Insurance & Financing

Does anyone here have Fallon Insurance or Fallon Community Health Plan? I live in Massachusetts and currently have Network Health, a part of Mass Health and they don't require a 6- month supervised diet which is great. My mother is also getting the band and has Fallon. She is moving a lot faster with the process. They put her in an exercise group and behavioral classes. I went to the seminar at UMass Medical Center a week and a half ago and the surgeon still hasn't called me to schedule the nutrition intake. Should I try to switch insurance plans? I was told I don't have to wait until open enrollment.

Hi all, I have Wellmark BCBS of Iowa and am about two weeks away from submitting pre-approval, so just reading over the WLS coverage on their site. VSG is listed as "investigational", which is bolded like it's important, but not explained. RNY gastric bypass is listed as "may be medically necessary when criteria below are met". I am having zero luck finding a good explanation of what the difference is, on the site. Can anyone clue me in to what that means in insurance terms, and what it may mean to my preapproval application? If it matters, my BMI right now is 49.6. Also, anyone else have Wellmark Iowa (not federal) and have any luck? Thank you for any help! H…

My medicaid is with deductible. when the bariatric doctors office sent it in my card was active but by the time medicaid got it and answered me back it was denied because my card of INACTIVE. they only activate it one month at a time depending on deductible and when u submit a bill to them as per amount . anywho, my case worker apparently is not familiar how it works and is not co operating with me she keeps arguing with me, . Should i call medicaid it self instead of the branch to make my card active??? helpppppppppp

Hi everyone I am new to this forum but have been going through all the preop stuff and jumping through hoop after hoop with tricare. I was told that I had to do 6 months of seeing a nutritionist. the office i've been going through told me that they submitted everything to the tricare office and that it would take a few weeks before i knew what was going on. yah and that was 6 weeks ago. I've one through everything and tricare has approved everything but the surgery. I haven't heard anything and the office that I have been going to is one from the `800get-thin numbers and has really random hours. so I was wondering if this has happened to anyone else and if you have tricar…

Hi guys, I was wondering if anyone has had any experience with Coventry of Kansas City? My husband is possibly getting a new job (we are waiting on the phone call any day now) with the largest Missouri University and they have Coventry which I am desperately hoping will cover lap band because our current health insurance excludes it. I was just curious if anyone knows the ins and outs. Even if the employer is different any information would be much appreciated...the suspense is killing me.

Hi everybody! First off, just a quick thanks for all of you who share your answers and thoughts:) Today, I called healthnet (HMO) and asked if they cover bariatric surgery. Turns out my plan does 80/20. I would have to pay 20% "if I qualify". A little history. I have been over weight my whole life. In the last 6 years its have been the worst ever. I had 2 kids in the last 5 years and it made things much worse. I have hypertension ( 5years now) and I think I may have sleep apnea. I am always sleepy. Both of my parents have diabetes, so I know I will if I dont change my life. Monday the 9th I have my first General DR apt. Where i will tell her that I would li…

Hi everyone, how are you all doing? I'm turning 17 pretty soon, just got approved by the doctor to get the surgery however my insurance company(Cigna) will not cover anyone under 18. The cost of the surgery is $16,250 and this Doctor has done thousands of surgeries. I graduated from high school when I was 15 and have been overweight for nearly 7+ years. It was just a bad portion control and it's just incredibly difficult to change my life with normal exercise/diet. I've tried all of the diets out there, including hCG. Currently working full time as an entrepreneur, business is my passion. I work anywhere from 80 to 100+ hours per week and used to sleeping les…

My surgeons office said Aetna PPO was one of the easiest insurance companies to work with. My PCP doctor is linked with the same hospital and place as the surgeon so they are able to see everything my PCP has done to get me healthy in the past two years. I meet the BMI requirements for the past 2 years, but i am worried about the three month thing. I have been seeing my doctor but we address all issues not just weight. I have proposed many plans but she gives me an alternative and I go with that versus the latest fad dieting. I have been doing this for beyond 3 months but they need to see three months. I guess I can start from the initial day she reffered me and move forw…

we're losing our insurace (aetna) and I have to switch. applied to Select Health and was denied coverage because I have the Lap-Band. any thoughts as to who would be able to provide health insurace for my family?

