Insurance & Financing

Insurance companies are very busy this time of year. You need to keep in contact and advocate for yourself. My precert was sent in June 21st. July 1st they still did not even have me in the system even though I had called everyday. They put me in the system because I called and expressed a great deal of concern. The insurance company requested more information July 6th and it was sent in that day. July 11th they still did not have it attached to my file. They finally attached it to my file because I called and asked them to look for the information that was sent by my doctor. Most doctor's office insurance personnel are pretty on top of sending in what is request…

Recieved a letter from Aetna saying that I am responsible for $1, 456.22 for the stent my doc put in during surgery. Furthermore Aetna wants to know if this is the first stent I have had put in.... My surgeon denies that he put in a stent. He said they only thing they sent Aetna was a surgical report stating that he did a sleeve gastrectomy and nowhere did it mention a stent. Sigh... Oh well I guess my surgeon won't be too upset if I don't pay him for the stent he never put in. Khy

Well, in two weeks I'll be finished with my 6 months supervised diet. I had a BMI of 49.9 but my insurance requires 50 to be approved for VSG. I'm so nervous they wont approve me. The surgeons office doesnt think it will be a problem for me to be approved since I'm so close. I have Humana PPO. Has anyone gotten approved and not had the exact BMI required?

So I really want this sugery and i have tricare prime, I have been reading that they are no longer requiring 100 lb rule that they are now using a bmi factor? what is the range that you would need to be in? I am 5ft and like 1/2 an inch that i will completely slouch down for if it helps and i seem to go between 199-195 (for the last 5 mos) GRR that puts me just under the 40 bmi I have no problem gaining a few lbs to get the band! but do i need the co factors too? I had high blood pressure for years and about 2 years ago i stoped taking my meds for it when i was pregnant and havent been put back on it would this count ? thanks any and all input would help

Sorry I haven't introduced myself yet, I promise I will get to that Its late and this has been driving me crazy so i decided to join instead of lurking and see if you had any opinions on where you think I stand. I did a little digging through the wealth of information my wifes employer has given us, to find out if I might be able to move forward with this process. I am no where in a position to self pay that this time From what I am taking from this, to start off I need to have 2 criteria. A. Morbidly Obese (check) and B. have co-morbidities (not that I know of) Other than my depression keeping me at home and unable to work, and my back pain. I cannot think of a…

Hi everyone. Well, I was just cleared today through the psych and they said they would have the report to Dr. Nick by Wednesday. Dr. Nick's office said it usually takes about 15 days to get a reply from Empire. How was your experience? I've also started worrying about not being approved. My BMI is 47 with high cholesterol, pre-diabetes, high bp, and some joint pain with a little reflux. Also, I read that as of 9/1, BCBS was going to begin requiring a $5k deductible be met. Has anyone had to deal with this yet? I figured since our insurance begins on 1/1 each year, this wouldn't affect me until next year. I'm looking for anybody who could help put my mind a…

Has anyone heard of how the approvals are going with BCBS of Texas. I have the teacher insurance.

I just had my sleep study done Friday night. It will be a week until I get the final results, but the preliminary results from the technician is that I don't have sleep apnea. I am so upset because without a diagnosis, my insurance will not cover the lap band. I really believed I had it. I had a lot of the classic symptoms. I am looking to buy a house in the next several months so I can't pay for the surgery out of pocket. I need to wait till after I close escrow to finance the surgery. How much does the procedure cost if financed? What financing company did you use?

Thank you in advance for any and all input. Here is my question: I have Kaiser and have had Kaiser for years. I didn't want to have to wait forever to get my surgery so I self payed in Mexico. Should I (GOD FORBID) have any complications or problems arise, will I be covered? I would love to take advantage of their bariatric aftercare program and see a nutritionist, psych .....

Hello all, I found out that if I get approved through my insurance the surgeon would be Dr. Ramin Sorkhi. Does anyone have any experience with him? Any info would be appreciated!

