Insurance & Financing

I never post anything about my personal life. But, I am so upset. I just moved to Florida in November of last year for a job. Got laid off in Ohio (real estate field) and found an opportunity in Florida (very lucky). I originally got my Lap Band in 2007 at the Cleveland Clinic. I fought with the insurance company and did eventually win. It was "THE BEST" fight / decision I ever made. I lost 60% of my excess weight. So I am proud of myself for that accomplishment. In August of last year, after the death of my mother, when I am getting ready to move and "of course" when I had no insurance, I noticed that my perfect restriction was becoming less and less. I knew so…

I have finally talked to my insurance company. Humana Medicare Advantage covers everything else, but the sleeve. They have been studying it for two years and say that none of the top 5 Medicare Advantage Insurance providers cover it. Do any of you have an Advantage plan that has or is going to cover the Gastric Sleeve? If we could find Medicare Advantage companies that do cover the procedure and send that information to our individual companies perhaps we could make a difference! They also do not cover complications of the surgery. :smile::mad::sad0:

I just submitted my paperwork to my insurance yesterday (BC/BS of CA). Hopefully they will approve it. I am kind of scared that I will be denied because I really don’t have a primary doctor and just went to any doctor to get them to refer me for WLS. Hopefully this will be enough. Does anyone have BC/BS of CA? If so, can you please tell me if they approved you fast, did they require a lot from your primary doctor?

i am getting a lit confused. i keep hearing about medicare paying for surgery. i am 24 5'5 and wiegh 245lbs. i have back problems and knee problems. my bmi is 42 so under a group insurance i would quilify but i dont have a job that offers any insurance. i am a low income person and would love to her from someone that has had this type of situation!!

I recently made the decision that I would like to go through with this surgery, but only in the process of trying to get in to see my doctor. Basically I'm 18, 5'4'' and pushing something around 245, and have been for years. I have a BMI of at least 41, and incredibly high blood pressure. I've been trying to lose the weight for 5 years give or take. I've done as much research as I possibly could but I really don't know how to get this process started. All information I have come across has said that you have to be 18 for starters to qualify but would my age set me back at all from getting approved? I plan on seeing my doctor on the 22nd of April or sometime before. About …

I have BCBS/Illinois PPO. I talked to the insurance company and they informed me that they don't consider sleep apnea one of the co-morbidities for the weight loss surgery (otherwise I'm fairly healthy). My BMI is 45 and I meet all the other requirements. Was just wondering if anybody else has run into this problem.

Hello everyone. I'm new here and have read allot but never posted before. My question is if anyone here has BCBSNC or knows someone who has it and has been approved for VSG sugery. I see quite a few people here have BCBS of some sort but I have searched here but only came up with one post regarding BCBSNC. That person never said if it was ever approved. Anyway any info on this would be much appreciated. TIA Ted

I have been thinking of getting the lap band, but since have been looking into the VSG. My sister had the lap band several years ago and lost 60 lbs, but has gained most of it back. Does anyone know whether or not Tricare Standard covers this procedure. I know they cover the lap band, but I think I would prefer the Sleeve. Any help will be much appreciated. Oh, I live in the San Diego, Ca area.

Dear Sir or Madam, I am writing this letter to appeal your decision to deny my sleeve gastrectomy surgery with Dr. Minkin. I received the letter that United Healthcare sent on Feb.24, 2011. I have included a copy of that letter for your reference. The letter states that I have not met the criteria of "5 years documented morbid obesity." I am currently 25 years old and have been at least 100 pounds overweight since I was 18. I was referred for this surgery by my PCP, who is very concerned about my health because of severe morbid obesity. I am a 25 year old morbidly obese female who is 5 feet 2 inches tall and weigh 230 lbs., giving me a body mass index of 42.1. (…

I just canceled my lapband surgery which was to happen tomorrow. The Bariatric Center repeatedly advertised and stated in their printed literature that the Lap Band Procedure cost was approximately 20,000 dollars inclusive (as an outpatient). When I began the process for having the surgery I knew there was a possibility that I would be a self pay patient because I did not know if I met all the criteria to be covered by my health insurance. As it turned out my employer sponsored health insurance approved the procedure and my surgery was scheduled. I have already paid 2300.00 out of pocket to the surgeon for office visits, his portion of the surgery charges etc. I call…

