Insurance & Financing

I was denied today because Cigna decided to tell my Bariatric center at the last minute that I had to have my surgery done at a hospital that was a "Center of Excellence". So they gave me the doctor and hospital I have to use. My bariatric office was so mad because they never once caught that when they reviewed my benefits at Cigna. They told me that I am pre-approved through Cigna. So I am hoping that when I get an appointment with this doctor.. The office said they will fax everything over. I did everything I needed to so I hope it gets approved quick. If anyone has been through something similar I would love some feedback.

Hi there, I'm Cate and this is the first post I'm making here, so hello! I've recently started this journey - did my seminar and had my first consult with the doc over the past two weeks. I have my UGI and nutritionist meeting this week and my psych next week, right before Christmas. Then everything's going to be sent off to insurance and we're going to play the dreaded waiting game, woo! So, here's my question: I have Empire BCBS H M O. I haven't read about anything negative or positive about H M O plans so I was wondering if anyone has been approved or denied with H M O and what the factors are, ect. I know you guys aren't experts on this, but I'm so anxious! Haha …

Since new people look or join LBT everyday. Just a reminder that open season was extended for federal government employees might be worth the switch to some looking to have WLS. BS/ BS health insurance basic plan is really good here in Maryland just needed bmi, psych and nut. (of course any evaluations the doctors require) Not sure if it works like that across the country. Just some FYI.

I am going through my insurance. Has anyone had any problems with GHI

I had private insurance (Aetna) and didn't have any problems getting approved and they paid the bills- thank god! I have a friend who is very excited at the success I have had with the sleeve, she is younger and on Medicaid currently in Missouri. I told her I wasn't sure if Medicaid had this as a list of approved procedures. Anyone with experience or know anyone who has gotten Medicaid to pay for the Sleeve?

So I got my approval letter in the mail on August 5th. My nurse received hers electronically along with my precert number. I was sleeved on Sept. 14th and sent home after 4 days in the hospital due to some complications. Today at my 3 week follow up, my nurse tells me that she has been arguing with my insurance company for 2 weeks now saying that they called her while I was in the hospital saying that my surgery was never approved due to no record of precertification. How can they say that when we have approval letters and a precert number and all forms regarding that are filled out and were submitted and approved? She showed them to me today and all the papers a…

Finally- DEC 22, approved for surgery Dec 22nd MERRY CHRISTMAS TO ME!!!

Hello all! I just attended my first information seminar this week and found that Medica will only allow the gastric sleeve with a BMI of 50 or higher. Currently, depending on when I weigh myself, I'm between 50.2 and 51 BMI. My Medica insurance kicks in on Jan 1 and I want to hit the ground running to get approvals. I'm scared that if I don't gain some weight that once I go on my pre-op diet I'll lose weight and on the day of the surgery be below 50 BMI and get denied or something. Any advice?!?

Does anyone have UnitedHealthcare Choice Plus ? If so how was the process to get approved. Did you have to lose weight and do 6 months? My company is switching from Aetna in Jan which would have been my last month and prep for surgery but since they are switching no one can tell me what's up until jan 1st. Really nervous that I will have to wait longer and jump through hoops. I'm 380lbs, 25 years old and I just want to be able to live my life normally. I NEED this surgery! Been overweight since I was 13! Super frustrated. About to head to my second to last VSG appointment, finally got my UHC policy # maybe the surgeons office could shed some light?

