Insurance & Financing

I am just wondering if there is anyone else out there with my bmi and height that is looking into getting the vertical sleeve, i am 4.11 with a bmi of 35 with hypertension.,,,,,,,,,,,,,,,let me know Lisa

I contacted Blue Cross Blue Shield of Illinois today to check the status of my request for coverage. I was told that I was denied due to a lack of documentation of the 6 month required diet. The only thing that the insurance company requires is Documentation of active participation in a comprehensive, non-surgical program of weight reduction for at least six (6) months, occurring within the twenty-four (24) months prior to the proposed surgery. They say they accept a recognized commercial diet-based weight loss program. I gave them copies of invoices from two months of Nutrisystem and 6 months of invoices from Weight Watchers. Now I am pretty sure both of those are rec…

Hi there, Just wanted to see if anyone can help. I started this whole process in September. I started my monthly dietary evaluations in October and finished them in March. I went through some very hard times and became very depressed during this time, and gained about 30 pounds. Before the weight gain, my BMI was 37+ and I had co-morbids of sleep apnea, hypertension, and acid reflux. After the weight gain, my bmi is now 41. My insurance required a bmi of 35 plus 1 or more co-morbidities, or a bmi of 40+. I meet both requirements now, and all the paperwork has been submitted. I have been through the whole process of being denied once because they said they didn't r…

I have a BMI of 37 one day 38 the next. I have been diagnosed with obstructive sleep apnea and hypertension. I have complted my consult with the surgeon, dietician, and psych evaluation done. I have completed the six month supervised diet. I have a letter of surgical nesessity from my GP and from my foot specialists, I will be getting another letter from the doctor that i weighed with monthly. I have requested my medical records, I have requested information form the sleep center. I feel as though there is something else I should be trying to do! Please tell me what I am missing! I want to make sure that my t's are crossed!!! Any advice will be very helpful! (S…

My insurance (Aetna) will cover up to $10,000 lifetime for bariatric surgery. I'm getting conflicting answers from my surgeon's office about an estimate of how much I will have to pay and when. When I first looked into the surgery, they said that after the insurance came back with its negotiated rates, the cost would probably be $15,000, so I'd be responsible for about $5000. At my last weigh-in appointment, I asked to talk to the insurance coordinator, who was the person who gave me that info before. THIS TIME, she said that she didn't think the cost would go over $10,000. She said that in any case, at check-in, I'd have to pay my $250 deductible for a hospital…

Hello everyone, I am in the process of completing all the criteria for my insurance (BCBS TRS Active Care) approval for my band. I have completed the psychological visit, I have one more visit to the dietician this week (YEAH) and my bmi qualifies me for the band. So far, my surgeon's staff has been great. Since I work at a high school with special needs students and I am required to lift them. I want to make sure I am completely healed before I return to work mid August. How can I make sure all of my paperwork is submitted correct the first time and some suggestions on how I can get the insurance to quickly approve me. I'm praying that I can have my surgery by June 30t…

Ok So I have Higher Education Consortium Benifits Trust from Arkansas and I don't know where to start. They will pay 10,000 per lifetime for lapband which I think is GREAT. I am currently 260 and need to be at 120 for idea body weight. First about how much does it cost, I am attending a seminar in June with the surgreon I picked.(which wasn't hard...there is only one!) but I want to know what I am up against with insurance. Do I need to look into diet plans, start accumlating data.....I'm so CONFUSED!!!!!! I finally have my family on board with me and my husband is GREAT and has always been supportive. I just don't want heart break and find out that I get denied.

FINALLY!!!! After 2 LONGGGGGGGGGGGG weeks of waiting and calling and stressing! I called Cigna they said I am Approved!!!!!! OMG!!!! I actually called twice to hear it twice (just in case)!!!!!

Anyone have any suggestions on how to finance self pay? I don't have the best credit and can't borrow from friends or family.

So I was looking at some of the posts last night and I saw people who had BCBS in other states who were getting denied for the surgery and I TOTALLY freaked out!! So I called BCBS and this is what I was told that they don't cover Sleeve Gastrectomy because it still "Investigational", and the the lady is like but we cover Lap Band! I am so crushed and don't know what to do at this point do I submit my paper work and have them deny me and then appeal it or do I go with the lap band that I know is going to be covered!!!!!!!!!!

