The "Up-Ward" part: I met with nutrition this past Friday. I GAINED! :( So much for reaching my goal of being below 300lbs! My last weigh-in I was 299...this weigh-in I was 302. I shouldn't be too surprised. The week before my weigh-in I was a voracious eater...when it's "that time of the month" I feel like I could eat non-stop. I NEVER feel full...that's kind of scary. It's gotta be head hunger...something I'm going to have to work on. In fact, I think it will always be a struggle, and I should just accept it and get a firm hold of some coping strategies.
The "On-Ward" part: I gave my notes to nutrition, and after reviewing them she said they looked great, and she gave me the number for the insurance lady in their program (the lady who submits to insurance). I called the insurance lady yesterday to make sure they had everything for submittal. She said I had completed all of the necessary requirements and she would be submitting in the next few days!!! I asked her how long CareSource usually takes to make a decision, and she said on average it's about two weeks!
I'm here...FINALLY!
I just hope there aren't any problems with approving the procedure.
Showing posts with label CareSource. Show all posts
Showing posts with label CareSource. Show all posts
Wednesday, June 23, 2010
Sunday, March 14, 2010
Insurance
As I said in my Beginning post my new insurance covers WLS...sort-of.
I have CareSource - Ohio. They only cover certain WLS procedures (Roux-en-Y and LapBand) and only on a case-by-case basis. When I first contacted them to see if they covered it the customer service rep said NO. Then someone (on the Obesity Help website) suggested that I call again with the procedure code for Roux-en-Y (CPT code: 43645 - Roux-en-Y Gastric Bypass). When I did that they told me it's not usually a covered procedure unless it is deemed "medically necessary" by my primary care physician, and that I meet certain "requirements" for approval.
What are those requirements?
-9 month doctor supervised weight loss program (completed within the past 5 yrs). The doctor must document weight, dietary plan, exercise plan and progress on a monthly basis.
-Documentation of at least one obesity related co-morbid condition (diabetes, high blood pressure, high cholesterol, heart disease, sleep apnea, etc)
-BMI of 40+
•My BMI is over 50 - CHECK
•I have Diabetes, high blood pressure, sleep apnea - CHECK
•9 month doctor supervised weight loss program:
Right now I'm in month SIX...so only THREE more months to go! I know I shouldn't be too excited right now, because I'm not approved yet. However, I'm going through a program at the Bariatric and Metobolic Institute at the Cleveland Clinic and they are almost sure I will be approved.
The first six months of my "diet" (beginning Sept 2009) I started with my PCP and told her about my decision to have gastric bypass surgery. I told her all the information that needed to be documented and that she would need to write a recommendation letter. She agreed to work with me and also counseled me about the surgery (the pros and cons).
During the same time I had also signed up for the bariatric program thru the Cleveland Clinic. In November I went to a seminar and got registered with them and made all of my pre-op appointments. They handle all the insurance stuff and won't make appointments with-out pre-authorization from your insurance company. I double checked on this. Every appointment the clinic made I called their "insurance specialist" to confirm my insurance had authorized it...and every time (so far) it has. I haven't received a single bill. I will be continuing the last 3 months of my diet with the Nutritionist in their Bariatric Program.
Here's to hoping for approval!
I have CareSource - Ohio. They only cover certain WLS procedures (Roux-en-Y and LapBand) and only on a case-by-case basis. When I first contacted them to see if they covered it the customer service rep said NO. Then someone (on the Obesity Help website) suggested that I call again with the procedure code for Roux-en-Y (CPT code: 43645 - Roux-en-Y Gastric Bypass). When I did that they told me it's not usually a covered procedure unless it is deemed "medically necessary" by my primary care physician, and that I meet certain "requirements" for approval.
What are those requirements?
-9 month doctor supervised weight loss program (completed within the past 5 yrs). The doctor must document weight, dietary plan, exercise plan and progress on a monthly basis.
-Documentation of at least one obesity related co-morbid condition (diabetes, high blood pressure, high cholesterol, heart disease, sleep apnea, etc)
-BMI of 40+
•My BMI is over 50 - CHECK
•I have Diabetes, high blood pressure, sleep apnea - CHECK
•9 month doctor supervised weight loss program:
Right now I'm in month SIX...so only THREE more months to go! I know I shouldn't be too excited right now, because I'm not approved yet. However, I'm going through a program at the Bariatric and Metobolic Institute at the Cleveland Clinic and they are almost sure I will be approved.
The first six months of my "diet" (beginning Sept 2009) I started with my PCP and told her about my decision to have gastric bypass surgery. I told her all the information that needed to be documented and that she would need to write a recommendation letter. She agreed to work with me and also counseled me about the surgery (the pros and cons).
During the same time I had also signed up for the bariatric program thru the Cleveland Clinic. In November I went to a seminar and got registered with them and made all of my pre-op appointments. They handle all the insurance stuff and won't make appointments with-out pre-authorization from your insurance company. I double checked on this. Every appointment the clinic made I called their "insurance specialist" to confirm my insurance had authorized it...and every time (so far) it has. I haven't received a single bill. I will be continuing the last 3 months of my diet with the Nutritionist in their Bariatric Program.
Here's to hoping for approval!
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