Insurance & Financing

Anybody have any experiences, advise, input on them? My insurance goes into effect with them on July 19 and i've yet to read about any WLS exclusions. My consult is July 26 with Dr. Pearlman in Denver...so excited! however just curious if anyone has had any dealings with them.

I live in Russellville, Arkansas . If anyone out there knows a secondary insurance that I can take out to pay the remaining 20% that Medicare doesn't pay Please let me know so I can check into it.. I have to find an insurance that will help because I can't come up with the remainder of the bill and my doctor has to have it before surgery.. If any one has any ideas... PLEASE let me know.. Thank you very much.

well, everything was going long fine, last week i went in for my last 6 month doctor diet visit. I was so happy! Well the surgerons office called me today and let me know that they recieved the notes from the regular doctor and guess what! He did not do the notes right!! He was only worried about the sugar and crap and for the first 4 months he did not put in the notes that I was there for weight loss program so I could get my surgery!! IF he is not willing to fix this I have to start over with another 4 months of visits.. He only documented May and June!! I can't stop crying, I have done everything I was suppose to do why did he not fill out the stupid notes right!:thum…

Hello, I finally got my insurance card for UHC! What is the first step I need to take to get the ball rolling for my surgery?

has anyone had any luck with BCBS of Tx. yet if so how did you do it..

Woohooo!!! I just got a call from my doctor's office and they got the approval fax this morning! I've been a very large, annoying, in-dire-need-of-oil squeeky wheel to Cigna. I submitted on 6/1. We'll set a date tomorrow! Woot woot!! I think I'll have my "last supper" tonight (before I start my pre-op diet). I'm thinking Texas Roadhouse w/ lots of butter and rolls. Oh, and a side of Coldstone Ice cream. :thumbup: Then, I'm turning my back to that junk FOREVER and EVER! Via con dios!

My BFF is 300lbs, 5'5", has had back and knee surgery, has diabetes, and everything else! She needs LBS!!! I had it last year and she just has ins issues! Finally her ins will pay $20,000! But we can't find anyone close that will do it for that!! She has bc/bs. We live in Colorado. Can anyone help with any advise or where ins would cover at that price???????? She cannot afford self pay.

My insurance cord. just called me and said my insurance would only pay for a lapband or bypass. They said if I wanted the sleeve I would have to be self pay. I am so sad and disappointed I could cry. She wants me to talk to the surgeon about it when I go for a visit before I decide what to do. I will have to pay alot of money at the visit. $250 consult $500 program fee $295 for Phych Eval. :tongue_smilie: Judy

I've written before about my insurance not covering any obesity services. Regardless, I've written to UHC to consider approving me anyway. It's a long shot but I don't have very many options. I also contacted hubby's HR to request that they cover obestiy services. It's unlikely that either of these will work and I'm very discouraged. I've asked hubby, "What other way can we do?" He suggest waiting for another year and saving income tax money. That would be another 10 months or so and I'd have to go to Mexico. I know this surgery is right for me and I just want to be on the other side. Our neighbor, who has a very good job, yesterday offered to hand hubby's resume into his…

I've never posted before, but have been enjoying reading about everyone else's victories and soaking in all the advice I can get. Unfortunately, my insurance denied VSG as "experimental or investigational". I did use my appeals, however I am not giving up that easily. Fortunately, my employer is open to helping me find a way for our insurance to justify covering the procedure - but under our current plan document guidelines. (We are a self-funded program.) I've been working with an insurance consultant to my employer (works for the pre-authorization co. who administers our plan) who is open to my feedback and has been researching alongside me. According to our plan …

Alright so here's what I've been dealing with. I cant afford insurance. So I applied through the state. DENIED! They say I make too much money, even though I make under their bracket. So I appealed...DENIED AGAIN! However they do say I qualify for Assistance if I'm on my Employers insurance. Which basically means they'll pay for anything my employers insurance wont cover. Which is cool I guess. Only problem is...I'm seriously torn here. My employer is my family, and although I qualify [work more than 40 hrs per week, been working over 6 years], I'm not particularly sure we can handle the financial burden on the business. If it were any other employer I wouldn't care…

New to this site. hope to have VGS. @ :thumbup:Washington Hosp center

43775 Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve gastrectomy) Source: http://www.hdmcorp.com/pdf/CPT%20Codes%20Effective%2001012010.pdf Now let's hope that more health plans will start considering the VGS a regular procedure and not "experimental and investigational"

:smile1: I am scheduled for my Upper GI on Friday ....(I so dread this -- but I will force myself to drink extra Water after - because the barium sticks to my small intestines like cement) My appointment with my Band Doc is on Thursday 7/8. I am getting my PCP letter and I will write a letter -- so all will be ready for my 7/8 appointment I am optimistic - but realistic but the good news is my insurance pays for a revision - so I am keeping my fingers crossed that he agrees my band problems warrant a revision at this time. How are the other AETNA insurance - revisions gals going with their process? Donna -- with a pain in the a** Lapband (2007) lost 80 - hopi…

Has anyone had their insurance company pay for band removal after complications when they self payed for the band? Thanks.

