Insurance & Financing

Ok, so all of my Pre-op approval appointments are complete, and I have met with every person in the state of VA, to get cleared lol. My papers were submitted yesterday, and I have my fingers crossed to get my approval. I really hope this works, My surgeon has a "proposed" surgery date of 8/26....

Hi to you all. I NEED your help. My surgeon wants to send a letter from my PCP saying why he thinks I need VSG. Soooooo he ask me what do you want me to say. I know on here somewhere there was a "dummy" letter that someone had one here and it was kinda fill in the blanks kinda thing. And some of you are better at this than we are so will you please help me???? Thanks much. My surgeon will be sending all my info to the ins. company the first week in Sept, so it will be here in no time. THANK you all sooooo much.

I posted this in the pre op area too, but i guess it is more fitting here....I am fortunate enough that my insurance company pays for 100% of the surgery if I jump threw a few hoops. The main one being "documentation of a successful completion of at least 6 consecutive months of supervised conservative weight loss program ( e.g. weight watchers, jenny Craig, etc)." Have any of you had to do this? Suggestions? Also, I have done many of these programs in the past with temporary success. My fear is if I lose 40+ lbs, I won’t have a eligible BMI, then what? Thanks!!

I started on this journey back in January 2010 and I'm still on the road keeping my prayers focused on my goal. I completed all my task and requirements by the end of March so my paperwork was submited and DENIED. I was denied because United Health Care claimed that I didn't have five years of documented weight history. So I gathered up all my medical files for the last 10 years and sent them over yesterday July 21. I just need somebody other than me to pray about this decision and keep me uplifted because my hope is going down slow. What do you think of this letter? Dear Medical Appeals Division, I am writing this letter to appeal the United Health Care decision to …

Has anyone recently been approve by Anthem bc/bs PPO CA? I'm waiting for my approval and was wondering if Anthem is quick with their response. Anxious!! Jessie!

So I have insurance, GREAT insurance at that. I work in a hospital for god's sake! And I called today to see if my surgery would be covered, and they said it would be after I've been an employee for 3+ years. Thats 21 months away! Are you kidding me?! I can't afford to wait 2 more years! I'll be a monster! Hell, I already am a monster. If my nephew asks me one more time when I'm going to have my baby I'm going to kill him. I love him to death but every time I feel like crying. Has anyone else had this issue with having to hold the insurance for 3 years before approval? Is there any way around it? I cant do 2 more years like this! I was hoping to get banded in September fo…

Has anyone had any experience with the United Health Choice HMO in Florida? Specifically going through their Bariatric Resource center? I'm just wondering what kinds of things they want to approve someone. I'm supposed to get a call from their case manager sometime tomorrow or the next day. I'm really worried because I've only been "morbidly" obese for about 2 or 3 years, and just obese before that.

Hi - Can anyone tell me if I have my lapband done in Mexico and then travel to the US and there happens to be a complication resulting from my procedure whether I could get coverage? I am from Canada. Thank you

I have been waiting for insurance approval for 3 weeks now and I am wondering if this is a normal wait time or if I should be concerned?!?!? I am in Arizona with a BC/BS insurance with a Zenith Administrator.......if anyone has any advice please calm my nerves :party:

Yepp, yep, yepperoni.... :w00t: I have my surgery date. Believe it or not, its on my BIRTHDAY, Sept 29!! I have been on the diet plan for about a month.... I am excited. (>|<)

I'm starting the process of getting the LB surgery approved by my insurance. I have Cigna, and was curious if anyone else has had issues getting approved?

Just wondering what you were told about coverage for VSG???? Thanks everyone!

Hi all, I cannot find any info on this site of anyone dealing with Harvard Pilgrim for this surgery, more specifically a band to sleeve revision.. My surgeon has approved me for this revision and said he is willing to help me fight to get it. I am no stranger to this site as I followed it over from lapbandtalk.com when I saw how many people were getting revisions and having beter success. The hunger with the band is killing me, and the constant fill/ unfill process is getting old. I am over the extremes of starving or sliming.. And always feeling hungry.. My doc feels as though the sleeve would be a better choice to address the hunger issues. I have lost 50lbs with the ba…

:001_tongue:I just had my 6 month visit with the Dr for my supervised diet plan. Got my pulmonary clearance, referral to the Bariatric surgeon (this was just an insurance requirement, he knew my intentions from the first visit), letter of medical necessity, and 7 months of notes faxed to the Bariatric Surgeons office. Now I wait to see how long it will take them to submit or if they need any other information. The 6 months diet hasn't been too bad. The time actually flew by. Only lost 7 pounds but at least it was a loss. So now I wait........

