Insurance & Financing

I'm a newbie, but have done extensive research here and elsewhere. I have a consultation with a doctor set up for several weeks from now. I have heard how insurance companies can drag their feet and want to get everything together that I can in order to expedite. I called my insurance company (United Healthcare) and got their requirements for my policy: BMI over 35, comorbidity, 5 year history of weight problems. My BMI is closer to 45, I can collect a 5 year history and may or may not have what they consider a comorbidity. Question is do I gather and submit this info to the insurance company prior to settling on a doctor (though I think I have). Or, does the s…

After months... and Months... and MONTHS of searching for over a year a change. I finally found what i was looking for. I was so ready to give up, but something deep inside told me, that progression is active and never stagnate. I swear to everything i love, i was going to remain this chubby, insecure guy forever, but THIS, THIS right here was the light at the end of the tunnel for me. i know a lot you are still curious and wondering what the hell i;m talking about, so let me tell you. Today i found the FIRST doctor in over a year, that didnt turn me down. Not only does this doctor ACCEPT my insurance (Amerigroup=trash) but he ALSO started doing the surgery i l…

I have Aetna. I have read Clinical Policy Bulletin #0157. I haven't seen that they require an H.Pylori breath test. However, my surgeon is. His office manager, Tina (his SISTER btw) said that the insurance is only waiting for this test to approve me for the surgery. At this point I do feel the office is only trying to squeeze more money out of me. I feel I have been lied to on at least two occasions and they charge my 4x's the copay for office visits. I really don't feel like starting over with another physician. Since it's only one exam I think I should do it and get it over with. Once I get my surgery done I can relax a bit. I'm really sick of this doctor's office (and …

I got a letter in the mail stating that my ins needed more infor before they could approve me for the lap band, which was weird bc im getting the VSG. so i called my doc today and guess what? that letter was a mistake they took care of it and i am officially APPROVED! OMG my heart sank i was so happy! i will be sleeved on AUG 22 in livingston NJ yay me!

Can not wait any longer...found out today I need to go through the 6mo. a program...sooo depressed. was thinking I was going to be able to have it end of Sept. Should I use some savings and just pay out of pocket????

It has been awhile that I have been contemplating surgery. Only now have I come to the realization that it is completely up to me. No one else will support this decision financially, and no one in my family is really ecstatic about the prospect of surgery but then again I'm not excited about the prospect of being unhealthy. So to finance my new life I have decided to pay for my surgery with student loans. Now before everyone's knickers are up in a twist, the loans are kind of superficial. I can easily afford college without these loans, but not the surgery. So I'll self pay and put the rest of the money in a high interest account to help the loan pay off itself. I'm smart…

Hello all, I have been on this forum many times as a reader only so here goes. I have just finished everything that is required for VSG, having a EGD done on tues am, after that just need insurance approval, during my 6 month diet i actually lost and gained with the last months weight up 10 pounds from 6 month diet start. During this six months our home was flooded during the flooding back in april and we were displaced and it was hard to eat healthy and stay focused due to having to eat all meals out in addition to being stressed to the max, our home is in the flood zone and we were expected to have 6-10 foot of river Water in our basement (GROSS) I did gain then, also…

ok so i have been batteling trying to have this surgery for yrs now. i don't know what to do. i go to the seminars and the next day when i try to make an app. with the surgeon they call my insurance company and my insurance says they wont cover the surgery. so they say i cant make an appt unless i payout of pocket. my primary care dr is on board with everything i just dont know what to do from this point can someone please tell where to go from here please!!!!!!!

Can anyone recommend a surgeon who does VSG who offers BLIS insurance? Thanks! I am a self-pay patient and concerned about complications following surgery. Also - does anyone have experience with complications insurance after having surgery in another country?

Company policy (all levels) excludes all things obesity/weight loss surgery related including all co-morbidities. Have to private pay. What is the risk that I will be denied insurance/treatment in the future due to this procedure? What happens if I need surgery for complications? Has anyone had surgeon use non-weightloss surgery diagnosis codes to cover corrective surgery? Has anyone successfully negotated private pay "retail rates" lower? What percentage of bill does the insurance company pay if I were covered? Basically I want to offer what insurance would pay plus a 10%. Can this be done? Can I negotiate a lower premium with my employer since they will directly…

Hi everybody. My name is Christina. I am from North Texas. I am 23, happily married for four years and a full-time student about to graduate. I have a seemingly good life, except for the big elephant in the room...which is me. I currently weigh 356 pounds. I have a BMI of I believe 58.1. I decided about 5 months ago to go to a Lap-Band seminar, and met up with "True Results". I have been doing all of my lap-band insurance approval requirements through them. I have Aetna: Open Access. I went through the four-months documented nutrition meetings, chest x-ray, blood work, psychiatric evaluation, sleep apnea test and submitted all the documented "weight history over the past…