Anybody got any recommendations on dealing with BCBS IL I have sumbitted everything once but did not have my 6 months of diet documentation. I am about to complete that and could use any info you having on getting approved. I had done everything 3 years ago and then found out I was preggers. Now I have been working at this again for 8 months and Walgreens(where I work) is requiring the 6 months its not even BCBS. Just want to make sure I get approved before my psych eval expires!

What was your approval process like? Do you have to have the comorbities for 2 years also? Does the blood pressure have to be high even on bp pills? I'm getting very nervous as my BMI is only 37 but I really need this surgery to help me. I am a yo-yoer and am starting to have a lot of problems. I suffer from chronic back pain (probably DJD), elevated BP, and now my sugars are starting to elevate as well. I recently was diagnosed with hypothyroidism after ten years of symptoms and am at a therapeutic level on my medications. Any suggestions or recommendations? Thanks! Has anyone actually gained weight to bump their BMI up??

Hi There, I'm feeling so down, this waiting process is getting the best of me today. I am currently in process-been denied by Blue Cross Anthem, appealed & waited 30 days-denied again. Now I sent in my IMR stuff to Sacramento, which means another 30-45 day wait for an answer, then IF I am approved, my surgeon requires a pre-op visit 30 days prior to surgery (their rules), so that means Sept would be the most likely first opportunity to get a surg date, that is only IF I am approved. I am hopeful that it will all work out, but to be honest, I am SICK of BEING FAT! I hate that another summer is going by and I don't want people staring at me, I have to wear pants to the…

AND if your current insurance also doesn't cover WLS complications, how about considering changing jobs to get better insurance? My insurance, United Healthcare (Texas) through my husband's employer, did not cover WLS OR WLS complications. I decided to use a local doctor and self pay b/c I would not consider going out of the country b/c what if I had complications and needed my doctor? To me I decided to spend the extra funds to stay in my home town. SO I self paid $14,500. My experience was no major complications thank GOD. BUT what if you self pay (went out of country) and after being home a while began to have complications, which of course your/my insurance…

:thumbup: Hey I was called today by Dr. Idhe's office in Dallas and told my insurance (UMR) does not cover Bariatric surgeries, so sorry thats it...$13,000 all inclusive cost:svengo:. Can anyone help me find a Doctor in Dallas that will go to bat for you. Or a doctor that finances. I dont have the means to get hold of that kind of cash. My BMI is 54.4, my knees are bad, I tore my achellies tendon and I have a job that requires me to be on my feet all the time.HELP... HELP..... HELP!!!

hey I was denied by tricare....I have no clue of what to do next aww well I tried guess I need to find another solution...Thanks for all the prayers and support.

I have Aetna POS and just had to post that I have been approved. After everything I had read on this board and what the doctors office told me - I had my doubts that it would happen. My current BMI is 40 (and heaviest) and was just diagnosed this year with sleep apnea while going thru all of preliminary stuff Aetna makes us do. My BMI for 2007/08 was 38 (no other health problems) & I did not have a documented weight for 2009. So there is hope for you guys out there in a similiar situation. My preop is scheduled for June 1, I start my preop "full liquid" diet on June 7 and my Lab Band surgery is scheduled June 10th. I'm so excited!!!:smile2:

My surgeon's office submitted all my paperwork for VSG to BCBS North Dakota. A week later it was denied. As soon as I got the letter, I faxed my appeal letter with many references to the surgeon's office, they resent all of the information, with a new letter from the surgeon. BCBS has had the appeal for 2 weeks, so I called them yesterday. The nice lady in member services told me it had been reviewed by their dr. in the appeals dept., but they sent it to an external reviewer for another opinion. Does anyone know what that means? I am encouraged that they seem to actually be looking at it, and didn't just immediately say no...I hate waiting!

