Insurance & Financing

anyone have this insurance and get VSG done? If so how much did you pay and how hard was it to get approved? Thanks

I am just starting on this journey and have an insurance verification questionnaire from the surgeon with whom I have a consultation next week. One of the questions is " Is a Bariatric Center of Excellence required"? I have Cigna Open Access Plus, and when I spoke to a Cigna rep earlier she couldn't tell if a COE is required or not as it didn't say. Does anyone have any recent experience with this Cigna plan and know if a COE is required?

Hi everyone! I have BC/BS managed under carefirst administrators. When I met with my surgeon’s insurance specialist, I was advised that I didn’t have a 3 or 6 month nutritionist requirement, instead that I just had to get an upper endoscopy, psych evaluation, sleep study, nutritional evaluation and letter of medical necessity. I did all of that really quickly because for deductible purposes, I wanted to have the surgery done this calendar year. My coworker also started the process soon I finished everything and was advised that she had to see a NUT for 6 months. My paperwork was submitted to the insurance company yesterday so I’m hoping to hear from them early next week …

Hi im schedule for surgery in march but my insurance health first haven’t approved yet my doctor said he is sending the form on January. Im 195 pounds and im 5’1 (bmi of 36)with joint paint. I used to suffer from hypertension but everything got better from a year to now im not taking any medication for it so my doctor said that it didn’t count anymore. Do you guys think that i should keep going until i see the denial or give up ?

I am soooo upset. BCBS of IL denied me because of my therapist report. They said I have too many stressors. My therapist put some inaccurate information. His wording was all wrong. I have a copy of the report and I am not happy. Has anyone ever dealt with this and anyone have information in how or what I can do about appealing this? I'm not sure if I should just get a new psychological evaluation or if that would even work. I've been seeing my therapist and I feel like he is biased and I just should not have had him do it in the first place. Best wishes! Dotty Cole

Hi, I have United Health Insurance (2017) but come 2018 I believe I will have BCBS of California. I'm wondering how this will affect my approval process and if my monthly visit will have been for nothing [emoji17]. I started in July and United requires a 6 month diet so my 6 months is December. If I get approved for surgery quickly after my 6th visit, there's a SMALL chance I can do the surgery this year, which is best for deductible reasons but also highly unlikely I'll for it all in December. So most likely my surgery will be in January. Any advice? Thanks in advance.

I am going to have to get my lab band removed or revised. I am going to choose removed, as they are no longer performing the procedures around here and no one wants to mess with it if I have problems, which I have had tons. I have had mine for almost 10 years and was down to 115lbs. I have since gained 50lbs. While my insurance will pay for the removal, they may not pay for a revision to a sleeve. I have IU health plans for an insurance, and I can add my husbands insurance, which is ANthem premium, if needed. Does anyone know what the rough cost is for a revision to sleeve? What about just the sleeve portion? Anyone had any luck with IU health plans on appeal, as I am sur…

Omg this surgery is costing me a fortune!! What ended up being 2300$ deductible is now up to almost 5 g,,, by the time I pay all the copays for all the darn specialists who want you to come back over and over and now just got the bill for this dumb cpap machine which is 70$ a month,, it’s just never ending!

I was wondering if anyone might give me some insight on what to expect from BCBS NC. Specifically if they required any proof of diet and how long did it take?

Hi, I have Anthem BCBS (Ohio). What is the timeline for approval? I read somewhere that they have 10 days to make a decision, but my doctors office is telling me 3-4 weeks. I've been waiting about 5 days and the anticipation is killing me!

Is there any insurance that will cover the gastric sleeve?

Hi Iam so new to this. I have been researching about this surgery for months now. I finally got me a primary care doctor and will be attending the seminar in 2 days. I'm so worried that Medicaid won't pay for it ?? help

At my surgery consult my doctor told me he didn't think my insurance mandated a 6 month supervised diet, and that we could most likely do the surgery during winter break. Well, my insurance does. I feel heartbroken, and like I have been sucker punched in the stomach. I allowed myself to feel hopeful that I could jump on that train to change my life and be healthy and able to do things like run. I have been fat my whole life- and I feel like I was so close to the new, healthier life, that I feel shattered. I know in theory 6 months shouldn't be a long time, but it really messes with my school schedule, especially if I have to wait six months before even submitting approval…

