Insurance & Financing

I have BC/BS of tennesse and they don't cover the sleeve cause it's "experimental" except for 1 group of people (but they won't tell me). Any ideas of when they would cover the sleeve versus the bypass?

I AM SO EXCITED (that's why I am yelling)!!!!! I got my insurance approval today!!! Surgery will most likely be during the first or second week of March. BCBS worked way faster than I thought they would. THANK YOU JESUS!!!

My doctors office was waiting on my primary doctor to fax them the needed information so I politely called my PCP and spoke with the receptionist and she said she would fax it over now. My job schedule requires a 6 week advance notice. I already put in for feb 1 thru 10th on good faith. Prayerfully next week I will hear something so that I can at least have it before I have to wait until the next schedule is put out.... I understand that the office staff have a load of cases to do but at the same time I do not want my caseworker to stop the ball from rolling. Patience is truly a virtue. I am staying prayed up that God allows the insurance to give a speedy O.K. for this…

im starting the process with insurance. BCBS in kentucky just flat out said we dont cover it. but they dont know any details of my weight and health issues, and that two doctors highly recommend it for me. i believe the next step is to talk to my HR department at work to see if they do? so basically, to me, it seems ill either a) have to switch insurances...or theyll approve it but only with a 6 month diet, which to me is not okay. ive been "dieting" my entire life and here i am, 5'4 weighing 296. anyone know if there is a way around the 6 month diet? is there standards i may meet to NOT have to do it?

Hello I am new to this. My name is Lisa and I just recently got approved for low income medicaid (Peach State) in Georgia after having my son. I gained alot of weight after pregnancy and now I have high blood pressure and borderline diabetic. I have a couple of questions to ask. :thumbup: First I wanted to know if Peach State will approve lap band surgery? Also if you're in the Macon area or in anywhere else in Georgia are there any doctors you can recommend that take this? I appreciate any help or advice!

Well I called today for an update on the insurance status.The received my information on the 21st.As of the 26th they have transferred my info to the precertification department for review.I hope it does not take much longer.I am so NERVOUS.I am with Aetna PPO.

SO I finally finish all my requirements after many months of appointments and as the doctor's office is getting ready to submit my paperwork to insurance- they say I may not be approved because I don't have 3 consecutive years proving my weight/BMI. Ok so I have a high BMI documented in 2008, 2010, and 2011. For some odd reason I never went to the doctor in 2009 and therefore do not have my weight recorded for that year- and because of this I may not be approved. I would have to wait a whole year to try again if it is denied for that reason. I had wanted to wait until June/July to have the surgery but due to my endoscopy showing ulcers and hernia the surgeon wanted it ru…

I spoke to a Penny (customer service Rep) today, had some more specific questions on my financial responsibilities, and also asked her where I could find information on the requirements for qualifying for this surgery. I thought I would share this here in case anyone else might have an interest/ need. http://www.aetna.com/healthcare-professionals/policies-guidelines/medical_clinical_policy_bulletins.html Then, just type in the type of procedure you want information on. Type in Obesity Surgery and it will come up. You can also type in Gastric Sleeve and it will bring up pretty much the same search information. Hope this helps others. It read a little confusing…

I have UHC EPO and I was wondering if anyone had a hard time getting approved. I don't have the whole 5 year weight history because I didn't have any insurance. Any advice would help!

I did some digging and got proof that I attended a weight loss clinic early in 2010. The records have cpt codes on them and the dates I attended. It doesn't list the name of the center or a contact number. Is the insurance company going to need to contact the center or do they just look over it to see that you tried to lose weight?

So finally my surgeons office answers my email! And they submitted all of my info (yay) only to get an email from Anthem BCBS that they need to submit it to another department! So again the wait is on...she said I should hear somthing within the week...com'on now! I'm anxious!

I am curious to know what your total out of pocket expense was for your VSG surgery after your insurance policy paid up. I myself did self pay for $5000 plus another $500 or so for travel and lodging. I did not pursue insurance because I did not want to wait for approval, my health was declining fast.

so, I haven't gotten to the insurabnce submission step yet (within days)...but the insurance coordinator at the clinic I'm going to has told me that most requests they make for my particular insurance are denied without a comorbidity (either uncontrolled diabetes, uncontrolled high blood pressure, or sleep apnea) even with a BMI >50. Isn't the band generally considered medically necessary for a BMI >40 without a comorbidity? While my BP has been creeping up, I'm not on meds and it's certainly not "uncontrolled," and I do not yet have type II diabetes. I went in sunday night for a sleep study but don;t get the results till Thursday. If it shows apnea, it's an almo…

Who is the best person to call to find out if I will have to pay anything out of pocket for my surgery? My surgeon's office or my insurance company?