Hi, I believe that one of the main reasons that people are being denied the sleeve is that they don't meet the 50 or higher BMI requirement. I was looking at BCBS Mid Atlantic's requirement information and found the following information. The company's policy is based on a position paper from the American Society for Metabolic & Bariatric Surgery Sleeve Gastrectomy, Update 2008, January: Sleeve gastrectomy has been proposed both as a stand alone gastric restrictive procedure, and as a first stage operation for the extremely morbidly obese patients, e.g. those with body mass index (BMI) exceeding 50, or for those with serious comorbid conditions that would incr…

This is my first post. I was hoping for a little better one but I have a "issue" that I could use some advice on. My primary care doctor (if you can really call her that) is seemingly against any WLS. I mentioned the band back in May during my annual checkup and she seemed off put by it. Flash forward to today, I'm trying to shoot for a Dec approval and a January banding. So far I've passed all my prereq's with flying colors (pulmonologist, blood clot test, nutritionist, and tomorrow is my psych eval). The problem is, my insurance company requires a letter of necessity. Not a approval for surgery, but essentially my PCP to confirm that I'm overweight and do in fact…

So I was denied. .I have my comobidities. I have the BMI. They denied me based on documentation.. They said that I do not have the behavioral modifications documented for my 6 months non surgical weight lost. I wernt to the Simply U Med Spa in Albany Ga.. They do not provide per visit documentation like a dr does.. This is a kicker. I offered my own journal notes. I sent them and will also send my pharmacy records where I used appetite suppressants. Also do not have documentation that I have tried extensive measures to treat my comobididies. I have a CPAP for sleep apnea, I have oestoarthritis. I have had two neck surgeries, I have had root deadners, and epiderals a…

I have had a life long battle with the chub. I have been at my biggest for the past 12 months. I was at 220, now at 206. I'm 5'3 and have not even talked to my doc about lap band yet. I will tho. I have an appointment in a week. Currently, he has me on Phenterimine and see's me every two weeks. But I've played this game all too many times. Diet pills, lose weight, no diet pills, gain weight back + tons more, etc. Its a vicious cycle. I'm hoping this is a safe and effective salutation to my life long problem. I have Tricare West insurance. Is there anything I need to know before bringing this up with my doctor? Do any of you have experience with TriWest? All suggest…

Found out today my insurance will cover 85% and 15% will have to come out of pocket..called today and got exact amount I will have to pay upfront and although it could be worse I still regardless do not have this much money just sitting around. I was hoping and praying I could have my surgery by January but I don't think I'll be saving that much money anytime soon..I was so ready, and idk if I can handle the wait now..

Here we go again. The dreaded waiting game. I talked with the surgeon's assistant and she sent my packet to my insurance company on Wednesday, Nov 31. She feels confident that I will be approved. Also, she says that if they dont, they may ask for more info. What else could they want? I will go ahead and send it to them now.. I was really hoping that I could get this done before the year end.... It would really be cool to start out my new years resolution with my lapband and loose incredible weight before spring break so that I could go to the beach with my daughter and not feel like a beach whale walking around... So she said that it would take afew days for the insuran…

I meet all the requirements for my insurance, Anthem of CA. I have BMI 42, 4 comorbities, clearance from all the pre-approval appointments etc. I was submitted to insurance for pre-approval early next week. I'm trying to stay... realistic about all of this. So I was just wondering if anyone has ever been denied by insurance despite meeting all the requirements? I am no good at waiting on things that have short timelines!! this 5-10 days is killing me.

APPROVED by Horizon Blue Cross Blue Shield on the first try! Getting sleeved on 9/21/2011!

I had no problems getting approved for the surgery, but my band slipped and the surgeon had to go in and unbuckle it in October, and that too was approved by the insurance company. I am scheduled to have the band rebuckled on December 8th, but the insurance company denied the coverage for this surgery because my BMI is too low!! I lost 55 pounds originally and had another 30 or so to go, but since the band has been unbuckled I have gained back 15 pounds! Do I need to gain it ALL back so they will cover the surgery? OMG!! I am so frustrated right now and want my band back!! Any suggestions on how to convince the company that I need this surgery? How can they let me have a…

Does anyone have Anthem BCBS of CT or from another state? I'm waiting on approval and I swear I'm going to explode if I don't hear an answer soon. I know this is a common feeling for everyone, but how have/did you cope(d) with the wait? I think I'm going a little crazy because my hubby has been deployed for a long time and is coming home soon which will be a MAJOR adjustment, my mom is coming to spend a week with me, and I'm a music teacher with lots of concerts coming up, not to mention my most important job of being a mom to my six year old. I'm so anxious about everything that I can barely sleep at night which I know is driving ME crazy but I also know my lac…

