Insurance & Financing

I'm new and considering VSG. I was reluctant to pursue any WLS but my last doctor suggested a band to me. After reading/researching for seven months I don't think it's the right option. I do need a restrictive procedure but my biggest issue is that I always feel hungry, no matter if my belly is full or not (and it's not always head hunger, either!), so I think the VSG will provide a better solution for me. I can see myself suspended in a special sort of hell with the band - unable to eat but still always starving, and having my food options limited, too! My question is about Tricare and VSG. I read on another thread that Tricare is going to start covering VSG very soo…

My info was submitted 3 weeks ago and I'm just wondering how long did it take to hear from your insurance? I know they said it could take a couple of months, but I'm so eager to find out. I just pray that I am approved!

Does anyone have an estimate of the out of pocket costs for the band on Tricare Standard?

I have wonderful insurance through my company. However, they will not cover bariatric surgery. However, my husband's company insurance will so we decided to switch during open enrollment. At the last minute, he was switched to part-time and has to pick up Aetna/SRC which covers the surgery but has a limited max that they will pay for everything (including doctor visits). So, I kept my insurance and he is also getting this insurance (which considers itself primary no matter what). My concern is, if there happens to be a complication, would my other insurance company cover that if they won't cover the bariatric surgery? I have this fear that, if there is a complicati…

My insurance will cover the lap band but my deductible is really high..$5000 after I meet the deductible the BCBS will pay 70%...My question is will I need to come prepared to pay my deductible or will the hospital make payment arrangements with me on the deductible? Any advice or help would be great.

Hi I just want to know if anyone out there delt with bcbs in my area and knows what they ask for. I was told I have great insurance as a government worker never really knew that since I'm 23 and I really don't use my insurance (kinda scare of docs) I just want to find out any information Thanks in advance

Has anyone had optima health medicad insurance and got the lapband. How long did it take to get approved for the surgery after you sent all your paperwork in?

Hi. I have BCBS of IL and they are requiring me to do a 3 month medically supervised weight loss attempt. If I follow the plan my doctor gives me, I will lose weight. My problem has always been keeping it off. So my question is this: Will losing weight make it less likeley that I get approved, or does the insurance company want to see you lose weight to see that you are committed? How does that work? I don't know if I should try really hard, or just show up to the appointments and not really try to lose weight during the three months. Have any of you had any experience with that?

I have Anthem BCBS with Tricare Standard as a secondary (though we haven't processed anything under Tricare yet). My doctor just submitted 4 office visits that were all pre-surgery and they were rejected by BCBS. Has anyone had that happen? If the surgery is covered, are the office visits covered too?

Has anyone ever had Medicare cover their Vertical Sleeve? Thanks, Tammy

I am just beginning the lap band process, and called my insurance company, Cigna POS yesterday for some clarification on my requirements. The website says that you need 24 months of medical history of obesity, the person on the phone said that it was 5 years of medical history that I would need. So, can I assume that is changing? I do have 5 years, but for one year, one of the my weigh ins had a BMI of less than 40. I talked to him about that, and he said that if the other weigh ins were over 40, that it would be okay because it would still show a cycle of morbid obesity. Also, I talked to him about the 6 month monitoring. My scenario is this: I went to the Dr in Ja…

Well so far iv had to get my family doc to put a referral in and that was approved. So i meet with the surgeon on Thursday. I was wondering if i have to get an approval from the surgeon himself or is it already approved and im just doing the appointments now. Also how fast are they with all the pre op stuff?? i mean am i looking at a few months before i even have the surgery or is it possible to get it and have all the stuff done in 4 to 6 weeks? thank you for the info.

My insurace will not cover the sleeve so I have to pay out of pocket for the procedure. The surgeon I have spoken to quoted me 13665.00 for the procedure, plus an additional 500 for the consult, nutr. & psych. I know some of you have went to Mexico for the procedure and I was wondering if you could tell about how much the sleeve procedure cost there.

:scared0:Out of curiosity I called the Hospital where I had my sleeve done. I stayed two day. THe bill is the total at the hospital no Dr. fee's they will be billed thru the clinic where the Doc works. Ready!! $20,482.35 I was there for two days. WOW I can see why people go to Mexico without insurance.

