Insurance & Financing

I read on my Dr.'s information site that it is a good idea to call your insurance company and ask about the specific procedures before going to your first appointment. I decided since I can't get my first appointment until the sixteenth (seems like years ;-P) and I have gotten so attached to the idea of having the sleeve that I had better find out- if they don't cover it I needed to either choose another surgery they do cover or figure out how to pay for surgery in Mexico. I was so scared- coming here has me so certain this is the surgery for me! I gave the CPT code and they put me on hold and then came back to the phone to say that as soon as a Doctor approves a patien…

After 6 months of the "hoops," I got a call yesterday to say that my surgery has been approved by United HealthCare UHC. The paperwork was submitted on June 3rd, but UHC indicated that they did not get everything in the fax, so it was resubmitted on June 9th. My approval call was on June 14th. My plan is an HRA. I have a $1500 deductible and a $3K maximum out-of-pocket limit. UHC covers 85% of the surgery, so I'm not sure if this means I still owe 15% since I've met the out of pocket limit for the year. Surgery date to be given to me later this week. Yay!

Im just in the begining stages of considering Lap Band Surgery. I have Tricare West Insurance and wanted to get some information on the process to get approval. Do I need to see my PCM for a referral? Is Triwest quick or slow to approve? Any information is helpful. Seminar is on April 23 with Dr. Malley in Kansas City

I have a bmi of 37, and I am scheduled to have a pulmonology consult this week because I snore so they want to see if I have sleep apnea. I don't think I have any other co morbidities. I might have high cholesterol but i was told that high cholesterol is not enough to get insurance to cover it. I have fidelis care of NY and I was told they do cover the surgery with 1 comorbidty... Anyway my question is, Does anyone know what to expect from fidelis care ny?? Thanks

I have Cigna insurance and as everyone else I have the 6 months PCP visits. I wanted to try and go to my last appt. on the 5th. All of the previous appointments I had were the 13th, 14th, or 11th. Do you think I would be pushing it to go on the 5th (August)? The previous surgeon's office said if i went April 29th and then May 20 that would suffice (her example). What do you guys think? I'm so close but so far it seems. LOL!

Aetna approved me today! Finally! I have to applaud my Dr.'s staff. They really know how to work with the insurance companies. Aetna requires 2 years history of weight. The staff said give us 5. Aetna requires 3 visits with the nurtritionist, the staff said you will probably need 4. They were right. They sent 3 and Aetna requested more. They sent in my last visit and I was approved. Now all I have to do is pass the cardiac clearence. Khy

There are so many BCBS companies out there, do they all have the same policies? I have BCBS of WNY and am waiting for approval and I have read alot of BCBS's feel the sleeve is investigational. Anyone out there have BCBS and they were approved first time out? SO anxious about getting approval!

Hi All - I am new and need some help. I am trying to figure out if I can have my 1st appt this year and still have surgery this year. My 1st appt. is next week 6/21. I have Cigna insurance. They require the 6 months supervised diet. So based on what I am reading I am thinking maybe I can but I wanted to find out what you guys thing (I know this is just advice and I will verify with dr. and insurance). Originally I thought 1st appt 6/21 so my 6 mo. would be complete 12/21. Based on that and submitting for surgery etc. my surgery wouldnt be til the beginning of next year and a new deductable. But it sounds like this may work 1st appt: 6/21 2nd appt: 7/15ish 3rd ap…

Okay, okay, okay!!! Somebody help me! I received a call yesterday from my insurance company, I had no clue what it was about--they never call. I made a mental note to call today. Well, I just checked my voice mail and my surgeon’s office called too, I HAVE BEEN APPROVED!!!! I had no idea they submitted my paperwork already. All of this before I completed the new EGD. Thank ya!!!!! I have 6 lbs to lose before I am at my pre-op goal of 230. I am so excited!!!! BUT, I just called both of them back and neither were available. Ugh! I so hope I can get it scheduled the 2nd week of August.

My doctor requires the pre-op diet of Protein shakes/soups for 4 weeks prior to my surgery... The problem is my insurance will NOT cover the shakes, even if they were perscribes so therefore I have to pay $85 a week ( 4 weeks ) for the shakes... anybody else run into this problem???

So I have had my band for 7 yrs with no issues! I have lost over 100lbs. My band slipped around christmas time and I JUST now got Humana to agree to pay to REMOVE the band, but if I want it replaced, I will have to pay for that, which is fine. My worry is this...what about if this happens again? What about future complications? I know they are rare but I was going to have to pay $18k to remove this band if Humana didn't agree to pay it. Anyone else ever had complications without ins paying to fix it? What are my options?

