Insurance & Financing

My doctors have not seemed concerned about insurance approval. I've completed all my tests and I'm set for surgery a month from tomorrow. I'm confused though because I see on here that a lot of people have to prepare packets and they have to wait for insurance approval. I didn't have to go through all that. It seems like the doctor has taken care of it all. I just hope I don't get everything done that the insurance requires, only to find out I'm rejected. However, again, they don't seem concerned about it at all and are acting like it's already been aproved and taken care of. Maybe this just depends on the insurance carrier. I use Highmark Blue Shield. I'm just curious i…

Hi all! I was just wondering if anyone on here would have any idea what the cost of lapband surgery in WV would cost? I live in Morgantown, WV and recently went to a seminar held by Dr. Akkary from Preston Memorial. My crazy insurance will not pay so I am looking into finacing the cost. Just wanted to see if anyone may have an estimate for me. Thanks

I received a phone call from my surgeons office this afternoon. They received approval from the insurance company.. I've been working with these same people for two long years for this moment. The coordinator said she got goosebumps when she read that I had been approved. After being denied (including appeals) by Aetna last year, I thought I would never see this day. Two full bariatric surgery work ups, 1 insuance denial and a whole lot of tears.. I will finally receive my band on 11/23/2011.

Hello all, I am new here and found this site after doing a search for someone who can give me some answers. I have completed my 6 month MD monitored diet and have almost all paperwork in hand to submit to BCBS of Alabama to hopefully get approved. I only lack the Medical Clearance letter from my GP (and that's a whole 'nother story for later.) I hope to have that letter in hand on Monday. My weight history is well documented, I had the psych evaluation, and completed all the nutrition classes and support group meetings as required....My questions are these: 1. How long does it usually take the insurance company to make a decision? 2. What are reasons t…

What if my BMI falls under 40 before I can get surgery? I am at 40.5 now, with no other real health issues. Thanks, Karie

Has anyone received an approval from their appeal quickly? Like, within 10 days? Or over the phone? I'm trying to figure out if it's worth it...

I am in Texas and am going through all the red tape that Medicaid is requiring thus far for me to be able to have Lap Band surgery. I have done all the tests like for Sleep Apnea, psych eval., Asthma and am now seeing a pulmonary specialists to keep track of the apnea and my cpap. I have found a surgeon in Tyler that meets the requirements so am now wondering what is left that I have to do.

I'm freaking out. My insurance coordinator just called to tell me that my insurance will not cover the sleeve unless I have a BMI of 50 or higher...which I do not! I'm scheduled for surgery on the 21st! She said it will cover lapband. I need advice PLEASE!!! I have to call her back and tell her what I decide to do. Have any of you been through something like this? Is it worth appealing? Should I just get the lapband so the last 6 months weren't for nothing? I'm so upset! I have no idea what to do but my doctors office has sure done a good job at scaring me off the band because I'm shaking at the idea of it. I just don't know what else to do! Opinions or ideas would be muc…

Anthem BCBS pre approved me for surgery. I had my surgery in July and now they deny the surgeons bill, the hospital bill and the anesthesiolists bill. I call and they say we will send it back over in the mean time I am on the verge of going to collections. BUYER BEWARE. Insurance companies suck. http://www.discountdesignsolutions.com/i-sad-apple-t-shirt.html

Oh my goodness so excited I just faxed my diets for the past 8 years weight watchers, Jillian MIchaels my gym check in since 2004 with all my clearances and primary dr clearance and letter of 5 years history I pray UHC approves it please!

My insurance experience is probably one of the best anyone could have. I will probably not work for this company through another year, so I'll end up having to pay for fills. At this point, they charge $600.00, UHC pays about $420.00 and I don't pay. I believe that the reason they can offer this surgery for self pay for less than $10,000 is due to the amount they are paid by some insurance companies. I am happy to see people be able to get their band at a more affordable rate if this is the case. My surgery was May 25th. They have finally finished paying it off. I was getting nervous about it, but the True Results center had quoted me $1300.00 for my share. That didn…

Does anyone know if Emblem GHI covers fills? Right now I have comprehealth - a division of HIP and i am having the surgery in december (hopefully) but in january i am switching to GHI and I was just wondering if they cover the fills...the do cover weight loss surgery

I have BCBS Tennessee PPO and wondering is anyone had the sleeve approved with this insurance. If so, how long did the appeal take since it is considered investigational? Thanks for any help or info.

