Insurance & Financing

ANY SUGGESTION OF WHO TO GO TO ? I CAN PUT 3000 DOWN. WHO IS THE LESS EXPENSIVE IN OUR AREA? DONT YOU HAVE TO PAY FOR THE SURGERY CENTER AND ANESTHESIA GUY THO?"

My blood pressure witch I was just dx is going up stressed out waiting for DR's office to send the darn papers for approval to Empire Bc Bs!

Has anyone found out anything as to the Medicare approval date for the sleeve gastrectomy? I am new to this forum but not to obesity. I want this surgery so bad as so many people do!

Hey All I have not been on here in awhile I had all my clearances done this past summer and was ready for surgery. As you remember I was literally down to the wire with setting a surgery date only to be denied my by insurance because it was not in our contract. I was not giving up the weight loss battle this weight had to come off. Being 293 lbs isnt healthy. I am proud to say I am working with a weight loss doc and am now down -38lbs!

So here I am. Nice to meet you all Back in April I had my first meeting with my surgeon and went through a 6 month diet nutrition class, psych eval, all that good stuff, Thursday was my last day of wait and all my paper work has been sent off to Tricare for Approval. I decided to go on to the tricare website to check out the requirements again and its making me a little nervous. Is 100 pounds over ideal weight for height and bone structure and has one of these associated conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome, hypothalamic disorders or severe arthritis of the weight-bearing joints Is 200 percent or more over…

I have an opportunity to take early retirement with my company at the end of this year (I will be 55). In am considering all my options. If I try to get insurance on the open market, will I be insurable? Or, do insurance companies automatically deny post-VSG patients that want INDIVIDUAL coverage (not group)? I have the option now for insurance either through the company's retirement option or through COBRA, but I am looking ahead over the next 10 years until I reach 65. I wouldn't bet the company will be in existence in 10 years, so my insurance will probably go "poof" at some point. If I jump back into another corporate job, I could get insured with them, but the job …

Hi All, I am going into surgery as selfpay and I could really use some advise/support from other people who have been selfpay and how that worked out for you and if you have regrets or issues with selfpay. My surgery is scheduled in August but I can't help but think what all I could do with 15grand! and I always wanted to get banded locally so Mexico really wasnt something I considered. :biggrin:

Does anyone have any experience with Geisinger Gold Med Advantage Plan? I am 45 and disabled but meet all the criteria for surgery...BMI 51, GERD, elevated cholesterol, etc...

I'm so disappointed. Its hard to even describe my feelings. I've been researching lapband for awhile; I met with a surgeon who thought I'd do great with the surgery; their office would do the insurance leg of things. Find out today that our employer does not carry bariatric surgery through insurance. That's it...end of discussion. There is no decision to even argue with. I can't believe it. I was so counting on this surgery. Paying out of pocket is not an option for me right now. I'm devastated.

hey guys! its been a while. i wanted to ask you guys.. how long after submitting your papers did you get approved by your insurance? how long after getting approved were you sleeved? heres an update and a little background on me. nov 1st makes my 5th month out of my 6month process. i finished all my tests except my cardiac clearance which ill be doing nov 2nd. im meeting with my surgeon nov 30th & dec 1st is my 6th month. hopefully, theyll submit my paperwork that day & ill be waiting to hear if im approved! im PRAYING to be sleeved by dec 20th! i spoke to my nurse practioner and she said dec 20th is very possible! a little background on me.. im 23…

Tricare says the MTF needs mor info before they can approve me for the VSG at the MTF. Any ideas of what I can give them that will help get this done? Tricare said Fort Gordon wants 6 months documented attempts of excercise, diets and meds. Doc has meds list so thats not a problem. Are they looking for food journal and excercise logs? I have a weight watchers thing with my wegh-ins on it from 2009, will that help? Any info would be helpful, just trying to get this done before my husband is unavailable due to military stuff at the end of this year. Thanks so much everyone!!!!!

I will be a self pay since my company has excluded all WLS from our policy. My surgeon is willing to adjust the price for that reason, however I still will need to finance the surgery. I was wondering who people have gone through that offers good low finance rates? I live in Illinois, not sure if that makes a difference. Thanks for any help offered.

Received Precertification letter from Cigna with approval code stating that surgery was medically necessary and a covered benefit on 10/12/10. Had lapband surgery on 10/27. Now I'm in the 2nd appeal stage to get Cigna to pay my surgeon and hospital bills ($17,000 worth!!). How in the world can this be possible? Does anyone know what my next step should be if the 2nd appeal is denied? Has anyone ever had this happen to them. Should I hire a lawyer?