So technically Aetna received all of my paperwork Wednesday in the late afternoon according to their records. It wasn't worked on at all that day because of the time it was received. The nurses weren't there Thursday or Friday in observance of Thanksgiving... I didn't know this until yesterday when I called to check the status. I was freaking out because my surgery is scheduled for 12/5 and I was so scared that I wouldn't be improved in time. I expressed to this to the person at Aetna I spoke with and he suggested that I have my doctor call and mark the case "urgent". So, that's what I did and my coordinator called them to do that as soon as I finished the phone call wi…

I called last week and they said my paperwork was in, but was on hold, apparently something was missing, I called this week and whatever was missing is there but still on HOLD.. I try to get understanding from the reps what that means... but they dont seem to know. if it is all there- it should be "under review" ? Guess, I am just wondering if the terms they use mean anything at all. I'ts Black Friday -so nobodys working today, so I'll check Monday. But just wondering if anyone ever had this " ON HOLD" term used on their approval request.

I need help finding a doctor that will take the IPA. I know it approves it but the only one I could find had to put me on a waiting list and can't get me in until July 2009. Please help I have other medical troubles that are stopping from alot of things and feel this surgery will help alot of those problems. I have thought long and hard about making this decision and feel this is the only thing left I can do. Please help. Thank you so much for any and all info. :help:

I work for the school systemso i have bcbs of ms state employees plan. I called several months ago and was told that they do not cover the lapband at all, even with prior approval. My hubby has bcbs of florida, was wondering if any one has had any dealing with either of these ins companies

I was approved for surgery under a different BC/BS plan, but for 2012 my company is making us switch to BC/BS of MA. Due to my work schedule, I am not sure I can have the surgery done this year. BC/BS of MA covers bariatric surgery, but it looks like the sleeve is considered investigational and is excluded. Just curious if anybody has practical experience with this provider. thanks!

Does anyone know if being apart of WW for 6 months counts as part of your 6 month dietary plan and exercise?

Well, as of 11/23 Aetna has all the paperwork they requested after the initial submission made by my doctors office. The nurses obviously weren't in yesterday (Thanksgiving) and they weren't in today either. Keeping my fingers crossed to hear something back Monday or Tuesday, because my surgery is scheduled for 12/5!! My cousin was approved for her RNY 11/23 and I was so happy for her! I'm so excited for it to be my turn! We really might just pull off having our surgeries together!

Wow, I never thought it would be this fast! I have to day it has been an easy process with Aetna. I called them a few months ago and they directed me to their "Clinical Bulletin" at "myaetna.com". Since it lists EXACTLY what they cover, there were no surprises. Having an experienced bariatric center I am sure helped too. They provided my PCP with a sample letter of medical necessity and the document to fill out on every one of my (supervised diet) visits. The insurance coordinator also gave me a list of everything I needed to turn in. I feel very lucky and happy tonight! There is hope if you have Aetna!

So I've completed all the requirements for VSG by my insurance company and my doctor's office submitted my paperwork. I was denied due to not having a letter of clearance by my PCP. Okay, no big deal. I went to my pcp and he wrote the letter and forwarded it to my surgeons office. I follow up with the surgeons office on Thursday to find out if my paperwork has been resubmitted and the coordinator states that after further review CIGNA requires a BMI of 50 for VSG. I'm like WTF? That's not why I was denied. She then states there is a clause they noticed and called the insurance company to verify. The coordinator said she spoke with a supervisor at CIGNA and that a …

So I was supposed to have my surgery the day before Thanksgiving, November 23, 2011. The doctor's office just called at 6:15 pm and told me that the insurance company denied my surgery because my BMI was not over 40 for two years. My BMI is now over 40, but they said that they needed to see that for 2 years. I am so devastated that I just cried! Is there any hope in me appealing this? I hate Aetna!

