Insurance & Financing

Has anyone gone through Multicare in Washington state and used Carepayment.com to pay the cost of surgery as self pay?

Allow me to rant for a minute. I have insurance, and I am lucky enough that it covered my surgery with a $1k copay after I hit my $2k annual deductible. So, I can't complain about my own outcome as far as that goes. But I just got a look at the hospital charges. My insurance company was billed in the neighborhood of $42k dollars for my surgery and hospital stay. They then had a negotiated plan "discount" of $32k applied, bringing the total paid on my behalf to just under $10k. Plus my copay equals $11k, or $13k if you factor in that my entire deductible was made up of surgery related charges. Why can't the hospital just say that a gastric bypass costs $13k…

I got Cigna at the start of this year as my job switched insurance companies. My surgeons office was preparing me with steps toward surgery when I got a call today saying that bariactic surgery isn't covered under my plan. I feel so disappointed. Now what? How can I get coverage? Anyone experienced this? Sent from my SM-N970U1 using BariatricPal mobile app

My Florida Blue (BCBS of Florida) policy excludes bariatric surgery; however, I am eligible for coverage with an approved application for “medical necessity”. Florida Blue defines medical necessity as: Adults Severely obese with a BMI ≥ 40 kg/m2, OR Severely obese with a BMI ≥ 35 kg/m2, with at least one comorbidity refractory to medical management (e.g., type 2 diabetes, hypertension, coronary artery disease, obstructive sleep apnea, GERD, osteoarthritis, pseudotumor cerebri), AND Does not have a medically treatable cause for obesity (e.g., thyroid or other endocrine disorder), AND Has made multiple attempts at non-surgical weight loss (e.g., diet, exercise, …

This is the what one Hospital provided me for Gastric Bypass Medicare costs and requirements. One thing I noticed is "Consecutive diet counseling within 1 year of surgery" but did not specify a duration time for the diet. Anyway, thought some might derive some useful info from this. TRADITIONAL MEDICARE Insurance Requirements Primary Bariatric Surgery - covered benefit? Yes Revision/Conversion Surgery - covered benefit? Yes - BASED UPON MEDICAL NECESSITY Special Facility Requirements? N/A Specialty Referral or Authorization required from PCP? ● No referral required for clinic ● Policy Copay Fees …

Hey all, so I’m in the process of getting a revision I have the Lapband wanting to remove it and getting the Sleeve. I have BCBS of MA. How was the process for you guys. What where your requirements, and how long did everything take meaning the whole process and the approval time. I went 2 weeks ago to my consultation, did the nutrition class then my ecg that same day now waiting for to talk to a psych. And the place is taking long I already called bcbs it’s in my network and also got my copay these ppl are taking long I’m ready to start my new journey

Today marks it 20 years my wife died from Gastric surgery and today marks or 17 years I had my successful surgery, my lifestyle became more healthier and my finances became so stable , I wish to support anyone in financial crises following the surgery in anyway i can, few loved and supported

Please help! I’ve been approved for surgery but I’ve been searching 6 months and can’t find a surgeon who will accept Alabama Medicaid. Can anyone help?

Has anyone used Bcbs IL if so I have a couple questions.

What’s the best insurance to have when you’re interested in having Bariatric surgery covered by insurance?

MY STORY IS I LIVE IN JAX FL AND FL MEDICAID IS NOT ACCEPTED FOR BARIATRIC SURGERY. I TRIED OCALA, ST. AUG, DAYTONA, AND SEVERAL WITHIN 100MILES BUT NO... EVENTHO THEIR WEBSITES SAYS YES.:sneaky: WELL I FINALLY LOCATED ONE IN SARASOTA BUT ITS 4+HOURS AWAY AND IMPOSSIBLE TO MAKE THE 6WKS MANDATORY MEETINGS AND APPOINTMENT EVERY OTHER DAY & COMUTE BACK BECAUSE OF MY(SPECIAL NEED SON). I KNOW MY DAY WILL COME BUT IF I CAN I WILL LIKE TO HELP SOMEONE ELSE: IF ANY ONE IS:huh2: INTERESTED ITS SARASOTA MEMORIAL/HER NAME IS MARIE 914-917-9000 / 18007648255. GOOD LUCK!!!

