Insurance & Financing

I know that there is no set amount of time and that every state is different but I'm just kind of curious about how long everyone ended up waiting for their approvals. I've completed the three month pre-op diet and all my info was submitted to insurance on 12/21. It's only been a week and I know that they say it could be 4-6 weeks before I hear from anyone but, like I said, I'm just curious. I'm excited to get this show on the road and stay positive! Thanks for any feedback!

I've been reading about Aetna and whether they cover the sleeve or not. My PA hospital got a bypass approved, but what I really want is the sleeve. Aetna told them they won't cover sleeve unless it's the patient has had a transplant (like a kidney.) I know it now has it's own code and there's more research, but wondering if anyone has tried to get it to a review board or something like that. I hear that case managers are good to talk to also. I just don't want to call until I know what to say. Any input on this would be appreciated.

Ok so I am just in the beginning stages of getting organized to "get sleeved". I am pretty sure this is the route I want to go, but now my biggest obstacle is the money. I am in Manitoba, Cananda. I will be going to Mexico for my surgery and I was wondering if anyone Canadian used the medical "money lenders" for their surgery? I know that we can pay for the VSG ourselves(eventually), but that means I would have to wait a couple of years..NOT! I really don't want to wait, so unless my parents sell their house and gift me some cash..I am going to need to borrow it. What are the interest rates like? What are the re-pay time frames? There are so many companies out there I don…

Im sooo frustrated...i had decided this was my answer. Made an appoint for the consultation. Then found on my insurance that it is not covered. Are there some good options out there...I cant pay alot for this monthly..im soo bummed out. any ideas???

Hi all IM new to this site and find it to be a great tool. I was wondering if anyone has been approved by BCBS of MN. I had my evals done my letter of medical necessity and I did weight management for almost a year and they will provide them with my information for the medical supervised diet. How long does the actual approval take? Does anyone know?:wink:

I got approved about a month ago but I figured I would let people know in case anyone else wonders about things with this insurance. I have Anthem Blue Cross Blue Shield PPO. It took about a month before I was approved. They claimed they were very behind for some reason so it took longer than normal. I only had to show some kind of proof that I attempted other weight loss methods and failed. In my case this included a life long history of up and down diets and I tried phentermine for a couple of months. They are also going to cover the assisting surgeon and the Lovenox injections after. They approved me for same-day outpatient (unless of course there's a complica…

Wanted to solicit any suggestions from everyone here. I was preapproved through all the hoops to have the RNY. When i went in to have the surgery, my surgery found tons of adhesions from a previous surgery many moons ago and was unable to do the RNY. We had discussed this ahead of time and the Lapband was not appropriate for me for numerous reasons. She did the sleeve. My insurance company denied it of course. But after they appealed it and they have denied it again stating it was unproven. They said I could submit a second appeal if I wished. The issue I have is that my Doctor did not know until she got inside me that she could not do anything. So had she sto…

I'm from MA, and psyched to do this NOW. I've been reading other posts that say you've got to wait 6 months and do the i can change diet for Tufts Health Plan. I've already been on diets and waiting for YEARS! Can the dr. bypass this or is it mandatory?

I have had no problems w. them. All of a sudden I'm getting bills. Anyone have this happen? I have been banded over a yr now. I guess I'll have to call. I hate it wehn you get a different story from each person you talk to. :-(

Hello everyone I have been doig a little thinking and I was wondering if I switch insurance due to changing jobs, will my future insurance disallow fills because it was a pre-existing condition? Hopefully someone can help me out with the answer to this question.

Does anyone out there have any other financing options they have used like care credit??? My insurance will not cover this surgery. Any advice is greatly appreciated

I went to a seminar last night -Step 1 - and it looks like my insurance will not cover me. Does anyone have United Healthcare in Georgia and have coverage? Which companies in Georgia will cover??

I need help guys!! Has anyone had the VSG approved under BCBS of TX, TRS for state ISD's? I was told today that the band and the bypass were covered but not the sleeve - this doesn't make any sense to me. Another question, how does BCBS of TX use or view the new CPT codes for 2010? I saw the sleeve code under another tread but I'm prayihg and hoping it will apply to TRS. The website in the other thread was http://www.hdmcorp.com/pdf/CPT%20Codes%20Effective%2001012010.pdf and the code # is 43775. Please, anyone w/knowledge help help help!! :cursing:

:smile2: Ok...So I was so excited because I was scheduled for my consult on 12/4 with my current insurance of Cigna's Open Access Plus Plan. This is my very 1st step in starting the whole weight loss process. A while back when I called them they told me that WLS was excluded unless medically necessary and I have a BMI of 49.1 so I am thinking that I was going to be ok. Well I get to work on Monday to get an email from HR that our insurance as of 1-09' is going to be changed to Aetna's Open Access Plus Plan. I called the Dr's ofc and they moved my consult day to 1/6 because the scheduler stated there was no reason for me to come in on 12/4 and they try to get approval th…

What happens if you don't lose any weight in your 3month supervisied diet will insurance still cover surgery. I have Atena Insurance please people help me out let me know the in's and out's of what I need to do to get the ok for surgery I have diabetes and High lipids and high blood pressure and weigh 275 pounds what do i do?

