sleevegenie
-
Content Count
248 -
Joined
-
Last visited
Everything posted by sleevegenie
-
what i feared the most has happened:(
sleevegenie replied to determined1's topic in Insurance & Financing
I'm gonna fight them all the way on this, if people with kaiser, united and aetna can get the sleeve, they no longer consider it experimental then its not fair that people with other insurance can't get the same chance, hopefully we will win and get our sleeves, best of luck to us both -
no i have to wait for the denial letter before i can appeal. So as soon as i get the letter i am gong to appeal and if i have to i will appeal to the 'State of California Insurance Commisionner, i have been told that they usually vote in your favor. so good luck to both of us
-
i got so happy when i saw that anthem approved you, it gives me hope, they denied me but i am going to appeal, best of luck, i'll be following your progress, wish me luck, jeani
-
what i feared the most has happened:(
sleevegenie replied to determined1's topic in Insurance & Financing
i was gonna send you a copy of my appeal letter, i have anthem blue cross and was denied because they say it is experimental, i am so JEALOUS, i wish you all the best and hope for the same for myself, take care -
wow, welcome, congratulations, i'm so happy for you, i'm trying to get the sleeve but my insurance still considers it experimental and they don't want to pay for it. hopefully they will all start offering it, i mean really, thankfully kaiser , united, and i think in april aetna is going to be offering it, hopefully anthem bc and all the others realize they need to offer this and give us all a good chance, so wish me luck on my journey and i wish you all good luck on yours
-
no it is definately not too old, i will be turning 60 next month and plan to have it, i'm trying to get approved for the sleeve right now, we all live longer these days and the quality of life will be much improved with this help, go for it best of luck
-
you have the same birthday as my daughter, only a month and a half late, happy belated bd, i'm right behind you on 4/20 the big 60 this year, i hope this is all settled by then, if i have a surgery date by then i'll be happy.
-
hey im with you on that, i will be 60 next month, how did that happen, i have struggled with my weight forever, now i have high bp elevated triglycerides, borderline diabetes, arthritis, and due to the arthritis i can't do any weight bearing exercise, and they tell me the sleeve is investigational, i wish i had the money to self pay, did your insurance cover it???
-
gastrip stapling, gastroplasty = VSG?
sleevegenie replied to valleyfree's topic in Insurance & Financing
i did that and was told if it is medically necessary it is covered, but guess what, when you apply they say sorry, investigational,,, very frustrating i hate to say it but the customer service people give out a LOT of false information -
VSG in Phase III Clinical Trials? (long)
sleevegenie replied to WI2AZ's topic in Insurance & Financing
well, i was told the same thing by customer service at Anthem Blue Cross, they said if it is medically necessary they will pay for it, but when the request for approval was sent in they say oops sorry, this is still considered experimental. its being looked at now waiting for the insurance to make a decision, need the denial before i can appeal,, even tho i was told to appeal and the paperwork has been with the appeal board over a month, what a bunch of hooey, -
are you compiling information about this situation?? if so please share it with me, i'm pretty sure i'll be denied, and i have every intention of appealing this, how much longer can they call it experimental when Kaiser and Untied offer it now, and :001_wub:they say aetna is gonna start offering it in april, :lol0:
-
i have anthem blue cross hmo, denied d/t experimental, appealed to bc 30 days later they tell me you haven't officially been denied, the letter hmo sent says this is not a denial, but you have to go to bc to appeal??? just found out today OMG, so now its gone to some other dept, i'm so frustrated, this has been going on so long, i got the letter from the hmo on 2/6 i'm ready to scream, i'm gonna keep fighting this , i want the sleeve, ;O)
-
Hi Tiff, well i thought you were lost, i haven't seen a post from you in sooo long, now i just realized that its me that's been lost, i was on the OH board, i haven't been on this one in a while, this whole thing is a trip, i have been appealing for the sleeve, I THOUGHT<----- my HMO said i had to go to anthem bc and appeal, they have 30 days to respond, finally yesterday was day 30 and i find out, oh sorry, you can't appeal until you are denied, and the letter from my hmo said this is not a denial but you have to appeal with anthem because this is experimantal, since 2/6 I'm just sick about this, i see why people say F___ this , i wish i could afford to self pay,, so i can't even think right now, so now it's been sent to some other department, OMG i need a drink, I'm so glad you're not lost, i've missed your words of encouragement to all on here,
) -
How did it go with the surgeon, i am appealing denial d/t considered investigational, its been a week, they have 30 days to respond, my surgeon is no help he wants todo the bypass, they make more money i think but i'm concerned about my body, wishing you all the best, let us know how you are doing, thanks for sharing Jeani
-
I think I am ready!