I am beginning the process of looking for a surgeon for wls. I have Medically Needy Florida Medicaid. I cannot get any clear answers from them about the requirements for coverage of surgery. Has anyone had surgery with Share of Cost in Florida?

Hello, I’m just starting the process I have an appointment next week to start stage one of Molina Washington state requirements. I’m nervous because my BMI is over 40 which is on the list for being approved but I don’t have any comorbidities. Does any have any experience being approved with just a bmi over 40?

I have meritain and of course my doctors office checked to make sure I had coverage. They gave them a list of pre surgery procedures I would have to do such as ultrasound, endoscopy, nutrition classes, psych evaluation among other things prior to surgery, which I have done and has cost me almost 3 thousand dollars out of pocket to do. Now they denying me saying I’m not covered because obesity is not covered on my insurance plan and the code on my file is flagging it as obesity , but the doctor offered called prior ( 8 months ago ) to make sure. When I call meritain they told me to have them remove the code that means “obesity” and resubmit documents and it should be appr…

So I had a lap band - approved by Fed BCBS in 2011, they also approved the removal of it 2021. Now it’s 2022 and Medicare is my primary and FedBCBS is second. They said will just piggy back from what Medicare won’t cover. Anyone here have experience with Medicare? Wait times once the pkg is submitted? Any info would help. Just getting started, and going through the process 3 mo dietician- psych appt etc. even though I have Gastroparesis now. Thanks

Hi there! I’m 24, 5’7 and 250 lbs. I’ve been trying to lose weight on my own since I was about 15 with little to no success. I’m currently pre-diabetic, and taking atenolol for hypertension. I’m young, and low income. My insurance is Medicaid through the state of Arizona, and after calling my insurance to ask about the process of getting a gastric sleeve, they were unfortunately not very helpful. I’d love to hear your complete process from consultations to receiving your surgery while being covered by Medicaid. I do know that they require a BMI of 40, or 35 (I think) with diabetes or high blood pressure. Either way, I am just about a BMI of 40. …

Does anyone have a detailed I guess EOB regarding weight loss surgery approval and denial from Tricare (more specifically Tricare East/Humana). I know what their website says, but it doesn’t give much info at all. Thanks!

In the USA, federal legislation called the No Surprises Act was enacted in 2021 to help patients out when they cannot consent to being touched by someone out of their insurance network. It has been supplemented with changes as recently as January of 2024. These types of bills fall under something called, "surprise billing," and patients have protections and rights against certain charges. Here's a link for more information: https://www.cms.gov/nosurprises Many of us have had to navigate the complex insurance system in the States and we are no strangers to advocating for ourselves. I was hit with a surprise bill 4 months after my surgery and having knowledge of t…

So I'm in the process of working on the requirements for my insurance to cover surgery. I start class 1 of 6 bariatric nutrition classes tomorrow. I have to do these classes once month for 6 months. But probably in a few months, I will be moving to another state. Has anyone moved to another state in the middle of trying to complete the insurance requirements? Was it easy? Did you have to restart the requirements in the new state? Sent from my SM-N975U1 using BariatricPal mobile app

Ugh! I hate the waiting process. My Surgeons office submitted for prior authorization yesterday 02/20/23. I realize it has only been a day lol but I am wondering how long you all waited to get approved by your Insurance?

Background.... I am a teacher in Missouri and not a single insurance plan covers anything dealing with bariatric surgery. Does anyone know of any supplemental insurance I could get that would cover it. I tried to finance but couldn't. Any info would be great. thanks

I was denied. Tomorrow is peer to peer review. It that is denied again I am going to appeal for the record to be official for the process of tracking these denials. I have been on this plan and expected my insurance to cover my recommended treatments. I could hardly believe it was denied. Feel very violated and taken advantage of by the company I pay every month for coverage

Blue Cross Blue Shield Alabama has pre approved my surgery. I also have Medicaid as secondary insurance. Do I have to have a pre-approval from medicaid as well, or is preapproval waived since it’s secondary insurance to a procedure being covered by primary?

Is there anybody that has marketplace insurance that covered Bariatric surgery? If so, what insurance did you get?

I was just approved by AETNA for the SADI-S procedure. I wanted to post this because AETNA has just recognized the SADI as an approved procedure. Before Dec 5, 2022, it was considered experimental and I was concerned it would not get covered. AETNA uses a "Clinical Policy Bulletin" to explain the requirements for surgery if your plan has bariatric surgery included. It really helped clarify what I needed to do with my team. Here is the link to the most current bulletin: https://www.aetna.com/cpb/medical/data/100_199/0157.html I hope this helps.

