Insurance & Financing

Hi My Sherry I just have one question I have went through everything that I had to do blood test GI sleep Study ect now I'm just waiting for the approval I talk to Dr Awad office and they said they were going to submit everything for the approval this was on June 8th the girl told me it takes 5 days what is the max days does it take to get an approval?? I still haven't heard anything I have tricare and I been looking on the website everyday waiting so frusterating could someone please tell me out I'm so inpatient should I go ahead and call Dr Awad office again or should I give it more time? ok so I lied that is more than one question :-) Sherry

I just called my insurance company (BCBS) of Minnesota to ask if they covered the sleeve. The said no and that it was investigational. I have heard from other people that this can be appealed. Does anybody know what BCBS requires for surgery. Do they have a 6 month diet, etc. Thanks for your help

I'll make it a quick summary. I have Aetna Open Access. I went through True Results to do everything required for my insurance approval; the four months of nutrition consults, psychological evaluation, 2 year weight-history documentation, chest x-ray, etc. I was denied because I lacked proof of being obese for two years. I appealed with pictures and was approved. In the letter, it says that I was approved for "Gastric-Bypass surgery". I had appealed for the Lap-Band surgery. Any idea what this means? I would not mind having the gastric-bypass surgery, but I had originally planned to have the lap-band. How can I get approved for Gastric-Bypass when I d…

Hey guys, does any one else on here have BCBS Care First, ours is based out of MD/VA, and I am in chicago, I would just like to know what peoples experince with getting approved by care first was like.

I AM SO EXCITED!!!! Submitted to FEP BLUE today!!!! WOOOOOOOOOOHOOOOOOOOOOOOOOOO!!!! Starting on Pre-op diet today so I can have surgery soon!!!!!!!!! PRAYING for a speedy approval!!!

Well, I finally finished jumping through all my hoops for the insurance co. and Dr. and my paperwork was submitted on Friday... After a little glitch that got worked out my dr's office sent everything in for approval... I am suppose to get a call on Monday from the surgeons office with a tentative surgery date. Anxiety and fear is kicking in now waiting to hear if I have been approved.. I just wanted to come on today and thank everyone even tho I don't post much at all, I am always reading and have learned so much from you all...

Finally Approved after fighting with Insurance Company for over a year. I am so excited to begin my life anew, really feels like a brand new birthday for me

I'm so bummed, I called the insurance company and was told that the information that I submitted was not enough. She said that the first 3 months of my diet was not supervised (I submitted WW) and that the last 3 months with my doctor was not enough detailed information. They want to know progress on my diet as to what I was eating and how much and exercise if I was doing 10 leg lifts a day and went to 15 a day each month. I'm so bummed. I called the insurance coordinator with our bariatric clinic and she said I must have gotten a really tough case worker. STINKS only me this would happen too right? ANyways, She's going to look at the denial letter when she gets…

I am a newbie hoping to be sleeved. I have had my initial consultation with the surgeon and bloodwork and have started my required 6-month supervised diet. Unfortunately my insurance company told me today that once I meet my deductible, they will cover 100% but there is a $10,000 lifetime cap on bariatric surgery. My surgeon's office says to be patient and that a lot of the BCBS policies are changing all the time to include gastric sleeve coverage. My question is should I contact my employer and talk with them about the surgery and the $10,000 cap, should I continue as is and wait and see what happens down the road after I complete my supervised diet and psych ev…

I just have to vent somewhere. I wish I wasn't at work so I could scream to the top of my lungs. I am so mad right now. I submitted my information to Aetna on May 11th. They promptly denied me stating that I didn't meet the weight criteria for two years. I submitted an appeal on 05/27/11 and showed that I met the criteria. So I just happened to call Aetna today just to check on the appeal. I wasn't expecting anything because they said it would take 30 days. To my surprise they had already denied my appeal, & get this, the appeal was not denied for what it was denied for the first time. This time they claim that I didn't get psych clearance. THAT's A LIE, I told the r…

I need help.. I'm trying to get the lap band surgery.. My doctor contacted healthlink to see what i needed to get covered.. I have everything covered EXCEPT.. They want me twice my ideal weight fr my height?? Has anyone heard of this the doctor even said this is a ridiculous qualification. I'd have to gain 50lbs to be qualified.. I was wondering if anyone has appealed this qualification and what was your outcome.. Also I'd like to hear from people with healthlink in te st. Louis area.. Thanks alot Nick

I saw some older info here and it doesn't look like they approve the sleeve, even for revision. Does anyone know if that's still the case? Trying to figure if it's even worth the effort to try or should I just go to Mexico. Thanks

I'm still in shock. Just found out today I was approved for surgery. My surgeons office got all my paperwork from my PCP and I had enough visits about my WL in her notes that the insurance lady thought she would try to get me approved with that, so I would not have to do the 6 month diet and wait. Of course they denied it at first. She sent in an appeal and I'm APPROVED! I have so many emotions going on right now. I'm excited and scared at the same time. I really thought I would not be able to get this done until late in the year.