Not much on here about GHI. Does anyone know how long GHI takes to approve??

Thank you all for putting up with my nerves waiting for the dr to call today with my date hes hoping this week nervous!!!!!!!!!!!!!!Ty for prayers and support!

I had my mind made up to go to Dr. Kelly i went to the bank today to get the loan she said no problem but you have to promise me you will not go to Mexico to get it done. So now im back to day one . So any input you have for us doctors would be helpful. Prices and how londg it took from start till surgery with self pay. thanks

The psychologist that I went and saw wrote a summary to my surgeon about my visit. I had to take this MMP1 (something like that) 500 question true false exam. I marked true on a lot of questions such as I have low self esteem. This is due to my weight but you can't explain that. Now the letter is summarized with "I recommend bariatric surgery with reservation" and that he recommend that I see a psychologist. Do you think this will make me exempt from UHC's requirements?

Hello! I have SSM Exclusive Choice insurance and I was wondering if anybody has ever dealt with them. I am still considering the surgery. I truly believe if I dont have it I will continue to gain until i 500 lbs, like my dad. Im curious about how to go about approaching the insurance with the issue. Thank You!

Well I called our insurance co.; yes they entered my information on 10/31/11. I should figure 10 to 15 business days for their review and decision. Hurry up and wait/weight.....The story of my life.

I know united health care now covers the sleeve, i have it through medicare and no medicare doesn't at this point. would i still get approved since i have united and they cover?

My bariatric surgery packet was submitted to Aetna last Friday, so 4 business days ago. Waiting for an answer is driving me insane! This is my second round with Aetna.. First time I was denied for gastric bypass, which was really a blessing. I have wanted a band all along, but felt pressured into the bypass. After my failed appeals, I vowed I'd never do this again.. low and behold, here I am a year after my failed attempts. I had to complete a second workup and now I wait. I've read some stories of other people getting approved by insurance while under a 40BMI with "minor" comorbids. Tell me your stories please.. Anyone been approved without the major comorbids and …

Has anyone else with BCBS-LA had experience with this? My company is self insured and BCBS is the administrator. I guess my company actually pays all the medical bills. Anyway, what they tell me when I call customer service and what they tell the doctors office are two different things. The main one - 6 MONTHS CONSECUTIVE OFFICE VISITS! I was told 3-4 times by customer service there was no waiting period and only needed to meet the BMI requirements. Then after my doctors office told me about this I called them again and got the same answer - NO waiting period. So I told them what my doctors said and she even put me on hold and talked with her supervisor and came ba…

I am in Northern MI and have been waiting for a week to hear back from the surgeons office. I was told by my insurance rep that they don't need to prior if the surgeon says I meet criteria. Surgeon said I met criteria. Now I'm just waiting and wondering why it might be taking this long to hear back. Does anyone have any experience with this type BCBS?

Ok, my dad went to see his doctor to see if he should do the lap band surgery or some other type of geriatric surgery since his PPO insurance covers it, but his doctor told him NO!!! It was his primary care physician that told him he is not stable enough to have the surgery performed. I told him to get a second and third opinion but he believes whatever his doctor tells him. What do you think? My dad is 64 years old He is 5'8 He weighs 330lbs He has been obese all his life Now for his current health: He is taking blood thinners He is pre-diabetic and takes Byetta injections (as recommended by this same primary care doctor) He was diagnosed with CHF about…

I am just devastated for the 2nd time! The insurance wants MORE information from my 6 month visits. They said the doctor was not descriptive enough. They want diet and exercise progress. I know what I discussed with my doctor in each visit but I can't control what she types in her records. I'm so frustrated now. I've been denied twice over this. I'll appeal but I'm scared this is going to go no where. My biggest fear is that I will have to find a whole new doctor and do another 6 months all over again. I've been on this for 9 months now. I just dont know what to do. ... Maybe curl in a ball in the room and cry? Advise?

I have my surgery booked with Dr. Kelly in January, but told my husband I'd give our insurance one more try... I have a BMI of 37-38 with no co-morbidities. With my insurance I have to be on a 6 month supervised diet. I get that I would need to be at 40 to qualifiy, but I wouldn't want to stay at 40 for the entire 6 months. When I called BCBS I asked and the rep said that my ending weight needed to be at 40, or 35 with 2 co-morbidities. Does that sound right? Thanks for any input or experiences that you can share to help me out!

