Guest guest Posted September 18, 2002 Report Share Posted September 18, 2002 I have got a question.......Im 25 years old and I meet the criteria for the Gastric bypass....My doctor said he would refer me to UMASS hospital where they perform the surgery..but the question that I have is does the insurance company ask if Your doctor put you on a perscribed " diet " ? in the past?hope you understand the question. I guess another way of putting the question is Im sure you all see a nutritionist before surgery is that just because they need to explain how you must eat for the rest of your life? My friend seems to think that the nutritionst would put me on a diet first. I don't know how to explain but hope you understand......... Does any one have Blue Cross Blue Shield Coast to Coast for health insurance and if so did they cover the surgery? Paranoid!!! please reply asap:) chica_b22@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 18, 2002 Report Share Posted September 18, 2002 Where are you? About Gastric Bypass I have got a question.......Im 25 years old and I meet the criteria for the Gastric bypass....My doctor said he would refer me to UMASS hospital where they perform the surgery..but the question that I have is does the insurance company ask if Your doctor put you on a perscribed " diet " ? in the past?hope you understand the question. I guess another way of putting the question is Im sure you all see a nutritionist before surgery is that just because they need to explain how you must eat for the rest of your life? My friend seems to think that the nutritionst would put me on a diet first. I don't know how to explain but hope you understand......... Does any one have Blue Cross Blue Shield Coast to Coast for health insurance and if so did they cover the surgery? Paranoid!!! please reply asap:) chica_b22@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 19, 2002 Report Share Posted September 19, 2002 Jennie, Different insurances have different requirements. It's hard for us to know specifically about BC C2C unless one of us has it. My BC here in Florida required that I have 6 months in the last year. Since I did phen-fen years ago and sustained some damage, I didn't have that requirement. So I'm self-pay. Usually, if an insurance wants you to see a nutritionist, it's to get advice on how you will need to eat post-op to keep the weight off. Some nutritionists know, but most aren't really aware of the needs of GBS patients. Some docs put you on diets prior to the surgery, for various reasons. Some just require you to lose a certain percentage of your weight. My doc wants us to not *gain* weight in the 4 months between getting our surgery date and the acutal surgery. There is such a tendency to have the " last meal " syndrome. The only way you'll be able to know for sure is to ask the insurance or the doc. Or you can go to www.obesityhelp.com and join and there you'll be able to find information about people's experiences with their insurances. Pam in Niceville preop Lap RNY 11/20/02 Dr. Champion/Atlanta About Gastric Bypass I have got a question.......Im 25 years old and I meet the criteria for the Gastric bypass....My doctor said he would refer me to UMASS hospital where they perform the surgery..but the question that I have is does the insurance company ask if Your doctor put you on a perscribed " diet " ? in the past?hope you understand the question. I guess another way of putting the question is Im sure you all see a nutritionist before surgery is that just because they need to explain how you must eat for the rest of your life? My friend seems to think that the nutritionst would put me on a diet first. I don't know how to explain but hope you understand......... Does any one have Blue Cross Blue Shield Coast to Coast for health insurance and if so did they cover the surgery? Paranoid!!! please reply asap:) chica_b22@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 19, 2002 Report Share Posted September 19, 2002 Hi Jennie - Many insurance companies do ask that you have proof of doctor supervised diets before paying for you to have surgery. At 25, you may not have any yet, huh? The nutritionist may give you a diet plan to follow, but this is a good thing, because if you can lose weight before your surgery, it will help you after surgery. Just because you are seeing a nutritionist, does not mean that you will have to see him/her for many months. It all depends on your particular insurance and what they require. It can drive you nuts. I hope you realize that this surgery is not a magic pill. It is a tool that will work for you if you follow the rules. That means protein drinks and vitamins for life, as well as keeping your meals to 1/2 cup max. in size. Good luck with getting your approval. Jeanne in WI Age 39 Open RNY 05/21/2002 314/ 255./150-175 5' 8 " djgraves@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 19, 2002 Report Share Posted September 19, 2002 Jennie, I saw a nutritionist before surgery just for a consult. No diet before surgery. I also have Blue Shield PPO in California and they covered 90% of the doctor and 80% of the hospital and that was of their allowed rate. In all it cost me about $1400. It may be different in Mass where I'm assuming you are. The insurance may want to know if you have tried other methods first. Call your insurance. I called them and knew the ins and outs before I started. Sharon http://www.DesignWithMerritt.com http://www.eclecticacademy.com 5'9 age 48 297.5/247/150 7/5/02 Dr. Ninh T. Nguyen UCI Medical Center http://www.ucihealth.com/news/uci%20health/mni3-02nnguyen.htm I have got a question.......Im 25 years old and I meet the criteria for the Gastric bypass....My doctor said he would refer me to UMASS hospital where they perform the surgery..but the question that I have is does the insurance company ask if Your doctor put you on a perscribed " diet " ? in the past?hope you understand the question. I guess another way of putting the question is Im sure you all see a nutritionist before surgery is that just because they need to explain how you must eat for the rest