Insurance & Financing

My starting lbs was 250 now I'm down to 160 lbs I did it myself it took me 2 years. Congrats to all of you with your weight loss success! My question is since I have lost the weight I need a tummy tuck went to a Plastic Surgeon that my Insurance Company referred me to. He did a consultation, took photos he sent his info in and I got a BIG DENIAL! He sent in a 2nd report also Denied. So know I need to write a letter to Ins. Co Does anyone have some advice?:eek:

Does anyone know if Mercy Care/AHCCCS cover the lap band? ANd anything you might not know about it..THanks ; )

I'm scheduled for Monday May 10th. Start my pre op diet Monday. Can't wait to join everyone. :thumbup:

I have just started looking for a loan to cover my surgery! The surgery is going to cost $13,550 I have called surgeryloan.com and they wanted a ridiculous interest rate. I have good credit but because I?m only 20 I haven?t got my credit built up yet but my Dads going to co sign and he has excellent credit but the surgerylaon.com told me that I can get two loans out to equal the full amount one at 16% and the other 23%!!!!! Ok hellz no I wound never be able to pay that off I?m getting the surgery to better my life not to drown in debt! So my question is what loan place did you use? Do you have any advice? What interest rate did you get? Anything you can tell me will hel…

Hello - as of tomorrow 4/14/10, I will be done with ALL my requirments asked of Cigna. My question is - I was referred by my OBGYN not my PCP to get the LapBand. I called to get my referral letter from my OBGYN because I have polycystic ovarian syndrome. Does anyone know it that would be exceptable? I see my OBGYN more then I see my PCP. She's the one who has sent me for blood work for my weight gain and she's been the one montioring my weight for the past few years. I'm hoping that this will be ok. Getting really nervous about submitting my paper work to Cigna and getting denyed. I've done all that Cigna has asked and I meet all the requirments. I just hope that it all w…

Hi all. I am posting as a follow up to many other posts regarding BCBS of TX via TRS active care 2 (for teachers in Texas). I have just been informed by my surgeon's office and by BCBS TX that the TRS plan does not cover VSG, but does cover RNY and Lap Band. So, if you have this plan, you will have to choose between the RNY and Lap Band. As of this plan year, VSG is NOT covered. I am disappointed because I have been in contact with BCBS TX and my surgeon's insurance people constantly since January and I am JUST NOW finding out that VSG is not on my plan, despite having said VSG in every single piece of correspondence since January. Oh, well. RNY here I come…

I work at AT&T in Missouri and UHC covered my gastric sleeve. They require a 5 year weight history and a psych evaluation. My surgeon sent the info in on Friday at 5pm and I called UHC on Monday at 7am and they already approved me! I had a co-worker who was approved in 1 business day as well. My total to the hospital was $222, which $40 of that was a co-pay. I paid my surgeon a $200 program fee and $20 co-pay for office visit prior to surgery. I was able to get all of this reimbursed from my health savings account. Usually they won't reimburse anything weight related however my surgeon wrote a letter that I had a medical condition of obesity and that I had to…

I called my doctor on Friday to let them know Aetna had changed the bulletin. They were ready to submit my paperwork Friday afternoon... Great timing right? Anyway... they submitted it Friday about 4:30 and had approval by Monday. WOO HOO... I am gonna be sleeved!!! Surgery Date: June 8th (I am a teacher... wanted to wait til summer vacation):thumbup::thumbup:

My insurance was billed $41,890 and I still have to pay $2950.00. This seems astronomical compared to self pay. I know they bill they ins. companies way more, but why should I still have to pay thousands when I have insurance???

:thumbup:I just called Aetna to check on the staus of my surgery and they just approved me an hour ago to have VSG on 4/20th! Don't know since it is such short notice if I can get it done that date, but I'm definately getting it done the week after. I'm so excited and nervous!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Yay for me!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

So here is my situation. I have insurance right now, one no one has heard of... lol, its Homeland Health Care with Multiplan. My doc here in the states, well, his office dropped the ball, and didnt help me with anything, so i said F it, and went down to Mexico and got my band done. I'm working with someone at the Cleveland Clinic to see if my insurance will cover the fills, if not, I'll be searching for another company. This is fine because right now i'm under my moms insurance, and that's who she has. My question is this, I'm going to be an individual pay for the insurance. Is anyone out there paying for insurance through an individual basis that actually will cover t…

Anyone know how long it took them to get approved by bcbs of illinois? I had all me eval etc last wednesday and my surgeon was just waiting for a fax from my doctor then turning it into my insurance. Just wondering if anyone has an idea how long it usually takes to get approved? Thanks!