About 2 months ago I went to the doctor thinking that with a 39 BMI with asthma, stress incontinence and fatty liver I would be approved with no problem. After being denied and appealing the decision I was again denied. Apparently my comorbidities weren't bad enough for the insurance. So after reading the evidence of coverage I learned that you have to have a BMI of 40 or over. A BMI of 35-39 had to have specific comorbidities. I just saw my primary doctor on Friday and am now a 41.78 BMI. She is submitting the request for authorization again. I have Pacificare Signature Value ***. I am almost certain I will now receive the authorization to meet with the surgeo…

Hello I found some information on when Medicare will cover the sleeve from the O A C. Obeasity Action Coalitition, the web site http://www.obesityaction.org/home/index.php. I had written them in June this year. I will share an email I'd written them in regards my concern. my original email is at the end. The answer email >>> From: "Stephanie Wielinski"<stephanie@obesityaction.org> To: "'Gerard'" <gerardzazzer@gmail.com> Subject: RE: Medicare Date: Thursday, June 30, 2011 10:09 AM Thank you for contacting the OAC. We apologize for the delayin a response To you. We were out of town at a convention and are getting things s…

Okay- I have BCBS PPO (Network Blue) here in Florida. I had my surgery on 7/5/11. Prior to surgery I called and checked my benefits and was told that VSG is covered with a 10% copay since I had already met my deductible. The surgeon's office made a copy of my insurance card and verified my benefits, and informed me that my co-pay would be $150, which had to be paid up front..... Well, out of the blue I get a call from my surgeon's office today saying they got notice from my insurance that I am responsible for $1340-WHAT?! So, I contacted insurance and they are blaming the surgeon's office saying that whoever verified the insurance made a mistake and that my surge…

Hello all! I am desperate to have this surgery, and lose the weight that has held me back from living a normal life for the past 10+ years. Unfortunately I have an extremely high deductible of 10k, and my insurance won't pay out a dime until this is met. I managed to save up half of the amount, but I don't know where I'm going to get the rest from. I was thinking that maybe I could find a finance company to pay the remaining amount. My husband said he would co-sign for me because my credit isn't so good. My question is this: what is the probability that we would get approved if his score is 660, and mines is 600?

Just wondering if anyone out there has gotten approved with BCBS of Minnesota?? I'm just sending in my paperwork to them soon. I see it's still considered "investigative", but I have read on google that some people did get approved. I just really, really don't want to have the RYN? or RNY...whatever they call that surgery. I want the sleeve so bad...I have baratric coverage, I'm just looking for some positive feedback....sorry, I'm just so worried...Thanks for listening. Janine

Has anyone had any luck getting the sleeve approved through bcbs of minnesota?

Hi All, I went in yesterday to have my Fluid checked and see if I could get a little more added to my band. I have not had any restriction since I had an unfill in February. Well they have determined that I have a leak at my port (stem). I am wondering how difficult it is to get the insurance companies to approve this. Bariatric Surgery is covered by my insurance but it has to be preaproved. Is this considered Bariatric surgery? ..... thanks for all the input. Robin

So today I had my first consult with my surgeon. (yay) I was given a ton of information plus all on my appointments for the pre-band testing. I am required to do a six month supervised diet per Cigna. It dawned on me today that with being only two months in that I won't finish my supervised diet until December. This means that I won't get banded until Jan when a new benefit year starts. If I go ahead and continue this process all of the money that I'm spending for the pre-band testing now won't be applied to the cost of my Out of Pocket. So I am trying to decide if I should just wait on completing the process until next year? This totally sucked b/c I had wanted to be …

Ok - So i started this journey 2 months ago. My insurance plan only requires 35 BMI with 2 Comorbilities. They also want 5 years of weight history. I have a BMI of 39, obstructive sleep apnea, acid reflux, hypertension, restless leg syndrome, irritable bowl syndrome, etc etc etc.......... I provided my dr's office with all my records and was told I should have no problem getting approved! We even started my liqued diet. My insurance company told my Dr's office patient meets all needs for surgery. Yay right?? 1 hour from pre-op we find out that I was denied. So, the nightmare begins. First we were told it was because I had to have a BMI of 40 or above and that was…

