Insurance & Financing

I received a call today at work from my coordinator at my surgeons office. She faxed over my packet to Cigna today. (YAY) I'm am super excited!!!! I can't think of anything that they could possibly want that I didn't put into the packet. If I'm defined it'll be out of pure hatred LOL. I have a BMI OF 62 (holy smokes batman) Hypertension, GERD, Mild Sleep Apnea, Hyperthyroidism, and Chronic Back and Joint Pain. I have done every study/test under the moon, I have my past five years doctor's notes, and letter of medical necessity from my PCP and Surgeon. The ONLY thing I am concerned with is the way my old doctor wrote up my 6 month supervised diet. She kinda lumped it a…

Does anyone know of a surgeon who accepts the medical card (IDPA, Medicaid) in Illinois that will perform Lap Band surgery? Please anyone with information would be great. I am new to Forums so not sure how to navigate. Everything I have found lately was posting years ago. Does anyone have an updated list please.

I've been in contact with my primary care doctor, inquiring about WLS and how to get the process started. She said based on my weight/height from my last visit (2008), I qualify, she just needs to get current information of height/weight to give a referral. So, great! Basic overview-- I'm currently living in Texas, and would need to go out to California for the process/surgery. I'm trying to get everything done in one lump of time (months long is okay, prepared for a few months at least), because I will be living with my parents during this time. I've asked my doctor if I could have a doctor here to send her my height/weight information, so she can send off the…

I just got off the phone with customer service so I could find out my benefits and was told that after Jan 1, 2011 they where going to be tightening up their requirements for WLS and that in the furture patients will have to undergo supervised diet plans, ect, ect. The agent was a bit vague but now I am worried because there is no way that I will be having the surgery before that time. I could use advice about how to speed up the process.

What happens say I need to do some medical things before surgery- do just keep going for weigh -ins each month- insurance only needs 3 months of supervised diet,, and I am done with that, but may have to delay,, maybe,,, just wondering- how long will your visits to the NUT dr and psycologist good for?

I met with my surgeon today for the first time -- really liked her! We both understood that medicare now recognizes the new code for VSG surgery, but she wasn't sure if they were actually covering the surgeries. I have private insurance, not medicare, but it could help my case if they are approving VSG surgeries. So, have any of you been approved for VSG in 2010 through Medicare? Thanks for any insight!

I have United Health Care and they will not cover the surgery unless I go through an appeal. Has anyone had success with getting the surgery approved?

Just found out that my docs office sent in my paperwork for the LAP BAND!! I was approved for that but I told them repeatedly that I had switched to the sleeve 3 months ago. Will this be a problem for me? She said it MIGHT be as simple as calling and switching a code but im not that optimistic. Will they have to resubmit? Will I be waiting another two weeks for approval? Im so sick of this process, I just want my sleeve.

Hi dear Bandsters and future bandsters... Looking for 411 about the lap band procedure? You have just found the right person, find me on facebook www.facebook.com/kfrancolapband or email me anytime at kfrancolovelapband@gmail.com and I will answer any of your questions, provide support, provide free insurance verification and even find you an awesome bariatric surgeon near you! Thanks Karina!

So I had my 1st consult w/suregon 2 weeks ago. He said there was nothing they could for me and that tricare would deny lapband for me because my bmi is 36/37ish. At that time I did not have any comorbids that I knew of. Sooo.... I made an appt with my pcp and asked her to run some labwork on me so I could make sure I didnt have any issues we did not know about. Well...total cholestrol is good but here are the abnorms: triglycerides is High 348(norm is 0-149) HDL cholestrol is low 34 VLDL cholesterol is High at 70 Im also doing a sleep apnea test tonight.... I also called to make another appt w/surgeon &Im waiting for that...can anyone tell me if this blood…

i'm dying to know what my copay will be for the band device. i have to pay %30 but i can't find anywhere that actually lists a price on the device. how much was your co-pay for the band?

Hi all!! I have been looking into the Lap Band surgery since June 2010. I attended the seminar and immediately filled out all the paperwork and mailed it in. I set up an appt with the bariatric naviagtor at the end of June. She informed me that my insurance required a 3 month supervised diet plan and documentation. I started weight watchers online the next day (a 3 month subscription). I did the 3 month's worth of dieting and weighing in with my doctor. However, my hospital was only approved to Lap Band those with a BMI of 47 or under. I was 53. I tried losing the weight over the next couple months, but couldn't get under their max. I had kind of given up on it …

I currenlty have Humana ins but will be moving to Cigna as of Jan 1st 2012. My company is no longer offereing Humana going forward. I decided to have WLS after a visit to my PCP when she suggested I look into it after discussing my weight. To give full disclosure, I haven't been to a doctor in quite sometime (probably close to 10 years), I just don't go. Other than my weight I'm fairly healthy. My first visit to my PCP early Aug I asked her to run a full blood panel and do a full work up on me since I haven't been to the dr in a long time. At that first visit my blood pressure was a little high so she put me a low dose blood pressure medicine. When I came in on …

Was wondering if anyone had Cigna and a BMI of 35 and been approved? I have sleep apnea, type 2 diabetes and RA. Just wondering what I should expect?

