Insurance Gurus...please Help
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littlebits 19 posts
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Hi littlebits, I don't think anyone should ever settle in life. No way, no how. You deserve the best, i do understand your frustration, but please don't give in. You know what you want, the slee
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I just had my surgery on April 16. Here's what they told me prior to approval. BMI must be at least 35 with co-morbidities (HBP, Diabetes, Respiratory problems) or 40 without co-morbidities. Here's so
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Hi littlebits, I am in the same boat as you. Ok originally I had planned on having surgery from dr Garcia in Tijuanna. But, then I thought I have insurance and my Bmi is 37.5-38 so my insurance stat
Hello everyone! I recently finished up most my clearances for BCBS of DE...I just have one nutrition class left in May.
Immediately following my 5th nutrition class I stopped to speak with the nurse to discuss a possible surgery date. At this time, I was informed that my insurance company still views the sleeve as a two part procedure; therefore, they require a BMI of 50 or higher. My BMI is 38.
I'm not really sure why it took five months for someone to share this information with me, but I am absolutely livid! I have HBP, Type II diabetes and (discovered during one of my clearances) sleep apnea. In addition to these issues, yesterday, the cardiologist (another clearance) informed me that I have a slight heart murmur.
Has anyone else ever run into a situation like mine? Were you able to get approved? What did you do??? I'm so desperate. My PCP isn't concerned. He is sure that I will get approved & he plans to fight for me. I don't know what to do.
Nonetheless, if all else fails, I have a backup plan...
My company's open enrollment begins on May 2nd. I could change to Aetna at this time. My new insurance would be effective on July 1. Aetna requires six additional nutrition classes, but that won't be too difficult. It would just push my time frame back. Does anyone know if there is a waiting period if you switch companies? I'm a teacher & I would like to have my surgery over the summer. I wanted to have it in June.
Any assistance would be greatly appreciated.
Addition vent---The only issue, at this point, is the BMI requirement. I have been very proactive in trying to find out what I can do to get around this road block. The surgeon is wonderful, but his office staff is horrible. He is the one who suggested the sleeve in the first place. I went into his office to discuss Lap Band, and I have since realized that this is not an option. He suggested the sleeve b/c I have to take anti-inflammatory medication for my ankle & back (from a bad car accident).
I asked if it was possible to speak with the surgeon or receive a call back. The office manager refused to let me speak with him & insisted that I would not be approved. I'm sorry, but this is not her call. BCBS of DE told me that they base their decisions on a case by case scenerio. (Just an fyi of how rude the office manager is--there are three surgeons in the office & she also tried to convince me that the female surgeon was my surgeon. I have never met her, but I have met both of the males.) She was absolutely horrible. Anyway, I waited two days & still had not received a call from my surgeon so I called back. She never sent him the message...Smh!!! I'm sorry, when you are stressed or sick, you don't need the office staff making matters worse!!! The nerve of her! I will be reporting her next week...
So sorry for overloading you with so much information...I'm so stressed out right now. :'(
Little bits