Vent... having a difficult time getting bariatric doc office to submit to insurance. I did a 6 month nutritional program through my former insurance, gave release to doc office (still haven't requested it). I also did 10 months of Weight watchers from august 2016 - may 2017 and even had doctor visits in august, October, April, (and several others) where my weight was recorded and even nutrition discussed - though the visits were not specifically for that. I have talked to my current insurance several times and they are very much encouraging me to have my doc office submit for approval. Especially now since my medical tests revealed a hiatal hernia and gerd (i knew I had g…

Has anyone ever had their waiting period waved? My insurance has the 6 month medically supervised diet as one of their many criterias. I made my plea and wrote to the begging for them to waive it or cut it in half due to concern for my health problems. They stated that I could have my doctor call and if he believed it was urgent and it should be waved then my case would be evaluated. Has this worked for anyone?

I have 1199 SEIU insurance. My surgeon's office just told me they won't submit paperwork to 1199 to approval until the 2nd consult/5th weight in at the surgeon's office. That won't be till around 1/15/18. 1st consult my surgeon said I needed 4 weigh ins but the secretary told me yesterday that's its 5. Any idea how long it will take 1199 to approve once they receive the request? I was REALLY hoping for a mid February surgery date. Doesn't look promising now. I know I've waited this long, it shouldnt be a big deal to wait an additional month or two but I just really want this to be done already. Thanks in advance!

Hey so I finished my last supervised diet on 11/10 and am waiting on insurance approval. Does anyone with UMR/UHC know how long it typically takes for an approval and their approval percentage? I know they get 30 days but I’m hoping they’ll approve sooner so I can get sleeved in December. Thanks guys!!! HW 304 CW 302 GW 190 December surgery not yet scheduled VSG [emoji1491]

Be aware! My surgeon apparently used a contracted surgical assistant not affliated with the hospital and probably not in my insurance network and I will be billed for this. I was not verbally informed of this, I was told students might be observing. I suppose it could have been in the hospital fine print? The surgeon's office however never informed me. There are three states that require insurance companies to cover these contracted assistants - Illinois, Kentucky, and Texas. That doesn't necessarily mean it will be at in-network policy coverage as they have not negotiated rates with your insurance company and you are liable for the bill/remainder within 30 days. …

I finally got my surgery date after a year and a half fighting with insurance. Good luck to everyone dealing with denial after denial.... I️t is exhausting. December 27th will be here before we know I️t and I️ could not be more thrilled to be done with this first part to my journey. Looking forward to a healthier happier me in 2018.

So, I just had my surgery two months ago and I just started my new job last week. Now, I'm continuing my last employer's healthcare under COBRA but I'm wondering when my new company's insurance plan kicks in, if the aftercare for bariatric surgery (follow ups with the surgeon, etc) are covered under Cigna? Also, I'm kinda curious if bariatric vitamins would also be covered under Cigna? If so, that'll save me a TON of money.

Can anyone tell me about what their out of pocket costs are for the surgery. I've met my deductible for the year, but not max out of pocket costs. I am responsible for 20% of doctor cost and hospital costs. Do doctors require this before surgery? Thanks Sent from my SAMSUNG-SM-G930A using BariatricPal mobile app

Hey Peeps! So I already knew my insurance excluded the procedure, but had hoped to get on a new plan during open enrollment that would cover. Found out for sure that since we are self employed, no plans in PA offer coverage for individuals or small groups anymore. Major bummer. So, finally accepting if this is going to happen then we are going to pay for it. Hubby is agreeable, thank God. I have been pre-approved for a loan (haven't pulled the trigger yet), but the amount is -right at- the point of the gastric sleeve at my local program, at Reading Health Network (now Tower Health) with Dr. Leon Katz, who I like a lot from the seminar (did not get to one-on-one yet).…

Has any body had a problem with humana. I have had one nutrtional visit have 3 more. Go talk to the psychologists in December. My Doctor sgin off on referral . my blood pressure is high. Joint pain. My BMI IS 45 hoping to get approved in about 4 months. Even my orthopedics wants me to get it. Because I can't get knee surgery until I lose the weight and keep it off.. Sent from my LGL84VL using BariatricPal mobile app

I have paid my deposit and scheduled my surgery. I am self pay, so this is a big deal to me. I will be using almost all of my savings for this. Worth every penny! My questions is for those of you who have gone to Mexico. Has anyone had to reschedule their surgery once they chose an initial date?