I was approved for the Lap RNY Gastric By-Pass on June 18, but my surgeon (Dr. Foreman of Al. Surgical Associates Bariatric Program) insisted I lose 30 lbs prior to surgery. So this is where I'm presently at - in the middle of trying to lose 30 lbs. At the time of my consult (Aug 2009) I weighed 371 lbs and was told I had a pre-exisitng condition that would not lift until May 26th of 2010. So I began my BC/BS required 7 office visits in 180 days prior to pre-approval submission for surgery. Since Aug 09 I had gained up to 393. So not only do I have to lose down from that to 371 I then have to lose 30lbs before surgery. :-( When I met with Dr. Foreman I clearly rem…

Newbie here....Regarding insurance...my doctor's office said my insurance (BCBS IL) is now approving the sleeve, however, most company plans haven't caught up with the insurance company, and the sleeve is still being denied due to the companies not reviewing their policies and adjusting them to reflect the ins. company. Has anyone encountered this? If so, is there possibility of appeal? To whom does the appeal go...the company or the insurance company? Thanks for any input.

Hi, I have been doing all the pre op testing in order to get my band. I found out a couple days ago that my job is switching insurance companies on September 1st. So here is what I am worried about, would there be any wait time with a new insurance, or if I have all my testing done already it should be ok for them to just do the approval? I plan to have all the tests done before September, I am going on vacation last week in AUgust and coming back September 2nd, so I planned to try to get approved when I come back. Please if you have any info, let me know, I am very worried this will make me wait to get it done.

Anyone know if General Motors insurance out of the Kansas City plant covers the Lapband?

Does anyone have Blue Care Network (HMO)? What was the criteria for the surgury? Did you have to do 6months of jumping through hoops and diets or did they just aprove it with weight related health issues. I have called my insurance customer service and was told yes they cover it if you have : High blood presure, diabetes, of which I have all of them. She said my doctor would tell me what is the list of requirements. He didn't tell me, he just said to make an appt for the seminar and then the surgeon. My seminar is 8/18/08. I am excited. So,,, any info from fellow BCN insurers. Thanks.....

I am happy that this journey to the middle is about to happen. I should get my surgery date next week. :thumbup:

So I got denied the first time because my insurance company AETNA needed 3 weights for 3 yrs and in 2008 my bmi was less then 40!!! so I gave my docs weights for 2005 and 2006 and prayed to get approved but once again I got denied!!!! so my question is.... is is possibly to put it in the 3rd time cause now I found a weight that was high in 2008!!! or after 2 trys do they drop ur case??? if anyone knows plzs let me know im driving myself crazy!!!!

Well its been a long stressful road but finally after three years and countless hours on the phone I have been APPROVED!! BCBS IL has denied me 3 times this week just because the werent looking at the info. They denied me for not having the 6 month diet documentation and for it being investigational. I called them and told then the documentation was there and that they had changed their policy as of July 1st. So it was noted and sent back over. Then they denied it for not having any new additional info but they hadnt l,ooked at the info. Yet another call and sent back. The last time they even had a medical reviewer look at it before sending it for review and she said it l…

Does anyone know if BCBS HMO Covers LAP-BAND®, and the process that one must go through to start this? Whether it starts with the Primary Physician or, I am all sorts of confused here. OR would it be better to switch to the PPO then do it that way, my job offers both HMO and PPO. Not sure what would be better to do.

Health Select Insurance Hello, I have question. I work for the State of TX and have Health Select PPO insurance through my job. I am more than 100 lbs overweight, I have 2 drs my primary & my orthopedic who have written letters of medical necessity for the surgery. But the insurance reps I have talked to all say no way - never- they dont cover Weight Loss. Is there anyone out there who has this insurance thru the State Of TX that has been approved? IF yes could you provide me all the details & info? thanks, MB

OK i have bcbs of Tennessee but they don't cover the surgery they will pay the pre op testing so i still need 13000 Ive tried surgery loans they would give me 8000 i got denied from cosmeticredit I'm 21 i make 8.20 an hour full time i have an 801 credit score i got a $4000 car but i don't have nothing else no house or co signer and i cant afford more than $350 month thank you

I have Cigna insurance. They require 6 months of a supervised diet. My question is this, I first saw my diet doc on march 10th. Would 6 months be Augusts 10th or Sept 10th? :tongue_smilie: Any help would be greatly appreciated. My surgeon's office won't make an appt with me until Insurance is approved unless I want to pay for program fees up front. And if Ins doesn't cover There is no way I can afford surgery for at least another year. I know its splitting hairs but i would love to get the ball rolling here. Thanks in advance. Tracey