Hello everyone! I attended a Lapband information session last week and I left out sure that I want to do it but unsure about the insurance portion. I am 5'8" 280lbs. I have a BMI of 42.5 so I know that I qualify in that sense. However, I don't have any comorbidities. I am actually relatively healthy considering my weight lol. I do suffer from pain on my weight bearing joints from time to tiime, and I have had sciatica since my first pregnancy so I do suffer from pain in my back and lower extremities. I am being treated for it with pain medication and physical therapy. What I want to know is if I still have a chance of being approved for surgery without any comorbidities. …

Hi everyone! I heard from my surgeon's office (Dr. Pirrello) that they are submitting my packet to insurance for pre-approval TODAY! I am so excited & nervous! I don't see many posts about bcbs- North Carolina, so I am hoping somebody will step up & share their experiences with getting approved. The assistant said that it normally only takes 2-3 days to get approval from them, SO HERE IS HOPING FOR GOOD NEWS MIDWAY THROUGH NEXT WEEK!! Is there any reason that you WON'T get approved if you meet the requirements ( & have for the last 5 years) & it is a covered surgery on your policy? I am just curious if they can deny you even if you meet the requirement…

I have already done my surgery and I didn't think to check to see if the Anesthetist was in or out of network. Well of course she was the only one not in network and she cost me more than the surgeon. Is there anything I can do because I didn't know? Should I always check before hand to see if everyone doing surgeries are in network? I'm just looking for some help, I don't want to pay over $500 just for her, it's gonna take me a forever to pay her bill along with the rest.

So I got my sleep results back...A dx of mild form of Obstructive Sleep Apnea, at this point I do not need cpap unless it gets worse. I still have the high cholestrol/lipid panels as well. My BMI is 37/38. I meet with the suregon tomorrow. We will not know my insurances decision for about a month. Even before the suregons office will submit auth for lapband theres a few appts through suregon I have to attend (Psychiatric appt x1, Nutrition class x1, and also a lab band seminar x1) after all these appts are done, they will then ask for auth from tricare for procedure. So, of course Im nervous, I will go through all these appts with hope for a good outcome. Anyone know if m…

I received my letter of approval today from BCBS Rochester! So happy and scared at the same time!

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So I went to the Metobolic Center last week and got disappointing news. I started my 6 month diet for the insurance in March and my last weigh in was suppose to be Oct. 3rd. The insurance analysis told me they just that day had been informed that BCBS of Illinois had changed their diet from 6 months to 8 months, so that will put me in December. Not even sure if I will get to have it now before the end of the year. Wondering if when Dec. gets here if they will move it to a year. So disappointing.

Wondering how many out there have had experience with Blue Cross Blue Shield DE and their approval process. I am a State of Delaware Employee and my journey has begun, have just started the approval process - also interested in anyone that used the States Delawell program as part of or for their 6 month nutrition/weightloss requirement.

after u get approved by your insurance how long is the wait for surgery? Also how long after u finish everything u have to do does your insurance take to give u an answer?

Hi guys, I wandered over to the Weight Loss Surgery Foundation of America's page to read up about their new grant program for WLS last night - and saw that they ask the recipients of the grants raise a certain amount of money for the foundation. The site one of the recipients is using to raise her funds is giveforward.com Here's my question - would anyone consider using this site to raise the funds for the WLS procedure? Is it selfish to do that, when there are people on the site raising money for kidney transplants, etc? Opinions?

I have BCBS Federal insurance (Basic). I have had more trouble getting answers for everything that I have to turn to you all for some help. First, I was told I was approved on the phone. Then I got a letter in the mail stating they needed further documentation. I called to ask what the deal was and they told me I wasn't approved. My doctor's office called and got it all straightened out. So, I am scheduled for surgery on October 3rd. The hospital called me to schedule my pre-op testing, which includes blood work, EKG, and upper GI test. I called the insurance to see what those tests would cost, and they told me the blood work is covered, but the EKG would be $75 co-paymen…

Ok soooo! I have BCBS h m o in southern California, I understand that I have to get a referal from a primary care physician before I can get the surgery, Here is my problem: I havent had health insurance since I was a kid until now that I'm almost 30 and I have no idea where to start, my primary care physician i chose when i first got insurance laughed in my face when i went to him asking for help with getting the lap band surgery, he laughed at me and said "all you have to do is eat salads" So aside from that humiliation, i changed my Medical Group, and how I need to find a physician associated with that medical group. I have gained 30lbs in 3 months since I…