Hey all... So I just wanted to vent a bit about my emotional struggle lol... I have been looking into the LapBand for a while now, a little over a year, and the last couple months Ive gotten serious about it.... Went to the Dr. and got a packet and got so excited. My best friend got it done and she looks great, and she's doing fine on the payments. My insurance will not cover the surgery, which sucks, but meh, I was willing to pay the monthly payments for this life change. I was scanning through the pamplet for the loan company who finances the surgery and WOW. The interest rate is insanely high... My excitement started to turn into dissapointment. My husband keeps tellin…

So when I began this process one of my first questions was, how much out of pocket? My lapband financial coordinator contacted my INS co & they told her that I'm 80% covered w a $500 deductible. She also told me that w their team they waive the excess 20% so naturally I was like ok let's do this! Well today the financial coordinator called me & said that whomever they spoke w from my INS gave them the wrong benefit information! So for a whole month I've been moving forward w the process ie: sleep study, endoscopy, psych evaluation, nutrition consult, travel expenses etc... Also come to find out that my Dr is not even in network for my INS! My only options now are …

Hi there, I just registered to this site, after doing some searches on people's experiences with WL surgery through Kaiser. I was able to find some info here but unfortunately, the info was pretty old & outdated (2007/08/09). I am 34, 5'5'' and @ 260ish. I have asthma, have foot/ankle/knee problems (surgery through Kaiser last year on 1 ankle), PCOS, and no other weight related issues. Yet..... I have been thinking about some form of WL surgery for some time now, and out of pocket funding is not an option for me. Since learning Kaiser offers up the Options program, I am looking to take advantage of it. I don't really have a PCP right now. My previous one was cl…

I was full steam ahead with a surgeon in Dallas, did all the hoops, had a surgery date set and then found out they are engaged in insurance fraud. So needless to say the brakes went on fast and hard.... I am now going through another surgeon and having to get re-approved through Aetna. They haven't changed their policy bulletin, and waiting for them to re-approve it. This Dr. is in network and such, so I would think it should be just a formality, but still worried I guess. Anyone have to get re-approved? Had any problems? Anyone who could share their experiences or people they know would be greatly appreciated. Aetna has had my information since Monday and wai…

Hi! So, this isn't really an insurance question but I figured this would be the most appropriate place to post it. Does anyone know if the Family Medical Leave Act applies for surgeries done in Mexico? I'd like to take sick time for this but wasn't sure if I would be able to as I wouldn't be seeing a US doctor. Thanks in advance for any guidance you can offer! Ann

I got the call today from the surgeons offoce to set up my first consult with dietician, insurance petson and dr. the office lady called back and told me if my ins didnt pay for the first consult o would have to pay for it $217.00 which id no prob. I called bcbs and ask them would they pay she said not until it has b een approved. How can the dr send it in for approval when this will be our first visit. So anything before surgery I will have to pay.

For those of you that have Aetna and used the 3 month Multidisciplinary surgical preparatory regimen, what exactly did you end up submitting? The clinical policy bulletin states the following items must be done: Behavior modification program supervised by qualified professional; and Consultation with a dietician or nutritionist; and Documentation in the medical record of the member's participation in the multidisciplinary surgical preparatory regimen at each visit. (A physician's summary letter, without evidence of contemporaneous oversight, is not sufficient documentation. Documentation should include medical records of the physician's initial assessment of the mem…

My primary insurance carrier does not cover the lap band, but my secondary does, which is what I planned on using. I plan on dropping my primary at open enrollment since I only kept it bc the last few times I tried to get on my hubbys ins, the hr dept kept 'losing' my dependency papers and I didn't want to be left with no ins. Will I be able to use my secondary ins for the surgery, I know they convert it and imcurrently onmy 3rd month med. Supervised diet. Has anyone used their secondary ins? Its bcbs il.

hi im new to this site but i found it very intersting....im lookin forward to gettin the lapband done but i want to know what expect from pcp and insurance company which is HIP Prime.....i have like a 46BMI with no other health issues...but i know this will be best for in the long run...I will ove to here everyones input... Also do have to go threw my pcp if im gettin it done or can i just see a surgeon..

I'm so excited I can hardly stand it!!!!!!! The insurance coordinator at the MD office sent me an e-mail yesterday and said that Humana State (for KY) is now paying for sleeve for patients with BMI >35 with 2 co-morbidities. They previously were only paying for 50+ BMI. I'm so excited to think that I'm going to be saving all that $. They were going to submit my 6 months of MD visits this AM. They said I should know something in about 72 hours! YEAH!!!!!!!!!!!!!!!!!!!!!!

