Tufts

[Jenn31MA 149]

I live in Mass with Tufts insurance and I have called a few times to see if the sleeve is covered but they can never find anything or dont know what I am talking about. When i had my first appointment at the hospital the NP stated that she has had some patients with Tufts and have it be covered. My question being does anyone on here have Tufts and have had it approved?? Its a new procedure thats being covered in New England and I guess they have only been approving it for the past year or so. My next appt with the NP is next month and I might ask her for the billing code as the customer reps at Tufts are pretty much useless lol

[Liberated Sleeve 148]

Why wait until your appointment? Call and ask them for it

[Glorita 0]

Hi Jenn31ma,

I was just wondering how your TUFT insurance approval process is going. I just had my doctors official first appointment at MGH today and was told that TUFT insurance requires me to do a 6-month program called "I Can Change" in order to be eligible for VS coverage. It seems that you were required to this program as well?

Have you been able to make any progress in that program?

Do you know how "I Can Change" works?

Are you aware of any exceptions that can apply in order to bypass this 6-month program?

Any information that you can share with me would be greatly appreciated.

I am devastated as I was hoping to have my VS done in mid June at the latest.

Thank you!

[Yorkie Fan 16]

Hi Jenn,

Here is the information you need:

http://www.tuftshealthplan.com/providers/pdf/mng/bariatric_surgery.pdf

This will give you the code which is 43775. It also gives you all the info for approval process.

Hope this helps!

Nichole

[Jenn31MA 149]

Hi Jenn31ma,

I was just wondering how your TUFT insurance approval process is going. I just had my doctors official first appointment at MGH today and was told that TUFT insurance requires me to do a 6-month program called "I Can Change" in order to be eligible for VS coverage. It seems that you were required to this program as well?

Have you been able to make any progress in that program?

Do you know how "I Can Change" works?

Are you aware of any exceptions that can apply in order to bypass this 6-month program?

Any information that you can share with me would be greatly appreciated.

I am devastated as I was hoping to have my VS done in mid June at the latest.

Thank you!

Hi! I havent found anyone yet that really has the same insurance but there is NO way to bipass the 6 month program. You basically just have a 10 minute call with a health coach once a month for 6 months straight and then they issue a completion letter and thats all that Tufts requires you to do really. You need to have your PCP fill out the form you can find on line and you just fax it to Tufts and I received an acceptance letter with a day. You will then have a first call with the health coach to get all your information and they are basically just there to check on your progress and see how your doing. My coach even said that she knows people lie to her and she isnt there ot judge anyone but that to use her knowledge as she is there to help us.

I found out about the I Can Change Program when i went to Laheys information session since Lahey is affiliated with Tufts Hospital so a good chunk of their patients have this insurance. My NP said that she is almost positive that they cover the sleeve but everytime i call they have no idea what im talking about but i swear that ive seen that they do as an update done last year on their website. I see her on Friday and she said she'd look into it for me so I can let you know!!

Im hoping to have my sleeve done in August but I am currently having issues trying to lose the 10% of the weight i need to before they will do it but i sitll have about 2.5/3 months before then so I hope i get my stuff together!

What made you choose MGH? I was going to do Beth Isreal or Lahey and Lahey was just easier getting around and they are Level 1 hospital so i choose them after the great reviews I read about.

[Jenn31MA 149]

Hi Jenn,

Here is the information you need:

http://www.tuftsheal...ric_surgery.pdf

This will give you the code which is 43775. It also gives you all the info for approval process.

Hope this helps!

Nichole

I saw that online but i wasnt sure if those were the correct codes. Thanks!!

[chitowngirl 885]

You can call your insurance and ask them to quote you the benefits for bariatric surgery, the procedures they cover should be in there, if not ask them specifically what procedures are covered for wls.

[Glorita 0]

Hi Jenn,

Thank you for your time and all the information that you have provided me with. I really appreciate it as this has served as wake up call in many respects. The first thing that I found out is that although Tufts is the administrator of my insurance with Cigna, my coverage benefits are the ones laid out by Cigna - not Tuft. This makes it even worse for me as Cigna imposes a formal 6-month weight loss program by a doctor or dietitian previous to the surgery approval. There are many other conditions imposed by the insurance company that I hopefully will be able to comply with. The other thing that I found out today at my doctors office is that the average cost of the surgery at MGH is $25K, as compared to Beth Israel and Lahey average cost of $12K. Does this sound right to you? I found this cost on the Cigna's website.

I have started to look into Lahey based on your recommendation (thank you so much for the information). They are a little bit far from me but definitively have great reviews. My sister knows a couple who went to Lahey and they were very happy with the clinic and their results, together they lost about 400 pounds in a little over a year. Lahey is not that close to me as I work in downtown Boston, but definitively will consider them seriously for the surgery despite having to make the effort to get there. I am not sure how much I will have to pay out of my pocket either, but if it is a % of the cost, that would then be another plus if I choose Lahey over MGH.

The other thing is that my lab work from last week shows very low Iron levels and severe anemia. I had been feeling very weak and with no energy over the last couple of months but thought this was related to my weight and some laziness - never imagined that I could have anemia. In addition, my levels of Vitamin C and D are very low too which don't help with the Iron absorption. My thyroid levels are low too. So I walked out from my doc's office today with a bunch of prescriptions as he strongly suggested that I try to fix all these issues before my surgery, which is going to be more like in November. He also thinks that if I can control the anemia, I will feel stronger and more willing to do a little bit of exercise and start loosing a bit of weight before then. I am starting my 6-month program today and will stay with MGH for now just due to the convenient location.

Tell me how your 10% weight loss is going. Have you had any success since we last posted? You must be very excited about your surgery in August. Please keep me updated!

Best wishes,

[Jenn31MA 149]

Hi again,

I actually just finished my 2nd behavioral class yesterday and I saw the NP last Friday as well and all my testing is done i just need to lose the weight. She scheduled me to see her at the end of the month and as long as i am moving down. To help lose some weight i started drinking Slim fast for Breakfast, having a salad for lunch with Protein and special K or a lean cuisine for dinner. Its only been a few days so i haven't seen a change plus i am going to try to only weigh once a week!

I am sorry that you've been having to deal with all issues and hopefully the meds will help. As far as Lahey like i said I love it there so far and everyone is really nice. They have the information sessions once a month..i believe the first Monday of the month and this is mandatory. I found the link to their site if you haven't found it yet but it tells you everything you need to know for their program.

http://www.lahey.org/Departments_and_Locations/Departments/Medical_and_Surgical_Weight_Loss_Center/Step-By-Step_Guide_to_Surgical_Weight_Loss.aspx

As far as the costs go for surgery I am unsure of that as all i cared about was the surgery being covered and i am only responsible for my deductible ($1,000.00). That is weird though that MGH is twice as much as the other two hospitals.

Keep me posted as well on which hospital you choose!