I was sleeved on Nov. 1st, and it is standard per my surgeon for a 2-night stay in the hospital. I got a letter this weekend from United Health Care, stating that they are denying coverage for 11/2 on in the hospital. The letter states that the second night's stay was not medically necessary since I did not have a fever, complications, bleeding etc. etc. Has anyone else experienced this and how did you resolve it?? I certainly cannot afford a whole day and night's hospital bill, that's for sure! Any insight would be greatly appreciated!

I am hoping someone here may be able to give me some guidance or answers. I had the lapband surgery in Mexico by Dr. Ortiz in May 2005. In October 2006, I moved from Michigan to Florida and became self-employed as of January 1, 2007. I applied for private health insurance (not employer-provided) in December 2006 with Aetna. I was declined coverage due to the lapband. I have also contacted Humana One here and have been advised that they automatically decline coverage for any applicant who has had the lapband procedure. This has absolutely nothing to do with the fact that I had the surgery in Mexico. It is the procedure itself that is causing me to be declined covera…

Just heard from United Healthcare that my appeal has been denied for a revision to VSG. They already approved the Lapband removal but not the revision. I don't have the paperwork yet but the coordinator said their response was several pages long but amounted to that they felt I didn't have success with the Lapband so would not have success with another restrictive procedure. I feel there is no comparison to having VSG vs. Lapband and I explained that in my appeal letter (which was 42 pages in total since it included years more of medical records). I'm told my next step is to submit for a Level 2 appeal which will be reviewed by my employer (a major corporation). I'…

Just wondering how long it took y'all to get approval from your insurance and is there anything I can do to speed the process up? I'm so readyyyy now!

Just getting started with this whole process... daunting. I have been researching this for a LONG time, and finally took the plunge. Attended Introduction to Weight Loss Surgery on Friday November 18th; set up first meeting with dietician on the 28th of November and first appointment to meet the surgeon on Tuesday November 29th. Then, I'm not 100% sure what the entire process is other than what I see on paper. I know it will be at least 6 months before I have the surgery based on my insurance. I'm a little terrified of the qualifications and being approved; I have a BMI of 39.01 right now and no history of high blood pressure, diabetes or sleep apnea. I do howeve…

Has anyone here tried lately to get medicare coverage of the sleeve? They authorized payment for the by-pass but now after much research I want the sleeve and they won't approve it. Just wondering if anyone else has had any experience like this. Thanks!

Has any one had any issues with this insurance? If so please share.

WOOHOO!! :party4: :party4: After months of calling and stalling BCBSIL has finally approved my surgery! It's a go for Dec. 5th! To tell the truth I'm still a little shocked. They gave me so many different BS excuses about why they kept denying me that all I was expecting was a no again! I had heard from many people that BCBSIL was one of the toughest insurances to get approved with and that most people get denied at least once by them. To all those who do have BCBSIL, stick with it! Don't give in! It only gets better from here. Divis :heart:

Has any Califorian people dealt with Anthem BC PPO..(pers select)...do they require a 6m diet program. I spoke with one the reps and she said no, and how long does it normally take to get approved..thanks

I have CareFirst BCBS (BluePreferred PPO, DC plan), and I have met all the requirements for my insurance. (I called back when I started this process, and my employer's plan does cover bariatric surgery, so no worries there.) I am over 18. I had a successful psychiatric evaluation for bariatric surgery. I did a structured diet (WW) for six consecutive months, going at least once a month. My BMI is over 35 and I have severe sleep apnea. My submitted all my stuff to my surgeon's office, and they submitted it all to my insurance. Well, my surgeon's office called me back to today and left a message that my insurance plan doesn't do preapprovals for bariatric surgery,…

I am SO happy and excited! My surgeon's office ROCKS! First try with BCBS and it's done. Pre-op visit is Friday and surgery is next Tuesday Nov 22nd!!