So, I am still debating between VSG and the band. I have my surgeon picked out and just sent in my deposit. Also have a date! But I still am not 100% for one or the other. I am wondering if, at some point I need the band removed after I went out of the country to have it placed, and payed for it myself, is my insurance going to cover its removal and the associated costs? I know this is more of a question for my insurance carrier, but I thought I would ask here (since it's the weekend and they're closed and all). Thoughts?

ahhhh help!!! does anyone know if ky access covers weight loss surgery!? i dont want to call because wont they just think im trying to get it for tha reason?

Hey everyone! I am scheduled to attend a seminar at Riverside Hospital in Columbus, OH on 1/22. I have UHC and I've been reading about other people's experiences in regard to that provider. I'm kind of nervous that I may be denied coverage for the surgery, or I may have to wait 6 months or longer. If there is anyone on this forum that had their surgery in Ohio, or has UHC, could you please give me some guidance? Thank you!

Does anybody know if acid reflux/heartburn is considered a comorbidity? (I have Cigna insurance)

I know each insurance policy is different, but I am just wondering if anyone here has been approved by Aetna. Please read what I've done for my requirements and let me know if you think it's sufficient or not: - saw psychologist in November - saw nutritionist once a month for 3 months. Once in Nov, once in Dec, and once in Jan. - saw exercise therapist once a week for three months. She also documented what I did everytime I can in and worked out and documented our talks about nutrition. - filled out three months worth of food logs - went to two WLS support groups - I have 5 years of weight history, two years being morbidly obese - Upper GI appt. - EKG and chest x…

So I'm 2 weeks out from surgery today and I got the nicest call from my bariatric Nurse Case Manager. She was the one from UHC that 1. decided if I was 'eligible' and a good candidate for the surgery, and 2. the single person who decided YES or NO once my case was submitted from the surgeon's office. I had also a bariatric case manager who was much more accesible than the nurse, and my case manager was wonderful, answered any questions I had and sometimes would actually answer the phone, but always returned every call, etc. She called and left a very nice message on my cell phone the day of surgery wishing me good luck, etc. But the nurse I only spoke once to, and the…

My Kaiser *** plan changed a liitle this year, before it was only a $20 co-pay for surgery. Now it is....Bariatric Surgery (Inpatient)10.00% coinsurance.. Does anyone have the same plan and know what this means? And what was your out -of pocket expense? Thanks.

So, I got the list of requirements from UHC today. My plan requires a BMI of 40 or over, or a BMI of 35 to 40 with two co-morbidity conditions. My BMI is 40.8. Another requirement is one year of weight managment effort medically documented by my physician. Monthly visits were not required. I have never been in a medical weight loss program, but my doctor is well aware of my weight loss efforts. I have been seeing the same doctor since 2002, and we have discussed my weight at length. She referred me to Weight Watchers, as well as discussing diet and exercise. I have a gym membership and I am also registered with an online weight managment program (Spark people).…

HAs anyone appealed with Aetna after beeing denied?

I have my first consultation on Friday and I'm really worried my insurance won't pay for the sleeve because i haven't had a BMI of 40 for two years and I don't have any comorbidities with a lower BMI. Does anybody know if I self pay, and God forbid i have complications, will Cigna cover the hospital stay and/or additional surgeries?

I was approved today by Cigna. I was able to show I had a BMI of between 35-40 for past couple years. But the real thing was having a 6 month history of going through a doctor supervised diet. There was no way around this. I had gone to a place called Medi Weight Loss (Phentermine is really the secret - they give you suppresents and a very low calorie diet - but once you stop taking the pills......you get your appetite back!) So they will pay out of network costs (so roughly I will pay out of pocket about 50% of the fees). Anyway - my general doctor was very supportive. She gave a letter to my surgeon's office that recommended me having the surgery. I had to follow a…

Just trying to find out if anyone out here has gotten approval from Cigna with a BMI right at 40? My surgeons office has verified that I have the benefits without co mob..withBMI >40!!!