Greetings All! I have AETNA HealthFund insurance. Does anyone else have the plan? Any comments about how your experience was with the insurance company covering costs, etc? Thanks in advance. Vickie :smile2:

I have heard that BC/BS FEP now covers the sleeve. Can anyone verify this for me? I would sure rather have this than RNY. Thanks

I heard a rumor that Tricare would start covering Vertical Sleeves in January 10. Does anyone know if there's any truth to this? Thank you!

Hi everyone! I was wondering if any of you out there in band land have/had experience with KHPE and your lap band surgery?? Mine does cover it as long as you meet the standard criteria. I am in the BMI 35-40 range but as for co-morbidities, I really don't have any. I do have 3 herniated discs in my lower back and arthitic knees. I am going to meet with the surgeon on 2/18 for my initial consultation and am nervous that my insurance may not approve me! The surgeon I heard is good at dealing with the insurance companies and "helping" the patient get approved but still...would just to know if anyone else has experience dealing with Keystone? Thanks!!!!!!!

I just found out that my company is changing Insurance for 2010 to Cigna. I had the Lap Band surgery in 11/08 - if you have Cigna - how are they after surgery? I'm worried that my surgeon doesn't take Cigna.

I am very new to the insurance world. I just signed for insurance that starts today and reading up they need 5 years of history, correct? well, i went to a doctors from the time I was in middle school up until last year (I'm 23 now) when they said they have no records of me going there. I was upset and got into an argument with the lady who insisted she couldn't find anything on me and I would have to completely come in as a new patient and do a financial screening, which is required yearly. I didn't have time for that and I was too upset so I just went to a 24 hour clinic as a walk in. I'm not just worried since they couldn't find anything on me then to update my fi…

I am double covered through myself and husbands insurance and both insurances cover the procedure. Can anyone out there who is double covered tell me if they had to pay very much out of pocket? Thanks:smile2:

I'm new to this forum, so please bare with me! I've had my realize band surgery on September 16 and the surgery went great. I was in and out of the surgery center in less than 3 hours. My doctor was great before hand and for the surgery. But my troubles started after the surgery. During my initial conversation with my Dr, I expressed concerns with regards to the cost. I was told that they will go through the process of verifying my insurance. I received an approval letter within a week. During my discussion with my dr, they assured me that my out of pocket expense should be approx. $4000 but it might go up to as high as $8000. I was okay with that. After the sur…

Okay. Blue Cross Blue shield, with the help of my PCP's office has completely driven me to distraction! I did my three month Dr. supervised diet, jumped through every single hoop they threw my way and they still denied me. Don't get me wrong, my surgeons office said they have never been able to get someone approved through BCBSIL on the first try. I called BCBSIL this week to see if they could (or would) tell me EXACTLY what they want to see. The csr I spoke to was actually really helpful and went through all my paperwork. Basically he found everything they need but said that it needed to be in a different format in the doctors notes. Grrr. I went to my PCP to…

I requested authorization to have the lap band surgery performed. I have been struggling with my weight for better than fifteen years. In many unfruitful attempts to bring my weight problem into control, I have tried many different diets plans and, all types of medications. I have reached the point that I am no longer healthy, I have chronic back problems, I have had 2 knee surgeries, I have high cholesterol, chronic fatigue, and suffer from depression. I have a family history of heart disease; my Father was 42 when he had his 1st heart attack and 53 when he passed away with his 2nd, my Mother was 48 when she had a heart attack that took her life. I am afraid I may rep…

Well, I called BCBSIL today to see if a decision had been made yet and I was told that they need to see my 3 month supervised diet documentation. I told her that I know that my surgeons office has it and that I would have them refax it and she said that was fine. I called my surgeons office and spoke to my 'insurance lady' there who said quite confidently that it's not that they didn't get it, it's that they are saying that what was provided wasn't detailed enough. I can't say that I'm shocked because I'm sure we've all heard about others having the same issue. What bothers me is that the girl with BCBS didn't say that- she didn't even use the word 'denied'. The good-…