Hello! Not too sure if this has been asked yet. My insurance covers 80% of the surgery. My max out of pocket it $3,500.00 My question is, if the 20% is higher that $3,500, do I have to pay all? Next question is, has anyone financed that 20%? How was it? Thanks so much for all your input.

Hey y'all!! I just started my process about 3 weeks ago and I have BCBS Federal. I was wondering if anyone can help me out with specific details about what I, personally" had to hand in to my doctor/coordinator during my 3 month weight management. For example, food journal, excersice log, etc... Another question, My BMI is exactly 40 right now. Can I afford to lose a couple of lbs and still get approved? Or should I just maintain my weight?? I would appreciate anyones knowledge and experience about this!!

Hi all, I found out at the bariatric cneter today that BCBS Fed now covers the gastric sleeve. Apparently this happened in JUly of this year but nobody told anybody on the inside! Sounds like the gov't to me but that is another long post. Just thought I would spread the news. Melinda

I'm awaiting my approval/denial from BCBS (of Tennessee Network P). Anyone dealt with them? How hard is it to get approved? I've already jumped through all their requirement hoops. Please - someone give me some advice on what to expect.

My primary Dr referred to one of only 2 bariatric surgeries that she trusts in our area. There office got him approved at a bariatric surgereon. I got approved for a referreal. Well then i got letters stating that I am approved for surgery BUT they will not cover the surgeon that they approved me for a consult. they now want me to go to a Dr out of state & follow there 12-week diet program for 12-mtonhs...?? thank my concerns are: financail burden of the diet & travel. do not know this Dr. they are about the pyschy & figuring out things and not so much surgery why can't i go w/ the Dr i was referred to that is in our network. the diet will make me …

Hi, new here and totally new to everything about the lap band! I was wondering if anyone was familiar with Premera (Microsoft) and their approval process? I have a BMI of about 40. What do they require to get approved, how long does it take, etc. Thanks for any info! Sarah

The patient advocate at True Results called and told me that my insurance, CIGNA, will cover my Lap Band, and she gave me an out of pocket price, CIGNA requirements, etc. However, when I look up my insurance summary it says obesity surgery is excluded. Could it be that CIGNA can exclude the Lap Band procedure from an obesity surgery exclusion? Or is someone pulling my leg?

I got approved!!! After 10 months, 2 denials, countless phone calls & faxes I got approved!!! I am soooooo excited I can hardly stand it... Thank you all for your support in this very long process! I will be joining the November group!! Wow, I can't believe it! Glenna

i called my insurance on Monday the 17th and it was approved!!! yay!!!! i'm really happy. i had them fax a letter to my dr's office. it was sent in on the 6th. so didn't take to long with BCBS of Illinois

Hi there. I just posted this in "pre-op questions." I didn't know there was an insurance section so I hope it's ok to post here too. Does anyone know which VA hospitals do the sleeve? I am a service-disabled vet who can use all medical benefits at the VA hospitals. I also have tricare prime, but of course they don't cover it. Grrrrr... Thanks, Shan

VSG and Tricare.doc

Hi all, Just thought I would let you know that the 2012 benefit book is on line at www.fepblue.org. It doesn't look like there are any benefit changes for WLS. They are however changing the pharmacy program. I have just scanned it but I thought you all might want to know. It is a relief to me as I am afraid I might have to wait until Jan but still hoping for Nov. Melinda

I'd love to hear from anyone that has BCBS of MI PPO. My insurance is under my husband, and he is a Ford retiree. I talked to a benefits rep the other day from BCBS and she said that the sleeve is an approved surgery as stage 1in a 2 part surgery for duodenal switch. Approved for age 18-60. I am 60 and will be 61 in December. Also, was told that I needed a 6 month documented diet with in the last 4 years. So my question is at age 60 already and without a 6 month documented diet, am I just out of luck for insurance to ever be approved?

im currently trying to get approved by uhc and i wanted to see if there was anybody here that was approved or denied by them. i want to hear your story to get a feel for my chances. thx so much! please respond! i need some help.

Hello all, I am in the middle of the appeals process with my H M O. I have United Healthcare. Is there anyone out there who was approved and had surgery through their UHC H M O? If so, how did you go about it? Any info would be appreciated. Requirements, appeals etc. Thanks!

Hello all, I am in the middle of the appeals process with my H M O. I have United Healthcare. Is there anyone out there who was approved and had surgery through their UHC H M O? If so, how did you go about it? Any info would be appreciated. Requirements, appeals etc. Thanks!

