end of the world

[bigjoemccarthy 0]

I was just told that my surgery was not covered but my blue cross health plan east coverage denied I'm not taking this news very well

[ChavaBling 145]

Honey, I'm so sorry. There has to be an appeal process. If you're feeling anger and negative emotions, maybe you could put that energy to use by mounting yourself a strong appeal case. It could give you a defined "next step"; something to work towards.

[bigjoemccarthy 0]

Thanks honey

[jjinWA 511]

Don't give up after the first attempt. Find out why you were denied and seek out what steps were missed as part of the "hoop" process. Go at it again and ask your surgeon and his staff to request a review of denial. That is usually a 30 day process. And if all else fails, Mexico is another viable option. I have followed the comments here on the various threads and it seems most have had good luck and very competent surgeons. I have been approved by BCBS for surgery here in my home state, but my daughter is still waiting on her ins approval.... She is Aetna. If they deny, if will support her to go to Mexico for the surgery. I will be by her side the whole way! You are right, it must feel like the end of the world and soooo disappointing. But Mexico is another option, don't rule that out if your review is still unsuccessful.

[SusinMichigan 76]

There are always appeal processes with insurance companies. If they are currently paying for treatments for high blood pressure, sleep apnea, diabetes, etc. you can pull more of a return on investment "defense". You will require less hospitalization, no sleep apnea effects or supplies, less medications. Do your homework instead of being devastated and angry (which you definitely have the right to feel) ... be logical and methodical!

Good luck!

[bigjoemccarthy 0]

I was just told by my surgeon that independence Blue Cross is saying that my policy does not cover bariatric surgery so there's no appeal process if its not covered under my Coverage. I also found out from independence Blue Cross that none of their coverages cover bariatric surgery which is insane so i can't appeal and i can't get better coverage because none of there plans cover it.

[Bluesea71 698]

I was just told by my surgeon that independence Blue Cross is saying that my policy does not cover bariatric surgery so there's no appeal process if its not covered under my Coverage. I also found out from independence Blue Cross that none of their coverages cover bariatric surgery which is insane so i can't appeal and i can't get better coverage because none of there plans cover it.

What state do you live in? Many states (thanks to Obama care) are mandated to cover weight loss surgery. I'm assuming if this is the case though, blue cross would be aware of it.

[bigjoemccarthy 0]

Pennsylvania

[Miss Mac 6,262]

I don't know why you have that particular insurance carrier, but could you change to one that does provide the coverage you need? Even if the process takes a year, a year is going to pass whether you are pro-active or not. Yes, international travel for healthcare is quite common.

Also, while you are waiting and regrouping your efforts, you could get a headstart by adopting the principles that are common among our bariatric teams around the world:

Eat Protein and plenty of it. Most of us are between 60g to 80 g per day. That's roughly 20g per meal with two Snacks.

This also means not breaded or swimming in gravy. Besides, it's summer now and grilled steak, chicken, and

veggies are awesome. Fuit in it's fresh natural state (not pie) is good - veggies (not breaded and deep fried) are better, even with some cheese on them (extra Protein for you).

Drink Water until your eyeballs float. Ditch the soda and any beverages with sugar, high fructose corn syrup....you know the drill. Seems like there is a canyon between sides on the subject of artificial sweeteners. I use them, but many people don't. I guess sweeteners are my cigarettes. I've cut back, from over a dozen a day to 3 or 4. That's my demon and I am working on it.

Exercise some way some how. If all you can do is sit in bed and wave your arms, then do that. Walking is absolutely the best exercise you can do. I go out in the back yard early in the morning and just do laps for 20 minutes. The grass is less tiring for me than the sidewalk. The general concept is to at least get up and move around every hour or so. If you need to shut the door, crank up any music you like and dance like nobody's watching, then do that.

Pretend like carbs cost you $10 cash up front...each. The fewer carbs the better. Yeah, I know, that means bye bye to bread, Pasta, rice, cream gravy, donuts.......or at best just wean yourself off slowly but reducing the amount as you can.

Weigh and measure your food. I found out with my first nutrition visit, that a serving was not nearly what I thought it was.

