Insurance & Financing

Has anyone had the lap-band surgery and due to the finding and repairing of a hernia was able to get a portion of the procedure submitted to, and paid by, insurance after the fact?

Any regrets ? Anyone cheat?

Hey guys I sent my appeal letter to UHC on Thursday and I was told that they have 30 days to reply. Does anyone know if they usually take the full 30 days or if they normally move pretty fast.

I have United Health Care and they require a 6 month supervised diet and allow it to be 6 months of Weight Watchers. I am worried because I missed a few weigh ins during that time. Do you think they will deny me because I missed 3-4 weigh ins during a 6 month time period? I think now I should have just gone to my doctor 6 times instead of going to Weight Watchers every week for 6 months! It would have been so much easier!!!!!

Hello first blog. Consult in April nervou but excited. Does everyone exercise and do you have urge to indulge ( cheat)? Anyone truthfully have regrets? Please be honest. Tried so long to get rid of chic looking at me in mirror. Gained mad weight after having kids and want to get id of the fab fat. Need truth n encouragement. Peace

I had my last appointment today so supposedly they will submit my surgery to insurance for approval tomorrow. With my new UHC insurance they cover the surgery 100% after $250 deductable if you have a 5 year history of obesity AND a BMI of 35 or greater. I have met these requirements. I saw the surgeon for the first time 2/14/2011. Someone mentioned to me that since I am so new on my insurance policy that it might be denied due to pre-existing condition. I looked in my insurance book and here is what is says " Expenses incurred as a result of an injury or illness for which medical advise , diagnosis,care, or treatment was recommended or received during the six-month…

I am insured through my work by Blue Cross Blue Shield of Illinois PPO and I am just in the beginning stages of the whole process (as some may have read in my introduction post). I am 22 years old and have a BMI of 48.5. I went to my PCP last Friday and he referred me to the local WLS surgeons. They faxed my info to the Bariatric center on Monday and the Bariatric center called me and scheduled a Lap-Band seminar which is next Tuesday (10/13). I'm pretty excited about the seminar, I just want to get the whole thing under way! I read that in July BCBSIL dropped the 5 year history and changed the 6 months supervised diet to 3 months, can anyone verify this? What else…

does anyone have this insurance- just wondering how long it took them to approve you from when it was turned in? Thanks.

Hello Everyone, I am going for my lap band consult on thursday. I have 2 insurance. Empire Blue Cross PPO (Primary) and Pennsylvania Capital Blue Cross PPO (Secondary). .The surgeon that I really want to use is a participating provider for Empire Blue,however where he would do the lap band procedure where he could do it (The hospital that is) is considered out network and they said I would have co insurance and I have to pay 30% out of pocket However with Capital Blue Cross which is secondary covers everything doctor is provider and is considered IN NETWORK for everything I'm trying to find out if capital blue cross would covere the di…

My center of excellence had my information for over 21 days and had many "glitches" in the way of it being submitted to insurance. Others were in line in front of me, I had to do an additional month with the NUT because I only lost 4.5 pounds during the 6 months of visits, they went through a computer conversion etc, etc, etc.... I was in contact the with bariatric coordnator weekly because I had not heard anything about it being submitted to insurance. I spoke with the coordnator via email this morning and she stated she would ask transcriptioning to type up my letter today to be sent. Well, only 3 hours after I received that email I got a phone call from my case ma…

Last year, I was told 100% coverage with Aetna. I call today to check on hospital and bennies were changed with the new year. Now it is 20% of my Dr's fees ($425) AND $1,000 to the hospital. Money I DO NOT have! FK. Nowww what. Grrrrrr. . ..update:,They might bill me for the $400 to the Dr. I hope..course, my Dr. will likely just get it from me on my pre-op appointment. Also, I have to get Cobra since my hubby is about to lose WLS insurance, I'll probably do one month or two of Cobra, just to make sure I'm covered, since the new insurance doesn't have any. "Luckily" the Cobra is only $400 for just me, much better than the $1,200 we were expecting. I also found tha…

Hello everyone... i just recently was put on my husbands ins. and looked to see if there was a way to get the lapband surgery. When I was reading it over I seen there was an exclusion that they do not cover services and supplies related to obesity, including surgical or other treatment of morbid obesity, this right away made me unhappy. I am 28 years old soon to be 29 and 5'6 and 396 pounds. I would say that I am WAYYYYYYYYYYYYYYYYYYYYY over weight. I dont think I can afford to go pay for it out of pocket at the moment. What I wanted to know is does anyone else have BC/BS of Texas PPO and have you gotten approved. Please all help would be nice . Thanks in advanced I would…

ins (bc/bs Minnesota) approval was sent in 2-17 so its only been a week. But i have been reading some people hear back as early as a few hours. I am worried because i have no other comorbidities to go along with my bmi of 40. I would appreciate any thoughts.....