Hey everyone! It has been a while since I've posted but the real world has been crazy insane recently! So, I am done my three-months PSWL and all my ducks are in order to submit for approval except for one. I went to my PCP for my letter. The FIRST visit she was all "i need all of your records from the surgeons office before i'll consider it". SO, I had all my stuff faxed over and I had to make a second appointment. At that appointment she finally agreed to write the letter. In other words, to me she said that she agreed to write the letter of medical necessity. BUT it would have to wait until her office person was back before it would be done. I wait about a week and h…

Hi everybody!<br /><br />I hate people who jump on to message boards and ask questions they could suss out for themselves with some research, but I'm desperate!<br /><br />This is our annual chance to change our health plans at work. I'm in Seattle, currently on the Group Health H.M.O. which, needless to say, does not cover bariatric surgery of any kind under any circumstance.<br /><br />However, there are two Blue Shield PPO plans listed, a "high" and "low" one depending on the amount of coverage you want to receive. The brochures I got at work don't have any detailed information about exclusions and limitations, though. Just cost.&…

I was told by co-workers that had RNY that the Dr bills as co-surgeon which should pay - however mine is showing assistant surgeon so I owe 1687.00. Which is fine I guess, can't do anything about it now. I am not sure when this changed but they do NOT pay for the assistant surgeon. I knew this going in (I work for them) but as I mentioned co-workers who have had the same Dr do RNY says he bills as co-surgeon. Not on VSG apparently.

So my surgeon;s office called Blue Shield to get started on the pre-approval process for a surgery date and they told her my Surgeon wasn't covered as she wasn't in the "designated county." (If you live in certain counties, you have to go to very specific surgeons here in Ca. with BS.) HOWEVER, I had done all my homework ahead of time and was already told I was not in that category. LUCKILY, I do all my correspondance with the issurance company vie Email so I have documentation of that conversation.. so they had to admit their mistake (mistake #1.) THEN, we get that clarified and taken care of just in time for them to tell the surgeon that I AM able to go to her BUT be…

Hello, I've decided that I want Lap-Band. I've done all the research and have been to a seminar. I even have a support system in place - my cousin and I want to do this together. BUT, here's my issue, I called my insurance company (United Health Care) and asked about my coverage. I was told that they do not cover this for me. So it's been a few weeks and I decided to call them again to see if I could figure something out and the rep told me that I do not have coverage for this procedure. So I asked if there was anything that could be done and she (the rep) said that even with a letter of medical necessity they would deny it because I don't have that coverage. Her advi…

Good Morning everyone, I have a question I am stuck and don't know what to do. My husband went to see the Doctor, he claims my husband is a perfect candidate for the sleeve; He has a BMI of 42, High Blood Pressure, sleep Apnea, and everything else that comes with it. The Insurance rep at the doctor's office looked over his chart and said that even though he has 4 years of a BMI over 40, UHC requires his BMI to be over 40 for 5 years therefore UHC would deny him. She is refusing to send UHC his information and request for surgery saying he has to wait until next year. So this is my question, can we send his file to UHC and try to get approved on our own, or should I …

Hey guys....I'm a little worried. When I started my Dietary appts for approval of Lap Band Surgery, I was told 3 months. After I finished 3 months, BCBS of IL said the policy changed and now I would need 3 additional months. I cried like a baby...I'm a teacher and I tried to plan just right, so surgery would take place during Summer. Here's my question: My primary doctor prescribed Phentermine for 3 months last year, do you thing that could count? In a ddition, I have proof of ordering Low Carb Proteins and shakes through an online program called Dramatic Weighloss. During the time I was on Phentermine and I also purchased an Elliptical Machine. What do you think my cha…

I was submitted on July 12 and got my verbal approval July 14 - my surgery is August 8th. If I waited for an approval letter? I would still be waiting! I work for my insurance and a co-worker told me the letters take 10 days to generate - who knows how long in the mail! I still don't have mine! So call your insurance and keep the ball moving - they can give you the approval verbally as soon as it is in their system! Don't wait for the letter - 2 weeks later and I don't have my letter but my surgery is a little over a week away! Glad I didn't wait for the paper confirmation!

