Insurance & Financing

United healthcare approved me today (UHC-Choice) My surgeons office said I must do 6 months of diet/sleep apnea study/nutritional visit/phyc eval/ekg/and get cleared for surgery. I asked is that my insurance requirements or yours? Billing coordinator (very rude through the whole process) no,no that's ins requirements see here. She pulls up what I know as "general guidelines" I told her that wasn't required of my lapband- please submit for me. She refused without medical clearance and a endoscopy/colonoscopy- I complied. Now please submit- shes stays true to her nasty self"what am I submitting? your band has no issue and you have done the requirements. Me please just submi…

Got the dreaded phone call today, my pre determination was denied. I have BCBS of TX. When told the reason for the denial there were a lot of doctor notes missing. They needed notes explaining how my band has failed. My doctor is doing a peer to peer review tomorrow. I feel completely hopeless and helpless. Has anyone had success with this?

I am currently waiting for approval for the lap band by BCBS anthem Missouri. I have changed my mind, I want the sleeve now. My paper work was sent 2/28 and i still do not have an approval or denial. Did it take longer to get a denial letter. After I'm approved, how do I go about changing the surgery and how much longer will it take to change after approval?

Has anyone used Lindstorm before and had a positive outcome? I am at the end of my rope with my insurance. They denied my ore determination, denied my peer to peer, now I have an urgent appeal that was submitted yesterday. The reason they are denying is my current EGD shows no sign of erosion, slippage, or reflux. In the appeal letter that I sent them yesterday I explained that the EGD wouldn’t show reflux because I take liquid Zantac daily to prevent it. I am completely lost.

Has anyone had to pay a portion of their hospital bill upfront? If so how much? Sent from my LGMS210 using BariatricPal mobile app

I know there have been posts about this before, but nothing recently. What’s the turn around time for BCBS Federal? My paperwork was sent in last week, and now I’m playing the waiting game.

I have BCBSM PPO and while the surgery is covered, the pre op appointments for the monthly visits with the dietician for the 6 month supervised weight management is not covered.. The BCBSM claims specialists stated it would never be covered because of the code they use to code the reason for the doctor visit which is a weight management code for “morbid obesity due to excess calories”. Has anyone else run into these problems? Did you just pay for your appointments out of pocket?

Hey everyone! I am currently in a 3 month program at an in-network hospital to do my surgery.They accept my insurance but as I am reading over the rider it states this as meeting requirements to be qualified: "To be eligible to begin the qualification process You must be an adult age 18 or over, a non tobacco user and have a documented medical history of two years or more of a Body Mass Index (BMI):  Equal to 35 and less than 40 with two or more co-morbid conditions  40 or over with one or more co-morbid conditions" under the definitions tab they have this as a co-morbidity: "Co-morbid conditions: Means for the purposes of the Bariatric S…

I am beyond frustrated with BCBS TX. My paperwork was submitted for pre determination on 03/14/2018. I have called every day since the 15th to check and see the status. I have had the pleasure of talking to some customer services reps more than once a week. Today I called, this makes my 12th business day, I talked to a very nasty lady on the phone. My paperwork is still in the review status. I asked the lady if she could tell me how much longer it would be, "Well like I've told you the past 8 times I have no idea!" She was so rude. I told her I have the right to call and check on the pre determination. I asked to speak with her manager and was refereed to a patient advoca…

I have bcbs of michigan and I live in Florida. Since my BMI is greater than 50 the documentation of 5 months in a weight loss plan has been waived. I have to do a psych eval, nutrional eval, egd, 2yrs weight history, and lab work. Wondering if anyone else had this experience and how soon they got the approval?? Sent from my LGMS210 using BariatricPal mobile app

Hi! New here and I am with anthem BCBS Illinois. We submitted to insurance on the 28th of March and I am wondering how long it will take before actual surgery? I’m calling BCBS tomorrow to see where they are in the approval process which from reading what everybody else is saying shouldn’t be very long. Thank you for your help!

I know that I have posted this topic before, but the waiting is killing me! I am having a revision surgery, lapband to bypass. My paperwork was submitted to the insurance company on 03/14/2018. I have called every day since then asking about the status of the pre determination. I've been told that it takes up to 30 days. Has anyone had it approved in less than 30 days?

