Sharon1964

You may be right. All I know is it seems like in our area at least it's awfully hard to find a doctor if you have Covered California plans! I know this is from a while back... in our case (I work for a doctor), this was not true. We got letters from the insurance companies that said things like, "are you willing to accept the new products we are offering that will pay you 70% of what we would normally pay you?" A $50 office visit for $35? Our motto became "Just say no".

Keeping notes has helped several people get their surgery covered. In their cases, they were told on numerous occasions that gastric surgery was covered, but then it was denied as "not a covered benefit" when it came time to get the authorization. If you can show the insurance company that their mistakes caused you to go through the pre-op process, you have a very good chance of getting them to cover it, even if it's not covered on your plan. As you said, though, you do have to have active insurance on the day of your surgery in order for it to be covered.

What exactly are you worried about? You've talked to the insurance company, right? Document the date, time, name of the person you spoke to and what they said. If you haven't actually called them, then do that. Ask for all of their requirements for gastric surgery, and ask them if they cover roux-en-y, vertical sleeve gastrectomy, and lap band (so you know what your options are). Keep written details of every interaction with the insurance company.

I'm August 8. Don't forget there is an entire forum here just for August sleevers: http://www.bariatricpal.com/forum/1139-august-2015-sleevers/

This. In spades. YOUR doctor (not you specifically, amylynns, but "you" in the generic sense) has his/her reasons for their rules. My doctor may allow certain NSAIDS and disallow others. My doctor may allow it for VSG and not GB. Your doctor may say "never ever ever." So ask your doctor what his/her rules are, then ask for the reasoning behind them. If you don't agree with your doctor, look for peer-reviewed research on the subject, then show those to your doctor. See what he says.

THAT IS SO FREAKING AWESOME! You must be on cloud nine!!!

Ask your doctor about naproxyn sodium (aleve) or mefenamic acid (ponstel). When I was in my 20's (yeah, 30 years ago), those two drugs were the go-to for cramps, as they contain antiprostaglandins which help prevent uterine contractions or cramps. At the time, they were both prescription only; now aleve is over the counter. The naproxyn sodium worked great for me but didn't work at all for my roommate. She switched to ponstel and had great relief. If your doctor okays it, you do start taking it about 3 days before you expect your period, and then stop when the cramps stop.

Call the customer service number on your card. PHCS (Private HealthCare Systems) was bought out by Multiplan years ago. They kept the name for some of their products.

Surgeon: Colonoscopy - check Endoscopy - check Mammogram - check Pap Smear - done within last two years, so not required Barium swallow - check Cardiac clearance - check Insurance: Psych eval - check 6 months of supervised nutrition visits - check I just had my last of the 6 monthly visits on Friday. They are sending everything to the surgeon. Now the surgeon's office has to submit everything for approval to Blue Shield of California. I started this process in November 2014 and it seems like it has taken forever to get to this point. The last time I checked in with the patient coordinator at my surgeon's office, she said he was booked for surgery until the end of July. Harrumph! Even if I get approved soon, it will probably be AUGUST before I get surgery! YAY for requirements done. BOO for having to wait some more!

You could try goal-setting. 1. Make a specific, measurable goal. "Eat no more than 1/4 cup of food at each of three meals and no more than 1/8 cup of food at each of two Snacks." 2. Set a time limit. "I will do this for one week." 3. Identify obstacles. "Eating out", "portion size", "lack of restriction in my tummy." 4. Identify ways to conquer the obstacles. "I will only order an appetizer, and I will ask for a to-go box with my order and I will portion it out before I take a bite." "I will wear super snug spanx to remind myself not to overeat." 5. Identify who you will be accountable to. "In one week, I will call my best friend and talk about my week." Read over your written list every morning and as often as you need to. You can do this, it's only for one week. Then when you are successful with that, do it for another week. Keep reminding yourself about your goals.

Oh my god, I've been approved. APPROVED! Sheeet just got real.

Yes it can get saggy. I remember back when the show "Extreme Makeover" was new. There was a woman who had lost a lot of weight and needed an all-over body lift. During the consultation, the surgeon commented on her labia needing a lift as well (which he did).

Wonderful!

I'm the office manager for a pain management doctors office. Trust me, we get more than our fair share of muffins, donuts, candy, etc. We started letting it be known that we were all trying to eat healthier, and now we get trays and baskets of fresh fruits and vegetables as well as meat and cheeses. It is VERY much appreciated!

You're so welcome. Keep up the good fight!

Here is the thread I was thinking of: http://www.bariatricpal.com/topic/334629-bcbs-carefirst-horror-story/

The reviewer has to have a specific reason to deny. It doesn't sound like there is a reason. Not to worry.

There is someone else on these forums who went thru the same situation. I'm not sure who their insurance carrier is. They successfully appealed citing the numerous instances of false information on the part of the insurance company. Cigna itself can cover it. It doesn't have to affect the employer's rating or costs. Appeal and keep appealing up the chain of command. Appeal to your state insurance commissioner if necessary.

Is there some reason why he can't keep his and add yours as a secondary? You can investigate to see if that would cover it.

It has nothing to do with it. Sorry.

Your best bet is to call United and ask them directly what the coverage is for vertical sleeve gastrectomy, including one or two days of hospital inpatient charges. For the surgeon: If they tell you they need a CPT or Procedure Code for the surgery, it is 43775. If they want an ICD9 diagnosis code, it is 278.01, morbid obesity. For the hospital: If they want an ICD9 hospital procedure code, it is 43.82. If they want a DRG or Diagnosis Related Group code it will be 619, 620, or 621 (depending on absence or presence of complications and/or comorbidities). Of course, there are no guarantees as your surgeon, for example, may have to change from lap to open surgery mid-procedure.

Call them again and ask them to send or fax you their medical policy for weight loss surgery. Also ask for a benefits booklet, and ask specifically what page of the benefits booklet covers weight loss surgery.

Here is a table by state of coverage for weight loss surgery under the Affordable Care Act: http://nofusa.org/news/health-insurance-cover-obesity-treatment/ There is also other information about financing and coverage. The state of NY offers bariatric surgery as part of the ACA. Perhaps a move to NY since you are there already is in order?