How can I get approved for loose skin removal? Only way is if I have a rash and I do but I’m too scared to go to a dermatologist! I keep getting denied I need help asap it’s taken a toll on my lymphedema

I have a friend who is a teacher and she has been told that her insurance does not cover WLS. Has anyone else appealed this or anything to get insurance to cover the surgery?? Any suggestions welcome. Thanks.

I see there are some posts on here about this topic but none are recent. I have blue cross blue shield federal. Has anyone recently went through the process and had surgery yet. I have one more visit before my doctor submits my paperwork to the insurance company. I had to do 90 days as a requirement for my insurance. How long after paperwork was submitted did you get an approval also how much out of pocket did you have to pay. There are Focus, basic and standard plans so I do know each one has different amount of coverage. Just trying to get an ideal of what is to come in the month ahead. FYI** I know everyone has had a different experience and had a different path. Regar…

So, I have checked my status and that is what is listed. Anyone ever seen this? It was updated this morning.

Does anyone know of a facility (preferably near Eugene) that takes OHG (Oregon health plan, which is a form of Medicaid)

I bought 2 different insurance policies to cover the surgery and both was not accepted. I'm still trying to find an actual insurance company that can provide the coverage I need. Yes I have my doctors referral for the surgery. Any recommendations or suggestions?

I live in Washington and have Kaiser Permanente of Washington! Has anyone had weight loss surgery and went thru Kaiser of Washington? Please share your experience below. I have my first virtual Provider seminar on 1/27/2023!

I have been trying to get a referral for a few years at Kaiser. My first PCP said the surgery doesn't work, switched PCP's, he refused to consider any weight loss options. I have a new PCP, he referred me to the Options Program, which gave the infamous Nestle Shakes, shots, prepared meals, and pills as ways to loose weight, but not any surgical options. When I asked about surgical options, the Options Staff told me I needed a Bariatric Referral through Options. I asked my newest PCP, he said he gave me the referral. I called back to the Bariatrics section, they told me he had not. Anyone experience this? What did you do to fix it? I have tried all the Options presented, n…

I hope this is the right place to post this question! I have Molina Medicaid Apple Health insurance. Two weeks ago I brought up bariatric surgery to my doctor. I even brought a copy of the Molina Medicaid Apple Health pre-surgical assessment form that she is supposed to fill out and fax. She is 100% on board with me having this surgery from what I can tell, so that isn’t the issue. And she seems really nice, I only just started seeing her. On Monday I sent her a message asking if she had sent in the form and asking what happens when they approve/deny it and she responded that she hadn’t yet. After a few misunderstandings of the actual criteria Molina has for sur…

Hello, lovelies! I just had my consult with the surgeon a couple days ago, but unfortunately the nurse that makes all of my upcoming appts to the nut, pulm, etc is in vaca until next week so I didn’t get many of my questions answered. for those of you that have Indiana hip state plus bcbs: I wanted to know let’s say I’m trending downward in weight during my 6 month program, and go in and I’ve gained even a pound, or even an oz, will they deny me? My surgeon said likely not, but I’m not sure he actually knows. I know I don’t have to lose a specific amount of weight, but my concern is what if I gain during those 6 months? Ive looked at my insurance requirements fo…

I'm scheduled for my RNY on 5/18. This morning I found out that UnitedHealthcare has denied my surgery as experimental. I've filed an appeal but have been told it's unlikely to be approved. My reason for surgery is not weight - I have gastroparesis. I need this surgery. It's the only viable fix for me, but because my insurance plan says no bariatric procedure, that's it, or so I'm told. Amy recommendations? I need this surgery. I've gone through all the testing because the first time my Dr's office called the insurance they were told yes, go ahead, I'm covered. Now surgery is denied. I'm sick to my stomach, heartbroken, nervous. I hate this. I ju…

After completing the last of your insurance requirements how long did it actually take until you had your surgery? I complete my last dietary appointment on April 5th and was told it takes around 3-4 weeks for insurance to approve and be scheduled. Does that seem slow?