Okay everyone after dealing with the first denial, then going through the process all over again because of some red tape I got approved today. I will find out on Monday (11-23-09) for my surgery date. I'm so excited I started to cry. This has been an overwhelming process and if anyone thinks there is no end in sight, well I got something to say to them. "If you want it, go for it and don't let anyone get in your way. Its your life to live, your family to support you. Most importantly freedom." Thank you everyone who has given me your prayers and good vibes. :thumbup:

Hi, I am new to the search for lap banding and have contacted my insurance policy to see if I am covered. the surgery is not covered. When I was looking for an insurance that does so I could either switch or add to it I found that Indiana has a state mandate to have bariatric surgeries included in group health plans. (I live in Indiana) Does anyone know what the mandate says? Do I call my insurance back and ask again stating that I know we are in a mandate state? It seemed like the CSR had to look up the information, could she have missed it because of the wording? How should I ask the next time I call?

I just found out I have had medicaid (thought it was only my kids for 4 months) how long did it take from start to finish? was this before the state mandate? (im still learning about that) what were your requirements? whay obsticals did you come across? thanks in advance!

Hey everyone, I have been fighting with my insurance company since september 09 to be approved for insurance. I have a weight history since 99' but I did lose weight for a short period of time within the past two years and I do have a comorbidity. They say that since I have not had a BMI of above 35 for two consecutive years that they do not want to approve me. The period of time that my BMI was low was only a few months. Now my surgeons team is going through lap band and obese law to attempt to overturn their denial. Has anyone else have to use obese law to get approved?

Does anyone know anything about anthem blue cross/cmsp?:confused:

I know it sounds weird but this is my situation, I swicth to a another insurance from my employer open enrollment and reading though the coverage booklet it said it covers the lap band. I was so excited since i been wanting to to this for the longest time, my coverage starts january i haven't received my card yet but i wondering how long do i wait to get this done im so anxious should i wait and if so for how long???

Got the call today telling Blue Cross as accepted my surgery. Go in 8 Jan 2010 for pre-op...what can I expect?

Hello everyone, I am working with surgeon #2 for my procedure and the frist one was nice but very difficult when it came to his team working with my insurance provider. My current surgeon is wonderful but he has decided not to renew his contract with my insurance provider significantly increasing my financial contribution. I have worked hard to be put back at square one. As an alternative I was considering traveling to Mexico for work there and then using my current surgeon for adjustments. I know many bandsters have had their procedures done in Mexico and I am looking for success or caution stories in traveling there as an alternative to traditional insurance …

I'm curious about who does the surgeries when you live in Germany and use Tricare Prime Overseas. DH is active duty and we're living on post in Mannheim. Landstuhl and Frankfurt are both relatively close (about an hour away). Is the procedure done at one of the local MTFs or are you referred off post to a German civilian doctor? While I'm pretty sure I might have to duke it out a bit with my PCM next Monday to get her to send a referral in, I fully expect to be approved because I have type 2 diabetes and have a BMI of 43.5. I also fit the 100 pounds over ideal weight, and possibly could fit the 200% over ideal weight if they consider me 5'1" instead of 5'2" - I'm 5…

I would like to know EXACTLY what steps the Insurance company takes once they receive your packet to get approved or denied?...I mean WHAT DO THEY DO? How many people touch the paperwork we send in? Is it one representative that makes the decision or a panel of people? Someone please tell me how this works? I will be submitting my paperwork packet on January 4, 2009…crossing my fingers for a fast approval and fast sx date. J

I have BCBS through my employer and I am also covered under my husbands United Healthcare.... would they submit to both insurance companies? just curious

i am soon to be a former student. i have been in college and without usable health coverage for about ten years. i saw doctors intermittently, i havent had a PCP in about 13 years. so, now i have a job like a real grown up and im getting benefits and i want to have lap band surgery. i have an aetna hmo in case that matters. my worry comes with all this talk of a 5 year history that is required. where on earth will i get that if i havent seen a doctor in like two years??? ive been obese since childhood, but hospitals arent really that great at keeping records are they? so, what am i supposed to do when my obvious girth isnt enough? granted i havent started the …

I was wondering if anyone has had this problem or any advice for me. I had the lap band surgery in June of 07. My company insurance was BCBS of NC at that time and they covered surgery and follow ups, fills etc. Later that year, my company went self insured thru med cost. At that time the HR department told me nothing would be covered related to weight loss or my follow ups. Because of this I have not been able to have regular follow ups and maintenance. I only go when I can save enough to. I spoke with our HR again, but she was no help and I also spoke with a company nurse and she said that she believes this is wrong. Because I did not change insurances and I h…

Has anyone been banded in the DFW area with Tricare Reserve? I'm jsut starting to learn everything I can about being banded and there is so much information just about insurance. Has anyone gotten approved by Tricare and found a Dr. in Dallas/Ft Worth that accepts it? What were your out of pocket expenses? How long did approval take? Anything else I should be concerned about?