I am beyond frustrated with BCBS TX. My paperwork was submitted for pre determination on 03/14/2018. I have called every day since the 15th to check and see the status. I have had the pleasure of talking to some customer services reps more than once a week. Today I called, this makes my 12th business day, I talked to a very nasty lady on the phone. My paperwork is still in the review status. I asked the lady if she could tell me how much longer it would be, "Well like I've told you the past 8 times I have no idea!" She was so rude. I told her I have the right to call and check on the pre determination. I asked to speak with her manager and was refereed to a patient advoca…

After months of googling information, I finally decided to join this forum[emoji847]. I am soooooooooo excited but very nervous bout getting the gastric bypass. I have Anthem BSBC and it requires 6 months of consecutive weigh-in attempts with my PCP. I am nervous because last month I actually gained 5lbs. Although they said I did not have to lose any weight throughout those visits, I'm afraid that will give them a reason to deny me. Can someone with Anthem insurance let me know how long it took to receive an approval? Was the process smooth for you? My patient advocate said she would send the paper work in as soon as I get the last weight attempt sheet faxed over. I reall…

So I have UHC and my work pays 100% for weight loss surgery. My question is, does that cover my phyce evaluation, labs, EKG, nutritional visits, etc that they need before surgery? Or will I have to pay for those? Thanks guys and happy Losing!!![emoji4] Sent from my SAMSUNG-SM-G930A using BariatricPal mobile app

I will be going for a revision. on my case status on my health insurance website it say anticipated admission. does that mean I am approved? also has a date of 6/19/17

I am pre op but wondering about insurance coverage on protein powders, supplements, etc. I tried calling my insurance and rx. Insurance said i did not have coverage for items like that under medical. RX needed specific brands/items to "run a test claim" to see if it is covered. Has anyone had any luck?

Has anyone use medicaid in Maryland...if so where and who was your surgery...I'm currently looking at the program at Doctors community hospital in Lanham? Sent from my SM-G935V using BariatricPal mobile app

I have UHC I have not contacted the insurance but the Dr. Assistant has. But now I have read several times that UHC requires you have surgery at Center of Excellence my question. How do i know if the Dr and hospital are that I am seeing? Will I be denied my surgery for not going to the Center of Excellence. ( the Dr. Works out of a large hospital here). Sent from my SM-G955U using BariatricPal mobile app

I’m planning to pay for a revision. I’m looking for a doc in the Huntsville or Birmingham area that offers this protection. My insurance will not cover for any complications during my stay only after discharge.

Hi there, I haven't really posted here before because I kinda gave up on the possibility of ever getting WLS because none of my employers' insurance covered it. I was recently accepted on Medicaid and I'm looking for some insight on which plans under Medicaid, particularly in Illinois, (as I gather there are different health plans under the Medicaid umbrella) cover weight loss surgery and how difficult it can be to obtain it. According to the acceptance letter I'm offered three plans: Illinicare Health, Meridian Health Plan, and Illinois Partnership for Health. I called each of the plans today and according to what I was told over the phone Illinicare and Illinois P…

My health partners timeline: Psych Appt- May 26 Day of Long Appts. - June 1 (dietitian/ nutritionist/ Surgeon) Health partners required coaching calls - 5 calls spaced two weeks apart. Readiness Appt - August 18 (dietitian/ nutritionist/ Surgeon) Everything submitted to insurance August 24. Authorization received Sept 5 Pre op Appt - Sept 13 Surgery - Sept 21 It seemed like it took forever, but it went pretty well actually. I hope this information is helpful for someone out there.

I've begun the process of undergoing the gastric sleeve surgery. I have the Blue Cross Blue Shield Federal Employee Program insurance. My surgeon seems to believe that my 4 months of supervised weight loss requirement can be satisfied with a physician supervised diet that I was on in 2015 but that ended on 3/30/16. Does anyone know what the acceptable timeframe is for the supervised weight loss? I'm a little nervous that my supervised weight loss may be too old.

Hey everyone, I'm just a little worried about the 6 months of pre-op dieting. According to my hospital's insurance specialist, some insurance providers are now denying people if they don't lose a pound per month or even gain weight during their 6 months of pre-op dieting. I've completed 6 months of dieting, however I did gain weight and lose weight irregularly. I'm currently a professional student living about 600 miles away from my surgeon so I'm just trying to make sure I get everything done & keep to my tight schedule! Is there anyone with Anthem BCBS that can offer a little insight on what is expected? Thanks!