Has anyone been able to appeal the 6 month waiting period for surgery? Already had sleep study, (severe apnea), and have letters from 2 of my doctors. I am getting appointment for EDG tomorrow. These are tests that I needed anyway since I am having more problems with headaches, fatigue, GERD, etc. I have 2 policies, but one has total exclusion of gastric surgery. The other pays 80/20, but has 6 months supervised MD visits before approval. I don't think my health will hold out another 6 months. Will a letter do any good? Has anyone written personal letters to the insurance company? The more I try to get testing and jump through hoops, the more depressed I am getti…

Hello everyone, I am in the process of an appeal and was wondering if anyone had any good thoughts or comments that I can put in my letter? I will actually be writing to the president of the union and his assistant,so it has to be very informative and have some good information in it.Thanks

I'm a week away from meeting/counsultation with the surgeon and submitting my paperwork for approval - after I had successfully transfered all my paperwork from my previous HCP to UHC PPO. My Nurse Manager who is handling my case stated that for my plan I need to provide a five year weight history - ok no problem right? Now she tells me: I need to make sure that my weigh ins are not a BMI below 40, which would be a weight below 280. And that UHC could use this as a reason to deny surgery stating you have not been severely obese for 5 years. REALLY! I'm very discouraged right now I can't even put this into words! Does anyone on here have UHC PPO Choice Plus who …

Was just curious if anyone has UHC and is under a policy through AT&T?

Got the good news yesterday morning...I'm approved to have the VSG surgery! I have United Healthcare and it took them 2 weeks to approve me. I'm very excited!

I am seriously considering lap band surgery and it is covered by my insurance, but the Dr I want to go to does not bill insurance himself. I would have to pay upfront and file the claim to my insurance myself. Has anyone ever done this? Is it difficult? Do they make you jump through hoops? I've downloaded some information but not enough to tell me what I need to file and when. I still need to hash that out and I was just curious if anyone else had done it and if it was difficult.

I have Highmark bc/bs of Pittsburgh, all my information had to be mailed they would not take fax, Dr office says it was mailed on January 8th insurance claims it was not recieved till the 24th of January, has anyone ever dealt with them waiting on approval, must get done before Feb 28th, my job changes to another company and new insurance, then if I dont get done by 28th will have to wait till new insurance kicks in April, have already paid my deductible for 2011 and most of my coinsurance, dont want to start over, I have called 2x they tell me it can take 6 weeks my handbook says they have 15 days to give a approval or denial. anyone ever deal with them... ??????? Really…

Hi All, I have BCBS- Federal and was wondering if anyone else has them and how hard/easy it was to get approved for VSG with them? Any advise or experience would be greatly appreciated! Thanks, Stacy

Please I hope no one jumps down my throat because I did search before posting this but could not find any answers in skimming about 6 pages. My question is if the surgery is covered by insurance (in my case Aetna at 90% after deductible) how do they cover fills? Is it treated like a regular office visit with copay or do I have to pay them out of pocket? I will be asking the surgeon's office but hoped someone had some info before then. I realize that all ins. may be different but if I could just get an idea I would feel a lot better. Thanks!

Hey there, I wanted to know if anyone has gotten approved with UHC Choice Plus (PPO). if so, how long did it take? Also, I am missing some of my 5 year weight history, and I know that my BMI was under 35 for some of the years. My current BMI is 44-45 and I have PCOS/Hypothyroidism/insulin resistant. Has anyone been approved on weight/BMI alone, or submitted to insurance without a complete history. My patient advocate said my insurance is wonderful and feels i will have no problems getting approved. I am just getting a little anxious about the entire process as I am hoping I will get approved. Thanks, Courtney

I've been denied twice for VSG by BCBS. Both times they are saying I didn't have the minimun BMI 40. At my initial consult with my surgeon my BMI was 40.5. BCBS required I follow a 3 month medically supervised diet. In which time, I lost some weigh. Now they're saying I don't qualify!! I'm going to call BCBS & discuss this with them. I've never spoke with rthem before. Anyone have tips, suggests, experiance?? Thanks fo much!