Does anyone on here have BCBS Federal of South Carolina that has been approved for sugery? If so, was it a difficult process? Did you get approved on the first try?

Ok, well I didn't have a full 5 years of documentation and in early 2008 after a fall I went to a doctor and my BMI at that time was under 35, then the other weights from doctors after that were all above 35, UHC denied me, I had a letter of medical necessity from my surgeon, my letter, my weights from last 3 years, photos, everything. I am going to appeal once I get the letter, but considering in the meantime to self pay. If I self pay this will put me in a bind financially. And although my kids are supportive of it and are willing to go through a month or two just "getting by" I am so afraid to do it. I cannot finance, low credit. I know this surgery will keep me f…

Hi all, I'm new this to this board and I'm excited about my possible journey. Right now I'm in the gathering stages of my journey. I found my surgeon through a co worker, but she went through her husbands insurance. I'm 26, 4'11 and have a BMI of 52.1. I went to the info session 6/26, had my consult with the surgeon 6/6, nutrition consult 6/7, psych eval 6/17. I turned in a letter of referral from my PCP, weight history from PCP for the past 3 years, a copy of my weight history from nurses who visit my job once a week, and now I'm waiting to receive a copy of my membership and weekly weigh-ins from Weight Watchers. As far as I can tell my insurance company, Empire BCBS d…

Hello everyone. My name is TInika and I am in the very begining stages of getting approved through my insurance company. I have started to gather my information and have seen my PCP to start my supervised nutrtion program. (I have lost 10 pounds in the last 12 days!!!) I have a question regarding the 5 documentated weights with doctor notes requirement. I have documentation from 2006-2011 apart from 2008. I was self employed that year and unfortunately did not see a doctor at all that year. How rigid are they with this requirement? I have 5 years total... just not consecutive. I would hate for this to be an issue for me. Does anyone else have experence with this?

Ok so I called the office of Dr Curry today to move my nutrition appointment up a few hours and decided to be brave and ask if they heard anything from the Insurance company (Aetna). They said they got a request on the 8th for "more information" which was promptly sent in (yeah Dr curry's office staff!!) So my question is...might is be looked at as a good thing if they didn't outright reject my claim? I'm of course hoping that's the news. My question comes into play is that i had a physiocian supervised diet in the past but they only made you come every 2 months. So thinking i was going to have to do yet another 3 to 6 month supervised diet. So once again i wait …

What has been your experience about how long you had to wait for insurance approval? I have Fed BCBS.

Can anyone tell me why insurances will NOT pay for the psychiatric evaluations prior to lab banding? I have Medicare and a supplement and was told by the dr's office that the psych eval would be out of pocket! any info appreciated!

Has anyone been approved by Horizon BC/BS since there policy changed and how long of a supervised diet did you do?

Talked to my insurance company and after asking for several other things which my doctor's office provided....They now say they are waiting on clinicals from the doctor... What are they talking about? Khy

My insurance considers VSG experimental/investigational...it specifically excluded it. My case manager says very very few people have got this surgery. I love my job but I'm considering a new job for new insurance. I asked if I paid my self if complications would be covered....they aren't...what a mess. I am giving up on surgery all together. I guess it's just not for me. My insurance company is small and only in the state of NM. I know I can appeal it and so forth but I don't even know if the surgeon would even submit it to my insurance being that they don't cover it.

Hello everyone I was approved this Monday for surgery through BCBS NJ. My surgeon is out of network with a 70/30 percentage. My max out of pocket is 2000. My surgeon office called and gave me my date but has not mention any amounts I have to pay she always said it could be NO MORE then 2000. My question is has anyone had similar situation when did u have to pay and how much? THANKS

I have searched many boards, and many sites and still do not have a good straight answer to my question.... Does tricare north require a 6 month supervised diet? I have seen some here say yes, some drs offices say yes, some say no and I did call tricare and 2 different people said they had no idea what i was talking about and that there was NOTHING in their information about that being a requirement or even a request, and i have a neighbor who had the band without the 6 month. So ultimately, my question is has anyone with tricare prime in the north region had this without having the 6 month requirement??

to anyone who has appeal tricare- How long did it take to get a response? Good or bad. I really want to hear either way.

I am schedule to attend the seminar on August 30. I recieved my packet from the doctor's office regarding the lap band procedure. I don't have to go through the crazy doctor or the six month weigh ins. I currently weight 278 with a BMI of 43. I don't have any major health problems except joint pain. However, I have a family history of diabetes, high chloesterol and heart disease. My brother was recently diagnosised with diabetes. So, its getting closer. My mom is on several medications blood pressure, Fluid pill, chloesterol, depression and sleeping medication. My father has a heart condition. My main reason for waiting the procedure is because I have a lit…

Hi, I am from Tupelo, Ms and I have been told about some great DR's here and Oxford, ms but I need to know does Anthem BCBS cover lapband?