Hello all I am 27 years old and a mother to five young children aged 7 down to 2. I am 248 pounds and barely 5 feet tall. I do not have high blood pressure, diabetes or any of that sort of problem however my weight restricts me from doing normal day to day activities that would otherwise be easy to complete. I have been overweight for atleast 10 years now. I have tried the Biggest Loser diet. I bought the books but lost weight and gained it back. I tried the weight watchers plan but also lost weight and gained it back. Drank a great deal of soda and pretty much gave it up and didn't lose any weight. I take trips to Boston MA on the train with my kids walk around for 8 hou…

I got home from work last night to find a letter from Cigna insurance stating they needed more information. So when I called them to see what else they needed the lady tells me "oh, it's already been approved the office must have faxed it in already.":lol0: Yay, the 6 month diet paid off. I called the insurance coordinator today to see what my next step is, just waiting to hear back from her. I've already had a pulmonary clearance and I go for my Cardiac evaluation on Friday. Both required by my surgeon due to hypertension, Asthma and sleep apnea. I know they make you see the nurse first. Then get all the clearances (I knew they would require these so I scheduled the…

Hey everybody! For all of you pros out there. I currently have health net *** through my husbands work. I started my six months supervised diet in may. He just notified me that in september, we will be switching to Aetna *** . I am so super worried that they will say " hell no" to me when I begin the process with them. I'm affriad they will want me to be insured with them for a certain amount of time before I can have surgery. My question is, has anyone ever had a switch in the middle and was able to pick up were they left off? Does anyone know if I have to be insured with my new provider for a certain amount of time before I can be approved? I have this we…

Hi to all! I was hoping someone could help me. Is there a Medicaid program in New Mexico that pays for the Lap Band Surgery (i.e., Lovelace, Molina, BCBS, Presbyterian)? If anyone knows ...??? God Bless!

Hello! This is my first post. I am desperate for some advice. I began this journey in January. On my thirtieth birthday, with my first appointment of a six month program. In March, I screwed up and showed up a day late for my meeting. The people at the Weight Management Center said it wasn't a big deal, happens all the time. I had a medical visit that day and they told me to come in April for a make-up meeting. I finished the program, lost ten pounds and passed surgical review board. Then I received a denial letter in the mail from HighMark Blue Shield. The letter stated I had over lapping visits in April. Long story, short. The doctors office never faxed my March medical…

It took me 3 months to get in to Emory Bariatric for an appointment with the nutritionist, which would be the beginning of my 6 month diet and exercise program. I knew before I went that if I wasn't a BMI of 50 BCBS wouldn't approve the surgery. I purposely gained weight before going over the last 3 months and weighed in at 49.9!!! The account manager that submits the insurance paperwork told me that even if Id been right at 50 they wont approve you unless you lose weight and show you can follow the program for the 6 month requirements, so I wouldn't be approved either way unless BCBS drops the BMI requirement. They only require 40 for Bypass and Band, but I dont want e…

Hi. I'm new here and was wondering if anyone has had any problems or has anyone has an easy time getting approved with Medica insurance? At my consultation I was told that that was the weight that insurance would consider when deciding to approve the surgery. I was at like 40.6 BMI, which is over their 40 BMI requirement. Everything else they require I will be able to meet. I'm penciled in to have surgery at the U of M at the end of Sept. I'm just concerned or I should say worried about whether they will try to deny based on the fact that I'm just over the requirement with no co-morbilities. I'm no longer at that BMI because my surgeon would like for me to lose 10 lbs bef…

Hello everyone! Does anyone know if Dr. Aceves is able to accept CareCredit? I did the application and was approved but I am waiting on a decision from cosmeticredit and medfinanceloans. I wanted to shop the best deal on financing, but now I am concerned that I messed up. Anyone know? Thanks! HDub

I have been denied twice in the last 2 days. The reason I was denied is that my BMI is only 34.8. I lost 30 pounds last year and have been gaining it back slowly. I thought that I'd head it off before it reached more than I had lost. Guess I thought wrong. I need to gain another 6 pounds in order to qualify and I don't really want to. I already feel horrible at my current weight..

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I think I have read all the Medicare posts on this forum and others, but I have not seen my particular situation so I would like to see if there are others like me. I have had an Aetna plan for quite some time as part of my pension benefit from the state of NJ. When I turned 65, I was required to also pick up Medicare. It is my primary and Aetna is my secondary. When I first started at the Banner Gateway Bariatric Center, the insurance clerk told me that I would not be able to get the sleeve since Medicare did not cover it. Even when I told her that I also had Aetna, she was very firm in her answer. I called Aetna four different times and was told by their agents …

Hi,I had my sleeve done May3,2011.I am very happy with my decision.I currently have BCBS of MI until Sept 1,2011.I have lost my job(not really I know exactly where it isLOL,my company privatized)I am now shopping around for health insurance to purchase.Any tips on what to look for when shopping around.I would like to know if new insurance will cover tummy tuck.

