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Benefits Approval
After doing the 6 month required diet, I was approved quickly. You do have to keep on Aetna though, because they kept saying that they hadn't received all of the information that they needed, even though they had. So it is a good idea to keep checking with them periodically. (Shelly K.) Aetna - EPO (KY) - 01/11/05 (Ms J.) Aetna - PPO (KY) - 11/23/05 After only 1 week, I am approved. I followed the guidelines my insurance company set forth. I went to my Dr's visits religiously. I didn't skip one step. It was a long process, but in the end - worth it. I am anxious to get through the surgery part and begin my healthier life. My opinion on the process, is call them - talk with someone at your insurance company. Ask questions if you do not understand something. Stick with it. Follow their guidelines and policies. (Patty F.) Aetna - Managed POS (KY) - 10/04/05 They are nice but want 6 months of nutrtion and exercise. Been there done that. Another 6 months to wait. UPDATE: I FINALLY FOUND A DOCTOR THAT WOULD KEEP RECORDS OF MY NUTRITION AND EXERCISE AND AFTER 6 MONTHS IN THE YEAR OF 2006, I AM APPROVED. (APRIL T.) Aetna HMO - HMO (IN) - 10/11/04 (Drainbamaged .) Anthem - Blue Prefered (KY) - 08/04/04 (lee s.) Anthem (KY) - 10/27/04 Before the initial letter was sent for approval, I had to change my policy type from PPO to HMO, but no problem after. My original contact, while I was on the PPO, wasan outright NO to the surgery. It wasn't until I contacted the Human Resource Personnel of my employer did I get any assistance. Before contacting Anthem directly, talk to your employers Human Resource staff, unless you totally comprehend your coverage. They will probably know how and who to contact. (Jean W.) Anthem - EPO (OH) - 06/23/05 (Jill R.) Anthem - PPO (KY) - 06/28/06 (Michelle L.) Anthem - KY - PPO (KY) - 12/05/03 exclusion in policy for morbid obesity (Mark S.) Anthem BC & BS (KY) - 01/17/05 (Sara J.) Anthem BC/BS (IN) - 07/01/04 (Carrie ~.) Anthem BC/BS (KY) - 03/20/05 (Christina B.) Anthem Blue Cross - PPO (KY) - 02/12/04 (Connie K.) Anthem Federal (KY) - 02/20/05 (Kena D.) BC/BS - Anthem (KY) - 04/13/03 (Debbie W.) BC/BS federal employees (KY) - 01/03/05 No troubles, so far they have paid pretty nuch everything. It was relativly easy to deal with them. I called them and asked if they covered the surgery. They said only if it was medically neccesary. One the letter was sent it moved quite quickly. From start to finish it took approx. two and a half months. honestly, you can't ask for better service than that. (Danielle M.) BCBS - Federal Basic (OH) - 03/28/03 Persistance is the key here.....and most importantly, check to be sure the doctor you chose is in the network! This I found out the hard way. Once I found one in the network, with the help of my family doctor who actually wrote a very supportive letter, it wasnt long at all until my date was scheduled and my approval went through. (Melissa R.) bcbs federal basic (KY) - 6/18/04 I personally didn't have to deal too much with them. My surgeon's office did all the work for me (Dr. Dwayne Smith, KY)I was approved after the first call/fax of info necessary. They have been very easy to deal with otherwise, what little contact I had firsthand was simple and they were nice and very efficient. Anthem BCBS has been VERY easy to deal with and had no trouble getting my approval. (Liane H.) Blue Cross - PPO (KY) - 08/18/03 My insurance company was great. Once I had completed everything my surgeon required and it was all submitted I had my approvial letter the next week. Thanks BCBS!!! (Lyda O.) Blue Cross - EPO (KY) - 05/20/04 (Susan C.) blue cross - ppo (KY) - 10/02/04 (terry p.) Blue Cross - PPO (KY) - 07/28/05 (Amy W.) Blue cross (KY) - 02/03/06 The insurance company requires alot of stuff, you must give them all they ask for. The 6 month diet is hard but you must do, it.. document everything. and everyone you talk to.... (peggy m.) BLUE CROSS BLUE SHIELD (KY) - 02/20/06 Papers were mailed at first and lost in the mail found out after 2 1/2 weeks calling every other day. Insurance said the doctor office could fax papers. Approval paper never recieved. So I kept calling a few weeks later I called and they said it was approved. They faxed the approval letter. Doc set up appt for later that week. (CASSANDRA B.) Blue Cross Blue Shield - Fed Employee Program () - 04-2007 I had no problems, because I met the guidelines in the contract. My employer covers this type of surgery,(RNY). Since I met the qualifications, I had no problems getting approved. After the first letter was sent I got approved after 4 weeks or approx one month. I recommend researching your employers insurance contract. Read the exclusions, as well as the covered procedures. Your surgeon can give you a code, call your insurance and ask them is the (RNY) procedure is covered. (Todd K.) Blue Cross of Michigan - PPO (KY) - 06/06/05 (Charlann S.) Blue cross&blue