I am seriously considering the sleeve. I am 35 yo, 5' tall and weigh about 170 right now. My heaviest was 244 in 2003. It has taken me years to lose the weight and actually got done lower last year to 130 but that is with a VERY strict diet and exercise regimen. I am a single mom with three small children and my profession is very stresssful. I just can't take the massive weight gain/loss constantly. My mom had gastric segmentation 16 years ago and it has been a blessing for her. Our family is obese, no way around it. I have BCBS Federal and understand after calling that they do cover this procedure. I know with a low BMI (ha low, meaning I am obese, not consider…

I was denied by my insurance company and plan on appealing the denial. Does anyone have a copy of the letter they submitted for the appeal? Any suggestions for the appeal? Any help would be greatly appreciated.

A year ago I called my insurance company (Cigna) and asked if they covered LAPBAND surgery, the rep said it is not covered but after calling around the doctor said that they do cover it if it is medically necessary. After my initial consultant visit they sent in information to my insurance. They have covered all my appointments. A month ago my doctor called and said the surgery was approved and the next day they said they recieved a letter saying it wasnt. They fought it with my insurance and they once again approved the surgery. Since then I have done all my pre op requirements and have a set date for surgery. Yesterday my doctor called again and said they denied it agai…

Hi, Bandsters... I am so grateful for this supportive, informative site. Here's my insurance question. I am just beginning to collect all the paperwork I am reading is needed for iins. approval, have a Psyc interview scheduled, go to the seminar tomorrow, etc. Because I have Aetna PPO, I see that they want a 3-month diet... but, last year I did a ONE YEAR medically supervised diet with a nutritionist and pills, and got a letter at the end of it recommending bariatric surgery b/c I only lost 18 pounds even tho I followed their diet for a year. Do you think this will count? And if so, how should I write that up? I really dont' want to wait another three months to get …

I called to check on my paperwork and was told it had been submitted and is in review and they'll let me know when they hear something, I hear all the time UHC is easy to get approved. my BMI was 39.2 with high blood pressure which is within my requirements of 35-39 with a comorbidity or 40 BMI and no cormorbidity.Maybe I'll be lucky and they'll approve next week.:redface1:

Two weeks ago I called my new insurance company to make sure VSG was covered - before I ever went to the informational meeting about any type of bariatric surgery, before I got my hopes up, before ANYTHING. I went to the meeting, got excited, got down and got funky with the idea of VSG. I filled out the forms, I made the appointment for my first visit with the surgeon. My first visit was today. I got weighed in, measured, and then the assistant asked what type of surgery I was interested in. I told her VSG. *crickets* "Oh honey," she said. "Aetna doesn't cover VSG." But they DO, I argued. They SAID SO when I CALLED THEM. They wouldn't lie to ME, would the…

Does anyone here have any first-hand knowledge of Medi-Cal (California) and if they pay for the Band, and if so, what is the criteria? I had a friend of a friend ask me this question, and I'm looking for someone here that might have experience with Medi-Cal in this regard. Thanks! HH

Ok, so I got a denial today from UHC because of BMI below 40 and no life threatening co-morbidities. SO, here's what I have going on and would love some successful appeal'ers to please help me know where to start and what to do with this info: Lower back pain due to all excess weight being in front abdominal area Hip pain from the same thing Knee pain PCOS putting me at higher risk of diabetes, heart stuff and other things and the excess abdominal fat making those risks even higher Cholesteral trending higher but not on meds yet Diagnosed Reflux & Ulcer I also have symptoms of sleep apnea but no sleep study done so I guess I should ask my PCP to order that f…

But not new to bariatric surgery, has anyone had success with Tufts of MA paying for their sleeve?

Guys, I am soooooo excited!!!! Got a tenitive Surgery date for 04/19 pending insurance approval....submitted the paperwork on Thurs. And got word this morning that they approve my sleeve....yay, so happy, there is nothing stopping this from happening....whew!!! It's been an emotional rollercoaster ride, since October 2009....so glad it's almost over.

So I am starting to get a bit fustrated. I have been calling every local surgeon to see if they take the Ca Healthnet Medi-cal and am getting no's across the board! I have talked to my endocrinolgist about having the procedure done and he said if by my next appointment I hadnt lost enough weight we would discuss it. Sooo .. if anyone knows of any surgeons in the central valley that take Medi-cal it would be a great help! :w00t:

I was denied for surgery due to having my BMI dip below 35 for 2 out of 5 years. My next step is to file a member grievance which I guess is like an appeal. I'm just not sure where to start. I've had my obgyn write me up a letter that I'll send with the appeal I write. I welcome any and all ideas!! Thanks!!