I was banded on 3/31 and have done fairly well sticking to the program, lost 30 lbs., etc. I did have to have a port revision several weeks ago due to my port flipped. But, what I am really discouraged about is I went through the usual routine of testing, pre-authorization, etc. and thought everything was ok until Monday, when I received a notice that my claim was denied with BCBS. AUGHHH! How can they do this? I have a pre-authorization approval, but, they are saying that obesity surgery is not part of my plan. I have asked that they reconsider the additional diagnosis that was submitted by my physician (GERD, Hypertension, etc.) that the surgery was to also correc…

Anyone? Anyone? This is not just about weight loss surgery. I have been to a local surgical center for several procedures. Each time I am handed a sheet with the cost of the procedures and, in the next column, my insurance company's negotiated price. I obediently pay my percentage of that, then look at the original numbers in disbelief. For an operation that the facilty charges the uninsured $20,000, insurance (and I) anted up $7000. Another time it was $9500/$1700. These places actively court the insured, so they must make money on these payments. I know there is very little discount for self-pays, as a friend had a similar spinal procedure and paid close to the full pr…

Well I'm just a bit frustrated and ticked off right now; just got an email from the money people of my surgeon's office, as a self-pay I apparently have to pay the ENTIRE fee up front before they will even schedule my surgery!! As if that weren't bad enough, all of the other fee's - hospital, anesthesia, psyche, are all seperate and I have to pay each of them myself. What is the office doing for me then, if I am running around paying various organizations individually and seperately?!?! This makes me anxious and I can just see one set of people claiming they were never paid, etc. etc. Grrr.

anyone havae any experience with them? esp if you work at mccg

I am just about to lose it!! I spoke to the surgeon's office and she is saying there is no way I am already approved. They have no submitted anything, yet UHC is saying it is approved. What is going on? I am so lost as to what to do next. No one can give me a straight answer. I'm just moving along with all the other stuff (pysch evaluation next week and support group tonight), but I am just so frustrated. I still don't know for sure if I have to do a 6 month diet before surgery, so everyday I go without knowing is another day added to my wait if I have to do it...No one can give me closure on this!

I'm a nurse, and I have a patient that needs surgery. No information here because of hippa, but I want your opinons. Patients been in and out of hospital for past 2 yrs with same insurance. Its all weight related. Patient called BCBS TX and they told patient they dnt cover it. My doc basically said its life or death for him. I really want to help get him approved but not sure how to proceed. Suggestions anyone?

I'm glad that cigna now covers vsg. Anyone know if cigna is pretty good about approving people in a timely manner?

I talked with a lady on OH who gave me the downlow. I also spoke with an Aetna patient rep and she also said yes they are approving but not until all the legal paperwork is complete, sometime mid April. Okay, there is hope and a light at the end of the tunnel. Be patient. Good luck to all.:001_tongue:

so ive been do my homework and im leaning towards this dr. in mexico and allows cosmeicredit for financing does anyone have or know some who has cosmeticredit if so what do you suggest and would you recommend them?

whether good or bad, im curious if anyone has had any experience with trying to get the sleeve with fidelis. i know they approve rny and the lapband, but not the sleeve directly as they dont recognize the new 2010 code 43775. but they do have an open restrictive code 43843 that they have sometimes approved and im wondering if anyone has tried that with them for the sleeve. code 43843 specifically says "gastric restrictive procedure, without gastric bypass, other than vertical banded gastroplasty". they also approve code 43845 which is bioliopancratic bypass w/duodenal switch, which basically is the sleeve with a bypass. and im wondering if they approve that code can i onl…

I have United Healthcare and they do not cover weight loss surgeries. I have decided to try and get an individual health insurance plan but I dont know who will cover it? Please let me know which companies are the easiest to get approved by. Besides medicaid, I dont qualify.

Waiting for insurance approval for surgery and... losing patience! Frustrated! Worried!! Is there anyone out there with the same insurance that has any encouraging or realistic news? My insurance verifier said she can't see a reason for the surgery to NOT get approved, but then again I'm at the mercy of the insurance. I was told approval will take 2 to 3 weeks after post op stuff. Ugh!!Almost one week down, more depressed than ever, feeling like I can't take another day being in this fat body. Any and all advice appreciated. Thanks!! :tongue2:

I am having one heck of a time with the VA. In multiple regions lap band is an approved and is a readily offered surgery, but in New Mexico where I live it isn't preformed here at this location. Unfortunately, I was laid off and lost my civilian insurance so I thought I would try the VA. My doctor agreed that I am a good candidate for it since I am diabetic. My patient advocate stated that I couldn't go out of region to a VA medical center that does it, but I could be referred to a local surgeon. Although that doesn't make much sense, I have tried to get this process going, but no one here knows how to do this type of referral. Has anyone on here received lap band through…

Hi! I'm just finishing up my six month diet and have my first surgery consultation on Monday. I had some questions about insurance approval. What do I need to compile for my doctor to submit to insurance? UHC sent me a form that my doctor/ nutrionist has to sign verifying each weight loss appointment, and I know the surgeons office has requested my complete medical records... For those of you who have been approved, did your insurance need medical records, payment receipts, did they call your doctor to verify info directly? What else do I need to gather? I don't want to be denied for failing to include some minute detail... But I also don't want to submit so much,…