of your life? My friend seems to think that the nutritionst would put me on a diet first. I don't know how to explain but hope you understand......... Does any one have Blue Cross Blue Shield Coast to Coast for health insurance and if so did they cover the surgery? Paranoid!!! please reply asap:) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 20, 2002 Report Share Posted September 20, 2002 Hello Pam, I read your message and could not believe the timing of it! I have just received my letter of Denial from Blue Cross Blue Shield, and when I phoned they stated the reason for denial was because I had sought prior treatment for Obesity by using Phen-Fen within the last 6 months. Is this what you are referring to? Where you able to your Insurance to pay for your surgery, and so did you have to wait 6 months? Thank you for posting, and answering any questions. D.Trice dtrice@... About Gastric Bypass I have got a question.......Im 25 years old and I meet the criteria for the Gastric bypass....My doctor said he would refer me to UMASS hospital where they perform the surgery..but the question that I have is does the insurance company ask if Your doctor put you on a perscribed " diet " ? in the past?hope you understand the question. I guess another way of putting the question is Im sure you all see a nutritionist before surgery is that just because they need to explain how you must eat for the rest of your life? My friend seems to think that the nutritionst would put me on a diet first. I don't know how to explain but hope you understand......... Does any one have Blue Cross Blue Shield Coast to Coast for health insurance and if so did they cover the surgery? Paranoid!!! please reply asap:) chica_b22@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 20, 2002 Report Share Posted September 20, 2002 Actually, BC/BS PPO has told me two different things and my doc a third. According to one of my calls, I needed a year of doc's overseen weight loss. Then on my second call I needed a year within the last year. Then they told my surgeon I needed 6 months within the last year. I got all the info together for a year's work in 1990, but that obviously wouldn't work. Ultimately, we didn't submit at all, because it would just be denied, and then an appeal would be denied because I didn't match the rule(s) in any direction, and in the meantime my doc wouldn't schedule for surgery until the insurance was done. So after what I anticipated to be about 4 months through that, I could get a date and be self-pay, or I could be self-pay and get a date now. (Now is relative, my doc schedules 4 months out). Or I could do a doctor sponsored weight loss thing for 6 months and resubmit. Of course, that weight loss would be without pills since I have valve problems from the phen-fen. So, Let's see, lose weight for 6 months, take another 2 months to gain it back, then start the process again. If I were 28, I would go the last routine. But at 56, I just didn't want to wait a year for teh surgery. So I'm self-pay. Pam in Niceville preop Lap RNY 11/20/02 Dr. Champion/Atlanta About Gastric Bypass I have got a question.......Im 25 years old and I meet the criteria for the Gastric bypass....My doctor said he would refer me to UMASS hospital where they perform the surgery..but the question that I have is does the insurance company ask if Your doctor put you on a perscribed " diet " ? in the past?hope you understand the question. I guess another way of putting the question is Im sure you all see a nutritionist before surgery is that just because they need to explain how you must eat for the rest of your life? My friend seems to think that the nutritionst would put me on a diet first. I don't know how to explain but hope you understand......... Does any one have Blue Cross Blue Shield Coast to Coast for health insurance and if so did they cover the surgery? Paranoid!!! please reply asap:) chica_b22@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 20, 2002 Report Share Posted September 20, 2002 I was self pay too Pam - we borrowed against our retirement - there was no way in this world that UHC would have ever paid for this - SO- we figured that if we intended for me to be around for retirement - this was a good way to use the money. It was either that - or use it for my funeral - it was a good deal as far as we are concerned and there are NO REGRETS!!!!!!!!! hugshugs deb in NE About Gastric Bypass I have got a question.......Im 25 years old and I meet the criteria for the Gastric bypass....My doctor said he would refer me to UMASS hospital where they perform the surgery..but the question that I have is does the insurance company ask if Your doctor put you on a perscribed " diet " ? in the past?hope you understand the question. I guess another way of putting the question is Im sure you all see a nutritionist before surgery is that just because they need to explain how you must eat for the rest of your life? My friend seems to think that the nutritionst would put me on a diet first. I don't know how to explain but hope you understand......... Does any one have Blue Cross Blue Shield Coast to Coast for health insurance and if so did they cover the surgery? Paranoid!!! please reply asap:) chica_b22@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 20, 2002 Report Share Posted September 20, 2002 I have UHC options PPO.. they paid for all three of my surgeries.. and I am hoping that they approve the abdominoplasty for next spring. Hugs, from GA open RNY 12/12/00 Revision 04/18/01 Revision 02/07/02 St wt.... 392 Cw.......187 Wt loss..-205 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 21, 2002 Report Share Posted September 21, 2002 , I didn't realize we had the same insurance..... kewl... Hugs, I have UHC options PPO.. they paid for all three of my surgeries.. and I am hoping that they approve the abdominoplasty for next spring. Hugs, from GA open RNY 12/12/00 Revision 04/18/01 Revision 02/07/02 St wt.... 392 Cw.......187 Wt loss..-205 Quote Link to comment Share on other sites More sharing options...
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