Just an FYI in case anyone else searches (like I did). I was approved in 1 week. Pt. Coordinator from surgeon's office called with the news (haven't had any contact with insurance company) Had to submit PCP's letter of medical necessity and 5 yrs of drs visit recording of weight, plus a form letter (supplied by surgeon) with a list of the diets I had previously tried and note how my weight was adversely affecting my life. I have a BMI of 50, and comorbidities of high blood pressure & joint pain (knees/feet) Good Luck! Lori

Hello all. I'm kinda new here. I'm going through the process of getting together artifacts for what I think I need to be approved by my insurance company (UHC epo plan). I had a psych eval last year but I think I has expired so I'll probably get another one done.. I have some weight history but I don't have 5 years worth, which he insurance requires. Has anyone ever been approved with a spotty weight history with UHC? How do I know if the bariatric center I'm consulting with is even on the list of UHC suggested bariatric surgeons? If you don't have you weight history what can be done to still get approved. How difficult is it to get approved with UHC. I'm a guy s…

Why woud Medicare cover the Gastric Bypass surgery but not the less evasive one like The Gastric Sleeve.???????? can someone help me understand this? I have been waiting to get the sleeve since December 2010.........

I am so furious right now. I had a hard time getting approved for Lap Band because my insurance company just felt like dragging their feet, but I confirmed that I WAS approved for the surgery before I went under the knife. I just got a letter in the mail stating that my claim was denied because the surgery was not approved beforehand. WTF?

Greetings Everyone, Although I've been a fan of this site and have perused numerous posts for months, this is my first post. I've been wanting to post for awhile, but decided I'd wait until I received the green light from my insurance company (United Healthcare). All of my information was submitted two weeks ago, and yesterday, while at work, I received a voicemail from a UHC representative that simply stated the following: "This is Karen from United Health Care. This message is for (my name). Your surgery will be covered. Your surgery will be a covered benefit. Good luck to you. Bye bye." I read it a few times (google voice). Listened to it. Then played it ten mor…

It's been a while since I was here and I still haven't come up with a way to pay for my surgery. Has anyone come up with a way to get Medicare to pay?. I think that weight loss surgery should be accessible to everyone who needs it. The fact that I am medically excluded from being able to have the lap band and the gastric bypass shouldn't keep me from medical treatment that will vastly improve my health. It seems to me that the powers that be are playing God with our health. Those of us affected should unite but I don't where to start to motivate people to write legislator including the White House. I don't think one voice will do it, but that is my next step since Medicar…

I was just wondering if anyone else has Empire BCBS? Several BCBS companies changed their policy toward VSG, but mine hasn't. I'm just starting this process (just turned in my ins packet to my dr's office) and wondered if anyone had any experience dealing with Empire BCBS (mine is a select ppo). Thanks SO much!

Hi... I'm right at 40 BMI and actually had to gain weight in order to get to 40. I have BCBS-Fed and they require a 2 year weight history. Well, I have the history however my history only reflects me being at 36-38 BMI and I was wondering if anyone was denied by their insurance due to not being the 40BMI??? I dont have any co-morbidities but I do have GERD and a Hiatal Hernia but no diabeties or HBP. Any experience??

Hello all, I used these boards a lot to ease my mind when I was getting closer to my information being submitted for insurance approval, so I just wanted to share some information with all of you. For those of you with Horizon Blue Cross Blue Shield, they used to require 6 monthly visits, at least 30 days apart before your surgery could be submitted for insurance approval, they now require only 3 (they changed this rule in December 2010). Your initial consulatation visit with your surgeon does not count in these visits, it is 3 visits in addition. BCBS also requires a letter of medical necessity from your primary care provider, a one-time psychological evaluation lette…

Hi, I am waiting for approval from my insurance company, my paperwork was submitted on March 10 to BCBS. I just need to know if everyone called their insurance companies, I'm kind of afraid of being a pain in the butt, I'm scared they will boot me to the end of the line every time I call but this is the hardest part of the whole 6 month process.