I am currently trying to get the Requirements in order for Insurance Approval. I am in Houston & have insurance through the Pipe Fitters Local 211 Union which is BCBS-Illinois and is handled through Zenith Administrators. (I think that's how it goes!) Here's my dilemma... I have, among other requirements which I have already fulfilled, a 6 mo weight loss program to complete. I have ALREADY completed 6 months of Jenny Craig within the last 12 months and gained it all back. Here's the kicker...True Results, the Office that I'm going through to have the LapBand done, has contacted them several times. I HAVE contacted them several times. They have ignored the Doctor's…

O wow !!! I miss You guys sooooooooooooooooo much!!!!! I've been locked out of the site for almost 3months. Well I celebrated my 6month surgiversary on March.17, 2011. As of March 16,2011 I celebrated......DRUM ROLL...... My 100lb loss...GO ME GO ME This has truly been a journey I have good days and bad days when it comes to eating and exercise. Me and my band are at a point where we understand each other. I know if I don't drink Water, move my body and eat whatever I like here comes the pounds, If I eat ok move a little and drink about 64 oz of water my weight stays the same, But if I drink at least 100oz of water move my body and stay on my 800-900 calorie diet,…

READ AND FOLLOW THE LINKS TO PROTEST AND MAKE A DIFFERNCE. ATTENTION GEORGIA CONSTITUENTS: The Bariatric Surgery Benefit for Georgia State Employees and Teachers has been Slated for Elimination. We Need Your Help to Preserve this Important Benefit The Georgia Department of Community Health (DCH) has proposed to eliminate coverage of bariatric surgery for its state employees and teachers in 2012. The elimination of coverage has already started impacting some employees and teachers, as they are not being permitted to start their required 6-month medical weight management programs. There is still time to act and save this important benefit! We need you to write your …

Hello, I'm new to the forum and just starting the process of being considered for the surgery with my insurance. I was wondering if anyone has GHC in WA and could maybe give me some insight as to how their approval, or disapproval, went and what the considerations are. I have called the insurance company twice, but they keep telling me I have to talk to the doctors. Anyone have any tips that have worked with this insurance?

I found out that tricare has finally put the new standard in the policy manual that will allow for bmi as the criteria instead of the 100 lb or 200% that has previously been their standard! It isnt posted on the tricare websites yet (they have until mid Sept to do that) but it is on the Tricare Management Activity site in the tricare policy manual. I believe the site is http://manuals.trica...ame=TP02toc.pdf and it is in the section for surgery, and is policy 13.2. I hope people can find the information from this link but if not you can go to www.tricare.mil, click on the TMA tab, go to policy, tricare manuals, click the 2002 policy tab on the left, then under the trica…

Hi, I'm new here and I should probably head over to the intro section first, but I hope you'll bear with me! I am scheduled for a seminar on Sept 26 and am looking forward to starting the process toward a band. I have cigna insurance currently, so I know there is a 6 month supervised diet required before approval. At the moment my BMI is 40.6, which just makes it for the insurance requirement. My husband will probably be losing health insurance in March (his company is going through bankruptcy and his job will be ending) and we will be switching insurance (either he'll start with a new company or we'll pay out of pocket for health insurance - no cobra available). In eithe…

. I have Aetna Health Maintenance Organization..Im currently 270 with a BMI of 41....I know i qualify with a BMI >40..I'm hearing that Aetna requires a 2 year weight history. Will they deny bc I havent been 270 for the last 2 years. My weight fluctated from 225 to 270...

So I was one of those ppl who was about to submit to the insurance when BCBS of IL changed the requirements from 3 months to 6 months so I decided to just do a 6 month with my Dr. Well, yesterday was the final visit so it is gonna be resubmitted next week! I am so nervous that it won't go through... my BMI was just over 40 when I started so I should be fine, but I just want to know for sure!! Even though I can't have surgery till November because of work... Wish me luck!!! Glenna

Hi there! 28/F here. I have been thinking about having surgery for a couple years now. I finally made an appointment a few weeks ago and this Wednesday I'm meeting with my potential surgeon. Last week I had my Mental Health Evaluation. She seems to think I'm in the right state of mind to proceed ;P I've been going to a weight loss center for over 2 years-will that count as a "6th month supervised weight loss attempt"? During the 2+ years I've been on/off Phentermine among other things. The doctor's office has the records I had sent over. My insurance is Care First Blue Cross Blue Shield (Maryland) My insurance rep says the biggest challenge is going …