I need someone to talk me down from the ledge! I am so flippin frustrated with the girls at my surgeons office. They keep dragging their feet with getting my surgery scheduled. I love the surgeon but the office staff leaves a bit to be desired! They scheduled me for a pre op appt on Dec 6th but I am still waiting for a surgery date! The scheduler is out sick so the other girl says, "Sorry, I don't do the scheduling." Seriously! Do you or do you not work in the front office? Why are you not cross trained? They are not supposed to schedule a pre op appt without a surgery date so I wonder if they even have any clue as to what they are doing.

The surgeon's coordinator has already told me that bcbs il is difficult .. but im trying to stay positive. I called on friday to see if they had recieved the fax and they were in the process then of sending it to the review dept. I asked her if every thing looked ok and she said that the documentation could be an issue.. hard to stay positive when i know thats the most common reason for denial Still hopin though!

I just want to give everyone heads up regarding insurance coverage. I spoke to my carrier BC/BS of New Mexico. They do cover lap band for patients with a BMI 35-40 who have co-morbidities, without a huge list of other hoops. That was the good thing I have been very excited because knew I was qualified and just had to wait it out.and go through the steps. I called again today and asked some more questions. What I found out is that even though those are the requirements for the insurance company , my employer has tacked on another more strict condition and you have to have a BMI of 40. No exceptions for co morbidities, or the fact that the plan covers it. I am so upset …

Hubby was approved yesterday, me still waiting. BCBS of NE. received approval on 10/31 made decision 11/7. The associate told my hubby that his approval was dated before mine, so hope to hear today. I am soooo happy for him.

I'm very upset right now b/c for the past 6 months i've been going to the dr and dietician for 6 months straight, saw a psyc, and did meal replacements only to find out that I was DENIED!!!! Now get this...they said i as denied b/c i didn't have documentation of 6 months non surgical weighloss, (duhhh i saw dietician for 6 months) and also b/c i only have 1 comorbid (high blood pressure) When i 1st started on this journey, the dr assured me that it wld be no problem for me to get approval with a BMI of 35 and HBP...What am I to do now??? PLEASE SOME HELP ME.....

the problem i am having is getting any kind of information on what my co pay is going to be. I have to deal with Desert Oasis, they are the medical group that i have to go through, but they tell me i have to talk to my insurance company to find out what the co pay is, blue cross says its up to desert oasis, but they still say its too early in the process to know. They cant seem to understand that i have to save up the money for this and try to get some of it covered by flex dollars etc. my question is, has anyone had to use either desert oasis or blue cross in southern california? I just need some type of figure to work towards. Im getting so frustrated. If i have to wait…

Hi How can get the lap band and get medicare to pay for it in Texas ,. I don't know anything about anything please help, Thanks Kim

New to the forum, but just figured I would post my wait time for BCBS of Rhode Island. It took about a month to hear back from them once my paperwork was submitted, but this past Friday, I got a call from the sleep study center my surgeons office uses. Apparently the surgeons office sent over the referral for my sleep study. After a call to the surgeon, they did confirm that I had been approved and would be getting my official letter with remaining requirements....YAY! I wonder how many more hoops I have to jump through!

Hi.. I will be changing to Blue Shield H MO after the new year. According to them, the way my husband's employer's contract was written, lap band surgery is covered...no restrictions! Almost too good to be true...I will be confirming next week. Anyway, since I see on these boards that BS H MO has covered others here, maybe I am not dreaming. I was wondering...since all bariatric surgeons are contracted....how do I know what doctor I will be referred to? I mean, usually on a H MO, you belong to a group and then any doctor you are referred to is in that group. However, bariatric surgeons are not in any group so how is the doctor decided on? I want to make sure I get a go…

Hey ya'll, new to the site. I'm nervous about my surgery. I'm with Aetna and have two last appointments before I get my papers sent off to get a op date BUT my company is switching to UHC in January so my worry is I'll have to wait two more months to get my sleeve. My body is in pain and I need this surgery pronto! Anyone know if UHC will honor my four months or make me do 6? Any advice is greatly appreciated. Thank you! Bre