As I am sure some of you may know that Medicare has a 6 months exclusion from doing the surgery. In this 6 months they require doctor controlled diet. Well my question is has anyone on Medicare had the 6 months Dr. diet exclusions waived? And if you did what did you do to get it waived. All help will be greatly appreciated. Thank you, Sal

i am 21 years old and 5'3 and i weigh 280lbs my BMI is 49..high chlosterol,back,knees and feet problems. I also have heart issues. I have medical assistance in maryland while i go to school for medical assistant. Does anyone know if its really hard to get it.

My insurance will pay to have the lap band put in. But should I have any problems from it or need it removed even due to medical issues they will not PAY for that....So now what do I do

I am going to have to pay for the band myself. I just want to get an idea of what others are paying in other parts of the US. Also, please give me your dr.s name. In my area, Charlotte, NC, Dr. Voellinger charges about $16K for the surgery and a year of fills. He also charges a $200 application fee and another $1200 for nutrition, psych eval & body fat composition test which are all mandatory. CMC Charlotte charges $15K for everything and year of fills and they seem to be just as good. However, my BMI is not high enough for them. I am also considering a Dr. in South Africa, Dr Constantinos Sofianos. drsofianos@iafrica.com Obesity Unit South Africa holistic approa…

Called Aetna to check on the status of the precert. Took along time just to figure out how to talk to a real person...so how often should I bug them about the status? They told me not to call back for a week and 1/2. They woudn't know anything until then. I was thinking maybe every other day would be ok or is that too often? Khy

So, I hope to hear soon. It has been about a week since I changed my mind from Lapband to Sleeve. I was previously approved for Lapband and already had my surgery date and kept reading about all the problems people had with Lapband and the having to have fills and unfills and hospital trips...etc.... So, I am so hoping that UHC will approve of Sleeve since it already approved my Lapband! AHHHHAHAHAH

I am so frustrated right now! I spoke with someone at my insurance company yesterday and she told me I was DENIED. WHAT??? I did everything EXACTLY like I was supposed to! The reason given was that I "did not complete the required 6 month supervised diet with my physician". But I did!!! I have ben very meticulous in meeting their requirements, and my surgeons office has documentation of all 6 months of visits. Obviously there was a mistake made somewhere. She is turning it over to her supervisor to hopefully get it all straightened out. Of course, it is a holiday weekend so I have to wait until Tuesday! I think it will eventually get approved, because I have mos…

Hello, I am new to this website and am in the beginning of my lap band journey. But I am wondering does anyone else have Advantage Health Solutions? I have a long history with my PCP of failed weight loss attempts but Advantage requires a 6 month medically supervised weight loss attempt prior to being approved for surgery. I am fine with that and more than willing to follow my doctors medical weight loss program but I am concerned that if I do lose some weight during that time, I will be denied surgery. Also is it ever possible to have the 6 months shortened, or waived? I meet with my PCP next week to discuss this but any suggestions, help or advice is greatly appreciated…

will bcbs of nj approve my sleeve if I gained 10lbs during the six month program. please helpfreaking out

Aetna is very busy this time of year. Slip ups do occur. My Dr.'s office filed June 21st. Aetna claims they didn't receive it until the 23rd. July 1st and I was still not in the system. Yes they received it but no they haven't done anything with it. I told them I was getting worried about that so they sent my call to another office. This lady lectured me on the fact that I could not file my own precert. Sigh... I told her she was correct. My Dr.'s office filed it for me. OH... well we do have 48 hours to get you into the system... I told her when it had been filed. Again she replied she had 48 hours to get it into the system. I pointed out that it had been long…

I was told today by Carolyn in Dr Daniel Lane's Office in Mobile, Alabama - she is the bariatric coordinator for that group (Dr Snow, Hannon, Ringold, Weinstein, and Lane) that Blue Cross of Alabama was now covering the Sleeve Gastrectomy. I hope this is true because that will open the door to many alabamians who are fighting morbid obesity and have only had two covered options - the Rouen - Y and the Lap-Band procedure. If anyone can help verify this information - i will be ecstatic. It was to late in the day when I heard to call BCBS to verify this information. Thanks, Auburn Tiger

Upset with my dr.'s office!! I received a bill from them for over $400.00. Listen to this, so I called them and my insurance. The doctor is a participating doctor but the group is not and thats how they bill Now I am wondering what to do, find a different dr. or fight with them and ins.????