I live in Ohio and have Caresource (Medicaid) insurance. I jumped through all the hoops and went to a cardiologist, a dietician, physical therapy, pyschologist, gastroenterologist, had a scope down my throat and everything. It was nine months of appointments and hoops. I have now been denied twice. My only hope is that the peer to peer convinces them. I am currently at 49.44 BMI and they denied me because my BMI was below 50 and I didn't have a comorbidity that was poorly controlled. I guess my question is if anyone has gained weight to get a higher BMI and then been approved? My doctor seems to think that if I gain weight at this point they won't approve it because it wi…

It sounds like I just need a psych evaluation? They sent me 2 copies of this denial letter lol. Does anyone else have Kaiser or can help me decipher this letter. Sent from my SM-G950U using BariatricPal mobile app

Hello, I found out my health insurance will be changing to Meritain in one month. Ive heard only horrible things about this insurance.Does anyone have Meritain? Did anyone have any luck getting Meritain to pay for their surgery? Sent from my SM-G955U1 using BariatricPal mobile app

I can honestly say I was cool up until this point.. I didn't care about going to the NUT monthly for 6 months and doing the GI, psych, and everything else lol, but this waiting to see if I get approved OMG is about to drive me crazy .... I guess im just really anxious to get it done and be a better me

I've been approved and scheduled for sleeve surgery Wednesday. Just curious if I did decide to back out and try one more time to lose on my own, how long is my approval letter good for? Does anyone know the answer to this? I have Tricare. Just wondering if I waited another 3 months to diet/exercise and see if I could still go back and get the surgery since I was already approved or if I'd have to go through the whole process again?

Has anyone had any luck going through their PCP to determine if they had a hernia before seeing the bariatric dr? I have the symptoms, but what are they chances they'll send me for a barium swallow or EGD to see if I have a hiatal hernia? My BMI is on the fence. 3 lbs and half an inch makes the difference between > 35 BMI and < 35 BMI. Also, just because my home scale says I weigh enough (barely) their fancy bio metric scale might say something else. that instant decides the self pay or insurance track. all of the other requirements are no problem, it's just not a 100% sure thing i will be 35 BMI that exact moment. If I go to the bariatric dr and…

And having surgery in dec or january?? Sent from my LGMP260 using BariatricPal mobile app

I never thought this day would actually come. I started my journey 1 year and 4 months ago was initially denied 3 times and a peer to peer was denied also. The staff at my office flat old told me I could appeal but wouldn’t help I wasn’t goi g to be able to have the surgery unless I was private pay. I did a year of consecutive monthly dr visits, did all the pre op scans and tests and met all requirements but the answer was still no. I hired lindstrom obesity advocates and they filed my first appeal in September. Today I got my approval letter in the mail. I couldn’t wait to call my surgeons office and let them know that I was able to get the approval..... especially when …

So my PCP referred me and I received a letter from Kaiser yesterday with approval for 12 visits to the Rockwood Clinic in Spokane with Dr. Spitz. Does this mean I am through the insurance hurdle or is there another round for actual pre-authorization for the surgery itself? I'm a bit confused and don't get to go to the info session until December.

My surgery is planned for the end of November. I am paying $554.68 a month for Cobra. I do not want to pay for December. I want to wait for my Medicare to start in January. Does anyone know if the first follow up appt, after surgery is free? My husband had a hip replaced at a different hospital and the follow up was no charge. Thanks for any advice or experience.

Just curious, I have insurance through the government. My doctor is having me go through the whole process . Does government ins pay for the sleeve ? I don’t pay for my ins

I've been approved and have my surgery date, but im wondering how much they cover of the surgery and how much I'll pay out of pocket.

My surgeon's office called me today to inform me that my insurance had approved my surgery. The surgeon's office told me last week that as soon as I had all my pre-approval requirements done, they'd submit it all to my insurance, and it would take up to 7 business days to hear back. That if they wanted any further tests, they'd find out at that time what else was necessary. I have an appointment in 2 days to visit my primary care doc for my pre surgical approval. So I figured the surgeon would likely submit my paperwork for approval next week. Nope - they did it already and I'm already approved! They still want the primary care doc's approval, but they know that'll …

Hi everyone, I currently we have anthem Medicaid and we just heard it requires 6 months of doctors visits. Well we want to get this sooner than that. I called one place that said that ky passport doesn't require any dr visits , only a referral? Can someone confirm that?