I've been reading a ton of posts on this site since I've begun my journey. I've gained a ton of knowledge ...you guys/gals are all amazing!! This is my first post. I've completed all of the pre-op requirements and my case has been submitted to my insurance for approval. I have GIC Unicare Idemnity in Mass through my employer. There isn't much info that I can find in wit members guide or on the internet about their approval process, stats, how long etc. I also read a ton of posts in this forum and haven't come across anyone who has this same insurance. My doctor has had patients in the past who have had this insurance. I am borderline 39/40 BMI, for co-mobs, my doctor i…

My surgery was approved and schedule and they cancelled yeterday because my insurance company have change to blue cross and masshealth under but i just call the blue cross insurance and they told me they insurance only will pay 80 % of the price for the surgery that i have to check if masshealth will cover the other 20% [emoji45][emoji17][emoji45][emoji45][emoji45] Sent from my Z982 using BariatricPal mobile app

Hi everyone ! I am new and currently completing all of my pre op requirements. I have bcbs of Minnesota and I would like to know how long it took for an approval ?? Sent from my iPhone using the BariatricPal App

My husband is starting the process for gastric sleeve. We have BCBS IL which doesnt require the 6 mo diet. We have already paid for the consultation with the surgeon and nutritionist appointment (both out of pocket, neither submitted to insurance). He has a cardiologist appt scheduled, and needs to have an endoscopy. My question is- when does the surgeon normally get approval for the surgery? And arent these other appoinments (ie cardiologist) normally covered? How are they covered if the surgery approval is not done yet?

Does anyone else have horizon bcbs of NJ that is trying to get cleared for gastric sleeve surgery?

I have BCBSM (PPO) where I have to do 6 months of supervised weight loss and my insurance covers the surgery, but won’t cover the pre op 6 month appointments. Anyones insurance not covered their 6 month pre op appointments? What did you do?

I have a hiatal hernia and am looking to have a VSG done. My insurance is Cigna; however, I noticed that Cigna will not cover the hiatal hernia repair done in conjunction with the bariatric surgery. Here is the statement from Cigna's coverage literature: Cigna does not cover ANY of the following performed in conjunction with a bariatric surgery because each is considered not medically necessary• cholecystectomy in the absence of signs or symptoms of gallbladder disease • liver biopsy in the absence of signs or symptoms of liver disease (e.g., elevated liver enzymes, enlarged liver) • herniorrhaphy for an asymptomatic hiatal hernia • routine vena cava filter plac…

So after 4+ months of going through all the insurance prerequisites (sleep study, heart test, psych eval, EGD, nutrition classes) I've been approved, but I'm really starting to have doubts about the facility. First, they tried to rush me into a surgery date that doesn't work for me (I have no one available to take me that day. They wanted me to take an Uber!), second, turned out that the reason they refused a later date for me was because my surgeon was no longer going to be at the facility (meaning I'd never even see her again for aftercare). Third, I want a night or two in the hospital and they only operate on outpatient basis. Fourth, they take ages to return my phonec…

From the time your case was submitted, approximately how long did it take for UHC to respond with your approval? I'm not talking about the whole process, like from your first consult, just only from the time that your information was submitted. That is, if you got approved on the first try.[emoji4]

I have 2 insurances, Aetna PPO and BCBSIL PPO. My surgery is scheduled for 3/16. I found out yesterday that Aetna will not pay for the surgery at the hospital scheduled as it has to be at an "Institution of Quality". There are 9 hospitals in IL and none of which my surgeon has privileges. I am not sure why this suddenly sprung up but that's another discussion. Aetna will not pay if I stay the course and have my surgery as planned. However, I do have a secondary that has approved/pre-certified everything. So I called BCBSIL and was put in touch with a "Benefit Value Advisor" where she advised the secondary ins looks at what the primary pays and then pays based off what t…

Hi all, I am so confused here. When I started my program I had a $250 deductible per year and zero out of pocket. I was responsible for 10% of my surgical cost plus office co-pays. I just learned today that this is changing, on May 1st, to a $500 deductible, a $2000 out of pocket maximum, 20% of which I am responsible for up to that maximum, and a 10% surgical co-pay. So am I reading this right? Will I have to pay my $2500 plus the %10 of the surgery? Or will it stop at the out of pocket max? Thanks to anyone who responds.