After getting the expected denial from Medicare last week, my surgeon's insurance director said she would try Aetna, my secondary insurance. I got home this afternoon and she had left a message saying that Aetna had approved my surgery. She asked me to call her. Of course, I was only able to get her phone mail box. I am actually scared to get too excited because I am afraid that she will tell me she called the wrong person! I feel that mainly because it was sooner than I expected to hear anything, but mostly because the woman (now on leave) who I had dealt with earlier got really angry with me because I was insisting that she move forward with a request for the slee…

Hi all, I have just joined this Forum today and have learned a lot from all of you....THANKS!! I'm wondering if any of you have experience with Aetna Insurance with a BMI that was less than 40 with a co-morbid condition. I know that they are requiring a two year history, but I'm not sure if my BMI had to be over 35 for these two years and if my sleep Apnea had to be diagnosed two years ago. I have struggled with my weight for my whole life but luckily I haven't had any health issues - until now - Severe Sleep Apnea, High Cholesterol, Knee and Back Pain. I need to get this done and re-claim my life!! Any information and sharing of experiences would be GREATLY appreciated…

ok here is my story......I had lap-band surgery in July 2008 and I lost about 75 pounds, granted I was throwing up most of my food that I ate, so I am sure that’s why I lost the weight. In my mind throwing up and losing weight and having a little bit of port pain and side pain was outweighing not having to take blood pressure meds and having sleep apnea and getting heart disease, (which runs in my family) so I just dealt with it up until March of 2011 when I got to the point where I could not get any food or water down without it coming right back up and I starting having really bad reflux and pain in my stomach and port area. I had to go to the Dr. and he removed all my …

I was thinking of forming a group of people who are looking to self pay or finance the lap band and have the surgery done in the Southern California area in order to get a better rate? I thought that if we got enough people together to do the surgery with the same doctor, they would give us a group rate discount since a number of us are willing to commit to one doctor. Does anyone have an opinion on this or has anyone tried this before? I am going through the process with my insurance but I have a feeling I will be denied and wanted to keep my options open. Anyone interested in this? I am open to any suggestions.

Hey guys, I have an exclusion in my insurance policy on the "treatment of exogenious obesity". So, I know it doesn't cover surgery. However, my surgeon in a different state has his out of town patients get their pre-op testing and lab work (EKG, Chest X-ray, CBC, H. Pylori...) done by their local PCP. So, I'm wondering if insurance would cover the testing. I don't think the insurance company would any idea that the stuff I am getting done will be for WLS later. Just trying to figure out how much the labs will be out of pocket since I am still saving up.

...she stated that some insurances require the 6-month diet and weight loss period. Does any with this insurance know if this is a requirement and also for an idea for out of pocket total cost. My insurance will pay for 80% with a lifetime max of $16,000.00 -- any help is greatly appreciated!

Has anyone's insurance changed because of the new FDA guidelines? Does anyone think there is a chance that theirs will? I am BCBS and considered a healty obese person so I can't have the surgery until I shink a couple inches or gain 15 lbs. I stay a set 38 BMI never going up or down and have been here for around 7 years. My doctor did give me adepex for 3 months just one time so I could know what it felt like to be 20 lbs lighter. I was awsome, but of course it came right back. Thank you in advance for your responses.

Im so disappointed I found out I was denied by Triwest for the band they called it a "factual denial" then they were telling me who qualifies. They said I didn't meet the qualifications but I clearly do I can't understand why I wasn't approved it just doesn't make sense. I will appeal and see what happens I guess.

I got a letter from insurance saying that I needed to do a 3 month diet for ferther consideration, but they want my Dr. office to re submit in no less then 45 days. How does that work?

Does anyone know if Tricare pays for fills?

anyone having any problems getting approved with Wal-Mart's BCBS of Arkansas

Hello, I am beginning the process of authorization. I have healthnet ***. Im nervous. Im starting out by going to a primary care physician. Can anyone give me some advice? I dont really know what to say or how to say I want the lap band to him. This will be my first visit to this doctor. Also does anyone have experience with healthnet ***? What was the process like for you?