I will try and make this short. For those of you have Aetna, how long did you have to do the supervised diet plan with the nutritionist? I made an appt with a doc, went for my first consult and was told that Aetna requires a 3 month course with a nutritionist. I completed all of my requirements including the course with the nut back in Feb. Then my doc ran into a problem with where he could do my surgery, because Aetna now requires the surgery be done at an IOQ, which the hosp. he works out of is not, and he was waiting to get privs at one that was. I got tired of waiting. So, I decided to switch docs. Now I am being told that Aetna requires a 6 month course with…

Just trying to get some advice on financing companies and who to go through . My insurance will not cover the surgery so I am trying to figure out what financing company is best... I plan on having the surgery at Silver Cross in Joliet Il. Does anyone know if they accept care credit? OR any financing for that matter?

Anyone here been banded through Kaiser? My doctor told me I have to go to a gastric bypass siminar to find out more info on the band. Apperantly they don't have a Kaiser doctor in my town that does the band, I may have to go futher up north to have it done. If you've been through this process with Kaiser, I would love to hear about your process. Thanks,

Hello everyone! I'm new to the boards and have a question i'm hoping someone can help me with. After reading the boards for weeks i have finally decided to go through with VSG seeing that so many people have a great success. My surgeons office advised me that my insurance was extremely good with approvals and gave me the list of qualifications before submitted to insurance that i needed. They were 1. Nutritionist appointment 2. Endoscopy 3. Psych eval 4. Letter of recommendation from my Primary physician Last week i finally finished the process and was ready to submit to insurance with a BMI of 41 Today i get a call from my surgeons office saying that the …

Well my surgeon submitted my package today to Cigna for approval...hopefully I will hear something soon. Does anyone have any recent experience with Cigna and their response time?

I was just curious on how long it took all of you to get approved? Did you get approved the first time, second, third? Am I gonna be waiting miserably for a week, 2 weeks, or longer to find out if I have been approved?

I have bcbs of tn ppo plan through kroger comp. Just wondering how good they are. Never had any surgeries of any kind. Can you tell me your exp with them. Did you have to pay any out of pocket beforo or aftet surgery Thank you for any information

I am wondering about the 6 month physician supervised program requirement. The requirement says "6 consecutive months" with "no significant gaps". So does that mean I will not be approved if I went to my doc for this supervision in May, June, September, October, November, December? I missed July and August b/c of my doc's vacation and mine. I don't see that as a 'significant gap' but will Cigna? Thanks!

I read on here that there is a difference in device co-pay if you're inpatient or outpatient for BCBS FEP. Apparently, outpatient pays 30% of device while inpatient only pays overnight hospital fee. I'd like some input: were you in/outpatient and what was your co-pay? Thanks! Nikki

For my insurance my PCP has to write a letter stating this is medically necessary. Just wanted to know if some of you may have an example of what your PCP wrote and submitted. Thanks

Hello everybody, I was approved for surgery by Aetna HMO of FL and I was wondering if there are any out of pocket expensed that I will have to incur that is not covered by the plan.

Quick question for anyone out there who might have encountered something similar. My wife and I have been looking into getting banded, but until now our insurance has excluded the surgery. My wife switched jobs and her new insurance does cover rny and the band, so we are both excited and get to work on setting things in motion. While going over my policy I find that it has a Lifetime Maximum of $5000 on bariatric surgery per person. I know self-pay can be 2-3x this amount and I know the Dr/hospital bill way more than self-pay due to the discount rate the contract with the ins requires. I have a hard time believing that a 30k-40k bill gets reduced to anything clos…

Hello, can anyone tell me if Cobra pays for the lapband and if so what is it I need to do to get things started? Also do you have to be in Cobra for sometime for them to pay ?

I found out yesterday that I've been approved for surgery. Surgery is scheduled for May 26!!!!!

I was told that my insurance does not cover a weightloss surgery. Has any of you been able to get one covered after being initially told that this was not one of the procedures covered?