Has anyone been able to look up online to find out what the benefits are for your health insurance concerning bariatric surgery? If so, how do you do it? I have BCBSMI PPO ford retiree and when I talked to the ins rep the other day, she went so fast through everything and now I'm confused on some parts. The rep said she would send the written part on my insurance for bariatric surgery through the mail. Said it would take 7-10 days to receive. Help!

So my mother in law is pretty overweight and has a lot of the health problems associated with it (diabetes, high blood pressure, arthritis). She can barely even move around because she's in so much pain and I honestly believe that if she could get some of the weight off it would immensely improve her quality of life. She said that her doctor wrote a letter to her insurance (medicare) saying that she should be approved for the lap band surgery and they wouldn't approve her. I was self-pay so I don't know anything about it. I have read on here about some people whose insurance companies tried to get them to go with gastric or something more drastic because they don't want…

I just got off the phone with the pre determination unit wonderful i have empire uhc bcbs and she assured me im approved just has to follow protocol with inline pts i haunted the i am so happy i cried i told her i dont take surgery lightly and i need this! GOD IS GOOD!

I have Empire Bc BS government plan and I did everything cleared so they were suppose to send to insurance last week. I called to day medical mngmnt dept and they said they need the Dr's office to call because all they need in preauth for the hospital not all that paper work! Im so confused I left them a message today! anyone have the same insurance

SPOKE TO MY MEDICAL MGER SHE APPROVED UHB BC BS SO FAST I HAUNTED THEM GAVE ME A VERBAL APPROVAL DR JUST CALLED HE IS READY TO GO SO MAYBE NEXT WEEK! SO HAPPY FIGHT CALL DONT GIVE UP!

Holding as I speak uhc said they sent to bcbs they dont have it so I have spr on the phone I am getting this I will not back off I need this I want t o Live!

After months of waiting I found out today that United Healthcare overturned the medical groups decision that denied my surgery! I am finally approved. I am so flustered right now I can't even think straight! I started this process back in July. My BMI was only 39 and I was denied for the consult because I did not have a qualifying comorb. In Sept I went back to my PCP and my BMI was 41. I was denied for the consult stating I needed to show motivated attempts for dieting for 6 months. I submitted the medically supervised weight loss program I was on for 2 years and was finally approved for the consult. Then the surgeon requested the surgery and I was denied citing I needed…

I have BCBS of IL PPO and I am in my 3rd month of my 6 month program. My starting BMI was 40 so instead of trying to lose weight now I am trying to maintain and focus on post surgery eating habits. Does anyone know now if it's hard to get approved through them once the 6 months is up.

OMG just got to speak to UHC and papers are there and by Friday I should have my answer did alot of sucking up but the accepted and are just reviewing COB so I think it sounds good !!! OMG so so happy

So, the coordinator at my surgeons office seems to think she will be okay submitting the precert to my insurance on day 84. I work with insurance companies and know that they look for any excuse to deny, not to approve. Was anyone approved prior to 90 days with Aetna? I wasn't even aware of this 90 day rule until today!

I'm curious. I can understand why someone would self pay for a surgery that will change their life. Also, regular Dr. visits for fills, etc. But my question is, are you not worried that once after you have had the surgery, something can go wrong at a later date, ie: slipped band, leakage, etc, that you would need an additional surgery?? Reason I ask, my Wife and I are considering a new health insurance policy/plan. My current surgeon would be in network. Now we will have flex-spending that can cover routing office visits. But if I needed surgery, then what.

I had my surgery October 3rd. I received my bill, and it says I owe $1612. Everyone I have talked to on these forums said they only paid $150 copayment. My insurance rep told me that if I could get someone else's ID number, she could compare to see what the problem is with mine. Is anyone sweet enough to give me their ID number? Or I can give you my insurance rep's name and number. You can call her or she can call you to get the info? I would appreciate it so much! I was expecting only a $150 copayment and not this crazy amount. Thanks so much.

It's so hard to just sit back after 6 months of preparing for this & wait just a few weeks on someone to say approved or denied. I'm a nervous wreck. I just want to hear something already! My stomach gets in knots when I think about it. I called the insurance on Monday and they said to check back on the following Monday.