I just started my 6mo supervised diet. I have a bmi right at 40, no co morbities, and bcbs il. They advised me asl I need is bmi 40, 6mo supervised diet, and medical clearance and I should be.approved. What has been your experience with Bcbs IL? I am also going through True Results in Houston, Tx. Thanks!

I have CIGNA. My paperwork was submitted April 19. There is still no word. The doctor's office said they had 30 days but usually when they deny it's within the first week or two. I'm interested in knowing if you were denied, how long before you got that word, and if you were approved, how long for that? My surgery is scheduled 5-23 and we're getting down to the wire here....

So here is my question... in your exerience were your WW weigh in books enough for the 6 month diet program?? I have that I am going to send in with my appeal, and if it doesn't work I have to start the whole 6 month thing over again!! How frustrating is that!! I am REALLY hoping that it is enough because that is why I did it in the first place. Thanks for your help & nput... Glenna

I am curious about a the six month diet! 1) I have completed six month diet. I only lost on my first weigh in! Is that going to hurt me? My BMI is about 37 and I have co morbities. I am planning to weigh in one more time just to cover the six months (not sure what they consider 6 months, I started in October)

Hi, everyone. I qualify for lap band surgery (BMI of 38 and I have severe sleep apnea). I am currently on health insurance that covers lap band after a 6-month supervised diet. I've dieted forever and forever and tried to lose weight forever and forever, but never medically supervised. I did start weight watchers in late March, so my 6 months with that will be up in mid September. I am hoping to switch jobs and therefore insurances starting September 1, 2011 (I'm a teacher). I would be offered group coverage through my new employer, but there is a specific exclusion to bariatric surgery. (Same is true with my husband's insurance). From what I can tell, I wil…

HI EVERYONE. i am scheduled to have sleeve revision on may 9. i was wondering will i have to pay my surgeon a co-insurance even after my deductible and in network co-insurance has been met for the year? the price they are quoting me is the 20% and the cost for s " startup" Vitamin pack. Did is anyone else's surgeon require them to purchase a so called starter pack from their office when you already have the exact same Vitamins at home.( prev band patient)

i have BCBS National and i've completed every last detail for them to approve me: 2 three month supervised diets, 2 psych evals, nutrion consult and 2 awful sleep studies (i think that was just for my doctor). i should be hearing back by monday but by the looks on the board i don't know if anyone has been approved with them! i've seen several threads about appeals and denials; i'm starting to get nervous. anyone have any luck yet?! if you have BCBS national, please share your story! thanks! UPDATE: just got word from my surgeon's office that BCBS National is NOT accepting my 3 month diets because they happened at the same time. even though nothing like that was spe…

I am curios about a food diary. I have not been told by insurance or surgeons office that I need to complete a food diary. I have cigna Insurance. Obviously I have not done a food diary. What to do??? Should I just not worry about it???

Ok, so I am totally upset, disappointed, confused...etc? I was denied by my insurance (bcbs-national acct) after an appeal because apparently I have to have a BMI of 50+ for the sleeve. I understand they are considering that the sleeve is usually done as a firt step for patients who will later receive a bypass, but obviously that's not me. I am approved for the bypass or the band but NOT the sleeve. I refuse to settle when I have been a faithful customer for YEARS with my insurance company. I have been diagnosed with pre-diabetes, asthma, joint problems; amongst other issues. I just don't know how to get past this stage. I was scheduled for surgery tomorrow and I h…

http://medpolicy.ibx.com/policies/MPI.nsf/e94faffabc7b0da68525695e0068df65/85256aa800623d7a852577e3006f56d5!OpenDocument This is the medical policy for my insurance. When I read this it sounds lime VSG is covered. This is a new policy as of the first of the year. Ibx had come out with a statement at the beginning of 2010 th at they would cover VSG as part of a 2 stage procedure but thus policy came after that. I called one of the programs that I had talked to last year when VSG was not covered and they thinks that it is still not. Can anyone look at the policy and tell me what they think or if you have experience with ibx in pa coveringvsg let me know Tia Ni…