OK. BCBS will start covering WLS starting September 2010. You will find the details on ERS website. In short, you will have to pay $5000 deductible and 20% co-insurance. I am not clear on all the requirements because they wrote it kind of funny! I have started what we (dr. and I ) think the requirement are and hopefully I can submitted everything on September 2nd. It looks like even with insurance I will have to pay $8,000 out of my pocket. WOW! :thumbup:

I have 1st appointment with the surgeon on 6/16/10 as well as the nutritionist, however, the psychologist they work with cannot see me until 7/7/10. I have Tricare Standard (North) and I'm wondering if the psych eval is required for approval. I'm hoping this won't delay my surgery! :frown:

Does anyone know where I can go for the psych eval in NJ (or surrounding area) that would be covered by Qualcare? Ive called everyone in my county that is on my Qualcare list but none of them will do the psych eval for this surgery

What the heck? Any tips out there? If the employer chose to exclude the WLS, is there ANY way to get that overruled?

I am preparing all my paperwork and six month history to submit to Cigna. My BMI is right around 40 (their requirement) but wasn't when I was on a medically supervised diet for 6 months. Do I have to show proof of all the times I exercised (like a fitness log)? Do I have to show proof of a food diary for 6 months too? I want to give them everything they require in the way they require it the first submission.....especially since they have only just recently started paying for Sleeve......any tips or advice on suitable documentation?

OK - This (copied below starts with "33.") is from the "not covered" section of my plan - Anthem Lumenos.. not good, please confirm? If I have flex benefits $ am I able to use that to pay against the surgery if I am a self pay? My husband works for a hospital and they are changing their policy this next year due to the increase in bariatric surgeries, go figure! So I'm going to have to wait until October to try to figure that out. I'm trying to stay positive and use this time for research and learning. I am going to a learning session on 6/12 and hope it doesn't depress me. Thanks for sharing your opinion... 33. For bariatric surgery, regardless of the purpos…

I want no no, I NEED this surgery and I would like to get it done this summer. My hubby has a full schedule with school and work in the fall. He is going back for his masters in geology and we are having to pay out of pocket for that. Add in that he makes 25k/year as a troubled youth counselor I am finding NO way to pay for this surgery. We have UHC but they don't cover obesity servies. I am thinking of getting a part time job just for the insurance to cover the surgery. Is there any insurance who is excellent about covering VSG? Who has the least amout of hoops to jump through? Thanks for sharing your knowledge

i have bc/bs insurance and was told I needed the 6 month nutrition diet prior to submitting insurance.:thumbup:

I'm a little confused :thumbup: about Tricare policies. I know that regardless of being 100 pounds overweight or having a 40 bmi you do not get approved unless you have a co-morbidity. So that leaves that option out and I'm hoping for the 200% of my ideal weight to get approved. I have a small frame and definitely make the 200% on the starting end but I am about 8 pounds away from the high end. Now Tricare manual 2002 had the following provision: B. In determining the ideal body weight for morbid obesity using the Metropolitan Life Table, contractors must apply 100 pounds (or 200%) to both the lower and higher end of the weight range. Payment will be allowed when…

United Healthcare would not approve me for surgery..they said it was not "under my husbands plan" for his work at all. They gave conflicting information to my WL clinic and told them it was not an exception and I ended up wasting almost 2 months on trying to get approval but they ended up just coming back and telling me its not covered. I am really bummed since I know so many other people who have the same insurance that it covers. they did cover my office visits but not any part of the surgery. I am going in this selfpay and my surgery is july 30th. I am looking for any suggestions that some of you might have in just being 100% sure that there is nothing I can do to get …

Well, I have Health Alliance insurance and they make you do a 6 month I can change program and lose 5% body weight...so I have finally completed that and everything has been submitted to insurance so all Im doing now is waiting for approval!!! YEA! I hope it wont take long....sigh

I'm currently on Tricare Prime, and I have a dilemma. I've read the manual and talked to my PCP - but neither had much info about Lapband. My understanding is that Tricare requires a person to be at least 100 pounds overweight, in addition to the BMI and comorbidity requirements. Now I've found out that the Tricare Prime that covers Key West also requires a 6-month supervised weight loss program before anyone can be approved for wls. I am right at 100 pounds overweight. If I lose any weight at all I will no longer meet the 100-lb requirement. I'm told I can possibly get a waiver, but no guarantees. So instead of wasting 6 months just to be turned down, does anyone know…

I have Anthem BC/BS (Blue Access) which we all know is NOT currently covering most VGS's. Hubby and I are both on MY policy. I found out today HIS company's ins. is Aetna. If we both sign up for his ins. would I be covered for my surgery? I didn't know if I would be considered pre-exsisting if I went for my surgical consult on the 17th of June. I haven't done anything else as far as seeking treatment or anything with any other doctor for any WLS.