I have Meritain Health (a company of Aetna) and am currently in the 4th month of weight loss management. With my plan, they require me to have a medical rehablition consultant for case management. I was just assigned to a consultant (she is sooo nice) and she has been helping with my case. Unfortunatly i was only able to get in a few quetions before she left this week for vacay, but she has been a big help with answers! I know that Meritain will cover VSG, but my case manager is going by Medicare Standards to review for necessity. Medicare does view the VSG as investigational, but she said we may be able to use other criteria for this form of surgery.
My requirements our as follows
*Must be at least 18 years old
*BMI of 40 or higher that has persisted for at least 3 years or
*BMI of 35 and less then 40 with (a list) comorbidities...
*Must have continued to be obese despite partcipation in a supervised weight management program for at least 6 consecutive months. The program should incorporate nutritional counseling, behavioral modification, and approprieat reqular physical activity
*Participate in multi disciplinary preoperative evaluations as identified by a physician and or nurse case manager.
I am 24 years old (check)
BMI 46.7 (check)
I am on my 4th month of WLM and im still obese (obviously with my bmi so high! ) (check)
I have had a gym membership for a few years now, and i go a couple times a week, and nightly walks (how am i to prove that?)
now for the behavior modification,nutritional counseling.... dont know how to check this off this list yet...
perop evals? dont know how to meet this yet either
I live in Alaska, and have chosen Dr. Hunter with Virginia Mason in Washington state. So far I have been in contact with his nurse Steve, and he has been a MAJOR help with my flood of questions. I have a consultation/ nutritionist/pyschologist meetings lined up in July I hope these will check a few off my list of requirments LOL
As far as prices - Dr Hunters nurse Steve says about $16000.00 out of pocket but her refferd me to VM billing and they gave me an estimate of about $35000.00- $45000.00 billed to insurrance, I believe my plan with meritain covers 80%-90% and I think there is a $20000.00 break point. Now if i could find my out of pocket/after insurrace amount that would be helpful!
Hope this helped a little, I have a hard time finding info/answers in these forums for Meritain
Good Luck with your journey!!!