Hey everyone... I have been patiently waiting on a phone call with a surgery date. Heres my time line March 23 - Met the DR, talked about which surgery was best for me...Decided on the Lap Band! March 30 - Had my 5 year weight history faxed to my drs office. April 4 - Met with nutritionist, got the food for my one week presurgery diet At my appt on the 23rd, the insurance lady said once the 5 year history was sent to the insurance company, it usually takes 3-4 weeks for a response. I have called 2-3 times in the last 2 weeks, trying to find out if the records faxed was enough info, I still have not received a return call. Im starting to get aggravated becaus…

Hi Everyone, I just want to wish all of you a Happy Easter.:girl_hug: For so many of us, we are so thankful for all the great things we have in our life since we have become healthy and happy and have lost all our weight, or we are on our way of losing the weight.:heart: Each day for me is a day that I am so thrilled that I had "sleeve" surgery. We all had our reasons why we wanted to lose weight.:lightbulb: When I first started I was thinking after having sleeve surgery I thought "what if I am the one person this will not work on"?:first: I had so many failures at weight loss in my past. Now I know this is the "one" thing that will work for me forever. …

Does anyone know of a way to avoid the 6 month diet requirement that insurance requires?... yes Im impatient I just want to get this done. Currently I dont have a job and if this were done NOW while out of work I could then not worry about needing time off or have to wait till possibly NEXT year to do this.(because some employers wont give you time off for the first year) I have been treated by the same DR for over 5 yrs... he has watched my weight gain and has been on me to loose and has given me diets to go on but since I dont have 6 consequtive months Im SOL.... I dont wanna be SOL... Any ideas?

Hi, Are you lurking out there reading all these posting by everyone trying to absorb as much information as you can about weight loss surgery. I used to be one of you too. I knew I need and wanted to do something about being fat. I had struggled for 25 or more years trying all the kinds of diets there were—yep you too—I knew it. I had my greatest success with Weight Watchers, and to this day I feel for so many people it is the healthiest way to lose weight. I saw over the year too many people including some of the Weight Watchers group leaders gain the weight back—and me too. I became interested more and more in Weight Loss Surgery the more I lurked aroun…

I'm in the waiting game now....all pre-op stuff is done..everything has been faxed into the insurance company...now I'm just waiting for approval. This is a sucky part of the process I've decided. I feel like I need to be 'doing' something since I've been 'doing' something for the past three months, every month, every day to get to this point. Now we wait in limbo to see if I'm approved. I'm scared to death. I don't know what I'll do if I'm not approved. I for sure meet the criteria...I'm just anxious to start the rest of my life....I'm told by my insurance that it could take up to 15 days to process my paperwork...so now I wait....

Hi!!! I'm new to this site and was wondering if anyone has gone through the approval process with fed bcbs of Va? If so, how long was the wait after submission for approval? Also what information did you include in the packet?

Anyone else out there with BCBS IL PPO who has done the 3-month supervised diet who can tell me exactly what to document. All of my paperwork will be done by the end of April, but found out I have to do the 3-month supervised diet and I don't want to mess this up and have to do it all over again for another 3 months! My main concern is where it says on the requirements about "exercise counselling" and "behavioral" modification. Is this something my regular physician and I can discuss and document on each visit or am I required to actually see a trainer or a counsellor? I'm going to do Weight Watchers on line and have monthly weigh ins and appts with my doctor, and I'm…

I have been doing tons of research on the lapband and I have great insurance that will cover 90% of the cost. However, my BMI is only 37 and I have no morbidities. I feel like I'm stuck because I'm not heavy enough and I'm too healthy for all of the extra weight I am carrying. Has anyone out there been approved without morbidities???

Does anyone out there have Kentucky Access Insurance? This Insurance is a subsidiary of BC/BS I used to have Anthem BC/BS but when it ran out , and my husband started a business of his own they wanted 3,000 a month for me, my husband and daughter, So we went with Ky Access because it was not as high. So basically my question is Do any of you have it? and does it pay for WLS?