Hi All, I have Kaiser but do not qualify for the surgery through them my BMI is 36 they want 40 or 0ver unless you have diabetes which I don't so I will be self paying here in the states. My question is if I were to develop complications would I be able to have them treated through Kaiser or would it also end up being self pay? Also would I be able to apply the costs of the surgery to my deductible? Thanks Nancy

I have tufts and did the 6 months I can change program and was approved for surgery for Aug 23rd 2010 and now my insurance is changing on Aug 1st 2010 to Blue Cross Blue Shield Ma. Has anyone had their insurance change right before their surgery? Thank you

Yesterday I just finished my final test before True Results sends my information to the insurance company. I completed the 3 month diet, all heart and pyschological testing and my 3 year medical information was submitted. My question is this: Aetna says that unless you have a co-morbidity which I don't, you need to have a 40 plus BMI to qualify. Also, you must have that for the past three years. I'm unsure if I was over 40 BMI for ALL 3 years. More than likely I was at 40 for the last 2 years. What are my chances that I get approved? Has anybody been approved with having less than 40 BMI for any of their past 3 years? I'm so hoping to get good news but that really hur…

Does anyone have information that can help me? I called UPMC Health Plan (University of Pittsburgh) in January and asked if I was covered for the VSG. The answer was yes. I started my 6-month Pre-Surgical supervised diet, weight program; lost weight, lowered my blood glucose, had my psychological evaluation and even met the surgeon. I thought I was ready to go. At this time, I was told to call "again" because on February 5th 2010 UPMC stopped covering the VSG. This was confirmed by the Surgeon and his PA. I appealed. But of course my appeal was denied and I have no proof. Has anyone had a similar experience with UPMC and/or has anyone had the VSG procedure under the UPMC …

Anyone out there gone with Kaiser Palmdale/Lancaster for the VSG? How was it getting approved and how long was the process. Who was your DR? Were the classes available for after 5 or Saturdays (I work FT)? Thank you!

I was banded this year under my partner's insurance plan as a dependent. That insurance coverage option will no longer be available to me as of Jan. 2011 so I'll be opting back into my employer's medical coverage. I have two options under that plan - United Health Care PPO or UHC EPO. From what I understand both specifically exclude WLS. I've read conflicting information here though concerning what UHC covers. I've confirmed that my lap band surgeon is not included in either network. Am wondering whether post-surgical fills or follow-up visits will be included? There is no preexisting condition clause so that's not an issue. What I'm especially unclear on is whet…

Well I'm still waiting to hear from the MTF on Ft. Hood to see if they will do my sleeve, but in the meantime I called Willford Hall Clinic in SA (another MTF) and have already heard back from them. The surgeon said he would be willing to do my surgery!!! I'm so happy and excited that I have another option! She did say I pretty much have to start all over and go to 2 seminars there. Also they require a 6 month supervised diet. That is going to kill me but I will do what I have to do. Then after all that is done I will be put on the wait list and there is no time frame as to when my date will come. So I'm excited and happy that I have another option but on the other hand t…

Can anyone tell me if they had the same requirements as me for United Health Care and what was your experience as far as approval. Mine are BMI 40, 18 years of age, IN Network Hospital and Surgeon, 2 cormo-.

How much did your surgery cost out of pocket using Tricare STANDARD (not prime)? Just trying to get a handle on budgeting. Thanks!

It looks like I'll have to pay out of pocket for my surgery since as of right now, my primary carrier (Aetna) nor my secondary (Tricare) cover the procedure. It'll probably come to pass that either or both will start to cover the procedure soon but I'm not holding my breath. I, like many could easily say "I don't have the money" and put off the surgery and put off my health at the same time. I guess this means a trip to the credit union to borrow the money to get the procedure done. My question is this: Does anyone know if we pay out of pocket and later the insurance covers VSG, is reimbursement ever possible? Thanks in advance:))) Kimberly

I GOT MY APPROVAL FROM AETNA TWO DAYS AGO!! I actually called Aetna with a reference number my doctor's surgery cordinator gave me and they said it was still in pending status but it said "approval all". I was like yessss. Haha, I called back the next day, and it was completed--The information was sent from my doctor on the 18, and on Monday, it was approved. I did the 3 month diet. I'm 23, a mother of a one year old little boy. I've been overweight most of my life. Right now I'm at 324, and I'm 6'1. My BMI is 43. When I did the two year of weight history, I only submitted 3 sets of weights; I don't know what problems people had with Aetna approvals, but I was approved ri…

Hi my name is REbecca. I have a BMI of 37 with high cholesterol, Gerd, Anxiety, and Depression. I know that my insurance does not require a 6 month preop. I have already been to the seminar and meet with my surgeon tommorrow. My issue is that I do not have proof that ive been above 35 BMI for the past five years. I have been up and down and all around. If i go back 9 years i had a BMI of 39 but then lost and gained lost and gained. Has anyone had this issue and if so what was the outcome of insurance approval?? Any input would be great. Im really nervous about this whole approval process.