sheild - ppo (KY) - 02/20/04 (Vicki T.) CHA (KY) - 01/14/04 So far every time I have called Aetna after Dr. Smiths offices submitted my claim they have been very helpful. They keep telling me to follow up with Dr. Smiths office to see if anything is new. When I was first trying to get my paperwork in order I was told I must be on a medically supervised weightloss program. When I called Aetna to find out specifically what they wanted the told me that it was whatever my primary doctor said. (Not very helpful) Now I am just waiting and waiting to find out anything. Found out 10/29/03 was denied due to not having evidence of a 6 month supervised weightloss program. I have decided to switch insurance companies and will submit my case to the new company after January 1st. Update: Switched to CHA and had my case submitted I found out 1/14/04 that I was approved. (Thank you Laura (at Dr. Smith's office) for all your work!!!!)Overall CHA is wonderful to have!!!! I am so happy I changed. (Denise B.) CHA Health - HMO (KY) - 02-18-03 (Thearesa M.) Choice Care (KY) - 10/11/01 (Sandi G.) Choicecare Humana - primary access (KY) - 6/29/03 I had no problems with insurance company. After my doctor submitted my claim, it was approved within a couple of days. (Lisa C.) Cigna - PPO (KY) - 06/11/03 (Rhonda T.) Cigna (IN) - 04/12/04 (Paula H.) GEHA (KY) - 04/03/05 (Melannie W.) Humana - Primary Access (OH) - 04/19/03 So far Humana has been very helpful and informative. Everytime I've called with questions and to request info they have given quick and professional responses. We'll see what happens when I apply. 4/10 My surgeon sent request today and I was approved today. Was notified at 5:15 p.m. that it was authorized w/ no problems. Great so far! I highly recommend Humana because it lets doctors make decisions. (Cecelia F.) Humana - Humana ChoiceCare HMO (OH) - 11/20/03 I no longer have Humana HMO, I now have Humana PPO. At the time of my surgery (December, 2003) Humana, approved me for surgery very quickly and paid for the entire surgery. I was very pleased with them. However, I was under a deadline because the following January, they no longer covered wls. I don't know how Humana PPO dealls with wls requests but I imagine they are pretty harsh. (Lady B.) Humana - Primary Access (OH) - 12/03/03 Humana remained consistant with answers every time I called them. The reps answered my questions to the best of their ability, one of the reps even recommended Dr. Smith to me. Just as a reminder when your dealing with your insurance company DOCUMENT EVERYTHING! (Linda G.) Humana (OH) I had no trouble at all getting approved. My surgeons office sent a letter and a few days later I was approved. (Claudia L.) Humana (KY) - 03/15/04 Humana is ok.I had them last year but I was under PPO.If I was still under PPO I think I wouldn't have much problems I did with HMO.Humana HMO was approving me the first time but they said I didn't have enough evidence,so It did take a while untill my PCP wrote them a letter and copy my medical file and sent it to the medical board.I would recommend Humana to anyone but getting them to cover something you badly need might be a while but they will do what they can. (Debra F.) Humana (KY) - 09/14/04 At the time they were approving my surgery. They have since excluded it. (Dennis Z.) Humana - Primary Access (KY) - 10/26/04 I have never once had a problem with Humana at all. Everytime I call they are nice and give their first name. They are friendly and always answer all of my questions. (Anitra F.) Humana (KY) - 11/16/04 I had no problem. My paperwork was submitted on a Friday morning and Humana called the doctor's office on Monday morning to approve the surgery. I was truly amazed at the speed of the approval. I feel very lucky. (Laura C.) Humana - PPO (KY) - 07/10/06 (Durell "Butch" H.) Humana Choice Care (OH) - 6/4/03 My information was submitted to Humana Choice Care on 6/2/03 in the p.m. I called my surgeon's office on 6/3/03 at 3:00 p.m. and was told that I had been approved. Humana was very quick, efficient, and communicated very well with my surgeon's office. (Angel L.) humana choice care - humana choice care (KY) - 09/08/03 My Ins. Co was wonderful,didn't have any problems at all and after it was summit approve in one week. (Debbie T.) Humana Choice Care - HMO New Health (KY) - 10/06/03 In Oct 03 recieved update from husb's work about insurances being offered some changing some staying the same, but under HMO sts after 2003 will no longer cover surgery for obesity. I called Choice Care/Humana to verify this. So I went into to this worried that I would be denied just to hold me off until first of 2004, when it would no longer be covered. Dr's office took care of filing paperwork and was approved right away!! I have never had a problem dealing with Choice Care/Humana and I have been with them for almost 10 years. Would recommend them to anyone. (Dena S.) Humana Choice Care - HMO (KY) - 10/28/04 I never heard a peep out of Humana. Only