I am trying hard to find out if my insurance through my job at&t coovers the procedure they said they have alot of POS plans ( point of choice ) so they keep givivng me the ruan around saying i have to wait a week and i just want to know if there is anyone on here that is with united health care through at&t ? were they able to get coverd please any answer would be a good answer i just cant keep waiting

As of 1/1/10 Tricare now covers the procedure- new cpt code- 43775. Ha! I gave the code to the docs office, they had never heard of it and used it on a patient that was closer to surgery than me and it was approved! It's been submitted for me and the status is still pending, but I'm checking 2 or 3 times a day to see that "A" for approved!! Such good news:)

Does anyone know if your BMI has to be 35 for 6 consecutive months with Cigna? My BMI has fluctuated be 33 and 35 and right now it is 35 at my 5th and 6th month. Going for my consult with surgeon tomorrow, was just wondering where I might stand with Cigna. I know i have coverage for the surgery. I have Fibromyalgia, Rheumatoid Arthritis, Sleep Apnea and Type 2 Diabetes.

Does anyone know if Tricare Prime is now using the same requirements as the FDA, approving Lap Band for BMI 30 and above? I am 75 pounds overweight and have several qualifing conditions, sleep apnea, .... Or, can someone give me some advice? Thanks

Helli everyone!! Im about to have surgery and bcbs of il is covering it. What happens if say, 6mos from now, I have a different insurance company? Will they cover the fills? Or if I need an upper gi or anything done lap band related? Do new insurance companies treat it as.preexisting condition? If I change insurance companies, can I expect anything lapband related to be OOP?

I've spent the past few months researching and reviewing various forums regarding insurance for the lap-band. The main question I sought to answer was, "Do I need to have the six months supervised diet or whatever". I couldn't find an answer anywhere. What I did find was conflicting, and often ambigious. I even resorted to calling the insurance company to see what they had to say. Nothing. Oh, the insurance company had pleanty to say, but they didn't say anything. No one could find anything stating that I needed the supervised diet prior to authorization. My medical group even called the insurance, and they couldn't get an answer. I requested that when all of my paperwork…

So, tomorrow morning is MY LAST VISIT for the 6months of supervised doctors visits and then they will be able to submit my case for insurance approval! IM SO EXCITED!!! (hopefully I get approved) How long did you have to wait once you completed everything needed?? I have BCBS IL. And, did you get denied first and have to go through an appeal??? What was your experience with this time?? I'm ready to have this surgery....yesterday!

During my journey one of my biggest worries was that I was gonna have to wait several weeks for an approval from Empire BCBS - EPO (most people are down with PPO). Needless to say, my approval took 6 days. My paperwork was submitted on Monday, September 13th, and my coordinator called me on the 19th with the good news. I also received a call today from Empire to verify who I was and to tell me that I was approved for Surgery on October 18th. *doin a happy dance*

I am just starting the process of looking into lap band. I previously contacted BCBS who told me that I would be covered but I had to have a current bmi over 40 (which I have) and prove through medical records that my bmi has been at 40 over the last 5 years. After that my deductible would be $2,000. Well I went to a seminar at a center yesterday, and the patient coordinator who checked our coverage during the presentation said that the only requirement I had was my current bmi being over 40, and if I used their out of network surgeon I wouldn't have a copayment just a small fee for the anestethia. Does someone have any insight into why this is the case? I have another …

So the bariatric Dr my primary referred me to was approved. so i drive 2 hrs away from my home attend there seminar & drive 2 hrs back. just to find letters from my inurance saying i meet the criteria for surgery BUT i don't need to see Dr. Bright we'll approve for you to seeing Dr. Pennings in another state!!! that's insane!! and they want me to there 12 week diet for 12 months first!! WHAT?? i don't understand. HOW DO I FIGHT THIS!!!?? jen

To whom it may concern (those who are waiting for that big answer).... for the sleeve ...I've been calling medicare since march 2010...I called again in June 2010....I just called today and I was told that the CPT CODE 43775 (which is the VSG) IS COVERED :teeth_smile:::cheer2::::cheer2::dance:::dance:. It covers the VSG if you can prove you have not been successful at other weight loss attempts, BMI 35 (or above), and you have 1 obesity related illness such as hypertension or diabetes. I know people who've had both the lapband, and gastric bypass, and while most have lost weight, some have lost weight PLUS they're dealing with complications. One gal I kno…

Has anyone heard of UHC *** requiring a BMI of 35 or over with one comorbidity for surgery? I was denied for the surgery stating that I need to have one comorbidity to qualify. However, when they first denied me for my consultation they indicated that I had to have a BMI of 40 OR a BMI of 35-39 with a qualifying comorbidity. That was the letter from the medical group. When I appealed the consultation denial to the insurance company I received a letter from UHC stating the same thing BMI of 40 OR a BMI of 35-39 with a qualifying comorbidity. Now all of a sudden the game has changed? They clearly left out the part of the BMI being 40 or over on my most re…

I see that some insurances differ on getting Fills. I have tried to get a little info on this, but am still lost. Does the insurance cover fills and are they considered surgery? I have noticed this year that every time the doctor punctures you it is listed as a surgical procedure and I then have to pay $150. (example, everytime the podiatrist made the slightest cut on my sons toe [ingrown nail], I have to pay $150. Needless to say, I am now on a payment plan..ugh!)