sleevegenie replied to WeekendWarrior's topic in Tell Your Weight Loss Surgery Story
Hi , hope it all went well for you. some insurance companies are starting to approve the sleeve, i'm in the appeal process now, hoping for the best, best of luck to you, hopefully soon we will both be on the sleeve train, Jean -
I think I am ready!
sleevegenie replied to WeekendWarrior's topic in Tell Your Weight Loss Surgery Story
tif, is oversewing the staple line good??? what's that about the barium leak check?? -
I think I am ready!
sleevegenie replied to WeekendWarrior's topic in Tell Your Weight Loss Surgery Story
'Tiffy, why do you say barium is a no no, i thought i read on someones page that they did a barium leak check??? -
congratulations, i am so jealous, lucky you , hopefully i'll be right behind you, kinda. I just sent my appeal letter today so wish me luck, you'll be great, Jeani
-
hey guys, i am so dissapointed, i probably shouldn't be i guess i kind of ecpected the denial but i guess in the back of my mind i was hoping it would be approved. The letter says this is not a denial of service, so i take that to mean i do qualify for WLS just not the sleeve because they consider it investigational. Several people on this site have shown that some companies are now approving this so i'm hoping to win this by appeal. my letter is all ready to go, Tuesday i will fax it over to Anthem BC of CA and pray that they will approve it. Fully intend to take it even further if i have to i just hate all the delays. thanks for being there and wish me luck, jeani
-
Introduction and Insurance Question
sleevegenie replied to achopp's topic in Tell Your Weight Loss Surgery Story
i wish you the best, my insurance company told me 43775 was covered as long as it is a medical neccessity if my HMO approved it they would pay for it, so i got REALLY HAPPY, i have HMO so the HMO decide, until my HMO said the insurance company considers it investigational, at least 5 people told me it would be covered, so best of luck to you and to us all, :thumbup:) jeani -
Introduction and Insurance Question
sleevegenie replied to achopp's topic in Tell Your Weight Loss Surgery Story
HI, don't want to be a bummer but i just got denied -my insurance company says it is investigational?? how can that be, i have been working on my appeal letter and i believe it is a good one, people on here have advised me that California has good luck with appeals so i'm praying very hard, this is the answer to my prayers, i wish you the best of luck with this, i think it just depends on your insurance carrier. Jeani -
List of Insurance companies and VSG coverage policies?
sleevegenie replied to WeekendWarrior's topic in Insurance & Financing
thank you so much, i really appreciate this, it's really the only option for me, i have to fight this, i DO NOT WANT THEM MESSING WITH THE PLUMBING i'm ok with a smaller tummy, that's really all i need i will do the rest, :biggrin2:) -
List of Insurance companies and VSG coverage policies?
sleevegenie replied to WeekendWarrior's topic in Insurance & Financing
i have been struggling with this same issue, i have HMO and they get to decide but because Anthem Blue Cross consider it investigagtional they denied me. I am faxing my appeal letter on Tuesday, just did the last of my preop, had cardiac stress test today, i cannot get anyone to tell me their obestiy surgery policy, please send good thoughts my way, i really don't want any other procedure, can't afford self pay, i think my letter is pretty good. If Anthem denies my appeal i'll be devastated. How can they still consider it investigational, several companies are starting to approve it????? -
Hi jsm, i hope you are feeling better, i'm so sorry about the insurance. I am still waiting, my dr office said i was denied, but me hmo said it is still being reviewed. Today they said they sent it to the insurance company to see if it is covered, Anthem told me if my hmo approved it they would pay so i'm really frustrated, getting the runaround, i may be in the same boat as you, best of luck, take good care of yourself, Jeani
-
Doyou have a date yet??? i just found out that having HMO is different than most of the stories on here, they are referring me to a cardiologist first, my surgeons office said i would have to be approved first then go to the cardiologist, but my group won't approve until after the cardiologist visit. I'm hoping it won't be a month or longer to get in to see him...... oh well ,,,, nothing to do but do it, good luck to us all, thanks to you guys for being there for me (us) well its 7:45 west coast time off to work :confused1:)