HI everyone! This is my very first post on the forum. :thumbup: I've been reading posts for several weeks since I made the decision to get this surgery. I decided that instead of doing my usual routine of observing and reading forever (lurking), I'll just jump in and get as much preop support as I can from the great people on this site. VSG has just been added to our WLS coverage options and I'm so excited. This is the only WLS that I've researched that hasn't scared the wits out of me. :biggrin0: I've started the ball rolling with my preop requirements by getting a psych assessment, scheduling my counseling sessions (I'm not the support group type), and getting my PCP…

Hello. I'm new to this site and it's been a world of information. I am hoping that someone can give me some information. I have Healthnet HMO and I live in the Pasadena area of Los Angeles County. I was wondering if anyone can refer me to a PCP that recommends weight loss surgery. Thanks for your help! Monica

I was told by my insurance (Aetna) that there was an employer exclusion . I emailed my employer to ask why. He got more info and forwarded me the response he was given. Here it is.. This is the answer from our insurance broker about your inquiry. You may pass on my answer to your employee. On fully insured plans in texas none of the carriers cover lap band or gastric bypass. This change happened about 5-6 years ago. It is not an option you could have elected. It simply is not covered. You can refer to your actual policy to find the exclusion. Some years past this benefit became widely abused and as your employee pointed out- it is very expensive. So the carriers …

After having a barium xray swallow and showing my stomach prolapsed up through the band, I was scheduled for "must-do" surgery. Got a denial for $14,000:eek: (plus $3,000 from anesthesiologist) for everything. Doc sent an appeal saying it was an emergency, had to be done, couldn't live with the band that way, etc... Also stated I had been slowly losing, until the surgery, and now that I'm not at my sweet spot, has gained a couple pounds. This basically shows that I NEED a working lap-band® in me to keep from gaining the 90 lbs I had lost. Well, now they approved the removal, but DENIED the replacement band. Apparently, my bmi is 39.9 (needs to be 40 to be covered or…

I am 98% sure I am going to Aceves to get sleeved this summer (hopefully in June:thumbup:). The email I got from Nina said: "*Financed procedures may incur in additional fees, please call us for details." Did anyone here finance with either of the 2 medical credit companies that Aceves uses? If so, anything to be warned about or was it all smooth? Were there additional fees? Thanks in advance! Nicole

Yeah!! I just got my approval letter in the mail and have my date March 22nd..... but the letter only states I was approved for 1 fill. Is this something normal or am I going to have to pay out of pocket for any additional fills. I did not see anything in the policy re: fills

Has anyone here ever appealed to a Independent Review Organization? My second appeal has been denied, and according to my insurance company this is my next option. Just wondering if anyone has been successful with this. Thanks

I got approval for surgery on Wednesday: thumbup: How long does it take to get a date?? I am with WSG in Reno, NV. I have already started my liquid diet.

Hello everyone! I'm in the 4th month of my supervised diet and I'm confused. My husband called our insurance at the beginning of all this and they said you have to have a BMI over 35 with 1 comorbidity. Then the insurance coordinator verified coverage and it was 35 with 1 or 40 with none. Not sure which one to believe. :thumbup: My issue is I have a BMI of 40 with none but from what my husband heard, I wouldn't get approved with this. Has anyone heard of the insurance requiring a comorbidity regardless of BMI? Thanks in advance!

Does Kaiser Permanente in the San francisco Bay Area region cover Vertical Sleeve surgery now? I know they used to only do Gastric-Rouen-Y surgery. I don't feel comfortable with the Rouen-Y as it seems so much more invasive and life altering. I think I'm ready now if they do it.

Hi my name is Amy I am getting ready to see Dr.Schumacher in miamisburg ohio who works with kettering baratrics on April 12th. My insurance is molina health care ( of Ohio), my weight is 275 with a bmi of 44.3 how can i get molina to approve having the vertical sleeve gastrectomy, I have asthma, prediabetes (which i am on metformin 2x a day). arthritis, borderline high cholesteral and high lipids along with anxiety and acid reflux . what are my chances of getting approved or am i just setting myself up for a denial?

Hi all. Would those of you who have been denied for VSG by your insurance company please respond to the following: Reason your comany gave for denying your VSG Insurance Company's name How long was it between the submission of your paperwork for approval and the denial by your insurance company? Action you took for appeal Was your appeal successful or not? If so, how long did the appeal process take? Thanks!

I was told today by Dr. M Owens office that they have submitted all paper work! Yay....but wait should I get excited they told me they did this a week ago, at least they thought they did! So lets keep our fingers crossed!:thumbup:

My sister has been advised that she needs to have a weight loss surgery done, because the weight is adding to the liver shutdown. But her insurance says there is an exclusion that they will not pay for the surgery. To me this does not seem right that they would pay for a liver transplant but not something that could prevent it. Can anyone give some advice here. Thank you.

