I've been denied :(

[champagne301 54]

My surgeon's office called a couple of minutes ago and gave me the news. The reason given was that in some of my Dr notes, it says I'm still smoking. They want me smoke-free for 6 weeks (which is not stated in their requirements). However, I've already been on the patch for 4 weeks now, so their office is sending a letter to appeal because of that. I'm bummed, right before Christmas too. Also, I am afraid that there may be changes made to my coverage come the new year. PA is supposed to make some cuts in Medicaid, but I can't find any info if wls will be one of them. I don't know...this is depressing.

[Elode 8,093]

Well that stinks but hopefully they will speed the appeal along. They are pretty serious about that smoking. Good luck!

[ProudGrammy 8,322]

smoke free 6 weeks on the patch for 4 weeks

@@champagne301

glad doc is working on the appeal

insurance will do their thing

so this will take a little while

i know nothing about the patch

when you tell someone you've been on the patch for 4 weeks

does that show insurance you were smoke free ????

or are people still able to smoke while being on the patch??

i don't know the answer to that

many/most docs require a blood test shortly before surgery

this verifies that you have been smoke free

i can only imagine that it must be very hard to quit smoking

you will do this!!!!

continue to be live smoke free

hopefully appeal will be taken care of sooner than later

before you know it, you will be on your way to a............

healthier, happier, longer, smoke free life

who deserves it more

good luck

kathy

[champagne301 54]

Thank you both! I'm trying to remain patient and positive. I was never a normal "smoker", I was an occasional smoker...maybe a pack a week. I smoked because I felt like it, I could have quit LONG ago, but was never given a reason to. I was told by my surgeon that I can't smoke once I start my 2 week pre-op, and if course, after surgery...but never said it was imperative for insurance approval, otherwise I would have quit when needed. That is what bugs me. I started the patch 4 weeks ago because I didn't want any cravings, like a just in case. They even started me on the lowest patch since I barely smoke. And I don't know how they would check to see exactly how long I've been smoke free, you would think being on the patch would be proof, but I don't know. We'll see how it goes. Thanks again

[Natasha Estrada 36]

They can do a nicotine test. Smokers in my surgeon's practice have to quit smoking 10 weeks before surgery and the rest them preop and will cancel surgery if they restart. I guess the 10 weeks part is that if you've been smoke free that long presurgery you're unlikely to restart afterwards.

[BLERDgirl 6,417]

My surgeon's office called a couple of minutes ago and gave me the news. The reason given was that in some of my Dr notes, it says I'm still smoking. They want me smoke-free for 6 weeks (which is not stated in their requirements). However, I've already been on the patch for 4 weeks now, so their office is sending a letter to appeal because of that. I'm bummed, right before Christmas too. Also, I am afraid that there may be changes made to my coverage come the new year. PA is supposed to make some cuts in Medicaid, but I can't find any info if wls will be one of them. I don't know...this is depressing.

What insurance do you currently have?I have Keystone 65 Independence Blue Cross and I'm pretty sure it's still covered.

[champagne301 54]

They can do a nicotine test.

Wouldn't this test detect the nicotene in my patch though? They didn't say patch free. I'm still waiting to see what they are going to say about what they are going to use to determine this. We'll see.

[champagne301 54]

What insurance do you currently have?I have Keystone 65 Independence Blue Cross and I'm pretty sure it's still covered.

I have Health Partners of Philadelphia/ Medicaid. Starting January 1st they are dividing Medicaid up into two categories. Healthy and Healthy-Plus...they put me into the Healthy category which is supposed to see the most cuts. They have not released what exactly is being cut yet...or if they did, I can't find it.

Edited December 21, 2014 by champagne301

[BLERDgirl 6,417]

I have Health Partners of Philadelphia/ Medicaid. Starting January 1st they are dividing Medicaid up into two categories. Healthy and Healthy-Plus...they put me into the Healthy category which is supposed to see the most cuts. They have not released what exactly is being cut yet...or if they did, I can't find it.

I read about that. Health Partners is awful, I never opted for that. I'm assuming you have no other medical conditions. I was reading about the changes but since I no long have medicaid I didn't follow it closely. I'll see if I can find that information again.

[Natasha Estrada 36]

Wouldn't this test detect the nicotene in my patch though? They didn't say patch free. I'm still waiting to see what they are going to say about what they are going to use to determine this. We'll see.

I think it would but you don't stay on the patch forever right. Just long enough to quit. The preop process at my surgeons office is about 6 months (8 months for me) so I think they make quit asap.

[JerseyCityGal 231]

It's extremely hard, if not impossible, to have ANY elective surgery approved for a smoker on ANY insurance plan whatsoever because of the risks involved.

Good luck with quitting. You will be so much healthier.

[champagne301 54]

Ok...so I think I feel a little bit better now? I believe my surgeon's office is going to send them a letter stating this for me. I called them again today (waiting for a return call) to see if that is all that is really needed. I stopped my patch on Friday to begin to rid my system of any lingering nicotene just in case I need a blood test. I can hope still, right?

[Natasha Estrada 36]

And all the money you save from not smoking you can spend on some cute outfits

[athena3127 199]

If in the very first meeting with my surgeon you stated that you smoked they advised you to quit. He would then ask at each visit when was the last time u smoked. He required 6wks without smoking before he would ever start the approval process. Yes there is a nicotine test and he gives one before he starts the approvAl. The you get another test in your last Appointment prior to surgery and the day you go in for surgery they send you to the lab for the final test. I do understand that this can be stressful. However in the long run it's what works best to give you the best possible outcome from surgery. Reduces risks and complications. Hang in there and follow through with things you can do this.

Hugs of support

[champagne301 54]

Just wanted everyone to know....I just received a call from my insurance...and I was APPROVED for surgery! I'm so excited, and relieved now I don't have a date yet, since the scheduler is out until Monday, but at least I know there will be one coming soon!

Edited January 2, 2015 by champagne301