I'm 21, 233lbs and BMI is 39.9. I dont have any health problems, at least not that I know about lol, and I wanted to know if anybody who has HIP had to jump through any hoops or anything like that? Is my age going to cause drama since Im young? thanks in advance

Does anyone else have this insurance? I'm curious if they made you wait the 6 months, or if they denied it?

I am finally approved for my revision!! It has been a long month... I am now just waiting for the date, hopefully it will be soon so that I can get the contraption (band) out of me!

So I have Aetna and had my surgery on December 27th. I stayed for 2 nights. My deductible and co-insurance has already been paid up so both my surgeries (Sleeve and Tubal Ligation) were covered at 100%. I was just on Aetna's website and you won't believe how much the hospital bill is???? Any guesses???? Just think, this is the hospital bill, not including either one of the surgeons bills! DRUM ROLL PLEASE....................... $94,429.45 now pick your jaw up off the ground!!!! So, let's break down those charges, shall we?? Room-Board/Semi :$3,116.00 Drugs/Detail Cod :$1,131.34 OR Services :$17,052.55 Supply/Implants :$20,063.00 …

I called medicare and the woman that i talked to said that as long as everything that i told her is accurate then i will be covered to get the surgery. I am so happy, i hope that the road ahead stays like this. On a less happy note i weighed my self today and about cried...263

I am in Fl w FEPBLUE ins and previous posts for 2008 every body was getting done. Anyone with newer info? I am going next thurday to the seminar. if I can afford it, and they approve it its a new life!

Harvard Pilgrim's website says they won't OK a sleeve. The good news is that they may approve the procedure on a case by case basis. I am one of the lucky ones for sure! My date is 9/28!

My Dr's office just called me today to tell me that they've submitted my paperwork. They had me schedule a surgery date even though the approval hasn't come through. I'm really, really nervous that they'll say no, but at the same time, I get excited every time I think about it. If anyone cares, here are my stats: Height: 5'1'' Weight: 209 BMI: 39.5 Co-morbidities: Severe sleep apnea and arthritis. Any support or tips y'all could give me would be awesome!

I can't believe it but BCBS of Ill approved me after only two days. My paperwork was submitted on Friday (June 3) and I called today to make sure they received it and the rep told me I was approved. I was so surprised, I asked her to fax me a copy of the letter. This has been such a long rode for me and I am sooooooo happy.

I had surgery on Jan 28th , I went trough my insurance BCBS , the checks have been rolling in for my WLS place , check here , check there , then I started to notice the bigger checks , 13,000 , 8,0000, then wow a check for 31,000 , I was like dang , so me and the wife started doing the math , my ins has payed 72,000 for my WLS journey so far , we just couldn't believe it , so far I have not payed anything , I know one thing if they try to come after me for ins not paying them enough , I will be yelling

About two weeks ago my ins. (health net) gave me a list of contracted surgeons. So I research the closest one to my house and narrowed it down to one. dr. Krahn I went to his seminar and gave them all of my information. I was very pleased with his rates of success and was feeling blessed that I got to choose a good dr like him. Yesterday, his office called me and said he is NOT contracted with my medical group. I'm ***. I called health net and he is contracted with heath net, just no with my group. Ok? So how do I figure out who will be my surgeon? Health net lady said you might get him because we have a couple o centers of excellence. I researched my…

I am on my way to completeing my 3 month insurance requirements, Did anyone call the hospital to see how much was out of pocket with lap band and insurance? they are the wiggliest people to get an answer from. It's like buying a car, we start here- sticker price unless,,,,,then the costs go up. I can handle, the complications, but can we get a base price? 1700 to 25 Gs is more than I can handle. insurance folks are worse,,, boy!

So the day finally came! I got an email from my Surgeon's office, telling me that I was approved!!!!! I wanted to cry because I was so happy. I just had to tell people who know how hard it is, but it is all well worth it in the end. I am now waiting to hear about my surgery date. Does anyone recommend types of protein drinks/powders?

