Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Recommended Posts

I need you guys help! I have met all of my deductible and majority of out of pocket for surgery but the kicker is that if I don't have surgery by January 1st I lose all of that. Can someone give me some advice on what I can do to speed up this process?

Share this post


Link to post
Share on other sites

Self pay? Do you have a 6 month diet requirement?

Share this post


Link to post
Share on other sites

Talk to your bariatric program and make them aware of this.

Share this post


Link to post
Share on other sites

Self pay? Do you have a 6 month diet requirement?

I do have a 6 month requirement but October 15th will be month 4. I'm with United Health Care.

Talk to your bariatric program and make them aware of this.

I just called them they weren't too helpful!! ????

Share this post


Link to post
Share on other sites

That puts you in November. Have you done everything else?

Share this post


Link to post
Share on other sites

Once all the info is turned in to insurance it typically goes pretty fast. Make sure and double check that everything is done and make sure your surgeon's office gets it all turned in ASAP and then become the squeaky wheel to the pre-cert department of your insurance company. Good luck!

Share this post


Link to post
Share on other sites

The end of your 6 months will be Dec right? That puts your possible surgery right around the holidays. If your surgeons office is on the ball it can be done. Providing your insurance gives you a super fast approval. Realistically surgery will be in January. Sorry.

Edited by cindyw41

Share this post


Link to post
Share on other sites

I had the same problem my clinic worked around it. My start over date is October first. They got me in for September 30th! It was a close call but I'm very lucky! I would keep bringing it up to them.

Share this post


Link to post
Share on other sites

I am in the same boat.. A rep from the surgerons office called me today becuses I emailed them last week to see if this could be done.. I have to complete 4 NUT appts which will put my last appt on 12/17
she said moset likly it is far fetched to have everything done and approval and surgery date by the end of the year
she said possibly you can call the ins co and see if the paperwork can be submiuted early
SSOOOO
I called the ins co,, and asked that if I had everything else done,,, by the 11/17 appt,, and all i had left was the last nut appt on 12/17,, could the paperwork be submitted,, ,she said yes...
ssoooooo
I called Ava back,, she said it is still unlikly that it will get approved in time.,. i said,, so your saying that it cant be done,, she said no,,, its just highly unlikely...
if you get declined,, then we have to do a peer to peer meeting to try to get it over turned,,, and its a lot of time and paperwork
I have a PT appt tomorrow,,, and a sleep study on sunday and bloodwork and chest xray next week... doing everything I can but she sounded so negitive...
should I still try??

Share this post


Link to post
Share on other sites

I am in the same boat.. A rep from the surgerons office called me today becuses I emailed them last week to see if this could be done.. I have to complete 4 NUT appts which will put my last appt on 12/17

she said moset likly it is far fetched to have everything done and approval and surgery date by the end of the year

she said possibly you can call the ins co and see if the paperwork can be submiuted early

SSOOOO

I called the ins co,, and asked that if I had everything else done,,, by the 11/17 appt,, and all i had left was the last nut appt on 12/17,, could the paperwork be submitted,, ,she said yes...

ssoooooo

I called Ava back,, she said it is still unlikly that it will get approved in time.,. i said,, so your saying that it cant be done,, she said no,,, its just highly unlikely...

if you get declined,, then we have to do a peer to peer meeting to try to get it over turned,,, and its a lot of time and paperwork

I have a PT appt tomorrow,,, and a sleep study on sunday and bloodwork and chest xray next week... doing everything I can but she sounded so negitive...

should I still try??

. Yes I'm not giving up until January first!!! Good luck ❤️

Share this post


Link to post
Share on other sites

I am in the same boat.. A rep from the surgerons office called me today becuses I emailed them last week to see if this could be done.. I have to complete 4 NUT appts which will put my last appt on 12/17

she said moset likly it is far fetched to have everything done and approval and surgery date by the end of the year

she said possibly you can call the ins co and see if the paperwork can be submiuted early

SSOOOO

I called the ins co,, and asked that if I had everything else done,,, by the 11/17 appt,, and all i had left was the last nut appt on 12/17,, could the paperwork be submitted,, ,she said yes...

ssoooooo

I called Ava back,, she said it is still unlikly that it will get approved in time.,. i said,, so your saying that it cant be done,, she said no,,, its just highly unlikely...

if you get declined,, then we have to do a peer to peer meeting to try to get it over turned,,, and its a lot of time and paperwork

I have a PT appt tomorrow,,, and a sleep study on sunday and bloodwork and chest xray next week... doing everything I can but she sounded so negitive...

should I still try??

they said I would have to do a pre-determination request. Have u heard of that??

Share this post


Link to post
Share on other sites

Yes.. my insurance required it. They denied my pre determination the first time and then approved it the second time.. I was approved on 9/15 and I have my surgery tomorrow (9/24)..

It's pretty normal to have to get a pre determination if you have bcbs

Edited by _Brooke_

Share this post


Link to post
Share on other sites

Yes.. my insurance required it. They denied my pre determination the first time and then approved it the second time.. I was approved on 9/15 and I have my surgery tomorrow (9/24)..

It's pretty normal to have to get a pre determination if you have bcbs

I just messaged you.

Share this post


Link to post
Share on other sites

.

Edited by ASUgrad

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Some days I feel like an infiltrator... I'm participating in society as a "thin" person. They have no idea that I haven't always been one of them! 🤣
      · 0 replies
      1. This update has no replies.
    • ChunkCat

      Thank you everyone for your well wishes! I totally forgot I wrote an update here... I'm one week post op today. I gained 15 lbs in water weight overnight because they had to give me tons of fluids to bring my BP up after surgery! I stayed one night in the hospital. Everything has been fine except I seem to have picked up a bug while I was there and I've been running a low grade fever, coughing, and a sore throat. So I've been hydrating well and sleeping a ton. So far the Covid tests are negative.
      I haven't been able to advance my diet past purees. Everything I eat other than tofu makes me choke and feels like trying to swallow rocks. They warned me it would get worse before it gets better, so lets hope this is all normal. I have my follow up on Monday so we'll see. Living on shakes and soup again is not fun. I had enough of them the first time!! LOL 
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Still purging all of the larger clothing. This morning, a shirt that I ADORED wearing ended up on top. Hard to let it go, but it was also hard to let go of those habits that also no longer serve my highest good. Onward and upward!
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×