HI all, I 'm new to this board. I orginally came from the lap band board, but have decided VSG is the way I want to go. Anyways, I have been reading all the posts about BCBS IL and am quite discouraged at this point. My hub works for UPS and I was just wondering if anyone out there has the same ins with the same employer and what their story was. Thanks, Beth

So I have Federal BCBS. Last June started seeing a nutritionist in order to started on the process of getting WLS. In August I started seeing my metabolic dr who put me on weightless meds, a new exercise plan, etc. I did everything my doctors and insurance company told me to do to meet the surgery requirements. I had to do the standard "dr supervised diet and weight loss" for 6 months. I have lost almost nothing. Come February I made my appointment with the surgeon. I called my insurance company to make sure he was still covered (they don’t always update the website) and found out that all of the requirements had changed as of January 1st. Now it is 1 year of Dr S…

My insurance requires a 5 year history of obesity. I was assuming that meant the minimum BMI to be classified "obese". But the surgeon's office says it has to be a 5 year history of over a BMI of 40. I don't go to the doctor very often (typical male). So my weight checks are very limited, one per year if I was lucky. Well, my BMI was 40.1 in 2006, but it dropped to a low of 34.7 in 2007. In '08 it was about 35.9. By '09 and '10 I had a BMI over 40 again. So minus those two freak years, it has been over 40 for the past 5 years. I hope they don't give me any problems approving surgery because I had temporary success doing Weight Watchers. What have you exper…

hi im leslie, im pretty new to the concept of the lap band so forgive me if i ever ask a question that seems silly Im on Aetna NAP and during my meeting with my doctors insurance assistants, she mentioned that i could do the 3 month medically monitored diet as opposed to the 6 month version. Has any one had a hard time getting approved with the 3 month plan? i dont want to do anything wrong, so any advice would be great!

has anyone dealt with coventry POS of md or de , trying to start the lap band process, went for consultation and have a bmi of 40 with co morbidity of joint problems, has anyone had any experience with them ? If so did you get approval

After being denied by BCBS of NC I appealed twice and was finally approved. Please do not get discouraged if you are not approved on the first go-round. It is possible to change the insurance company's decision. I received some online help and gave some detailed information about myself and had my Drs write letters supporting me. So happy I continued for the second appeal......I was actually so discouraged after the second denial I was about to throw in the towel. Now I am approved -- horray! Going to see my surgeon on tuesday since it has been a long time since I've talked to him. Want to update him on my fears and concerns. Good Luck to all waiting for approval.

Well I have finally gotten to the point for sending papers in for approval to BCBS Highmark today!!!! After 7 months I am excited and stressed over waiting for approval. Here is my big frustration and I don't know what to do. The nurse asks me today If I have decided which procedure I have to do, now mind you this is the 4th time they have asked me that and I am still telling them lapband. She says to me that DR Rashid is not really doing too many of those procedures anymore because it doesn't work......What now....... I told her to put papers in for lapband.........I think I will prove them wrong..... Should I be concerned with his lack of confidence in the procedu…

I filled out the paperwork for the lap band surgery on Friday 1/14/2011. I hear it takes about 3 weeks for ODS to contact your doctor with an approval or denial. I have about two weeks to go as of 1/21/2011. I have PCOS and my OB/GYN and endocrinologist are both treating me for my weight problem. I am taking metformin 500 mg 3x's a day to aid in weight loss and preventive measure for diabetes. With these diagnosis combined I am being optimistic that the surgery will be approved. I will keep the Oregon/Washington residents updated. Weigh: 250 Height: 5'6 Preauth sent in:1/14/11

Ok so I'm fairly new to the Army life and Tricare and what not, but I just have a few questions regarding Tricare. (We are stationed at Fort Lewis, WA) I have an appointment at Madigan to discuss with my Doctor my eligiblity for the lap band on 4/4. I'm 21, 5'11" and 287lbs. Which is 200% overweight, I think. My BMI is 40 and I have no co-morbidities. I have a friend who is in a similar situation and she said they approved her fairly quickly, but she was on the waiting list for like 3 months and now she is taking all these classes and such. My biggest fear is that my Dr. is gonna tell me that I am ridiculous and I don't need the lap band. I have been overweight since I …

Wondering if anyone else was required to submit to Tricare - History of 6 mos medically supervised diet/exercise and 5 year history of 100lbs over ideal weight by PCM before you can get a referral? Also, has anyone read that effective March 16, 2011 Tricare will now accept BMI vs. Met life ideal weight?