Hi there! I am so frustrated right now! My insurance company told me that I need to have a 3 month "weigh-in" period with my primary with diet/exercise plan in place, etc., get the psych eval, and nutritionist. I did all of those things and they just denied me! My BMI was 37 at my first visit and unfortunately due to some hormonal problems I am having I have gained probably close to 10 pounds and I think my BMI is 38 now. The only comorbidity i have is asthma. No high BP or anything else. I haven't had labs drawn in awhile, so I am not sure what my cholesterol is, but I am wondering if i need to go eat a cheeseburger before i have labs drawn instead of fasting to g…

Has anyone had Illinois medical card (IDPA) and had the VSG surgery approved? I'm currently in the Peoria Surgical Group program with Dr.Marshall and was looking for any data on him or how long the approval process takes.

So I have been waiting all week (impatiently) for my approval. When I called this afternoon to check on the status, it wasn't the news I wanted. All of the information is in my file with the exception of my co-morbidity failures. What exactly does that mean because my PCP hasn't even been presented this before. Needless to say, before I get this initial denial letter I am being proactive and went to my PCP today (within 2 hrs of getting this info) and he took down all of the information and writing me another letter. I am hoping this will be enough to suffice the medical review team and they will approve this. I was hoping to have my surgery date in September becaus…

My file was submitted to the insurance company 8/5/11 but they couldn't find some items so I re-faxed what they needed and now I have to wait again. Although they said it could take 30 days to review, I will begin calling tomorrow for updates. I am seriously impatient and going out of my mind. I want to have my surgery date so I can relax!

My surgeon's office is saying that nutrition counseling is not required by my insurance as long as I have had my three month supervised diet. She said the only thing required is two year weight history, three month supervised diet, psych evaluation, and a letter from PCP saying medically necessary. Did anyone else that has BCBS Federal not have to see a nut and still got approved?

Last Friday the insurance coordinator said she submitted my request to Cigna and we would hear something Tuesday or Wednesday of this week. I called Cigna on Tuesday and they told me my request was pending clinical notes from the surgeon's office. I called the insurance coordinator and told her what Cigna has said. She said she would call Cigna. When I called Cigna on Wednesday the status was still pending clinical notes. I asked what clinical notes they needed and they proceeding to tell me it is all the paperwork we have been getting together to submit to insurance.Can you imagine my frustration at this point? Couldn't get the insurance coordinator by phone or emai…

Just curious as to if any has gone through the process with Amerihealth POS. How did approval go? So far it's been good with my pre-op appointments. Just have my $50 co-pay (ugh). Now that I'm coming near to the end and getting ready to submit to my insurance I'm getting nervous as to how it's going to go.

Soooo, I got denied for my insurance because basically, Im fat, but not fat enough and Im "too" healthy. I have a BMI of 38 and at the time of my weigh in weighed 248lbs and my height was at 5'7 1/2 (i slouched a little lol) and I am NOW (about a month later) weighing in at 253lbs but it hasnt been documented. My insurance is (empire BCBS) telling me that I either need to have a BMI of 41 or higher or I need to have a co-morbidity with my current BMI and I dont. Im very healthy, Im just fat. But apparently not fat enough. So i guess my question is, would it be ethical to gain 12-15 more pounds just to get this insurance approval? Because when push comes to sho…

I really want this surgery. I have not been to a doctor in almost 4 years because I USED TO have a phobia about it. Pretty sure I have got over that. So I am about 105 lbs overweight. It makes everything harder. I don't know if I have any pre-existing conditions (high blood pressure/high cholesterol). I have not called to make an appointment yet - I just upgraded from TriCare standard to Prime. I am very nervous about getting approved. From what I have read on these forums - some sort of "medical paper trail" is necessary. I don't have that. Does anyone out there have a experience with this?

OK, so I am new the site and have a few questions. I have TriCare Prime South and have been reading some different info about what they require in order to approve the surgery. Does it go according to BMI, Weight, Health Issues????? I am starting to get discouraged Any info y'all could provide would be a great help!!!!

What are some Self Pay Finance Options? I heard Care Credit, Chase Health. But the rates are crazy, and they won't lend for the full amount.

http://www.georgiahealthnews.com/2011/08/state-health-plan-launches-premium-kids/#more-12743 Just passing this along. FYI.