Hi everyone! I’m starting my weight loss journey to get VSG. I am on month 2 of my 6 month weight monitoring. My insurance is UHC and requires it. I asked my Bariatric registered nurse if I needed a “doctor aka licensed physician” to sign off on my 6 month and she said my nurse practitioner is fine. I just don’t want to go through these 6 months and then have to start over. Did anyone else use a nurse practitioner and get approved? Any advice will help. Thanks in advance.

How long does it take for Georgia Medicaid to approve you for surgery 4months or 6months...

I have horizon nj health, I'm looking for a surgeon in my area that takes my insurance for the sleeve I'm desperate I've tried everything

Is there anyone on here whose insurance didn't have any requirements other than the 35 or 40 BMI? I have called both my insurance provider and Human Resources for my employer and they are telling me that my plan doesn't mention anything about dietitian, psych or exercise requirements. The surgeons office has me tentatively on the 6 month until we can verify if this is correct.

Hey! I just had my first appointment with the surgeon today. My main dilemma is that I am a college student and would only be able to have RNY surgery during the summer most likely. I have been seeing my endocrinologist for 4 months (since October 2017) which my doctor said is fine for the 6 month weight loss program which means I would only have 2 months left! BUT she said I had to have met with her every 30 days and I met with her every 60 days. Did anyone else have a similar situation? If I have to start my weight loss over then I will, but I would prefer not to. I also heard sometime the insurance approves 3 months weight loss instead of 6...did any one else get apprv…

My paperwork and everything was submit to BCBS of IL on 2/20.. and still no answer yet! I know it’s only been 7-days, but it’s been a long 7-days!!!! Anyone else take longer?

Anyone?????

My first visit with Dr.Graber was Jan 24th, I was scheduled for 2 weigh ins, (feb+March) i am 21, I weigh 236 lbs, with PCOS, within the last year I’ve gained 70 lbs.. I have surgery scheduled for May 11th.. I just received all my appointments in the mail. I’m nervous has anyone not had to do the 6 months?? And still got approved? I’m wondering if it’s because it’s on record that I’ve been trying to lose weight the last year. My endocrinologist referred me to graber.

Hey y’all. I have united health care choice plus. My deductible is $1750 and my max out of pocket is $5000. I have an endoscopy scheduled for April and the hospital told me I’ll have to pay $1900 because of my deductible and 20% coinsurance. So how much will I have to pay for the surgery up front? Will it all be billed to me because I’ve met the deductible with the endoscopy? sorry if this is a silly question but I’m fairly young and don’t know anything about health insurance.

Hello All! I have been looking into getting surgery for years now. I have a job that covers the surgery so long as I meet the requirements. I have Cigna and one of the requirement is that I follow a weight management program for >89 consecutive days or 4 visits. I have my last visit on March 13th and I am nervous because my surgeon advised not to gain weight. I gained 2 lbs my last visit so now I'm working towards losing those 2 lbs I gained plus an extra pound or two. My question is did anyone go through the weight program with Cigna and gain and still got approved? They don't specify whether you need to lose during this time or you will be denied so I just wan…

I am wanting to have VSG. I have a BMI of 35 with hypertension. Does anyone with a similar situation have any experience with ChampVA. Did ChampVa pay for the procedure?

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hey guys so i have anthem blue cross blue shield va their requirement for weight loss surgery is a weight management program for 12 months i can get a call once a month from a health coach my question now i start loosing the weight im 3 months now into the program im afraid by the time i finish i will have a lower bmi and then they will deny me surgery ? can that happen? also what do you guys know about type of insurance i have does it cover all surgery? thanks

A.y anyone here from Virginian.? Sent from my LGL84VL using BariatricPal mobile app

Hello, I am going to be self pay since my insurance excludes bariatric surgery. I am looking for a recommendation for a surgeon that was a good price and had a great experience. I am willing to travel North or South in FL. In my area (Orlando) the average price for self pay is approx. $14,500. There is a surgery center that does the sleeve as an out-patient procedure. I am a little hesitation about that. It is around $10,500. Thank you! =)