Hi everyone, I'm new

[Melanie1218]

Hopefully it will. All policies are different and we use my wife's which is an awesome policy. $185 a month for health, dental, vision and life for four of us. $25 co pay for office visit, $65 ER, $150 out patient procedure and $300 for an admission...ZERO $ after that. We have had a couple situations where the hospital billed $175,000 and we paid $250 (old admissions copay amount) and not another cent.

I almost took a job in Romeoville a few months ago, but they flaked out so I told them don't call me again (I had turned down an offer around the first of the year and they came back a few months later with a sweetened deal).

Romeoville is about 1/2 hour or so from me. Gotta love some of these companies and their crazy antics. LOL My best friend lives in Washington, IL. I am on my husband's policy we did not know it was a PPO with an HSA I had a $2,600 deductible and once that is mad everything's covered at 100% I'm only $526 away from the deductible so my surgery will be covered at 100% he pays $90 a month for him his daughter and myself it's great insurance and dr. K already verified that they do cover weight loss surgery revision but they still have to approve if it's medically necessary.

 

[DSRIGGS]

Romeoville is about 1/2 hour or so from me. Gotta love some of these companies and their crazy antics. LOL My best friend lives in Washington, IL. I am on my husband's policy we did not know it was a PPO with an HSA I had a $2,600 deductible and once that is mad everything's covered at 100% I'm only $526 away from the deductible so my surgery will be covered at 100% he pays $90 a month for him his daughter and myself it's great insurance and dr. K already verified that they do cover weight loss surgery revision but they still have to approve if it's medically necessary.

They will get you qualified.

I worked with a lot of people from Washington. That city was absolutely decimated by tornado a few years ago. My small town lost pretty much all of our downtown business district about 5 years ago to tornadoes. We are definitely tornado alley.

 

[Melanie1218]

They will get you qualified.

I worked with a lot of people from Washington. That city was absolutely decimated by tornado a few years ago. My small town lost pretty much all of our downtown business district about 5 years ago to tornadoes. We are definitely tornado alley.

Thats so devestating. She was lucky her house didn't get destroyed but still so sad for al those small businesses and the people who lost their homes.

I pray they do accept me for revision to DS based on dumping and not BMI. Thank you for the positive words

 

[aaa]

Hello.

 

[DSRIGGS]

Thats so devestating. She was lucky her house didn't get destroyed but still so sad for al those small businesses and the people who lost their homes.

I pray they do accept me for revision to DS based on dumping and not BMI. Thank you for the positive words

No problem and BTW I don't know that Dr K will even have Kristina submit this as Bariatric surgery since it really is to a medically necessary fix for a serious issue. It might be submitted something like "exploratory lap to alleviate dumping syndrome" and then he kind of has free reign to do what is medically necessary in his professional opinion to fix the issue, which would include the switch part. I am pretty sure that is how my revision for malnutrition was written up. They approved within a couple days.

 

[Melanie1218]

No problem and BTW I don't know that Dr K will even have Kristina submit this as Bariatric surgery since it really is to a medically necessary fix for a serious issue. It might be submitted something like "exploratory lap to alleviate dumping syndrome" and then he kind of has free reign to do what is medically necessary in his professional opinion to fix the issue, which would include the switch part. I am pretty sure that is how my revision for malnutrition was written up. They approved within a couple days.

You just keep making my day!! Thank you!!! I go Tuesday for an upper GI here (already had it scheduled prior to talking to Kristina about Dr K) to still get it done and ask them for a copy of it on a disk and send it to dr. K

 

[Melanie1218]

You just keep making my day!! Thank you!!! I go Tuesday for an upper GI here (already had it scheduled prior to talking to Kristina about Dr K) to still get it done and ask them for a copy of it on a disk and send it to dr. K

Sorry that was supposed to say and Kristina told me to go ahead and get it done and a copy to her or dr. K

 

[DSRIGGS]

You just keep making my day!! Thank you!!! I go Tuesday for an upper GI here (already had it scheduled prior to talking to Kristina about Dr K) to still get it done and ask them for a copy of it on a disk and send it to dr. K

I don't want to get you too excited because we all know insurance companies can be blithering idiots, but I am hopeful for you.

Good on the upper GI and imaging.

 

[Melanie1218]

Hello.

Hi aaa

 

[JuliaDS]

I am a weight loss patient from RnY in 2003 looking to have revision surgery to DS. Thank you for letting me join the group.

Hi and welcome! You'll find a wealth of quality information and genuine support here. Look forward to following your journey!

 

[hilary1617]

Hi and welcome @Melanie1218. I'm another Chicagoland neighbor (north shore).

I have BCBS IL PPO and went through ridiculous hoops for DS (around diet), but they eventually covered everything. They also are very good about paying for me to go out-of-state (New Orleans) multiple times a year for the best treatment / surgery / testing / follow-up visits for a rare condition unrelated to DS.

You'll be in great hands with Dr. K! All the best.

 

[Melanie1218]

Hi and welcome @Melanie1218. I'm another Chicagoland neighbor (north shore).

I have BCBS IL PPO and went through ridiculous hoops for DS (around diet), but they eventually covered everything. They also are very good about paying for me to go out-of-state (New Orleans) multiple times a year for the best treatment / surgery / testing / follow-up visits for a rare condition unrelated to DS.

You'll be in great hands with Dr. K! All the best.

Thank you for the information. Do you mind telling me what types of Hoops you had to go through to get the DS? Were you a revision or a newbie? I have Blue Cross Blue Shield Illinois PPO put on the card it says blue edge

 

[hilary1617]

Thank you for the information. Do you mind telling me what types of Hoops you had to go through to get the DS? Were you a revision or a newbie? I have Blue Cross Blue Shield Illinois PPO put on the card it says blue edge

Hi, Melanie, it was a virgin DS in 2012, so rules likely have changed since then, but the hoops were actions necessary to meet a prerequisite for a medically-supervised diet.

I applied for DS pre-authorization with the full support of my PCP following strict adherence to a 1200 calorie diet plan in which I received prepackaged meals, videos and pamphlets by mail.

As background, when I initially undertook that diet, I had no intentions of getting surgery. I was convinced if I stuck to it long enough I'd reach and maintain a desirable weight, but, as with numerous prior attempts, that didn't happen. It was my diligently sticking to that diet for an extended period and not losing much weight that convinced me I *had* to look at surgical alternatives. So, my approach and record-keeping didn't contemplate a need to demonstrate compliance to random insurance requirements for pre-qualification for surgery.

That said, I readily was able to provide BCBS IL with receipts for all of the meals and PCP records demonstrating (minimal) weight loss, along with his notes that he counseled me on diet and exercise during several visits to his office during the period (including one just before I started the diet and we discussed it, and the final visit where he drafted a recommendation for surgery).

My initial pre-authorization request was denied on the basis that in the view of BCBS IL, my diet didn't qualify as medically-supervised as I didn't visit my doctor frequently enough during the period.

So, to make sure there would be no way for that to happen again, I changed diets, making arrangements with a "diet doctor" whose office was close to my workplace. He provided a 900 calorie a day liquid diet that only was supposed to be offered for a short period of time as a "quick start" - but since I was SMO he let me stay on the liquid for a year. I went to his office and met with him in person to be weighed in, get my drinks, and receive counseling each and every week, building a huge paper trail.

My next request was then approved.