It's time...Now I need your help. - Page 9 - ThinnerTimes

JustAnotherVictim1 · 02-14-2006, 09:59 AM

Hey everyone, sorry I didn't post last night, but things got kind of hectic in the household.

So I went to the meeting yesterday afternoon, I was the only guy, lol. It was pretty informative but really wasn't what I was looking for at all. At one point the nurse even said that this class wasn't a weight loss class, but a way to teach us how to eat, or some crazy stuff like that.

After the meeting, I talked to the nurse one-on-one. She is nice, I'd like to point that out. I told her my situation and how I've been looking into Bariatric Surgery. She asked me how old I was and I told her I will be turning 16. She said that I should be old enough (kind of odd since Sparrow Hospital doesn't do them until your 21, but I'm sure she knows other places do). I let out a tiny sigh of relief, and told her that quite a few people have told me I am most likely a candidate, and she nodded her head.

She talked in the meeting at the end about calling our insurance. She gave us a bunch of codes (Body gems, physicals, all that good stuff) so that our insurance could tell us how much we'd have to pay on each. That was mostly for the group thing, though. But none the less I will be calling my insurance today and will have having them look up my Contract #.

I will be asking them what they cover, what the coverage is when it comes to this sort of surgery, and the requirements. Qweets, among a few others, have told me that it MAY be possible to get approved without doing the 6 month diet (he said they never even mentioned it for him), so I will trying that route today and maybe the insurance won't even NEEEEEEED it.

I will also be asking about PCPs in the area since it is PPO coverage. Even if its not, my good for nothing Father has to pay 80% of all medical bills that arn't covered by insurance. Like my Mom says, she has a kick @$$ lawyer who dislikes my father and can't believe my Mother ever married him.

Well that's the update. The nurse also told me that there are free Bariatric Surgery information meetings on Thursdays, so I am signed up to go listen in on that one as well in 2 days. Can't wait!

MiladyB · 02-14-2006, 10:51 AM

Hi, just wondering what kind of insurance you have? I'm from the same general area that you are. My insurance is Priority Health. If it's the same I can give you the info on what their requirements are.

JustAnotherVictim1 · 02-14-2006, 12:05 PM

Ok, I have a problem.

The insurance said they don't cover anything that has to do with weight reduction...NOTHING...not just the surgery...but everything to do with weight reduction. All that they recommend is that on their site there is different organizations that offer discounts for things like Weight Watchers...

There has to be something I, my Mother, or my mothers lawyer can do. They don't cover the disease of obesity, but can do others? What???

I really need some help, I am on a nervous break-down right now.

cnvh · 02-14-2006, 01:39 PM

Well, I know my insurance doesn't cover weight management issues, or surgical procedures for weight reduction-- UNLESS the patient is morbidly obese (i.e., BMI over 40) and the treatment is deemed medically necessary. Don't just go by your insurance's patient handbook-- call the insurance company and ask them if they cover procedure code 43846 (roux-en-Y gastric bypass), "if deemed medically necessary by the doctor." (Important that you include the "medically necessary" part!)

I did this, and the insurance company said that, yes, they do cover it, provided the doctor includes the proper certification codes-- I presume that means documenting what particular comorbidities you have, verifying your BMI as over 40, etc., etc. (I asked what these codes might be, but the insurance company wouldn't tell me-- I guess they think that would make it way too easy for patients to go through the process-- god forbid that it shouldn't be a headache!)

Don't be surprised if they truly do NOT cover the procedure, though... some insurance companies simply DON'T, and my understanding is that, at least for now, it is within their rights to not do so. (That could vary by state-- I'm not sure.)

JustAnotherVictim1 · 02-14-2006, 01:50 PM

Quote:

Originally Posted by cnvh

Well, I know my insurance doesn't cover weight management issues, or surgical procedures for weight reduction-- UNLESS the patient is morbidly obese (i.e., BMI over 40) and the treatment is deemed medically necessary. Don't just go by your insurance's patient handbook-- call the insurance company and ask them if they cover procedure code 43846 (roux-en-Y gastric bypass), "if deemed medically necessary by the doctor." (Important that you include the "medically necessary" part!)

I did this, and the insurance company said that, yes, they do cover it, provided the doctor includes the proper certification codes-- I presume that means documenting what particular comorbidities you have, verifying your BMI as over 40, etc., etc. (I asked what these codes might be, but the insurance company wouldn't tell me-- I guess they think that would make it way too easy for patients to go through the process-- god forbid that it shouldn't be a headache!)

Don't be surprised if they truly do NOT cover the procedure, though... some insurance companies simply DON'T, and my understanding is that, at least for now, it is within their rights to not do so. (That could vary by state-- I'm not sure.)

Yes, she said it varies by state to state and Michigan doesnt require them to. She also talked about the if medically neccessary situation and said that even if it is, they still do not cover it.

I even asked her if it was LIFE THREATENING according to a Doctor if they would cover it, and they said no.

cnvh · 02-14-2006, 02:06 PM

Hmm... well, you know the saying, when one door closes, another door opens... perhaps start a new thread and ask what have others done when their insurances have refused to pay. The obvious answer would be that you may have to pay out-of-pocket (right-- like THAT'S feasible), but perhaps others know of alternatives.

Grnize · 09-07-2006, 10:23 AM

I have hasimoto hypothyroid since I was 6 years old. It will affect any diet you are planning to do. Get tested to see where your TSH panel levels are and then do a diet designed for thyroid. Good house keeping magazine always has diets specifically designed for thyroid patients. There was one that came out last Novemeber issue.

Stay focus and pray and you will lose the weight.

goshera1 · 09-25-2006, 02:40 PM

Hi Eric,
I know how it is to be young and overweight. I remember the horrible names and the cruelty. It is a nightmare. I lived through it and it has effected me my whole life. I also see my son who is now 21 live it. You can loose the weight. But you can also put it on easy...
I think you should write about all your experiences with any diet and also print what ever you can get your hands on regarding the surgeries on the teenagers that you mentioned that had the surgery. Do internet searches or call the surgeons...what ever it takes. Take that information to your Dr. to let him or her know how serious you are. It will also show that you are mature in your age and you have done your research.

Good luck.
Goshera

AlabamaChick · 09-25-2006, 03:26 PM

I wonder how he's doing. This thread is from Feb. of this year and he has not posted since.

ready4achange · 09-27-2006, 06:13 AM

Hi, Nice to meet you. Although I was not as heavy as you in school , I do kind of know where you are coming from. I was "the heaviest" in my class. It's good you are researching your options. This IS a life changing decision. I found this forum on the ObesityHelp site and thought you may want to check it out.. Good Luck
Sandy

http://www.obesityhelp.com/forums/teen_wls/
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