Hey guys! So, I've only gone to one of my six appointments pre-surgery (I need to go once a month for six months because of the insurance), and I've already run into a problem :w00t:. I have BCBS (wellmark), and I meet all of the requirements...except for ONE. They want a three year history from my doctor to prove I was overweight. PROBLEM: i haven't been to the doctor in years!! I have no record at all of an 'official' weight written down with a doctor's signature. I'm going for my second appointment tomorrow and I know they're going to ask for it again.....but I have nothing to give them! I have a family friend who is a doctor that has known me for those three years, …

OMG-I just realized I made a big boo boo! My insurance requires a Pulmonologist appointment within 30 days of surgery. Pretty Simple, right??? Wrong! Leave it to me to go to my appointment 32 days before my surgery!! I am stressing now and wondering if I am gonna have to do it again and pay out of pocket because I am sure insurance is NOT gonna pay for 2 just because I made this mistake. :doh: I feel like such a goofy goober!! Has anyone else done this or anything similar, and if so what happened?? HELP!!!!!!!!!!!!!!!:Cry:

I hope i'm in the right place for this, i've had a little trouble navigating the forums. Anyways, i've been in this process since feb of this month. I've completed everything i needed to, there were alot of hoops to jump through, and i mean ALOT..lol..so my information was sent to BCBS federal basic of michigan on may 11th. I still have'nt heard anything. I've read about people getting approved within days. I've called 3 times so far, and nothing . I'm getting frustrated and am having 2nd thoughts about the whole thing..but I know i need this lifestyle change. I just wish they would hurry with my approval. I just needed to vent!!!

I'm wondering if any of you folks have Anthem Blue Cross California (PPO)? If you do, do you know what the requirements for approval for VSG is? I'm not actually a member yet, but will be able to choose it during open enrollment starting 2012. Thanks!

Aetna has two ways to get approval. One is the six-month route while the other is three months. Obviously I would rather the three month option but Dr Teng is adamant that Aetna wants to see six months. I've gone over their policy bulletin (#0157 if you are curious). I want the Multidisciplinary one that green lights me in three. As of right now, I have documented (prior exercise regimen of mine requires it) 2 years of BMI of 50+, 3 months (more really) of food logs, 3 months of doing plyometrics and weights with my friend (a Certified Personal Trainer) and I start seeing a NUT on the 16th (JUN, JUL & AUG). So by the 16th of August, I will have all the aforem…

I just wanted to share my experience with going through the insurance requirements for Aetna that I did NOT have to do the supervised diet. The first surgeon I was supposed to go with- their office just had me submit supporting documentation of the issues I was having from my original surgery 13 years ago. None of the "issues" are life threatening- but rather I was able to demonstrate that the original surgery was a failure. I was diagnosed with Grade C Esophogitus, submitted the weight history, and also had a history of exercise for the 6 months prior which actually was a report from a pedometer I wear and it showed that I regular walk an average of 8,000 to 10,000 st…

YAAAAAAAAAAY! It was sent on 5/26 and approved on 5/27! WOOOOHOOO I LOVE YOU BCBS FEP!! )

Just curious if anyone is post-op or currently in the pre-op process that has Priority Health out of Grand Rapids, MI or Michigan in general. I'm starting the inital inqiries with my PCP and local surgeon's office. I have looked online at the requirments of Priority Health and feel as though I am on the bubble. I am currently 276lbs but I'm 5'10". I have extremly high cholesterol and have struggled with my weight since about age 10 as puberty/hormones started setting in. Both of my parents have high choloesterol, high blood pressure, and diabetes. My dad had a heart attack at age 45....and that's only 14 years off for me. Getting scared I cannot turn my ways around…

YAY!!! I got approved for the Sleeve today! ( After a crazy process of being approved by mistake for Lap Band) I finally got my approval by phone and Mail today! I am so excited!!!!

. Hi just an update from my research. I talked to United Healthcare today and asked them what would happen if I got a vertical sleeve and then applied for a policy. They told me any prior bariatric surgery makes me uninsurable and they will not write a new policy. I asked her what people do when they have uninsurable conditions, and she said people look at "other options" -- their employer (?), a COBRA policy, or for high risk policy insurance. !

I had a lap band in 07, an erosion in 2010, I had HIP at the time. Now I have United Health Care. I lost 91 lbs and was working the plan. I had no pain from the erosion and the only way it was discovered was from going for adjustments and they would not hold.. Fast forward to now and my insurance had changed and my I am slowly gaining weight. I have a BMI of 33.2 now.. The insurance company wants a BMI of 35 and 2 special circomstances like sleep apnea, high blood pressure, dibites..I do not have any of those... From working with the band my sleep apnea is gone... I want to get the sleeve and the insurance company will not cover it because I am not heavy enough... The ban…

SO stoked!!! Our surgeon originally told us, "we typically don't file claims to insurance for Nutrition or PSWL." That didn't seem right to me, and I really, *really* don't have a lot of money to spare. So after talking to an Aetna rep who just so happened to have had the surgery and who just so happened to have been told the same thing I followed her advice. After talking to them, I faxed the surgeon's office a copy of Aetna's Clinical Policy Bulletins outlining the coverages available along with a letter requesting reimbursement for the 2 Nutrition consults we paid for and the first 2 PSWL's that Emily went through. Checked Aetna tonight, and the NUT is covered at 1…

Hello, I am trying to find out if anyone has had the band removed with Aetna insurance. What is the crieria fo removal? My suregon is super confident that it will be approved because of the complications that we already scheduled surgery on the 16th of June. I am having severe acid reflux and vomiting. I have a 10cc band with 1cc fill in it right now. So I wanted to know what are the chances of getting this out?