I have cigna and i am resposible for 10% of my hospital fees. I thought that those fees included to Dr but NOT. My surgeons off called and explain to me the amount that i need to bring to my pre and said that my hospital and anes bill is seperate but it is also 10%. Does any one no what the estimated hostital cost is?

Does anyone have Orange Coast Memorial Medical in Fountain Valley for their surgery Dr's? I just got my surgery date today and they stated their 1st available surgery date isn't till 9/1/2010. THIS IS CRAZY! Not only will my authorization be expired by then, I have a feeling my insurance is going to be changing in July! Does anyone have any advise that could help me out? PLEASE!!!!

As far as claiming the surgery on your taxes I saw a Tax Professional on one of the morning news shows saying that you can claim the surgery as long as it was by doctors orders. He said people are claiming it when they have elected to have it done and that cannot be claimed on your taxes. If anyone knows more about this please respond. I just sharing what I heard which if that is the cases it leaves me out since I did not wait to get doctors orders to have it done. Also what about those of us who went out of the Country to have surgery? Gary [Edit] [Reply] [!!]

I had my lapband surgery at Good Samaritan Hospital in San Jose, CA on Jan 12, 2010. I stayed overnight at the recommendation of my surgeon. All went fine, I've already lost 32 pounds. I am insured through Blue Cross of CA, specifically through the Writers Guild of America. Both approved coverage of my surgery. When I got to the hospital they asked for $5000. My surgeon (Dr. McKeen, who is terrific) told me I would get this back later on. Then a month later I got a hospital bill for services NOT covered by my insurance for $70,000!! Of course I plan to fight this, but any help/insight would be greatly appreciated. Anyone else get blindsided like this? Is it even…

Thank you BCBS....Cannot believe how quick and painless this process has been for me so far. (Knock on wood.. I don't want to jinx it) I just received Insurance approval within 5 days of when the info was sent, and my surgery is scheduled for 3/29... It really baffles me how some people are having such a hard time for insurance approval. I guess each situation is different.

I have healthsmart insurance in Indiana and my surgery was approved in 1 day...so excited.

So I got the news that i was denied . I have a couple other co workers who had the same procedure done and was approved with out the 6 months supervised diet , 1 of them said she had her doc submit a letter stating that she was under his care and the other only did a 3 month supervised diet. I submited a letter and I did a 3 month supervised diet and I was denied with reason being I needed to be on a 6 month supervised diet which I guess I can go the other 3 months but does anyone know If I could appeal this decision and if so how do I go about it?:Banane20: It seems kind of unfair that they got through and I didnt using the exact same information but I guess it depends…

Ok so I am newbie. I have tons of questions. I really appreciate y'all (yes, I am a southern girl) taking the time to answer my questions. I wonder about out of pocket expenses. I have medicare. I really haven't decided to be their patient. I am going back and forth between les Schmitt of Birmingham and Dr. Freeman out of Anniston. I would love to hear what you have to say about both Docs. Thanks you so much!

Does anyone know if oxford cover VSG?

I started the entire process in Jan. with my physical, but my BMI was not high enough...38.7 and I have no other medical problems other than high cholesterol. My insurance Capital Blue will cover if you are 40 BMI and higher or 35 BMI with medical problems. I went for a sleep apnea test about 2 weeks ago...hoping to have it because that would be my "medical problem". I only have mild sleep apnea. I am so frustrated because I will eventually have high blood pressure and diabetes if I don't loose the weight...all runs in the family along with heart disease. I don't know if I should continue with the 3 month pre-op ($415 out of pocket) and hope I will be covered or just …

I got the call from the insurance company today that I was denied. I meet the criteria for the insurance to pay for the Lap-Band in all areas except one. I need hypertension, heart disease or diabetes and I have neither. I am fat (BMI over 50), have high cholesterol and depression. I am only 34 and will eventually get high blood pressure or diabetes if I don;t lose the weight. I told a fellow bander that I was denied and she said that I should go see her surgeon and see if they can get the insurance to approve. Do you think it is worth it? Do you think that maybe I can find a doc that will give me a diagnosis of high BP even if it really isn't? I know that's bad! This suc…

We have UHC Choice Plus. I called that number that Mary posted on another thread and they said that they do not service my hubby's employer's policies so to call the regular UHC number. So I did. I was told that the number they said I had to call 5 days before receiving services referred only to the actual surgery, not the consults and testing. That those things would be covered under the regular policy stuff. Let's pray that's true because I want to meet with as many surgeons as I can. Anyway, according to the rep, there is no required 6 month diet plan. She said if that was a requirement it would have been listed right there with the bmi requirements and co-mo…