to NY since you are there already is in order?

My surgeon requires you to have all the preventive care and age-appropriate procedures before he will do the surgery. He wants to make sure that anything else going on is discovered and taken care of before the surgery. I'm 50 so I had to have the colonoscopy and I was overdue for a mammogram.

Tell her you want her to submit without the records. If they ask for them, you can respond, in writing, that their written policy doesn't require it. If they deny, appeal with copies of their own policy. It looks like "right" is on your side.

Surgeon: Colonoscopy - check Endoscopy - check Mammogram - check Pap Smear - done within last two years, so not required Barium swallow - check Cardiac clearance - check Insurance: Psych eval - check 6 months of supervised nutrition visits - check I just had my last of the 6 monthly visits on Friday. They are sending everything to the surgeon. Now the surgeon's office has to submit everything for approval to Blue Shield of California. I started this process in November 2014 and it seems like it has taken forever to get to this point. The last time I checked in with the patient coordinator at my surgeon's office, she said he was booked for surgery until the end of July. Harrumph! Even if I get approved soon, it will probably be AUGUST before I get surgery! YAY for requirements done. BOO for having to wait some more!

Look at the parts that I highlighted. I think you would do well to spend some time examining your ideas of "healthy". What is healthy for you and your existing ideas of what is healthy for you are not the same. A "healthy portion" for you is not a plate full of food. As far as babies go, the baby gets nourished first. Your body will cause you to lose weight if it has to in order for the baby to get what it needs.

It's a form letter. Here is an example of what it means: If your plan allowed 10 chiropractic visits and you had already used 8, you can still get a letter authorizing 5 more, but they will only pay for 2 of those. You will max out your visits and will have to pay for the balance of the visits, or 3 of them.

I also have children. I would say to skip it. It's only one night. If it turns into more than one night, then I would reconsider. Edited to add: my hospital is a bariatric and cardiac hospital. To visit on the bariatric wing, children have to be 12. To visit on the cardiac wing, children have to be 16. No children visit during flu season.

Should you find yourself in this situation again, you could say, "these booths are murder on my back, do you mind if we move to a table?" Being how uncomfortable you are all over, it's not really a stretch.

We've all experienced the typical ways of not fitting into the world... restaurant booths, airplane seats, amusement park rides, chairs with arms, student desks, regular sized blood pressure cuffs, etc. Friday I had to have a cardiac stress test in order to get cardiac clearance for VSG surgery. It's one of the last steps I have before getting insurance approval. In the nuclear medicine area of my doctor's office, there is a waiting room with a little alcove where they put the IV port in. There is no door on this alcove. I can hear everything the tech is saying to each person as he explains the procedure and puts in the IV and then sends them back to the waiting room.. Most of the people there are over 65 or so, and I know some of them are hard of hearing, just from observing them in the waiting room. I'm 50, and definitely not hard of hearing. So when it's my turn, and the tech stars his spiel, I stop him and tell him I've heard him give it about four times now. Then suddenly he stops, and in that same loud voice, says he's not sure I'll fit into the imaging machine. So when there is an empty machine he takes me in there to make sure I'm going to fit. It does, just barely, go over me. When I come out of that room to go back to the alcove, every eye in the waiting room is on me. I don't get embarrassed easily, and being fat doesn't embarrass me. I wasn't embarrassed that everyone knew that I might be too fat for the machine... they all have eyes, they can all see how big I am. Normally, I would have schooled the person on how they should treat fat people, so that other fat people aren't embarrassed. But for some reason, this time I didn't. I'm not really sure why. I have a followup appointment in two weeks and I might bring it up then. Anyway, yet another example of how I don't fit into the world. That's my main reason for getting the surgery, I want to fit into the world.

I wish I had been able to do it at your age. I'm 50 now, and will likely turn 51 (July 26) before surgery. I have one more nutrition visit this week, then one visit with cardiologist next week to go over my test results for cardiac clearance, then everything gets sent in to insurance for approval. My surgeon is booked through the end of July right now, so it will probably be August before I get my surgery. When I look back over my life, I realize I should have found a way to make the surgery happen much sooner. I didn't have health insurance for a long time, and then when I had it, it didn't cover the surgery. Now I have insurance that covers it. I think about all the things that I passed on, all the things I couldn't do, all the times I missed out on, because I didn't physically fit into the world. I wish I could go back to 35, where you are, and do it then.

You look fabulous!

Current untruths regarding medications: If the price went up, it's Obamacare. If they won't give you the opioid your doctor prescribed, it's "the DEA cracking down". If they won't give you the amount of pills your doctor prescribed, it's "the DEA". If they don't have it in stock, it's "doctors are overprescribing".

If you don't have some sort of supplement, you would be better off buying one before surgery (check if there's a waiting period before they cover surgery). If you don't have a supplement, you'll be paying the first $147 of outpatient care (part B deductible), then 20% after that. On a high level office visit, that will be around $30, depending on where you live. For hospital inpatient care, you'll pay the first $1260 (part A deductible), then nothing else for the first sixty days in the hospital.

How about a retro-style suit with a higher waistline.

Go to your employer and tell them about your desire to get healthy. Ask them to investigate getting a rider that will cover weight loss surgery. Over your lifetime, paying for the surgery will be far cheaper than paying for your healthcare for weight-related problems.

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