Hello. I'm wondering about Aetna's insurance coverage for the sleeve. I have read the posts about Aetna, but here is my dilemma. I don't have insurance yet. My husband will be getting insurance through his work, but that won't be until June 1st. I wonder if I can call them and ask about our plan before it starts. No problem in trying I suppose. But what I'm really wondering is if I can start the three month pre-approval process before they even cover us? It's about 3 months until our coverage starts, so I was thinking during this time, I can get a jump on the process, by seeing a nut, doing exercises, logging my food, etc. I guess I just have to call them to f…

I'm doing this a little backwards: Self Pay...I have a surgery date 3.28.11 with Dr. Kelly in MX (Yay!) I have no Insurance, however I just applied to Kaiser. I am wondering if anyone if anyone else was in a similar situation and what the outcome for coverage was? Also, just a bit worried for after care here in the States. If I had to I could fly back to MX to be seen, however what about emergencies or routine follow up? Any insight or info is greatly appreciated! Heidi

I had my self-pay VSG done in Mexico Dec 9, 2009. My doctor has wrote the orders for my 3 month followup Baruium GI and blood work ~ should I get preapproval from my insurance company (Signa) or hope it will slide thru? What have others did?

I just talked to my insurance rep about approval on a policy after the fact of VSG. She told me that, first of all, if my BMI was over 40 that I was uninsurable. I am *right* at the line, just under 40, so the underwriters told her that I might not be approved anyway because I may be considered too close to the line. FACT 1: IF YOUR BMI IS OVER 40, YOU ARE POTENTIALLY UNINSURABLE BY MAINSTREAM CARRIERS She also told me that if I had already had VSG and I was applying for a policy and did not disclose it at time of application, on discovery the policy would be rescinded. FACT 2: IF YOU LIE TO PROSPECTIVE HEALTH INSURANCE CARRIERS, IF THEY FIND OUT THEY'LL CAN…

We sent my papers in to bc/bs of Mn on Feb 17. I spoke with the nurse 2 times over the last month and she assured me they received the fax and that it just takes time but she would call and double check with bc/bs. She called me back and said they didn't have everything they needed and couldn't read part of what they did have! So she re-sent them what they needed and now I will have to wait longer! I just have felt totally on hold for the last month. I have nothing to go with my bmi other than the length of time (2 years) - I know the end result is to lose weight and get healthy. But I feel like it will be easier with the help of the band. Right now I feel like I …

I had met all of my insurance requirements. According to my plan I must complete 6 months of diet visits and 6 months of support groups. I attended several different support groups in my area. My NCM told me that my groups were "unapproved" support groups therefore, she will not approve my case and will have to attend 6 additional months of "approved" support groups. I attended groups led by post op wls patients. UHC wants me to attend groups led by nurses, docs, or psychs. I am pissed at this point because I know coworkers that were approved with the same support groups but they had Cigna(same employer insurance). I can't believe a support group would stop me fro…

I have a letter from the insurance company today that says " we have approved your request to receive care as described above" and gives me a code for lap band and a start date and end date. I think that I am approved!!!! I am so excited and nervouse at the same time.