I have heard that if you have already been on a medically supervised weight loss plan for more than 6 months, that those records are ok to submit to satisfy the 6 month supervised diet criteria. Is this true? Does anybody have any input on this?

I am just beginning this process and have an appt to meet with my doctor to hopefully see if he will recommend me for this surgery. I have a bmi of 37 and my father has a lot of cardiac issues. I haven't been on a medically supervised diet per se but have spent the last 15 years of yoyo diets and many attempts to lose weight that failed I am so ready to begin this, like now. I was wondering if anyone dealt with univera and if they have special requirements like a 6 mos diet plan. I don't want to wait. I want to begin now. I called them and they said there weren't any requirements to fulfil but just that my doc deem it medically necessary. Any input would be much apprecia…

Before I had my lapband I went to 2 doctors at different times that both prescribed phentermine, I was unsuccessful so got the band as a self pay in Mexico in 2004. My band eroded in 2009 and have gained 60 lbs and want the sleeve. I tried doing a Dr diet back in November but when I started I broke my foot and couldn't continue with the expense of the broken foot and the $100 wk to the diet doctor, so I quit. I went back and tried again, but just could not afford it. I also, on and of have purchased Herbalife weightloss products and was unsuccessful. I have bought My Alli, which of course I didn't keep receipts. So my question, why wouldn't the fact I had a Lapband be pr…

I've been thinking a lot of having lap band for quite some time now. I only recently started taking the steps towards possibly making that happen. Based on the below and your experience, think I'll be approved? Maybe? I'm 208lbs. I'm 5'5". But, when I went in for my intial appointment my doc said I seemed more like 5'4', which would mean that I am only 3 pounds from the 100 pound mark. I'm on Tricare Standard (south region) and they require at least 100 pounts overweight with comorbidities. Only, I'm not sure if you need just one or more health issues. My health issues are that I have slightly elevated blood pressure and pre-diabetic according to my PCP. He did no…

Hello all! I am sitting here still waiting to hear from my medical group if I have been approved for surgery or not. In the middle of my research I found a link I wanted to share. I am not sure which plans this applies to but I do know it applies to mine (check your policy). I have United Healthcare *** Sig Value Advantage (used to be Pacificare Sig Value ***). I do know that my policy allows for bariatric coverage. Hope this can help some of you out there with questions. I was originally looking into lapband but decided on the sleeve and was researching whether or not the insurance would cover it. Based on this it does. https://www.unitedhealthcareonline.com/ccmconte…

Hello all! I am new to this site. I was originally signed up with the lap band forum. I finally had my appt with the surgeon today. I went in thinking Lapband and came out thinking gastric sleeve. My surgeon has submitted the request for the sleeve. So now I am waiting to see if my insurance will approve the surgery. I have United HealthCare *** which allows for bariatric surgery if it is deemed medically necessary. Which I would think would be obvious if the surgeon is requesting it. Only thing I am wondering now is if they will cover the sleeve. I originally was so focused on the band that I never researched the insurance process for the sleeve. Is it different? Accor…

I am hoping maybe someone might know the answer to my question. My husband is currently stationed in Connecticut and there is no place to have the sleeve done here. They only offer the lap band or bypass. We just got orders for North Carolina and there is no place to have the sleeve down there either. What I was thinking about doing is going back to our home of record and staying with my parents for a few months. My parents live in Colorado and I just found out that there is an MTF that does the sleeve near their home. Would I be able to do that? My son is currently out there with my parents and he has received medical care while out there and no one has asked us about…

So here is what I found out about getting insured after the VSG. If you are a self-pay patient because you can not get approved by your regular carrier, or because you have no insurance at this time ( possibly because your BMI is too high) -- then your next option is federal or state PCIP insurance. I am posting this here because even if you have health insurance now, there might come a time later when you lose your job or want to apply for private individual insurance and are denied because the VSG makes you UNINSURABLE. According to the rep at BCBS the surgery needs to be two years old with no complcations in order for them to write a policy. According to AETNA, you …