that they were not covering bariatric surgery after 01/01/04. I got approved almost immediately. I didn't have to provide any written documentation of weight loss attempts and they were extremely informative whne I initially called to find out if they covered the surgery at all. I called late October 2003 and had the surgery 12/31/03. I didn't have to persist on anything. All I did was have my Surgeon send the letter and I got approved within 10 days. I did not hear from them again until a month or 2 after surgery and I got a bill for $200 and it showed the surgery cost was $22,000. (Jami T.) Humana Choicecare - HMO (KY) - 05/18/03 (Sandi G.) HUMANA CHOICECARE - HMO (IN) - 07/09/03 (KATHERINE R.) Humana Health Plan of Ohio - POS (KY) - 08-08-03 i didn't have to talk to my insurance doctors office took care of it for me not at all yes very persistence (julie r.) Humana HMO (KY) - 10/10/04 (Debra F.) Hymana - NewHealth HMO (KY) (linda b.) Lori A Fisher - Humana (OH) - 7/5/03 I didn't have to deal with them. The doctor's office sent for approval after my first consultation and it was approved the next day. (Lori F.) New Health - Humana - Claudia Edwards (OH) - 11/15/04 (Claudia E.) tri-care prime - steven dugan (WA) - 04/09/04 Dealing with tricare has been a pain in the butt.I'm so mad at them and I really hope my appeal goes through.I'm fighting them tooth and nail. because my bmi is 41.6 they say I need at least 3 comorbidities which is not true, plus proof of diet (supervise)for six months. They didn't wait for all my medical papers to get to them. They would of seen I was on many supervise diets and I due have problems due to my weight. Than they had told me I was still being review but told my doc.office I was denied. All within the same day almost the same hour. (diane d.) UHC - EPO (KY) - 10/12/04 (laurie b.) uhc - pos (KY) - 06/27/05 (alison b.) UMR (Healthspan) - EPO (OH) - 02/02/04 I haven't had to deal with the insurance myself, the doctors office has taken care of everything. I was approved in only 2 business days. (Schoreen T.) United Health Care - Options PPO (OH) - 01/14/03 3/1/03 So far, so good. It SOUNDS simple enough to get approved based on what they've told me on the phone. We'll see how it goes once I call them to check in... 3/13/03 First letter was sent on 3/1/03. Surgeon was notified of approval on 3/7/03. I was notified by phone of approval on 3/13/03 by surgeon and by mail on 3/15/03 by insurance company. Pretty efficient! From here, I only have to notify the insurance company's "pre-certification" department prior to my hospital admission, which is pretty standard, prior to any surgery. 3/17/03 Too weird! I called for the last step -- for the "pre-cert". They said I was already in the system, and that it was all taken care of. This has all been FAR too easy! YAY! (Kristin H.) United Health Care Florida - PPO (FL) - 12/03/03 I talked to them after my knee surgery in August. I told them the situation and they said all I will need is the normal evaluations that all doctor require.. psych and diet evaluations.. 3 documented tries of weight loss and boy I've had those. I couldn't believe how much money I've spent and times I've tried. I never have any trouble with United Health Care.. (Robin B.) United Healthcare (KY) - 10/29/03 Actually the coverage for the Gastric Bypass was discontinued August 1st, 2003. (for our plan, not all UHC plans are alike) I got my approval prior to that date so it was allowed. As for the Insurance Co., since you talk to a different person every time you call them I can't say that persistence works. What I do know and highly recommend is to be sure and get the name of the person you talk to (first and last name) every time, and get a tracking number if a procedure is approved over the phone. (Judith K.) United Healthcare (KY) - 11/19/04 (Sherry H.) UnitedHealthcare - PPO Plus (OH) - 04/15/03 After fighting for this surgery with Choicecare for over two years at another employer, I was half scared to even try through UnitedHealthcare when I learned that gastric bypass was supposedly a covered benefit through my new employer's UHC policy. But it was so easy and so fast that I'm still almost afraid that I will wake up and find that it has all just been a dream. When you call them to verify that it's a covered benefit, they will tell you it must be deemed medically necessary by your doctor. However, as far as I can tell, "medically necessary" is a very broad term. The office of the first surgeon I selected submitted my information and I had an approval letter in the mail in less than two weeks. However, that surgeon left my insurance network. So to avoid some hefty out of pocket expenses for using an out-of- network surgeon, I was forced to switch surgeons, which also meant re-submitting for insurance approval through the new surgeon. I was so scared that it would not be so easy obtaining approval the second time, but all it took was a phone call from the new surgeon's office. (Amanda S.) |