My deductible is $2000- Noone has mentioned it- I am wondering if I will need a check that morning or if I will get a bill from the hospital? My surgeon uses a hospital not day surgery center so I am kinda hoping they just send me a bill after and I can work out a plan...

Okay it been an emotional 2 weeks Aetna has denied my surgery twice due to not having proper documentation to do the 3 month multidisciplinary plan. Anyone have a copy of exactly what the doctor has to put on his paperwork every month. I have given up on the 3 month and am just hoping to get approved on the 6th month.... Any help or suggestions would be greatly appreciated. Don't think I can handle a 3rd denial... July 8- primary care Aug 5- primary care Aug 5- nutritionist Aug 19-nutritionist Sep 2- nutritionist Sept 9- primary care Sept-30 nutritionist Oct 7-primary care Oct 21- nutritionist I have been going to curves twice a week and walking …

I bought something online that helps get you through the insurance approval and also helps you keep track of who you spoke to and when, etc. If you want a copy sent to your e-mail, post it and I'd be happy to send it to you. I hate for anyone to have to pay $50 for it, when I bought it and can share the information!!!

Has anyone been told that only their surgeon's office can call to check the status of their approval/denial? They won't give me any information and I'm starting to get frustrated :0(

Hi everyone, I am on my 3rd month of my supervised diet, but I haven't even met the surgeon yet. My PCP wants me to wait??? Does this sound right? Seems like it will just prolong a process that I have been excited about for a year!!!! Any suggestions??? :-)))

PRAISE GOD! I have BCBS of California and was approved in only four days. :bananajump: I did call and check on it EVERY day (at least once a day), and they were very patient with all my calls & answered any questions I had. My BMI is barely 40 & I have moderate sleep apnea, so I'm sure that helped. I am SUPER excited!!! My surgeon's office, (Dr. Shahram Salimitari) said they will be calling me on Monday with my surgery date, but tentatively Nov. 17th!!!! It can't come soon enough!!! I am so anxious to start a new life with this tool and once again have energy & confidence and be able to look in the mirror without wanting to cry!

Hi everyone! my names Amber and i'm currently in the process of getting this thing started. I have already met with my surgeon, today in fact. I sat down with the woman who takes care of insurance and i got up a little confused. I asked her at least 5 times how much the actual procedure was going to cost and I never got a real answer. I have united heath care through Target and they pay 80% after i meet my deductible ( which is almost met). I know insurance companies negotiate prices with doctors so it makes it difficult for me to find out how much im actually going to have to pay. I'm pretty sure she said for just the doctors fee, without insurance, is 9000, that doesn't…

I have 2 insurances, NC State BSBC(70/30) and UHC(80/20). I have heard BCBS is easier to get approval and fast at responding but UHC can take awhile to respond. I am hoping so bad that both of them are approved. If I get at least one approved I will be happy but would have out of pocket expense, if both approve no $$ OOP. Does anyone have 2 insurances? What was the outcome? My family dr said that if they are going to pay for all the pre-test, why wouldn't they pay for the surgery?

Hello, i'm new at all this, so i had a few questions if anyone can help. i am 5'4 and I weigh 205 lbs. i have high bp, depression, borderline diabetic, and severe restless leg syndrome. i am worried that i may not be heavy enough to qualify for insurance to cover. I have bcbs IL, which i do know they cover this surgery. what does anyone think, oh yea, my BMI is 35..

What I am learning from this experience it not to trust what you are told. The predetermination assistant at my surgeon’s office assured me when I completed all the insurance requirements that I didn’t need anything else, she was going to fax all the documents to the insurance company for approval. I waited a week and called back and she said they hadn’t heard anything, so I called the insurance company and was told they just received the fax and it was missing information and they had called and left a message with the predetermination assistant at my surgeon office. So I call her back and she said she would check her messages to find out what they needed. So she called…

i just found out my healthplan with UHC thru the AZ state retirement system no longer covers it. but the lad i talked to said to have my doctor send a letter with weight and BMI and things wrong with me. i am 330 pounds and bmi of 49. I have been overweight for many years. i have proof from a doctor supervised program for years that didnt work well and jenny craig too. She said a doctor will look at it and let me know. she said she has seen it overturned many times. i guess just have my primary write a general letter giving all the basic info and then later if they need more stuff. Should I just send this all in one synopses type letter stating all these things …