Since I applied for surgery 2 years ago with Aetna and did a 3 month diet requirement (before obviously being denied), my UHC nurse proactively told me she'd look to get manager approval to use those months towards my 6 I need now since they were less than 2 years ago, along with any other months my PCP can prove we talked about diet and exercise. I'm VERY surprised by this, and I'm still waiting to hear back if that will be ok. If this goes through, I won't need to do any more PCP appointments...HOW FREAKING COOL WOULD THAT BE!?!? I really don't want to get my hopes up, but how could I not when it wasn't even my idea?! Just like everyone else, I can't wait to be on…

Has anyone been approved by BCBS of Illinois since they changed their 3 month supervised diet plan to 6 months? If so, what was your experience? Thanks for the feedback.

Submitted on 7/12 called on 7/13 and they sent to medical review then, approved 7/14

I was informed at my pre op visit yesterday that my insurance, tricare standard, requires an overnight stay. I had not heard this before and kinda wonder if it's just the hospitals way to make more money or if it's true. I was told at my dr clinic originally it would be day surgery and i could go home if there were no problems. If I need the care I'm all for it but if I don't that will be an extra 1000 bux out of my pocket. Anyone know anything about tricare requiring this?!?!? Surgery scheduled Wednesday July 6th!!!!!

i posted awhile ago asking about anyones experience aetna NAP and the approval rate, i was asked to update. Well, i ended up doing 4 months instead of the required 3. they submitted everything to insurance on a wednesday and the following monday i was told that i was approved! i didnt run into too many problems with the insurance except when it came to the mental evaluation. Aetna has a side program to handle mental health and they gave me hell with covering my 2 evaluations. I am booked for surgery on monday (july 25th), im super excited! thanks for the support!

I posted this in pre-op section yesterday and no hits yet but I did want to put it in correct topic instead of bumping it like I was wanting to do. Any help on doctors that offer in house financing in Mexico would be a helpful start. I am trying to help a friend out in their journey. Thanks in advance

Hi all Just posting for those who have Anthem Blue Cross Blue Shield. For MY employer(I hear employeers can have different coverages), They will cover the sleeve with pre-certification and medical necessity needs to be shown. They then cover 80% with a 1,000 deductible, then up to 2,000 out of pocket then they pick up the rest. Just in case anyone else has this insurance company. Lisa

So I have been called my insurance regarding if this or that is covered and whatnot. Everything is covered at 100% however one rep with my insurance stated that since I have not been with my current employer for 1 year that I would have to wait until I hit that date. Spoke to the lady at Surgeons office regarding scheduling everything else and mentioned the 1 year thing and she said she has never heard of this requirement. I have no idea...Anyone heard of this? If it matters I have Sutter Select under UMR.

Hi!! I paid off my surgeon, and got small bills from the hospital. However i just got this $2000 from the anesthesia!! I just hope i don't keep getting bills like this Anyone else get bills after???

I just found out today that BCBSIL stopped covering an assistant surgeon on VSG 6/1/11. I have been told that my Dr's assistant bills and co-surgeon which is some how different. Just wondering if anyone has gotten a bill and knows how BCBSIL is now paying? A little freaked, I won't do this if $20,000 will come from my pocket!!

So, here I was waiting for the call. The one from Dr. Davidson's office (Bariatric Surgery Center of Dallas)to let me know that I was officially approved. When I answered the phone on Monday, I was soooooo happy to hear her say, "This is Dr. Davidson's office" and then WHAM! She told me that although I met the qualifications for both gastric bypass and lap-band surgery, my insurance (Blue Cross Blue Shield of California) does not cover the sleeve. I was overwhelmed by an intense disappointment. I don't want the other two surgeries, and this (the gastric sleeve) is the best one for me. I told my hubbie that I would just go without, but he knows me and said to find out how …

My doctor required me to stay overnight after my lap band surgery. He did not request pre-certification from my health insurance company. The company approved a number of after surgery monitoring hours, but not the overnight stay. Does the doctor's office accept payment received as payment in full, or will they ask me to pay the difference? Insurance is Fed Employees Blue Cross.

I'm so nervous, anxious, scared & stressed that I will be denied. I have UHC Choice Plus & my insurance policy under my job covers WLS. Here's the deal -- I have no major comorbidities & my BMI is only 37.4. I don't suffer from high BP, cholestrol or diabetes. I do have sever lower back pain due to bulging disc & knee issues. I don't know if this is enough for them or would they deny me because I don't have what they are looking for. Please help me I'm desperate.

I was looking at my insurance exclusions and it stated this: for weight management services and supplies related to weight reduction programs, weight management programs, related nutritional supplies, treatment of obesity, surgery for removal of excess skin or fat. Do y'all think I can try to see if it will be covered and appeal? Do I have a Chance? Thanks!!

I couldn't make the first payment. So they said you have to be late like 4 months to lose the promotion so I just paid $100 for the first payment...this month July 2011 I owe $1000. No problem. I will make the payment, but it isn't due until next week and because I was late last month they literally call me 3 times a day on my cell phone and work phone. THEY ARE CRAZY!