I am tentatively scheduled for surgery mid March. Having stumbled onto a couple of posts last night about people not being able to get insurance after being banded I suddenly had a bad feeling. The money guy at my work had mentioned looking into different insurance later this year. We are currently with Blue Cross Selections but my surgery will be a self pay. I am presuming that I cannot be removed from my current insurance because I have the procedure. My guess is that people are having trouble when they go to change coverage after the procedure. I have seen some things about having to be 3 years out from surgery to get an individual policy and such I am just u…

Hi, Cigna policy states weight watchers is an "accepted alternative" if done in conjunction with the supervision of a physician do you need to provide the weight watchers stamped book of attendance and then proof that you had doctor visits as well? I am a little confused as to what will satisfy requirements. Any insight would be greatly appreciated! Thank you!

Hello. Just wondering how long it took for folks to be approved once everything was submitted to the insurance companies. And then, how long was it before your surgery date? Thanks!! Melissa

Which plan of either Aetna or United covers the surgery for the sleeve? I'm getting so discouraged, I don't feel like I'll ever be able to get this weight off of me.

I have found out that my policy does not cover the gastric sleeve surgery. But I'm wondering if my doctor were to write a letter to the insurance company on my behalf explaining my health issues, etc if that would make any difference? I need all of the help/information I can get.

Hello everyone, I wanted to ask if anyone with kaiser norther california has recently had the lap band? How was the process ? was it approved? I have gone to the orientation,several other classes in roseville, and also did the pshyc evaluation. My primary dr already did the referral..but sadly got denied. My bmi is 39 with no co/morbites ..it was at 40..but I was working out and have lost a little bit of weight....is there any chance that kaiser will pay for it? please help..I need to know..what to do to apeal the process and how to do it. Any suggestion of how to apeal? Kaiser is such a complicated insurance... thank u for taking time to read this post...

UHC approved in 1 day!!!!!!!!!!! I have to do pre-op testing before they will schedule surgery ~still very exciting!!!

Hello every one .. Does any one have this type of Aetna HMO? if so ,was it easy getting approved for the LapBand? What are some of the reasons they give why they will not approve you for surgery? I know you need a letter from your PCP, But can I also write giving my reasons also why I need the Lap Band? All the info that you can give , would be great. I'm stressing so bad over this and I have not even submitted my forms yet. lol

There is something in the insurance that says you have to have tried other weight loss methods that failed before. Do you have to prove that you've done Weight Watchers or whatever or can you just say it? I'm just wondering if I should go try to dig up my old WW journal or some receipts from buying Slim Fast or whatever.

I have had my surgery in October and already paid $450 up front and $250 deposit to my surgeon. I have to pay 2,200$ co-pay for the surgery, and a couple hundred for the anestezia. The question is - what kind of programms are out there to be able to put all the bills together and have one summ payment every month that you can afford? I do not want to pay too much to be able to do that too. I can pay some accounts in full as they come and pay some portions of the other accounts over time. I need some ideas and names. I am not sure what the rules of this website is but if you don't think that you can post it here just try and write a private message to me. ( I am no…

Does anyone have experience dealing with Anthem BCBS of MISSOURI? Thanks, Tina

just got done calling around getting ready for my consult next week. and i have a list of the requirements that they have. so i figured id post them if anyone needed this information, referral from pcp 3 month supervised diet (3 consecutive months of weigh-ins) cardio, pulmonary, psyc evals 1 meeting with nutritionist(not covered by insurance, the person im seeing is 60$) bloodwork those are the basics, your surgeon might call for more testing based on their requirements, but i see alot of people posting looking for insurance info so i posted what i found out

I wanted to see how much you paid out of pocket to the hospital and sugeon?I hope to find this information out today.

So excited that I got approved today after waiting only one week! I am so happy and am not hiding this from anyone. I am not doing this in secret as I am not ashamed that this is what it is going to take for me to get this weight off. Can't wait to tell my husband and talk to my awesome surgeon! Ready for this journey...

