Disappointed in Atlanta

[LynneB 0]

I am in FL & I have UHC. When I called they told me no way it was totally excluded no matter what medically necessary reason, but my Dr called & I guess explained my co morbitities & how a one time surgery cost would save them a ton of $ in the long run. They then "found" a loophole in the exclusion policy and agreed to cover everything @ 80%. Dont give up!! Request a copy of your policy & take it to your Dr, they understand the ins jargon better & can find a way to make them cover it.

[essieburton 0]

You may be thinking about the "Any Willing Provider Law".

[WASaBubbleButt 41]

You may be thinking about the "Any Willing Provider Law".

What is that? I realize we are not talking about my state but I like to understand various issues that will help get people banded in the US if they choose.

[Lottie 0]

Cosmetic Surgery, Dental Procedures, Vision Costs and more: Healthcare financing

Capital One -Healthcare Finance

Check it out.

[GreenChrysalis 1]

I looked up the "Any Willing Provider Law" and found the following. I don't see how it can specifically assist with getting bariatric surgery covered by insurance companies. It appears to require insurers to allow different medical providers to participate in their networks. I suppose that in some applications it could force insurers to allow bariatric surgeons to participate in their networks if they did not, but that doesn't mean that the insurer would be required by law to cover bariatric surgery. I copied the section that related to Georgia since that's what we were talking about.

I don't claim to know anything more about this than what I've just found via Google. Maybe someone better versed in this kind of thing can share.

From the National Conference of State Legislatures site Health Policy --Federal Issues:

Any Willing Provider

Almost half the states have laws prohibiting health insurers from excluding participation of willing and qualified health care providers in their geographic coverage areas. Although most provisions are limited to pharmacies or pharmacists, several states have adopted broad provisions applying to hospitals, physicians, chiropractors, pharmacists, podiatrists, therapists and nurses.

Typical Provisions

A typical any willing provider law requires all health insurers to be ready and willing at all times to enter into service contracts with all health care providers who are qualified under state law, who practice within the general geographic area served by the insurance company, and who are willing to meet the terms and the conditions set forth by the insurer.

Pros and Cons

Proponents argue that, by selectively contracting and thereby excluding some providers, health plans are threatening providers' freedom to practice. Because providers increasingly depend on managed health plans as a source of income, they have lobbied aggressively for laws that would obligate plans to contract with any provider who meets the terms of participation.

Opponents of the concept claim it undermines cost control mechanisms employed by health plans allowing them to offer lower premiums to enrollees.

Georgia: The two laws apply only to Blue Cross Blue Shield contracts or rural health care providers' participation in plans in their geographic regions. Defines qualifying counties.

What is that? I realize we are not talking about my state but I like to understand various issues that will help get people banded in the US if they choose.

[LynnM 2]

Hi I Too want to get the Lap Band but I have Aetna and they have a written exclusion. So I am now thinking about self pay. About the law in GA. I was also excited to find out about this law, but quickly I learned that was meant to be good was turned around by the insurance companies The law states only that insurance companies have to offer it but companies can exclude it. So guess what most companies are excluding the coverage. Hope this helps.

[NEWME10 1]

Hello all, I was wondering if there is anyone out there that has been through the appeal process. I am with Cigna in Virginia. Has anyone been approved aftergoing through this process and about how long does it take? I started this journey back in September. It took them four weeks to deny me the first time. The Dr's office resubmitted it in January. Just anxious I guess.

Newme10

[CCDC74 2]

I went through four appeals before being approved. So just hang in there, and keep calling the insurance company every day!!!

[NEWME10 1]

Hello CCDC74, Did you have to do anything different when it was resubmitted. The dr"s office said that I had met all the requirements and just resubmitted it. When they(cigna) sent the denial , I looked back through my paperwork it looked like I had covered all the bases they addressed. But they were a little vague with where I didn't comply. Just wondering if you had to add anything to the request each time or any of the times?

Thanks

Newme10

[CCDC74 2]

No, I just kept resubmitting the request. I also called every day the insurance company was open and spoke to them. During this time I had to go to the hospital with problems with my knee, and told them if I had to have surgery on my knee because they did not approve my lapband that I was going to sue them for the pain and suffering I had been through waiting for them. Hang in there!!! I was the first one at my Dr.'s office to be approved by BCBS.

[2browneyes 0]

Good Luck with your surgery...

[NEWME10 1]

How do you get the tickers? I want one.

Newme10

[GreenChrysalis 1]

Hi Newme10, see the Ticker Tutorial

How do you get the tickers? I want one.

Newme10