I got a call last wk from a hospital, that I was referred out to for bariatric surgery. I was confused because I thought I was going to have my surgery at an MTF. So I called the MTF and they said that because I have a nueromuscular disease they felt it would be best to refer me to somewhere else. The problem with this is that Tricare doesn't cover the sleeve off-post. She said my options are the lapband or bypass! I called the new hospital and they said I have to go to the seminar, fax over my pysch. eval and maybe have more tests like sleep test etc. I asked if they have heard of Tricare maybe covering the sleeve soon and they have not. So now I have no idea what to do?…

Hello All- Im a longtime lurker and decided to register and create a thread today... I'm aware all health plans vary however I wanted to put ease in someone elses mind who may have a similiar employer health plan as me. I have Blue Shield of CA Access+ HMOSM Plan 20. When inquiring about coverage for lapband and any and all prerequisites that would need to be completed prior to surgery, this was the response I received: "Thank you for your inquiry. Medically necessary bariatric surgery is covered under your health plan. Blue Shield will provide benefits for medically necessary inpatient or outpatient bariatric surgery procedures to treat morbid or clinically sev…

I was denied, appealed the denial, and my appeal was denied. All because of so very little. I met the criteria for 100 lb. overweight, but my comorbidity was "not severe enough". (sleep study showed sleep apnea requiring CPAP therapy but too low of a severity index for bariatric treatment. And I was 6 lb. under for 200% over ideal weight. My weight loss center was shocked. They said they've never seen such stringent policies. And I'm left fat. My surgery (which was supposed to be Friday) was cancelled. I'm trying so hard not to cry right now. :confused:

Of couse I was at work so I missed the call. It was the Aetna nurse. I did talk to the doc's insuracne person late tuesday so I assume she's submitted the revision paperwork - might Aetna be calling me to comfirm or praytell guild me thru the process? I will call on monday because she left her direct extention.

Hello, I have read this forum a handful of times and it looks like a great supportive community. So I weight about 400lbs and I am 6"1 so my BMI is way up there. I am going to go talk to a surgeon once I find out who is covered by my plan. I have an Atena PPO from my mother who works for UPS. I have had knee problems since 2003 and have had one operation, and many injuries over the years directly related to my knees and weight. I have had custom braces made and all sort of expensive things insurance has paid for X-Rays, MRI's and physical therapy. I do have some records I can get from my gym where I did got consistently for four months this last year, I got hurt in the wi…

Happy dance...I called and asked today just because I could'nt take it any longer and I'm approved...YAY!!! My surgery is scheduled for April 29th At Methodist Hospital in Houston(COE)..I wanted a different hospital but it's ok.. because I'm getting sleeved next week!!!Now i have to start making broth to freeze and clean house.Thanks guys for being here.Carla:lol0:

Hello, I was wondering if anyone has submitted for approval with Cigna lately. If you were approved: What did you have too submit for approval (How many appointments and with who) and when did you start the entire process? If you were denied: What reason did they give you (if you don't mind telling us). Thanks for your time and looking forward to hearing from other Cigna folks. Cathy

Just wondering if anyone has any experience with using it? Thanks!

Anybody whose insuance paid for gastric sleeve, even though they didnt have the bariatric/weight clause in their policy?

Hi everyone! I went to my first appointment today and found out my insurance requirements (I have United Healthcare Choice Plus) -- 40 BMI or 35-39 BMI with two comorbidities, and 5 year health history with 40 BMI. Today when I weighed I was at 40.5, and I know I was not that high through the last 5 years, although I am sure I was above 35. The only comorbidity I have is hypertension although they told me the insurance might not count it b/c I am not on meds. I am scheduled for a sleep study which might diagnose me with sleep apnea. Anyone think I have any chance of getting my insurance to approve? Thanks!

So I got approved same day at first I thought I wouldn't get approved but bcbs came through and my surgery date is ..... July 15 i have like 4 days till my surgery omg:D

I was wondering how ppl get the money to self pay? I will be a self payer also but can barley afford my bills right now as in having a child with disabilities. Any tips would be great! My credit is not so great so no financing for me. My insurance won't cover it either.