I'm new to this whole process!! I am extremely excited to get this going and finally get my life back!! I will be attending a seminar next week in order to schedule a appointment with the surgeon. I live in the Tampa Fl area and my insurance is Tricare. My question is does anyone know if tricare requires 6 months of dieting and weigh in's with the weight loss clinic before they will approve my surgery? The reason I ask this is beacuse for years I have been seeing my primary doctor asking for solutions to get control of my weight. I have been a extreme yo- yo dieter!! I lose weight then double it back!! I guess I am just very eager to get banded!! I've been researching…

I am going to have my surgery on the 17th of May. The hospital called to day and gave me an estimate of 25,000.00 for the surgery cost. This is not with an overnite stay. My part is only 20 percent which is a lot of money to me but that seems to be a lot of money and higher than what most are being charged.I pay for my regular visits seperate so that cant be why. Any lite on this would really help. Thanks Kathy

I'm getting ready to submit all of the paperwork to my insurance company, Atena. Has anyone been through the process with them? I've been through the 3 month diet (that really turned out to be 6 because of a stupid mistake on my part). I'm such a worrier and would love to hear about some other experiences with Aetna!

Who did you finance your sugery through? There are so many options, it's kind of overwhelming! Thanks

Hello all! I am hoping someone out there, knows of a surgeon in Orange County CA that is in network with United Healthcare. I"ll even take any info for surgeons in LA. I have done all my pre-op tests with 1-800-Get-thin doctors in West Hills / Beverly Hills. And just found out from my insurance that they are not in network. Any info would be appreciated! Im checking out the NEW Program as well. But just want to keep my options open just in case! THANK YOU

So a little history since this is my first post... I have been overweight since I was 5 years old and I've tried almost EVERYTHING you can think of. It took us 7 years to conceive with our son and when he came out, he had complications and needs a feeding tube until he can eat on his own. I really think that me being overweight and having diabetes contributed to all the complications..... Well...I finally sat down with my PCP and he insisted I get a lapband...I didn't know Tricare covered it and he instantly put in a consult.... fast forward to today...... I had my seminar and my one on one appt with the doctor. He evaluated me and told me that my diabetes is ext…

Can anyone tell me if Medica which is a Mn Care insurance will cover Lap Band Surgery? If you have an answer you can email me back at jenniwooton40 @yahoo.com. Thank you

Well I have called both my insurance companies already and I know that my BCBS and Medicaid does cover bariatric surgery. I was just curious if anyone knew how things worked when you have a primary insurance with BCBS and medicaid as a secondary insurance. How does the coverage work for medicaid as a secondary insurance? Will medicaid cover all of what BCBS wont cover or just a certain percentage?

I am a 19 year old female that weighs 284 lbs. I have been overweight my entire life, ever since I can literally remember, I mean even in my kindergarten school pictures you can tell how much more I weigh than the other children! I am so sick of tired of being this way. I wake up and look in the mirror every day just to think how disgusting I look. I was diagnosed with Sleep Apnea yesterday and it really scares me. I need to do something about this. I have been on so many yo yo diets but just keep gaining more weight back and then some. I have put at least over 200 hours in researching all about weight loss surgeries. I think that getting the Vertical sleeve would be the …

Anyone been approved for the sleeve? Did you have to wait the 6 months? I've been hearing so many things!

I have a Cigna HMO plan. I am more than 100 pounds over weight, BMI of 41 and sleep apnea. Has anyone been able to get Cigna to pay for the lap band surgery? I am in the early decision making process and honestly cannot afford $12K plus out of pocket. Thanks!

Hi guys! Looking for DR's in the gool old USA who have sleeves for a great price. Mexico Dr's around $5,200.00 GREAT price and all of you have great things to say about them. I want to stay in the US but LOVE the $5,200.00 cost. Any ideas????? Thanks much! Vicki:thumbup1:

I am starting to get a little concerned. Aetna has had my paperwork for a full week now and I still have not heard from them if I have been approved. I've watched some of the dates of others on this site and some were approved by Aetna within 3 days. Is there anything that I can do to "push" the process along or should I just patiently wait for the answer?

I have BC/BS Federal Texas. I just found out that I have what the Dr. said I have what is called mechanical breakdown of my 4 year old lap band and now a hernia too boot that I never had in the beginning. I now have to have the band removed, the hernia done and a revision to RNY and I am trying to see if this might be a procedure that would be approved or not? Hope some one will answer me back

Has anyone had any luck getting Humana to approve everything? They have a "Bariatric Management Team". That would make one to believe that they do approve under certain circumstances. I am going through a seminar Monday at my surgeon's office. My gastroenterologist has all of my medycal records ready. I have read on a couple websites that Humana may require that you go through a 6 month medically supervised diet. I'll learn more tomorrow. I'll keep you posted. Harve