Welcome, Friend!

It looks like you're new here. If you want to get involved, click one of these buttons!

Veritas-Health LLC has recently released patient forums to our Arthritis-Health web site.

Please visit http://www.arthritis-health.com/forum

There are several patient story videos on Spine-Health that talk about Arthritis. Search on Patient stories
Protect anonymity
We strongly suggest that members do not include their email addresses. Once that is published , your email address is available to anyone on the internet , including hackers.

Notice
All discussions and comments that contain an external URL will be automatically moved to the spam queue. No external URL pointing to a medical web site is permitted. Forum rules also indicate that you need prior moderator approval. If you are going to post an external URL, contact one of the moderators to get their approval.
Attention New Members
Your initial discussion or comment automatically is sent to a moderator's approval queue before it can be published.
There are no medical professionals on this forum side of the site. Therefore, no one is capable or permitted to provide any type of medical advice.
This includes any analysis, interpretation, or advice based on any diagnostic test

gastric bypass and methadone or other meds

AnonymousUserAAnonymousUser Posts: 49,731
edited 06/11/2012 - 8:31 AM in Health Insurance Issues
My insurance denied my gastric bypass due to using methadone for back pain. Need feedback !!!!!!!!
advertisement

Comments

  • You should check with your doc. Maybe the methadone has adverse effects on the bypass? Sorry, that is all that I can think of.
  • I had to hound the insurance company and ask to speak to supervisors and stuff to get help to get approved. I told all of them that I would do whatever I had to do to get approved, just tell me the process. They weren't real helpful, but I did finally get the lowdown and I sent in everything they needed. I also wrote a personal letter stating my feelings, problems, and why having the surgery was so important to me. I got approved after that. I don't remember anything about my current medications being asked about. Did they say why that was a big deal? Did they think you wouldn't do well due to your pain level from your back? Seems like the weight loss would help just a bit on the pain. The one thing that I've found though (hate to give you another negative thought), but I've had more problems since having the bypass....from the calcium deficiency, anemia, and my osteoarthritis. I'm 44 and even though I lost over 100lbs and have kept it off, I'm not sure that I feel more healthy. But who's to say that if I hadn't had the GB that I wouldn't be in the same place anyway.

    Fight! Fight! Fight! Find out what to do to appeal the decision. Get the doctor that has prescribed the methadone to write a letter stating why and if they think the GB would be a benefit to you. My GP totally supported my decision to have one. Good luck!
  • EDITED

    Standards agreement and posting rules
    Please note that Spine-Health reserves the right to edit any messages posted or submitted or e-mailed to the Company and use them for content on the website or in other company materials. No e-mail solicitation or advertising of other companies, products, services, or web sites is permitted in the Spine-Health.com forums.


    Post Edited by Moderator haglandc
  • SpineAZSpineAZ WiscPosts: 1,084
    Work with your physician's office to appeal based on the medical necessity of the procedure you are requesting AND the medical necessity and verified treatment value of the medication you are taking. The insurance company may not understand that methadone is for pain management, they may instead be viewing it as related to an addiction problem. The surgeon you want to do the procedure has to tell the insurance company you need the surgery and how you can manage going forward with methadone or perhaps a new mediation needs to be considered (perhaps methadone is not well tolerated in gastric bypass patients).

    I think you have a good chance at appeal if your doctor can submit a strong case of medical necessity, methadone necessity for pain (not for addiction), etc. Usually a surgeon's office has staff dedicated to insurance and well versed in how to appeal and even customize their approach to different insurance companies.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
advertisement
Sign In or Register to comment.