Has anyone recently gone through Illinois Medicaid for their surgery? I'm working night shift, and I keep forgetting to call during normal business hours (which is my sleep time) to find out. I don't have one of the managed care options (Molina, Meridian, etc), but just the direct state Medicaid since I do have a primary insurance through my employer (who does NOT cover WLS). How did you go about finding a surgeon who accepted Medicaid?

Hey everyone, So I've finally come to terms that I may need help. I've tried to lose weight since I was a teen and I'm now 29 with no success. I've hit my highest weight of 250lbs at 5"3 and it's extremely depressing. I know I'd technically qualify based on bmi but every clinic I've called has said I need a referral even though I have a PPO through Covered California. Does anyone have any experience with covered california blue shield of California? I am meeting with my doctor tomorrow and in the off chance that she doesn't want to provide a referral, I want to know my options. Thanks in advance

Does peach state pay for this surgery?

If I choose not to tell anyone at work is there any way Human Resources can find out what I had done ?

Hi, For those of you who had your insurance approved to cover your surgery - did you have to pay your copay/coinsurance amount up front or was the part that you were responsible for billed to you after surgery? Sent from my SM-G990U using BariatricPal mobile app

Hi everyone !!! I recently decided to try the gastric sleeve option which my doctor supported. I am currently 223 pounds 5’2 so my bmi qualifies. Family history of diabetes and hypertension and heart disease cholesterol you name it they got it. The question I have is about the necessary documentation as far as documentation of weight loss within the previous 12 months. I had been going to Urban Skin solutions weight loss mes spa. Trying lipo injections and phertamine to no avail I have the documents which show my bmi and weight for every visit. Would this be enough ?

Can someone tell me if this is saying it isn’t covered by my insurance. Please help. It says generally not covered is that just like in general unless you qualify

Hello, all. A bit nervous with my first post. It's been less than a week since I got a new general practitioner (the previous one retired) and formally raised the idea of (probably) gastric bypass surgery. I haven't done any of the consultations, finding a surgeon, etc, that's all in the future. But one thing I can worry about and start to plan for in the present is insurance. I am in Illinois and have Anthem BCBS. Something I see listed on their requirement is: Past participation in a weight loss program; and Inadequate weight loss despite a committed attempt at conservative medical therapy (for example, comprehensive lifestyle interventi…

I know all the plans are a bit different but if you have Anthem BCBS, can you tell me about the process for you? My BMI is 40 and I've always had mild sleep apnea. I'm sure they'll do blood work etc when I have my consult on 12/14. I'm hoping to convert from Lap Band to Bypass. Sent from my SM-N975U using BariatricPal mobile app

Hello all, has anyone had any luck with getting their secondary insurance to pay for their surgery when the primary doesn't cover it? My employer provided healthcare insurance is Florida Blue & it sucks. There's an exclusion for everything related to bariatric surgery - no band, balloon, gastric bypass, sleeve, revision, or repair of previous surgeries. My secondary insurance, BCBS Michigan, covers everything. It's a great plan and I hardly had to pay for anything when I got the lapband 20 years ago. I've had trouble with the band & I want to get it removed. I would like to get a revision to a gastric bypass so I don't regain all the weight I lost. I've made so…

I am writing this to help those whom have United Health Care. Here are the following things to know and tips: Before reading these tips, contact UHC for confirmation that Bariatric surgery is covered under your plan. Confirm the requirements. Confirm that your surgeon and his associated hospital is In-Network (if they are not, it will be like paying for the surgery without insurance). Make sure you have an understanding of what the insurance wants to see or have done. 1) You are eligible if you have a 40 BMI or Higher / Greater than 35 BMI with Co-Morbidity. 2) Once you find your surgeon, you will have to do 6 months worth of testing, dieting and education. 3) …

Anyone have luck w wls with this ins ? Sent from my SM-S901U using BariatricPal mobile app

I am planning on having my surgery on base. The bariatric center there is very highly rated, so I'm good with the location. I'm in the pre op stages (psych eval, nutrition, ect). At my initial appointment with the surgeon, he said I qualified because of my sleep apnea. I have tried other attempts at weight loss through Weight Watchers and Noom, but it wasn't supervised by my doctor. I also work with a nutritionist, but she hasn't been tracking my weight. Anyway, my question is, if you had your surgery on base, what was the approval process? Sent from my SM-S908U using BariatricPal mobile app