Take smaller bites and chew until your jaws hurt. This takes you longer to get through your meal and helps your tummy to feel fuller sooner.

The kitchen is CLOSED after dinner. Another one of my own personal demons was night eating. I could go downstairs to the kitchen and have a whole 'nother meal at 2:00 in the morning. Now, if I feel like I have to have something or I will surely die, I make a cup of sugar free cocoa with sugar free whip cream.

Go to My Fitness Pal (myfitnesspal.com) and set up a free account. On there you can customize what nutritional values you want to follow and add data every day. You can record what you eat and it will tell you how you are doing based on calories, carbs, protein, sodium, etc. It is a great tool of accountability so that you can be aware of what you are actually eating in a days time.

Also, I would recommend a website called Mark's Daily Apple. It is a web community for people who want knowledge about the Paleo/Primal lifestyle. One of the best things about Paleo/Primal is that the food choices are very similar to what gastric patients are already doing such as low carb - high protein eating, and get up and move around some.

So, see??? If you can do all of this, then by the time you get your surgery done, you will be a pro at this and able to encourage someone else down the line. Plus it's sure to knock off a few pounds to give you a head start.

Does your insurance cover anything like nutrition counselling or exercise physiology????? I hope that you can stay strong and come back to visit us often on Bariatric Pal. This is an awesome community for support and encouragement. I wish you good luck and good health.

[bigjoemccarthy 0]

Miss mac. Thank you I appreciate everything you wrote

[jjinWA 511]

Yup, these are very good steps and certainly doable. Weight watchers follows the plan that you can eat all the fruits and veggies you want. I once was told that you will easily stay in you calorie intake limits if you follow this theory. An Oreo cookie and a small apple are the same calories. I can eat a whole package of Oreos in one sitting but I can not eat the same number of apples.... Good example for me to follow. :-).

I still would look into Mexico option.

Can anyone that had the surgery recently in Mexico give their updates as to how they started the process and did their research... And a range of how much in cost.... In a quick summary format. This might be helpful at this point.

[cherylstark 0]

So sorry to hear that! Something good will come up! Head up!!!

[Mayshula 40]

Sorry to hear that, same thing happened to me. I decided to get my surgery in another country, in the US you pay about $25,000 without insurance. I paid $8,000 in Guatemala in one of the best hospitals they have there. They have a great team with lots of experience. I am back at the US now and in my 5th week post surgery. I don't regret my decision at all. It was worth it!

[ProudGrammy 8,322]

surgery not covered

@@bigjoemccarthy

hey dude

re-enforcing what everyone else has said

don't give up

appeal, appeal, and then appeal

don't take NO without a fight

I "think" @@Miss Mac has a great list of co-morbities that can be used to appeal their decision

going out of the country is a great alternative/suggestion for surgery if you are not approved

but paying ONLY ie $7,000.00 can be the same as paying $7 million

if you don't have it, you don't have it (maybe you do have the money though )

determination, willpower, strength

you will need the above post surgery (when you do have it )

remember - don't take this laying down

good luck guy

kathy

Edited June 7, 2014 by proudgrammy

[Jersrose43 837]

Sorry to hear its a coverage restriction.

This is not an appealable option.

But you have other options.

1. If this is through an employer, talk to your employers HR department, ask them if they have given though to adding the coverage. It is a known fact that obesity related complications are costly. And in the end you would save your company money by having the surgery.

2. If you purchase this plan on your own - look elsewhere. The fact that IBC doesn't cover bariatric is BS. They have an indemnity plan, it is more costly, much more so, but it covers way more than the HMO / POS Keystone option they like to sell you.

3. Welcome to Obama care babe --- SHOP! Go on the exchanges, see what is offered, call each and every one of those plans and get the information on coverage of benefits. Someone has the coverage. Buy it.

4. IF you're married, check the wife's plan for this coverage. Get on her plan.

If you have an employer coverage, you can buy a private plan as well. If you can afford another plan for a year, and it covers bariatric, buy it. Cheaper than paying cash for this surgery and its potential complications out of pocket.

You would be required to get a denial from the employer coverage first, then file with your personal plan, it works.