Im almost finished up with all my pre tsting , the only tjing left is to go see my pcp for the six month history and get my pretesting date ,

Just wondering if anyone has this insurance and if you had any problems with approval

Maybe someone with medicare can shed some light. I currently have United Healthcare through my husband's work. I am disabled and qualify for Medicare 4/1/11. If I start the process now having UHC..meet with surgeon, all the pre-op stuff, etc..will medicare help pay for the actual surgery when that time comes? If the starting process is up to 6 months or possibly longer, I'd like to at least get started now. I've seen the seminar, filled out the pre qualifying forms, waiting on appt with surgeon,,haven't gotten a call yet? I've already called UHC and they will cover lapband 80% if I qualify,,bmi is 43, i have comorbidities and past 10+ years of all my weight document…

BEWARE OF MyMedicalLoans.com I have had the most frustrating day dealing with this company and trying to get to the truth. I submitted for finance information from this company and in turn received an application from a company called CosemitiCredit. I was approved for $5000 and planned on using this money to put towards my sleeve. Remona (mymedicalloans.com) told me that my doctor had been paid and all was well. Well, I received a call from my patient coordinator Teri (love her) that payment had not been received for Dr. Rod. So we contact the bank WFNNB (the lender for cosmetic credit) and they let us know that $4978.59 was CHARGED to a Dr. Ramos-Kel…

Don't seem skeptical because I only have one post. I am known as ATLGirl on VerticalSleeveTalk. i just wanted to share my experience with everyone. Its all WLS love! BEWARE OF MyMedicalLoans.com I have had the most frustrating day dealing with this company and trying to get to the truth. I submitted for finance information from this company and in turn received an application from a company called CosemitiCredit. I was approved for $5000 and planned on using this money to put towards my sleeve. Remona (mymedicalloans.com) told me that my doctor had been paid and all was well. Well, I received a call from my patient coordinator Teri (love her) …

I've been reading a lot of people have trouble with insurance. I have a bmi of 43 recently diagnosed with high blood pressure & high cholesterol. Hoping insurance won't require the 3 or 6 month diet. Can anyone give me any insight?? Planning to call the insurance company Monday...

Hi All. I was told by my surgeons office that my "packet" went to Cigna yesterday. Cigna is one of 4 companies in VA that covers VSG. Yeah me (I hope) . Has anyone been approved by Cigna? What type of turn around time was it? My doctors office says about 4 weeks, but that seems extreme. When I was considering Lapband I was told by my prior surgeons office (I changed because he did not do VSG) that the turn around time for approval with Cigna was usually 3-4 days. Anyone have any idea? I really need to know about taking clients next month. Don't want to turn away paying clients, but am ready to schedule surgery ASAP.

Calling all Cigna folks....did you have to do 6 months of Dr. supervised diets prior to approval????? I read on the policy that over a certain BMI you don't have to....but the surgeon's office coordinator told me there are no exceptions for Cigna.....what do you all think? Thanks, Tracy

Just curious if anyone has experience with this loan company. I have seen lots of mixed reviews about them online and am currently waiting to hear back on my application. (they had to do a manual review).

Anybody have BCBS MI teamsters? If so did it cover the sleeve 100%?

I was able to get approved for the Realize band, and my insurance(Blue Cross Blue Shield of Delaware PPO) paid everything, without me needing "six months of nutritionist counseling". Because I used TheDailyPlate.com faithfully for over 6 months, (Actually over 2 years) They approved me, and waived the need for additional wait time / 6 months of counseling. You just have to fax your surgeon's office the FAQ on thedailyplate.com informational page. This is important because I saved a TON of money & time, by not needing to pay for a nutritionist, nor Weight Watchers Online. This program is very similar to Weight Watchers Online, but it's free! Love it, use it aft…

Ok, I'm looking at hospital and anesthesia bills of $13,000 that does NOT include the surgeon's fees. This $13,000 is my share AFTER insurance. On the docs website the cash pay price that covers everything is...wait for it... $12,200. I am practicing great self-control with my grammar so I do not get banned from VSG Talk. Lots of 4 letter words with a couple of 13 letter adjectives. Everybody was in network, deductibles and co-insurance met. I will be making some phone calls over the next few days. My 6 week follow-up is next week so I may have lots to talk about.