Hi all, I am wondering if anyone know where i can apply to have about half of my surgery financed. My out of pocket fee is $4000.00 and that would pretty much wipe out my savings. I was hoping to finance half of it, at least but don't have good credit. Anyone with not so good credit get approved with a finance company? And if so which one? Thanks for your help!!

I am a 19 year old female, 5'4 and 293 lbs. My BMI is 50 exactly. I was diagnosed with moderate sleep apnea yesterday. I have called both of my insurance companies, BCBS and Medicaid, and they both cover VSG. I was wondering how likely am I to be approved for VSG by them?

Hey everyone, I have tricare west prime and I went through everything that they wanted me to and got approved for everything except the surgery. I'm a bit confused and a little pissed off at the same time. why would they go through and approve everything but deny the surgery???has this happened to anyone else? and if so what did you have to do about it to get them to approve it? Thanks a bunch

I am looking for those who are currently or have recently used Tricare to have your surgery done. I know the rules have changed a lot over the past few years. I attended my seminar last night and am waiting to hear from the doctor's office (already got my consultation referral). I have an appt with my PCM next week for a f/u to check my blood pressure (borderline high) and am going to ask her to do my referrals for blood work and chest x-ray when I am there since it takes so long to get an appt on base. I live in Vegas and have heard everything from "it was easy" to "I was denied". I am 5'8' and weigh 275. Any thoughts/suggestions/advice?

All of the patients at the company who did my surgery 3.5 years ago have been notified they are going out of business at the end of May due to the doctor taking a new position out of state. I was self pay, as were others, and part of the perk of paying cash is that I was to recieve lifetime care and fills at no charge. The company changed hands a year ago, but the terms of my original contract transferred and was continuing to be honored. My question is, since I was promised lifetime care at no extra charge, and my lifetime isn't over like the company is, should all the self pay patients be eligible for some kind of reimbursement since we will now be paying out of po…

I have been approved for lap band! My dr. Requested inpatient and my insurance approved me for outpatient. I'm fine with outpatient but my doctor's office said they have to call the hospital and see if I can be outpatient. Shouldn't they know this already? Aren't most people outpatient for lap band?

Hello, Our company is switching to either Humana or United Health Care and I'm trying to figure out if either one of them covers the procedure. I did find out that Humana does not. However, am I going about this the wrong way? My husband and I both want to get the surgery done and if our doctors say that we should have the surgery is it better to go about it that way? Just trying to figure this all out?? Thank you!

- I have 2 diabetes ... - Hi Cholesterol.. I have been on several prescription medicines for the past 2 years and it just seems to get worst .. I had mentioned this to my endocrinologyst .. but he was not ok with the surgery. I went to my primary care physician she requested it under medical necessity and it was denied ... because I did not meet the "criteria" ... what is the BMI that I must have in order for my insurance to cover this?

My policy states that I have to complete 6 months of medically supervised weight loss program with no significant gaps. I have completed 1.5 years of medically supervised programs but I have 3 60 day gaps. Just curious if anyone knows what significant means? It is very vauge.

Hello; I am being submitted for approval tomorrow and am concerned because I was told that Medicare requires among other things, 5 years worth of doctor notes with weight information. Like many overweight people, I didn't like to be weighed. So for my notes, I only have the last 3 years notes with weights and the first 2 years it says I refused to be weighed. Has anyone else run into this particular problem? I was told that some insurance companies will take pictures if the date of the pic is shown on the pic. I am hoping not to be denied, but was wondering that if they are a stickler for this information, what can I do. I cannot speak to the pre-cert department wi…

I've had a terrible time with Federal Employees Blue Cross Blue Shield. At first, my pre-authorization paperwork had to be resubmitted after it was "lost." Then they pre-authorized the surgery within a day. Unfortunately, they didn't bother to tell me or my surgeon's office that you have to get TWO pre-approvals, one from the office that handles the surgeon's professional fees, and another from the office that handles the facility (hospital) fees. To make matters worse, these two offices don't share information, so the office handling the hospital charges ended up sending me their refusal to process $37,000 worth of hospital charges, because they had no records to su…