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Exclusion for “One Surgery Per Lifetime”?!? Not So Fast…..
Posted Nov 13 2018 by Walter Lindstrom in Appeal Case Studies, Bariatric Appeals, Bariatric Insurance Issues, Walter's Blog with 7 Comments
There are many challenges in cases like these. Can it really be established that there IS a “complication” in a case where there is no erosion, slip, obstruction, stricture or other identifiable “technical defect” in the original procedure? Shouldn’t this be challenged based on simple “fairness”? After all, insurers don’t limit members to one cancer treatment – one knee replacement surgery – one diabetes medication, do they? ISN’T THIS PLAIN OLD DISCRIMINATION?????
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BIG NEWS! Several insurers are going to REMOVE pre-surgery supervised diet requirements
Posted Nov 6 2018 by Walter Lindstrom in Walter's Blog
The Health Care Service Corporation (BCBS IL, TX, MT, OK, NM) Bariatric Surgery Medical Policy no. SURG716.003 effective February 1, 2019 is, believe it or not, good for bariatric patients. HCSC is eliminating the requirement that patients engage in supervised weight loss programs prior to surgery.
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