Hi!!! Is there anyone with Arkansas Medicaid? I just got approved for Arkansas Medicaid and I know that Arkansas Medicaid will cover weight loss surgery. I live in West Memphis, Arkansas and I am in search of a surgeon. Any suggestions? Also, I would appreciate any other information that you can provide about your experience with weight loss surgery preferably the gastric sleeve. Thanking you in advance, smilee

I have Cigna Insurance with a 3 month diet requirement. My last appointment is set for October 13th which is exactly 87 days of the diet program. I'm wondering if I need to try to set my doctor's appointment back because I heard they may deny you if it's not a full 90 days. Just wondering if they go by three separate months or actually count each individual day?

If insurance doesn't cover my surgery, I want to do the option of having my hiatal hernia repaired and billed to insurance and I'll self pay for my sleeve. If you did this, how was your experience? How long did it take for approval, and who did you use? I appreciate anyone taking the time to give me advice

Hi there! I was wondering if any of you had a successful appeal with BCBS for a revision? Specifically, approved for a sleeve to bypass revision? If so, how was the process and what what were your requirements? thank you!!

So I don't know much about how insurance works and was hoping to get some clarification. I am insured with BCBSIL but I live in Texas and I have not met my deductible yet. I went to my psyc evaluation which showed up on my BCBS account for $500 but I did not have to pay anything out of pocket for that. A little over a week ago I had chest x-rays done, a stress test some type of breathing test. For all three of those I was billed $963 and the nurse who had done my chest x rays told me it was because I have not met my deductible but that it would be applied towards it. I guess my question is why was I billed for the tests but not for the psychological evaluation? …

I was wondering if anybody has used www.wlsfa.org to help pay for your weight loss surgery or and plastic surgery? If you have a patient who needs financial help or are a patient looking for financial help to get weight loss surgery or reconstructive plastic surgery you might be eligible to apply for a grant from the Weight Loss Surgery Foundation of America. This is a little bit of a description of www.wlsfa.org: If you have been medically approved for weight loss surgery or reconstructive plastic surgery after weight loss surgery and have been denied surgery for financial reasons you might be eligible to apply for a grant from the Weight Loss Surgery Foundation of Ameri…

Has anyone had success with the Dr. doing a peer to peer review with the insurance company? If so how long did it take the insurance company to make a decision after the review?

Hey gang. I am almost to the stage where my info is sent off to insurance for approval. I have united healthcare community plan thru Medicaid or Medicare. I was wondering if anyone in here has this plan and if so how long did it take to get your approval or denial ? Any info would be greatly appreciated Thanks and god bless Will

Good evening all! I was recently approved for medicaid and I'm now looking at choosing my managed care plan. I cannot get a clear answer online whether or not VSG is covered by any of them. I have to make phone calls tomorrow, but due to Hurricane Harvey I don't know if they'll be available, so I wanted to reach out and see if any of you have medicaid in Texas that covered your surgery? I weigh 320, BMI 53, currently and have been obese/morbidly obese for at least 8 years I have IIH, non-alcoholic fatty liver, and had my gallbladder removed when I was 16 I know I qualify, I just need to know if any of you have had it covered or know which managed care…

I understand every doctor is different but my doctor told me he would have a surgery date for me in dec and having surgery in jan being my 5th weigh in in dec and 6th weigh in in january how would that work? Will everything be submitted 1 week before supposedly surgery date to insurance??

My husband works for AT&T as a retail sales consultant. He would like to get sleeved and contacted his healthcare provider, United Healthcare, twice. They told him his plan does not offer coverage for WLS. He knows a few managers at AT&T who've had the the sleeve and they were covered. At the time he signed up for insurance last year, he went went the cheapest/highest deductible option. At this point, we are hoping the issue is that he just chose the wrong health coverage for WLS, and are wondering if he can choose a better plan in November. However, we are also considering that maybe this coverage is only available for managers and others higher-ups at At&…

Hello there i want to know if somebody has gone threw something like this. I was sent by the doctor in charge of the surgery to a medical office where they practice sleep studies because they think i have sleep apnea. I am 35 bmi with no comorbidy but i have a high blood pressure record long ago that wasn’t bothering me anymore but when i got to the sleep study doctor y had my blood pressure high again. I don’t know if my insurance company will see that and if thats going to be favorable for an approval (i have never taken medication for my blood pressure) because the first time that it was high i was nursing and i couldn’t take any medications but now i don’t know whats…