Beginning my journey and hoping some of you old pros can help me! I'm a female, 5'8, appx. 275, BMI of 43. I went to a bariatric surgery seminar offered by a local bariatric surgery group. After completing piles of paperwork and setting up an intial consultation for surgery, I found out my insurance denied my request for surgery. I have Premera Blue Cross. My policy has an exlusion that allows no claims for any overweight/obesity surgeries, etc. I was told there are no exceptions to the exlusions and I cannot file an appeal. There is nowhere further to go with my insurance (that I know of). I know of the self-pay option but I simply don't have the money f…

I have been going through the process of getting insurance approval through BCBS of MN. I just finished my six month supervised diet, psych eval, etc. just to get a denial call today. The reason for the denial was exclusion of bariatric surgery services. The insurance company told my surgeon's office that starting January 1st of this year that they changed the policy to exclude bariatric surgeries. I wasn't even aware that the policy was changed until my surgeon's office called me today saying insurance wasn't going to cover any bariatric procedure. My question is that since I started meeting with my surgeon and my dietician prior to this change (I started seeing them in …

I found out that my insurance will only cover band removal, which leaves me with a large amount to self-pay for my revision to the sleeve. I was wondering what companies, if any, any of you have used to finance surgery. I'm not sure how to go about finding someone, and my doctor's office wasn't that helpful. Thanks!

does anyone know how long is the aprroval with healthfirst? do they require alot of documentation?

Does that mean 6 dr. visits or 7? If I had my 1st diet appt. on April 1, my second on May 1 and so on would I have to have the last one on Aug. 1 (6 visits) or Sept. 1 (7 visits)? In other words do I have to actually BE ON the diet for 6 full months or just have 6 visits? Does that make sense? And in your experience are the insurance companies sticklers for the "within the last 2 years" requirement? I ask because I have some diet visits from April-Aug. 2009 and I'm wondering if my surgery is not scheduled until like May or June would they still count those from 2009?

Okay so I got the news I have been stressing, agonizing, and desperately waiting for this afternoon. My surgery has been approved! I am so happy. I had begun to doubt the process. Rationalizing that it would be okay if I was denied. Thinking of other options. Maybe I would self pay and finance my surgery. I have been praying that God would let the best thing for me happen in regards to this surgery, but knowing that I wanted to have it done and hoping that He would agree. I'm nervous but ready to go. These next twelve days will take forever...... Surgery on 4/13.. Anyone else scheduled for that day? Lisa Aetna Open Choice PPO

I have Aetna and am starting to try to jump through their hoops. My BMI is right at 40. If I do their 3 month diet and my BMI drops below 40.. will they deny coverage? If I don't lose weight will they deny me because I didn't show that I could comply with after surgery diet restrictions?

Okay so I am looking to have my surgery at the beginning of February 2011. I have my weight records of a BMI over 40 for 2009 and 2010. I have seen the nutritionist for the month of November and I have my December appointment scheduled. I am currently seeing an exercise therapist once a week and also logging my daily walking at home. I guess my questions is does Aetna want to see that you're LOSING weight during these months. Like am I supposed to get getting monthly weigh ins or anything? Also do you think Aetna will be satisifed with me seeing an exercise therapist only one day a week? I have just done SOOOO much stuff and I am freaking out that this won't g…

Hi!! I am new to this site. I have Tricare Reserve Select and have already gone for my consulation with Dr. My BMI was 41.2, I almost fainted BTW!! =) I am going this afternoon for my Pshyc visit and waiting for nutritionist to contact me for my 2 visits with her. My consultation I had to pay $64.00, which included my deductible ($50.00) and then today they said it would cost me $94.00. I know they said I would have to pay for the nutritionist visits and should only be about $50.00 each session. My question is: How much out of pocket do you end up paying for the surgery itself? Just curious how much it's gonna cost me. Help!! =) Have a great day!!