I have Harvard Pilgrim and will likely have to self pay -- BMI 37 w/ 1 co-morbidity of sleep apnea. My question is if I have the sleeve self pay and anything goes wrong post surgery, will insurance cover any compliacations if they didn't cover the sleeve surgery in the first place?

Need advise on how to proceed getting insurance to approve/pay for replacement lapband. Original lapband wasn't working. Went into surgery to have it repaired or replaced, but lazy surgeon took it out instead of replacing it. I asked him why; said that he didn't have authorization. That was a lie...I talked to the insurance company and he had authorization. It has been 1.5 years since he took it out. It has taken me this long to get up enough trust to go back to talk with another surgeon to get it replaced. Not back to my original weight (10 lbs shy). Insurance says I don't meet criteria. What options do I have to get them to pay for it to be replaced? They were…

Ok I have jumped through every hoop Dr. Baker's office has dished. I've done all the crap my insurance required. I've played by the rules and still get kicked in the teeth. By my insurance company.... No not at all. !!! By my doctor's office. My insurance was never contacted for preapproval. My patient coordinator knew I needed to have surgery the first week in March due to my husband having his first hip replaced at the end of March. I've been dealing with them since Dec. My appt with Dr. Baker was Feb 1st. My coworker who hasn't even finished all his requirements gets a call Tuesday with her surgery schedule. Exact same insurance and saw him the exact same day. Only …

Hi. Just starting to think about thisw surgery. I am weigh 250lbs. and have BMI of 40. No other health problems. Will Tricare standard approve this? What are my first steps in this process? Anyone know good surgeons in the Tacoma area? Thanks for any info.

I have been considering this for years, but I would always say let me try one more time with a new diet... So this morning I said the heck with this I need to call the insurance co. and find out what I need to do... I picked Dr. Pomp @ cornell I have met him before ( my husband works with him ) I want to make sure I have everything with me before I have my consult with him in January 1) UHC said I need a Pre Determination Letter who does that come from the surgeon or my PCP because my PCP is against elective surgery when I saw her 2 mos ago and told her I was considering it she wasn't happy and gave me a lecture, so I don't know how she is going to feel about wr…

My carrier, Independent Health does cover Vertical Sleeve, and my BMI is certainly high enough (50+). They do require a pre-surgery weight loss of 5% starting weight. Last time I was at the surgeons office he gave me a hard time because I barely lost anything. I am journaling, exercising, and have been eating right. I keep getting depressed because I'm so afraid that when I go back on february 17 that he'll put me on the backburner and make me wait forever. Self-pay for this surgery, including the hospital stay and necessary consults is $29,000. If I can't lose this 5% by then (it's been 3 months of dieting like this), can I ask him to make a petition to my insu…

How to Get Your Health Insurance to Pay for Your Vertical Sleeve Gastrectomy By food that a person can eat. In addition, the part of the stomach that is removed is the part of the stomach that produces the hormone ghrelin, which stimulates feelings of hunger. Removing that part of the stomach reduces the appetite. It is an effective treatment for morbid obesity, but it is very expensive. Difficulty: Challenging Instructions 1Call your sleep apnea, diabetes, or high blood pressure. You may also have to have a documented history of obesity going back several years. There may be other requirements, as well. 5Study the criteria your insurance company sends you and s…

I have looked everywhere and I havent come across weather or not avmed helps or does lapband? help please

I've been denied twice for VSG by BCBS. Both times they are saying I didn't have the minimun BMI 40. At my initial consult with my surgeon my BMI was 40.5. BCBS required I follow a 3 month medically supervised diet. In which time, I lost some weigh. Now they're saying I don't qualify!! I'm going to call BCBS & discuss this with them. I've never spoke with rthem before. Anyone have tips, suggests, experiance?? Thanks fo much!

Hello!! I have been doing some reasearch and was wondering if anyone had any luck with United Healthcare Insurance. I also would like some information on how to go about seeing if I am a covered candidate for VSG. Thanks, Margoboo

Question...I have PCOS, and the only way to lessen the symptoms is to lose weight. PCOS makes it EXTREMELY difficult to get pregnant. At this weight, I am pretty much guaranteed not to get pregnant. Could having this speed up the approval process of having the Lap Band done...skipping the 6 month waiting period?