Believe it or not, I just got off the phone with a phone sales rep for Blue Cross Blue Shield Nebraska. I am applying for an affordable single policy now that I'm divorced and now that my kids have flown the coop -- and I told her I was considering weight loss surgery and I wanted to know if emergency serviices connected to surgery were covered. She said that if I had had gastric bypass surgery already, I would be considered UNINSURABLE by Blue Cross Blue Shield Nebraska. This is for gastric bypass surgery only. I told her I was not going to get gastric bypass surgery, but something called a vertical sleeve, and she said, well, that's a little different. But she did st…

Hello VSG world!. I have UHC (Gov't Employees Health Assn) PPO. In the literature for bariatrics they state that you must have a 6 month failed diet attempt. Does this mean you are not supposed to lose weight at all or that they consider losing 10 pounds in 6 months a failure? I am right at 40% bmi. My co-morbidities are Gerd,Joint Pain, Family History (mom and sister) of diabetes, heart disease and hbp,hiatal hernia. I did email the UHC coordinator but she did not give me a clear answer on if I can lose a few pounds or not. She just said it "should" be ok.. Sorry but "should" does not sit well with me in insurance situations. Has anyone on here been…

I have my initial appointment on Wednesday, I have my documented diet and exercise, but I'm wondering, has anyone been approved for VSG with BCBS of Michigan? I'm afraid that they will only pay for the Lapband and Bypass. Thank!

My case was submitted the first week of January and I am still waiting for a response. I am getting nervous. Why is it taking so long. I hope they don't take the whole 30 days to respond. I need this and I am praying for an approval.

Hi this is actually a repost I think I may have put the wrong name for my insurance. I am recently on Oxford Health Plan and I wanted to know if they will pay for the lapband surgery and what requirements they have. i had GHI CBP New York City workers and they want you do a lot before they will even consider you. I know I am probably paranoid but from what I have read Oxford has minimal requirements for approval. It looks too easy and you know what they say if it looks to go to be true it probably is. If anyone has this coverage and can shed some light on the subject I would greatly appreciate it. Thanks

I am in the process of trying to get approved. The doctor's office stated that I needed to have 6month journal of my weight on Weight Watchers or something similar. Honestly, I gave up on Weight Watchers and the like a couple of years ago. However, I do not want this to hinder my approval. Has anyone else had this recommendation? Anyone else on here approved by Blue Shield of CA for the Sleeve that can give me some good direction? Thanks so much in advance for you help! Jen

Does anyone have Paramount Elite Insurance in Ohio? Just wondering what your experiences are with the whole banding process, fills and costs etc.

I was told by my case manager that for people that go the self pay route that any complication from the lap band surgery will not be covered. Is that true. I h ave BCBS of Tennessee. I am being held up now because I did not have a 10% weight loss in the last 5 years. So they say I need to loose that 10%, before I qualify. However, that would put me out of the BMI range, even though I have several comorbidities. The did say that it would not be held against me. I could do it in the pre-op diet. Any thoughts?

If I am not approved by Aetena by the time my husband leaves full-time employment within days (which my Dr. thinks Aetna knows is about to happen, hence the wait), do i then have to re-apply thru COBRA? It is supposed to be a continuation of coverage, but is Cobra like it's own insurance company and thus could deny my request for VSG ? Additionally, the Hilton gives NO grace period. The day you leave full-time emp, is the day your bennies end. We can get COBRA, but we can't get COBRA until after he leaves the Hilton and they send us paperwork, so essential a gap in coverage (that is retro-active). So then I guess I'd have to make sure my surgery isn't right around that…

My surgery coordinator submitted my information to UHC for approval last Thursday, she said she will call them on Thursday to find out what they have to say. I am so excited/nervous! I really really hope that UHC approves me!

UHC has had all my info for a week now and still no answer. Just getting really frustrated. I'm usually a very patient person, but I am so anxious to find out if they are going to approve me or not. I think I have literally made myself sick worrying about what they are going to say. They said it could take up to 15 business days to make a decision, ugh!

I currently have GHI through my husband and I am signing up for United Healthcare/Oxford Liberty thru my job. I already know that GHI wants you to go through 6 mos medically supervised diet. Does anyone know what the requirements are for United Health/Oxford from what i'm reading it seems like a letter of medical neccessity and a BMI above 40. If anyone can shed some light on this please let me know I would appreciate it. Thanks

im going to my first bariatric meeting this wednesday, is there anything i need to know,and do's and don'ts?what about psychiatric evaluation?i'm afraid to say the wrong things and won't qualify for my lap band surgery