I am fuming! I did all my research prior to my testing and was told as long as it was medically necessary, they would approve the sleeve. Now I am being told it?s too new and considered investigative. I know other regions for BCBS Federal have covered the sleeve. I?ve talk to people on 2 different supports group, but I not necessarily in my state. I left a message with a rep to discuss but don?t know how far I will get. They will approve the bypass. I understand most sleeves are self pay, but I just think this is ridiculous!:cursing:

MY NAME IS MICKEY I WEIGHT 325 5 "9" FEELING REALLY DEPRESS CAUSE MY WEIGHT IS KEEPING ME DOWN I HAVE MEDCAID AND IM WANTED TO HAVE THE SURGERY. DOES ANY ONE NOW IF MEDCAID COVER MORBILY OBESE I HAVE HEART PROBLEMS AND KNEE PROBLEMS. I WANT TO HAVE SURGERY TO BETTER MY HEALTH THIS HAS BEEN A LONG LIFE BATTLE FOR ME.

Hi.... Is there any insurance anymore that covers this surgery. I want to find out which so I can seek a job that has that insurance. Yes.....I am that desperate for it. I have sleep apnea. I cannot afford it on my own as I have a child with a disability so there goes any extra cash which I am not complaining about. It just is what it is. Someone out there...please help. Thanks

I know every plan differs, but I just want some rough idea on how much I will need to come up with. I think my plan covers 85%. I was just wondering anyone who was Aetna, how much did you end up paying for everything?

Did anyone had trouble getting approved from Atena? I am doing the three month program,but I am having doubts that I will get denied.My PCP is not really on board with this wls,and I am noticing that she is not putting any notes in regards of weight loss the last two visits.My nut is fabulous,but my PCP is what i am worried about.I really don't want to be fat for another year lol.If anybody went through this please give me some insight.

So, long story short I was approved for in house financing through beliteweight. I contacted my coordinator after faxing in all of the documents they wanted (and they wanted EVERYTHING) to see if everything was in order, as I had faxed them in over a week prior and heard nothing from them. She sent me an email back saying that they got everything, and that everything was in order, but I needed to call this Jamie person in the finance department prior to booking my flight. This was last Friday morning, and I have called to reach this Jamie person several times a day since then and my calls have been unanswered/unreturned. Not only this, but today the phone only rings…

Hi everyone! I'm coming to vent a little. My case was first submitted for approval to UHC (Choice Plus PPO) in early November. I was denied (but never received a denial letter in the mail) because I did not have psych eval info or a 6 month diet. The psych eval had just been done and for some reason they hadn't received it yet, and I was told that the diet was not required (by 3 different reps). Just this week 2 different supervised diets were submitted (one while I was pregnant and the other when I was not, both took place in the last 2 years). My doctor thoroughly documented both diets and weights and everything. My psych eval was also re-sent. Now the NCM said she STIL…

So as of right now I have no health insurance. I work part time at my job so I don't get benefits. However, I'm 22 so I can get added to my parents insurance which is Health Plus in Michigan. I weigh about 360 and am only 5' 2". I really want to get lap band surgery but does anyone know or had any experience with Health Plus? Do they cover the cost or part of it? Any help would be really appreciated.

I received a letter from my insurance company (Health Partners) last week approving my surgery and verifying coverage. Today, however, some of my claims for pre-op orders and tests (ultrasound, EKG,, chest x-rays) were denied-for reasons due to pre-existing condition???? I'm confused-How can I be approved for the surgery and at the same time receive denials on claims for orders, tests and evaluations that are pre-requisites required by Health partners for approval. I did have a lapse in coverage and the only thing I did was get a health screening at a CVS minute clinic so that I could apply for insurance before I found my last job. It's very frustrating. If anyone kno…

I want to appeal the payment of the Anesthesia. They charged $2400.00 for their time in the OR and Aetna only paid then $30.00. So now they send me a bill for the rest. I want to appeal to Aetna to pay more or agree with the Anesthesia folks to accept another amount. I am not good at writing these things so looking for some advise. According to Aetna they do not have a contract with the Anesthesia company which is why they only paid $30.00. It's crazy that they have a contracts with the hospital, and the surgeons but not he Anesthesia company. You would think that they would all be in concert. Thanks in Advance.. Connie

bonjour ben on m'a conseillé la mutuelle de SwissLife mais j'ai besoin avant ça de vos avis cela m'intéresse beaucoup merci d'avance.

Has anybody gotten approved by COBRA for the VSG?