Hello All! This is my first post and hope everyone is good! I have just started the process to start attempting the Lap-band® Surgery. I have been to my primary doctor who did some blood work and went over my health records. I have had high blood pressure for years and ashma plus last set of blood work my blood sugar was a little high. However I am nervous because my BMI is 38 not 40 has anyone ran into this? What has their luck been with insurance paying since mine has to be authorized first? I would greatly apprecitate any input...and thanks!

Hello All, A newbie here, scheduled for surgery on Jan 25. Can't wait. I have a question for the group, however, and I'm not finding answers anywhere. I will be self paying in Mexico and financing most of the procedure with Med Choice. Apparently MedChoice charges the surgeon a commission of 6%. My surgeon is passing that on to me. Anyone heard of this? Is this common practice? Sounds a little slippery to me not to mention a chunk of dinero! Love to hear your thoughts. Carol

I am in tears, I found out that my insurance does not cover any form of weight loss. I don't understand how they will pay for a pap smear to prevent cervical cancer or mammogram for breast cancer but they won't cover Lapband or gastric bypass to help with cancers and numerous other things. Does anyone know if there is an insurance company that offers health insurance with bariatic that you can buy as an individual plan? I am in search of dumping my current health insurance I get through work to get this done. I started Weight Watchers and I am starving, it sucks! Please help with any information on an individual plan. Thanks

My health insurance company sent me a check recently for $3000 and I was curious why and after I called them they said that I overpaid my deductible since I was in the hospital many times this year and had 2 surgeries including the recent lapband. They told me that check they sent was mine to keep. It just seems strange, I've never heard of this before. Does this make sense to you?

I have Aetna POS and I initally went in for Lap Band as I had never heard of the sleeve, but in the middle of my nutritionalist visits I was told about it from a friend. But anyway, my question is I had the Dr. office call and I am covered 100% for lap band and the sleeve no copays or deductables. I have my last nutritional visit the 4th of Dec, do you think I will get rejected and have to go through the appeal process? I have done all of my PSYC, Phyysical, and even had a stress test done and I didnt know if anyone has had any problems if they are covered 100% or not. I was also wondering what the average time from approval to the point where you can set a date is, a…

I googled medicare 2010 and found this. check out the link and tell me what you think. I think it means that medicare will cover the sleeve, code 43775 starting in January. I don't have medicare, but I'm hoping anthem blue cross will follow suit if medicare starts covering the sleeve! http://www.cignagovernmentservices.com/partb/pubs/news/2009/1109/cope10956.pdf

The following bariatric surgical procedures are considered medically necessary for Members who meet the associated criteria: Gastric bypass (Roux-en-Y; gastrojejunal anastomosis) Vertical banded gastroplasty (gastric banding; gastric stapling) Biliopancreatic bypass (Scopinaro procedure) Biliopancreatic diversion with duodenal switch Gastric sleeve procedure (also known as laparoscopic vertical gastrectomy or laparoscopic sleeve gastrectomy) when done alone and not a part of the full operation to complete a biliopancreatic diversion with duodenal switch (BPDDS or DS) Medical Necessity Criteria The Member must meet the criteria of either A or B: …

I am new here and just started exploring the option of the LapBand. I am 32 and have a BMI of 42. I have BCBS of NC the PPO version. With my insurance there is no manditory 6 month diet restriction. But I'm reading alot on here about a letters from your dr stating the medical necessity . I just recently got a family doctor before that I was always seen in urgent care if I was sick. Does the letter of medical necessity have to come from a family dr. or can it come from the surgeon who is to perform the lapband? I do not have any health problems so I do not have any other doctors like cardiologists, etc. Thanks in advance.

Just wondering if anyone else has this & if so how hard was it to get approved?

Hi, I was self pay with my first band because my BMI was 38 and if I had done a six month diet, I wouldn't have qualified. Then I got a dilated pouch, was in heartburn hell and couldn't keep any solids down. I needed a new surgery and a new band and the insurance wouldn't cover me because I had been self-pay. It really frys me because although the first surgery was optional, the second wasn't. We had even paid our ten thousand dollar deductable for the year! Insurance companys suck.