Has anybody gotten approval with United Healthcare that did NOT have the bariatric rider to their policy?

Hi. I meet my surgeon for the first time next week.. I have tricare prime and have been approved for 4 office visits with him.. Does anyone know what the wait period and requirments Tricare wants before surgery approval? also.. does anyone know if tricare prime covers the fills, etc.. thanks so much! : )

Aetna is my primary insurance and tricare standard is my secondary insurance. Will tricare pay anything since they are secondary? I know they paid part of my hysterectomy but I am thinking maybe this is different since they have taken a hard line against approving vsg outside of a mtf? Anyone have any experience in this area? Khy

Just got hit with an unexpected today - found out that on my company Aetna plan where it says they will cover 100% of WLS if you use one of thier Centers of Excellence, is not really 100%. Apparently (and I called Aetna to verify - the lady I got had to go ask someone else cause she did not know) the Surgeon and the Anesthesiologist are not covered at 100% - they are 80% covered. The Surgeons office called me up and said I will need to pay $523.36 (my 20%) but I have no idea what the Anesthesiologist is and what I need to pull from savings. Does anyone who has had thier sleeve done know what the Anesthesiologist "agreed" rate is with Aetna? Thanks!

Hi everyone! For those of you who have Cigna for insurance and have the 6 months PCP visits. Does your plan explain how they count 6 months? Is it just once a month around the same dates( March 14, April 13, May 10, etc.) OR do they count out 30 days between each visit? I have called my insurance office and I seem to continue to get people who don't know anything. I plan on asking my surgeon's office, just thought I would post. Thanks

I have been denied by Aetna for VSG. First because they stated I didn't meet the criteria of weightloss. However, I appealed and proved that I do meed the medical criteria however, they came back with a second denial because they say that I didn't meet psych clearance. Which was untrue. I faxed in the pysch clearance but now they want to do a Level II appeal committee tele - conference. I can choose to phone in and state my case to an unknown board I will be given 15 minutes to do this. Then I will be asked to leave the call where they will deliberate without me and send me a letter with their decision within 5 business days. They also state that I can have a lawyer pre…

Hi! and good day everyone, Im just new in this community but im looking forward to have a great conversation on exchanging ideas with you guys. I love to discuss about Senior Planning and Its services.

Im scheduled for surgery next month. My insurance is Empire Government. My insurance says I need to pay my deductable $388. then they pay 80% and I get the 20%. The dr office says I will pay nothing but my deductable and I am worried I will have to pay the whole 20%. It is 100% covered if I use an IN network doctor. I really LOVE this dr. am already scheduled with him and dont want to walk away now. Any thoughts or experience with this??? How come my dr's office will cover the 20%??? HELP please Thanks in advance for any thoughts, ideas, or suggestions.

Hi all, I was approved yesterday by BCBS, four days total. Not too bad. I don't have a date for sugery yet, I was told there's about 40 other people ahead of me to schedule so it will be about two weeks before I hear about a date.

I won my appeal from blue cross blue shield. Two weeks ago, I was rejected by my insurance company for the gastric sleeve because they declared my bmi 35 was too low..for the surgery it has to be 40. I'm very thankful to my wonderful bariatic insurance coordinator who fought on my behalf because I have high blood pressure. I am so happy I will be a sleevey soon. They are calling me tomorrow to schedule my surgery...yesssss I feel like a new beginning. I use to be very athletic but I injured my knee over time in which I have developed arthritis and if I don't lose 60 to 80 lbs I will need a knee replacement by 55. So now I can save my knee, and save myself...yes. …

So one of the reasons that I chose the sleeve over the LB is because there will be no need for umpteen follow up visits and fill appointments after the surgery. My question is: for how long after the surgery do I need to worry about keeping this current insurance (that covered the surgery) and/or checking future policies to make sure they cover bariatric procedures? I am currently covered by my husband's insurance AND my own insurance specifically because the insurance through my work covered the surgery but my hubby's did not. I would like to be able to drop the second policy after this year but don't want to do it too soon if I'm not considered "in the clear" yet…

Dr. Terricina's office will file with Aetna tomorrow. His office says Aetna is really picky. They said it might take as long a 3 weeks for them to approve or deny. If they deny I don't know what I am going to do because I am a teacher and have to go back to school in mid to late August. I asked how long for an appeal and they said it depends on what Aetna thinks the problem is...a week to months... So now the wait begins... Everyone here has been through it so you all know the anxiety I am feeling... how do you get through this? the Dr.'s office did pencil me in on the surgery schedule in case they approve the first time around. Khy