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Any Successful Approvals with GEHA or Healthlink?

MzGee

By MzGee, in Insurance & Financing

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MzGee    65

MzGee
Posted

I currently have GEHA but when I go to the doctor they refer to it as Healthlink. I am in the 6 month physician documented diet which is mandated by the insurance company and I am getting disappointed with the process. Has anyone ever been approved with GEHA/ Healthlink? Also did you lose any weight during the 6 month diet requirement? Thanks in advance

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chooter    7

chooter
Posted

I have GEHA. I went to a gastric sleeve seminar in July 2013. Since then I've been jumping through the hoops. First my hospital (Mercy) said I wasn't morbidly obese, so I couldn't have surgery unless I had a co-morbidity. So I had a sleep study done and I had sleep apnea so that qualified as a co-morbidity. I started the 6 months of visits with my PCP, I've had the psych evaluation, met with dietician, went to an all day seminar. This week I meet with exercise and activity. I've had to keep a food and exercise log (started both of those last August). I've also met with surgeon and the RN in charge of the bariatric program. To my knowledge, I dont think they have submitted anything to GEHA yet.

I called GEHA last August to see what was required and they mailed me a sheet of requiements.

My recommendation is start tracking everything now, exercise, food journal, monthly visits with PCP. If your BMI is not 40 or greater, you'll need a co-morbidity (sleep apnea, diabetes). I'm hoping to have surgery in May or June.

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chooter    7

chooter
Posted

Forgot to say I have not lost any weight in the 6 months worth of doctor visits. Haven't gained any either.

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MzGee    65

MzGee
Posted

Thanks for the feedback right now I don't have a PCP but I have going to a nutritionist who is covered by my insurance and keeping the logs for food and exercise, this last visit I've lost ,9lbs in one month . And initially at the wls seminar it seemed as if the insurance would be the easiest step listening to the wls advocate but now I'm not so sure.

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MzGee    65

MzGee
Posted

@@chooter I will be getting that checklist this week from GEHA , I've finished my 6month diet and I'm ready!!!

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tom_thumb    0

tom_thumb
Posted

Have you all learned anything new with GEHA? I have been on the 6 month visits, and next week is my PET class and Psych review. I have GEHA, and I am worried that they will deny for some reason.

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chooter    7

chooter
Posted

I was approved by GEHA, surgery scheduled for 6-16.

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tom_thumb    0

tom_thumb
Posted

Congrats! That is very soon.

Did you have any obstacles? Anything off the wall I should be looking out for?

I have sleep apnea. I am on the threshold of 41-40%, so I don't want to lose too much, ya know?

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chooter    7

chooter
Posted

I think you'll be fine since you have sleep apnea. I didn't purchase the machine since my main goal was to have the sleeve surgery.

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chooter    7

chooter
Posted

I think you'll be fine since you have sleep apnea. I didn't purchase the machine since my main goal was to have the sleeve surgery.

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tom_thumb    0

tom_thumb
Posted

yeah, You can purchase it after the surgery "if" needed. But the weight loss may fix your apnea. I sure hope I can breath easier at night. :)

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myfutureme    13

myfutureme
Posted

I also have GEHA. I talked with them a million times before starting this process. Now, AFTER 6 months of diet and exercise they tell me that I was supposed to be writing down each activity and the duration this whole time. And my PCP didn't take detailed enough notes. Great. So now I sent more info and am awaiting another letter

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MzGee    65

MzGee
Posted

I got approved in 2weeks ! I got the good news today.

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chooter    7

chooter
Posted

Surgery on 6/16, with 1 night in the hospital, all went well (though no sipping liquids while laying down, it will come back up). Stomach was a little sore (6 holes). Went in to hospital weighing 216.5, weighed yesterday and down to 212.

You seriously don't feel like eating, your not hungry at all, no cravings, no nothing. I think I'll have to just set up a schedule to remind myself to eat something. Right now I'm doing Protein shakes, sugar free jello/pudding, greek yogurt, sugar free ice pops and malt-o-meal. You can only eat about 1/2 cup of food at a time, it takes me like an hour to get down the small container of greek yogurt.

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chooter    7

chooter
Posted

Forgot to mention that at my last meeting with surgeon, I had to pay $4,900 before they would schedule surgery. This is what was not covered by GEHA.

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Go To Topic Listing Insurance & Financing

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    • Alisa_S

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      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
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    • Alisa_S

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      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

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