I have been approved for the VSG surgery and have my surgery date however my nurse manager told me that my healthcare provider has a requirement that the employee has to be employed 2 consecutive years with their company. Well it's my husband's company and they were bought out in in 2009 and he was told that his time of service was grandfather over to the new company which he has worked for his company for 10yrs, so I thought no problem. But I called the new company's HR and they stated that they show his affective hire date with the new company as Oct 2010. So at this point he's not meeting the requirement of 2 consecutive years with the new company. I don't know wh…

Hi all. BCBS says I have to see a dietitian for three months and have my doctor supervise my diet for the same three months. What do you think they expect from me? If I lose weight will they tell me I don't need the surgery? I have dieted enough to know I can lose about 30 pounds before I fail and start gaining it back. I am 6'1" and exactly 400 pounds yesterday.

I was just curious if anyone had any experience using the federal employee BCBS? I'm just waiting on my approval and was wondering how fast people were approved...thanks! :thumbup:

hello, I am writing this because I am upset. When i first started for lap band my bmi was at 36.4 after six months of diet it fell to 33.7 now they say i do not quailify for this. I have several issue also high blood pressure chol. pre diabieties I am just so upset any info? thanks kim

Does that mean 6 dr. visits or 7? If I had my 1st diet appt. on April 1, my second on May 1 and so on would I have to have the last one on one Aug. 1 (6 visits) or Sept. 1 (7 visits)? In other words do I have to actually BE ON the diet for 6 full months or just have 6 visits? Does that make sense?

My info was submitted to BCBS Illinois on Wednesday, 2/16. I called today and it had been received. The rep I spoke to got all the info together and sent it to review while I was on the phone with her. She said it takes up to 14 business days for an answer. I will let you all know how long it takes for me so people may have an idea for the future if they also have BCBS Illlinois. After approval, my surgeon says surgery will be scheduled for two weeks later! Woo Hoo!

Hey everybody! I am in the process of trying to have the LapBand! I just found out the amount I am going to have to get financed, and how much i will have to put down. It has been a nightmare for me. I am starting to get discouraged. My husband and I have applied for 3-5 surgery loans and have been denied by all. Our credit is just not good enough. We are just starting out. Im 24, almost 25, and we have been married since I was 19. I am trying to have this surgery so that we can have a baby! We want one badly, but I want to take care of myself, and my health problems first. I need advice on what to do...We cant get a loan. The hospital said they will finance the 20…

I am in a bad place today I have done all my requirements, 6 months of the required diet, just to find out today that BCBS of MN still isn't covering the sleeve..unless you have serious other issues (which I don't, I am only morbidly obese). So now I am stuck, I was hoping that while doing the 6 month diet, that BCBS would switch their policy, but no such luck. I am torn between switching back to the RNY, (even though I really want the sleeve) because insurance will pay for it, and the other option I have is Self-Pay, which is $20,000 I am so frustrated! Crying all day! The Husband says put it in the budget, so yes in about 2 years, we could pay for it, and I am …

Hi. I am currently on COBRA; but it will be running out in a few months. I called my insurance to see what my policy will cost after COBRA. Turns out that due to LAPBand they will not cover me at all and that I need to turn to my states high risk insurance pool. They will not cover me because of the lap band surgery. I have to be 3 years out. For a 1700 deductable the insurance will be $526 a month for 80/20 policy. FYI. So hears to hoping that I get a full time direct job with benefits before my COBRA runs out!

What reasons were you denied whether it was the first time second time etc? What did you have to do to get the insurance to reverse their decision?

Does anyone know what Cigna requires to be approved for the sleeve. I have a band and would like it out and am thinking about the sleeve. I have gotten my first denial letter and they said they wont take out my band because the is nothing technically wrong with it. Apparently my suffering and new hiatal hernia from the band doesn't seem to matter. I was going to file an appeal, however, I wanted to see what I need to give them to get this approved.

Hey all, My husband and I are doing the 6 month Dr. supervised stuff right now for Cigna. On the first official meeting my doc filled out the appropriate paper and then we scheduled the next 5 appointments. What I realized is that there will be 6 papers but it would only represent 5 months of monitoring....do you have to go for 7 actual appointments? Another thought is that I went in for an appointment before the first official appointment to discuss what we would do for the insurance requirements and would this count? If so does the dr send in a copy of the office note or a letter or what???? Thanks, Tracy

I've seen some people talking about a max their insurance will pay for the surgery. Does anyone that has Aetna know if they have a max? Thanks!