Hey Folks, I just found out this morning that Highmark (Pa.) BCBS has denied by request for VSG . Apparently their medical policy requires a BMI greater than 50 and VSG as a 1st stage in a two stage procedure. My BMI is 37 with 2 comorbidities, I plan to appeal with a letter and substantiated research articles. My surgeon's coordinator says the surgeon will do a peer to peer review next week. For those of you who have gone through this, are peer to peer reviews typically successful in getting the insurance decision reversed? Thanks Lisa

We have BCBS of Nebraska through my husband's employer. He called the customer service line for me a few weeks ago and asked about any bariatric surgeries being covered. Naturally, the answer was NO. But I do plan to go though the policy with a fine tooth comb this week and call with the procedure codes that are turned in by the surgeons I plan to use. At the seminar I attended last week, it sounds like the nurses really work hard with you on insurances. In the mean time, I was wanting to know if anyone out there had tried to utilize them for coverage of the lap band? I am very eligible for the sugery with a BMI of 43 and type II diabetes. Thanks!

Ok all I am angry! I am so upset over my insurance company. As of May 1, 2011 I was off my parents amazing insurance and onto my company insurance which was fine. I was on Anthem Blue Cross Blue Shield of Kentucky. As I was researching surgery I was told that it was covered and then this week I got a call from my surgeons office that it was taken out of the contract. I am so upset... I dont know what to do. Anyway my surgeon, PCP and Psychiatrist all recommended the same weight loss docotor. So I am going be doing medical weight loss.

Psychologist said the report would be ready today and sent to my surgeon's office. At 2:15 today the receptionist sent me an email the report would not be ready by the end of today. This is the last piece I need before the documentation can be submitted for insurance approval. I was so hoping the insurance would have been submitted today, instead I will be worrying about it over the weekend. Just needed to vent, I'm sure everyone has been through the same thing. Best wishes to everyone on this site. Stephanie

Hi there, My name is Jen and I am looking into Gastric Banding. Right now, my BMI is in or around 47, and I have several medical issues. I was born with Plantar Fasciitis, both of my feet are affected and being overweight is hell on them. But ontop of it, I was also diagnosed with Diverticulitis a few months ago. The only insuarnce we have is something called "Share of Cost Medicaid", and we are in Florida. Basically, every month they give us a dollar amount and the medical bills must exceed this amount before medicaid will pay for it. I am certain that seeing the surgeon will exhaust this limit and I would have my bills paid for, however before I go jumping into the boat…

Hi all! This is my first post, however I am totally obsessed with this site and have been lurking for awhile! Anyway, im wondering if anyone can tell me what a "exercise therapist" is?!?! Im trying to do the Aetna 3 month plan, but there hasn't been a single person that can tell me what that is! Ive asked Aetna, my surgeons office, i've called a physical therapist... everyone ive talked to is completely clue-less and Im feeling defeated! Im hoping someone here can shed some light for me... Thanks so much! Sarah

Does every body get a SURGERY date with the insurance packet that is submitted for approval? ? hmm new question for me.

OMG! This is so exciting! After all this time, BCBSNC has finally decided that VSG surgery is no longer investigational. I was making plans to go to Mexico because I really didn't want RNY or the band. I'm just so happy, I could dance (well if my knees didn't hurt, lol).

i called and set up my consult with the program coordinator and when i told her i didnt have one she hesitated..i have insurance but i just havent been to a doctor..(i dont like to go unless i absolutely have to)..if i have to have one i can get one..was just wondering if it was totally necessary

Hi, All of my paperwork was submitted to Aetna last week. I called today to find out if it was reviewed yet and I was told that it is still under review and that within 48 hours a Nurse would be assigned to my case. I'm hoping that this means that it is looking good. Has anyone ever had a denial from Aetna and had a Nurse assigned to them or do you get the nurse when you are approved. This waiting is so stressful!!!! This decision will be so life changing for me. Thanks everyone!!

Does anyone know how much the network rate for the surgeon and asst surgeon is, for anthem blue cross blue shield. I have to pay 20% of the network rate. I was trying to get a guess on how much money I will need. I am going to be sleeved on Aug 30th. Thanks.