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State by State Lap-Band Surgery appeal rights link

gviscio

By gviscio, in Insurance & Financing

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donnajorn    0

donnajorn
Posted

I have an opportunity to elect Blue Cross Blue Shield of Illinois and I'm wondering if anyone has any experience with them. I'm in the early stages of considering Lap Banding...

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jjw19697    0

jjw19697
Posted

Does anyone know a way around the DR documented weight loss attemps of 6 or months? I have been on Jenny C, WW, Atkins, Phen-Fen, Cabbage Soup diet, you name it I have tried it, but never with a Dr's help. I currently have hypertension that is being treated w/ meds, GERD, and a BMI of 36.7. I contacted my insurance (BCBS) and I meet all criteria w/ the exception of the Dr documented weight loss attemps. I feel so frustrated.

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adaniels    0

adaniels
Posted

donnajorn

I have an opportunity to elect Blue Cross Blue Shield of Illinois and I'm wondering if anyone has any experience with them. I'm in the early stages of considering Lap Banding.

Hey donnajorn,

I don't know if you have already had your questions answered. I have Blue Cross Blue Shield of Missouri and they did say they would pay for my surgery. However now that I have had surgery they are saying it's over the maximum allowed and are refusing to pay. The Weight Loss Center stated that they will fight with them and I hope that is true and I hope they WIN! I can not afford to pay the charges they have sent to the insurance company it's a bill of like 56,000.00 if I had that kind of money laying around I wouldn't have too many worries. Anyway just be careful if you get them as insurance and they say they will cover your surgery. You may be fighting with them later.

Thanks,

Amy B)

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Waters    0

Waters
Posted

Hi, I took all my receipts to my PCP, who I see at least every 3 months anyhow. He was satisfied with that and signed the form.

Good Luck to you

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vfran    0

vfran
Posted

Check out UT Medical Center in Knoxvile Tn

Address 1924 Alcoa Hwy 37921

Phone: 865-544-800

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vfran    0

vfran
Posted

I know what you mean about being frustrated. I also have BCBS. At first my Doctor wouldn't do anything with the paperwork so I made a appointment with him and asked why he wasn't be supportive. He filled in the date, weight and BP as well as all my DX and I'm to fill in the rest and after he looks at it and signs it I can then send it to BCBS. With all the waiting I told my doctor to go ahead and send the other paperwork ( which is a complete copy of all my office visits with my PCP )in to see it they would approve it without the 6 month doc.

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Waters    0

Waters
Posted

I have the same problem, have you found any way of getting around the 6 month???

I took all of my credit card statements and receipts from weight watchers Jenny craig, nutrisystem, curves and listed all the over the counter stuff I took for weight loss. He was glad to see my proof and waivered the 6 month issue.

But even if you go to him/her first, by the time you see the lap band doctor and have all the tests it will at least be 8 weeks and with your proof of diets, your PCP will know you mean business and sign the form.

Good Luck

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vfran    0

vfran
Posted

I got my reply by phone today I was denied due to my BMI. 1 point or (3 pounds) can you believe it I have High BP High CHOl./Trig and strong family history heart disease. I'm so down

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klassicant    0

klassicant
Posted

I also have Medicare as my primary hospital insurance. I will have my surgery at Grinnell, Hospital in Grinnell, Iowa. You might try contacting Medicare or going to their sight on the web and do a search. Previous to finding out about this hospital - my only choice in Iowa was to go to Chicago!!! Good Luck

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Go To Topic Listing Insurance & Financing

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    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.
    • KimBaxleyWilson

      KimBaxleyWilson

      Three months and four days ago... I was in Costa Rica having a life changing surgery! Yesterday we had a followup visit with Dr. Esmeral via video chat and this morning my middle number changed.  I'm down 47lbs and two pants sizes. I can wear a Large tshirt for the first time in like... 14 years! Woot!! Everything is going great. I have zero regrets. I went down to the riverwalk with a friend and walked 2 miles on Monday without even getting fatigued. And no more snoring or chugging pickle juice for crazy leg cramps! I need to go to the gym more... I'm making new shirts next week so that will motivate me. LOL But I'm also just not as TIRED all the time! I have a LONG way to go...but seeing the progress on the scales and in the mirror is a huge motivator!! Thank you all for cheering me on and supporting me!!
      · 0 replies
      1. This update has no replies.
    • bellaamey

      bellaamey

      https://alluniqueguide.com/java-burn-coffee-reviews/
      · 0 replies
      1. This update has no replies.

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