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debmersmom5

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debmersmom5    0

debmersmom5
Posted

I'm new to all of this. Have Humana ins. with a bmi of 33.9 and weigh 203 currently but have high blood pressure, prediabetes, non alcoholic fatty liver disease, severe GERD and I could go on and on. Not sure if primary will approve with letter or insurance will approve?

Also, I've been going to a dr. supervised weight loss clinic for a year and only lost 26 lbs plus gained 8 back. Now down again slightly. It is very frustrating. Will this count as my 3-6 months weight loss trial?

Any experience with these issues?

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WLSResources/ClothingExch    3,443

WLSResources/ClothingExch
Posted

When you attend an info seminar conducted by a surgery practice, ask for some idea on your chance for approval. I have no knowledge of your insurance plan and, even if someone who does comes along, the info you'll get isn't necessarily iron-clad.

Honestly, only your primary will be able to say whether he'll refer you for WLS. Talk with her now that you are considering it.

Very often a list of co-morbidities offsets a BMI that's otherways too low to get approved. This may be the case for you, but, again, who knows. The clinic program should qualify, but that's me saying so.

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weneebug    88

weneebug
Posted

With my insurance (BCBS) I had to have a BMI higher than 35 with one co morbidity. If no co morbidity you had to be at a 40 BMI.

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weneebug    88

weneebug
Posted

I know that has to be so frustrating. I hope you come up with a solution.

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sonkat5355    70

sonkat5355
Posted

Cigna contracted by Miami Dade school board will not pay at all not even the hospital stay. We have no other insurance choice. I will be paying $15 k for this surgery. Plus I needed an endoscopy which cost $750. Plus they are going (Cigna) to charge me another 30% adding $850. So $1600 added to the 15 k. I pray I have no complications because the insurance is being so tough. My internist/cardiologist wanted to make it medically necessary but Cigna told me they won't pay out. Only good side is I don't have to wait 6 months for approvals. Saw the psychiatrist, nutritionist, XRAY, blood work and I am in my drs office as I text waiting for approval and some heart tests.

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Go To Topic Listing PRE-Operation Weight Loss Surgery Q&A

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    • Clueless_girl

      Clueless_girl

      Well recovering from gallbladder removal was a lot like recovering from the modified duodenal switch surgery, twice in 4 months yay 🥳😭. I'm having to battle cravings for everything i shouldn't have, on top of trying to figure out what happens after i eat something. Sigh, let me fast forward a couple of months when everyday isn't a constant battle and i can function like a normal person again! 😞
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    • KeeWee

      KeeWee

      It's been 10 long years! Here is my VSG weight loss surgiversary update..
      https://www.ae1bmerchme.com/post/10-year-surgiversary-update-for-2024 
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    • Aunty Mamo

      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. 
       
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    • BeanitoDiego

      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
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    • BeanitoDiego

      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! 🤣
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