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

I just got the news I am approved for a consult with the surgeon. I jumped through the hoops and finally reached my goal! From what I hear getting the consult authorization to see the surgeon is probably the hardest part of the process. This is my story. I started 2 years ago. I went through the nutrition courses then I lost my insurance when I was laid off. So now I have UHC West (formerly Pacificare Sig Value ***) through my husband's employer. In July I found out they cover the lap band. I had a BMI of 39 at the time and I have asthma, stress incontinence, fatty liver, heel spurs and low back pain. My doctor was very helpful and submitted the authorization which was…

I have RightChoice in Missouri. I am semi lucky in the fact that my company is self insured, so all of my appeals eventually went to the higher-ups within my company. What almost cost me the procedure, though, was the fact that I have NEVER done Jenny Craig, WW, etc. The only "measure of failure" I had was to approach my PCP and have her write a letter stating that she had been my PCP for over 10 years and that we had discussed WL on numbers of times. Insurance even initially balked at that because they wanted documented discussions of weight and, lucky me (not), my PCP had recently converted over to a completely electronic filing system and only had her "important" …

Hello all, I have a family member that is wanting info about requirements with Cigna! I am not able to find any info on the Cigna website, I know it is there somewhere. If anyone could tell me the link or how to navigate the cigna site to find it. I would greatly appreciate it! Thanks

date is september 2011,,, does anyone know if medicaid will pay for the lap band ? am on diability and my medicare will kick in in jan... doctors in cntral fl woud b helpful thx all jackie

I found that my approval was for the Lap Band not the vertical sleeve! WTH???? My coordinator atates that she "Only" needs to change the medical codes. What does that mean for me??????? I am so confused! Is the insurance going to just change the code or am I going to have to stress another 2 weeks!!!!! HELP!!!!!!!

I may have a good chance for a job change with a different agency and it be well worth my time to take it, so far they have gotten a reference from my supervisor so it looks good. I have e-mailed HR (VT) and trying very hard to find out if CIS carries the Fepblue with the 3 mo WLS lapband plan - no answer ---If you know anyone who works for them, If they have the BCBS fed plan and if the coverage is the same with the same WLS prerequisites, please let me know... I know it is alot to ask, but the job is falling right in the middle of when the surgery could take place. - I am stressed because I do not have a surgery date until after OCT 6 when paper works is submitted, a…

Hi everyone, I'm trying to find anyone that has this insurance that completed the required 3 months supervised diet and gained during that time. I was wondering if your surgeon's office submitted anyway and if you got approved. If it was denied, did you have to do another 3 months during the appeal? I'm looking to revise from band to sleeve. When I started this I was 233 and 244 at my last weigh in on Mon apr 4. On wed the 6th I put myself on an all liquid diet and I'm down to between 235 and 236. I want to call the bariatric nurse tomorrow and ask her to schedule another weigh in for me and then submit Do you think I should lose a lot more before I try? Tha…

Hello there Bandsters, Looking for patients or future patients that would like support, advice or just simply someone to talk to. I'm a lap band patient and a lap band representative. Please visit my facebook. www.facebook.com/kfrancolapband

I may have a good chance for a job change with a different agency and it be well worth my time to take it, so far they have gotten a reference from my supervisor so it looks good. I have e-mailed HR (VT) and trying very hard to find out if CIS carries the Fepblue with the 3 mo WLS lapband plan - no answer ---If you know anyone who works for them, If they have the BCBS fed plan and if the coverage is the same with the same WLS prerequisites, please let me know... I know it is alot to ask, but the job is falling right in the middle of when the surgery could take place. - I am stressed because I do not have a surgery date until after OCT 6 when paper works is submitt…

My doctor said they started approving VSG recently, but I don't know all the details yet. I had to share this good news! If you find out any more details about this, please share. Thanx!

Does anybody know?

Hello Everybody- Got a call from my ins. rep. at Foothills Weight Loss Center, Maryville, Tennessee. They sent my file in to the insurance today! My question is: If I am approved do I have to pay the total amount of my coinsurance before the surgery? I have BCBSNC. My maximum out of pocket is $700 deductible with $3,210 coinsurance. $600 has been applied to deductible and $311.98 to coinsurance.

So there was a LOT of mis-communication between my surgeon's office and myself. I was led to believe that the costs of surgery that I am responsible for would be due after the surgery and that I would be billed for it after it went through my insurance, like EVERYTHING else has been. I was totally prepared to pay my portion... after the surgery. What I wasn't prepared for was to find out a week BEFORE my surgery that I owe them almost 1600 dollars before the surgery. Ummm.... yeah. I don't have that kind of cash lying around. I was able to come up with 455, and the hospital wants a min of 800 on my account before they will "work out payment arrangements" with me. My fa…

does arizona state health care cover lap band or bypass and if so what do i need to do and what are the requirements and time line?