Hi! I'm currently banded and I've been having some issues with banding. I have been reading about the VSG for some time now and am getting more and more interested. I am not interested at all at getting re-banded, and even if I couldn't be Sleeved then I would probably just end up having my band removed all to gether. It just didn't work out for me no matter how hard I've tried and the side effects of it is more than I can take anymore. Anyway, It's open enrollment at work and I'm able to make a health care provider at this time. However, I've heard Kaiser does perform this surgery - only I'd like to avoid Kaiser to be perfectly honest. I grew up with them and I r…

Below is a link to the updated position on the Sleeve Gastrectomy from the ASMBS. I wonder how long it will take the insurance companies to stop denying this procedure due to it being considered experimental. http://www.asmbs.org/Newsite07/resources/Updated_Position_Statement_on_Sleeve_Gastrectomy.pdf

Hi, I was just wondering what your experience with Tricare has been? I am 5'3 and 229 BMI 40. I do have arthritis in my one ankle, have degenerative disc disease in my neck and am pre-diabetic. Just wondering what you think about my chances for approval? I also am considered disabled through the VA (I am a vet, for migraines, and my arthritis, etc). I am also tricare standard (best decision I ever made in regards to doctor choices) I am near St Louis now Thanks for your help. Are you glad you got it or are getting it? Heidi heidshosh@aol.com

Has anyone been approved by Blue Cross Blue Shield of Alabama ?

Can someone please explain exactly what this program is? I have heard it's phonecalls but what info are they looking for? Are they checking to se if your attending the preop classes? That I am still trying to loose wt. on my own? And I assume it's the doctor who enrolls you in this program? I have a informational seminar 1/7/09 but it's not Tufts specific so I'm not sure this will be addressed. I would want to start the 6 month wait ASAP and having a June-Aug surgery date would be great and maybe see a little results by Christmas. My goal however is fourty, fit & fabulous so I actually plenty of time to accomplish my personal goal. :Yawn:

Does anybody with HMO insurance got approve on this surgery? Anthem said its not cover. Just wondering if any one has.....tnx

Hello everyone, I have seen quite a few posts about Aetna POS but I have yet to come accross an Aetna HMO member who has gone thru the insurance approval process. I am curious to hear if anyone has any experience with this particular type of insuance. Specifically, I am interested in finding out the following: Has anyone previously completed a 6 month supervised medical weight loss program? If so, was it applicable to the prerequisites for Aetna HMO authorization process? Has anyone been seeing a psychologist already, and if so, was that also applicable to the prerequisites for Aetna HMO authorization process? As a side note, I am finding it must easier to co…

So, I had a surgery date scheduled with Dr. Alvarez in Mexico (self-pay) but it looks like my grandparents changed their minds!! :'( sooo... my mom is putting me on her Work (IRS) health insurance..she's trying to go with BCBS of Texas..i'm not sure which policy yet. But I was wondering if its hard to get approved by BCBS of texas? I have a BMI of 41.2 I have no health problems other than being over weight... And I have been overweight for more than 10 years... And also would there be any chance of me having to do that dreadful 6 month weightloss program req??? Thanks a bunch ya'll!! -Priscilla

Does anyone have any information that might be helpful for at&t employees with united healthcare ins. in California, getting their surgery covered? My friend works at a call center where she is required to sit all day, and you can just sit and watch all these ladies gradually gain weight over a period of a few years, and naturally they pick up a few weight related medical problems along with the extra pounds. And wouldn't you know it, AT&T does not allow coverage for WLS?! :party: Does anyone of you know ANYTHING that my friend can do? Thanks so much.

Wondering if anyone can tell me the criteria required by Blue Cross Premier Care of Michigan

Has anyone used BC/BS of Massachusetts insurance for surgery? If so, How was your experience? What were the requirements for you? I called and I'm told that all I needed was a doctor's letter, having a bmi between 35-40 with a co-morbid disease or being 100 pounds over weight. I'm just curious now because I see so many logs of people who call the insurance company and they are told all the same info., only to be denied when you apply. Thank you, in advance, for any input.

My doctor does not know how to evidence the years of obesity. Please help! What does the insurance require? Is there a particular format? Does anyone have sample templates?

Hi, I have my first appt today at noon... I have so many medical records I am not even sure what to take, what to copy. Did you all have a letter from your primary care doctor to take with you? Since I am on standard I barely go to my primary doctor... could never find a great one (except for colds and all that) but had a great GYN doctor , neurologist, pain doctors for all my things... So I have all those records. I am also a disabled veteran and have all that documentation (basically it documents in outline form what happened to me over the last 10 years). I am 5"3 and about 229, so I am right on the cusp of the weight requirements. Any thoughts of how to organ…

I just got a call from Kelley at Obesity Law and Advocacy Center or obesitylaw.com telling me that she was just faxed my approval from BCBS IL. My employer has an plan exclusion on weight loss surgery, so this was a difficult process and has taken close to two years. I was denied twice by BCBS IL and obesitylaw.com was denied once before finally approved. I am very excited and ready to make the necessary changes to start my new life. I truly appreciate all the support and encouragement I have received from all of you at this forum, and I can say without hesitation that I will have many more questions for you in the future. Thanks for being there for me. Dan

ok i know medicaid cover my surgery and all my appointments except the nutritionist but do they pay 100 percent of it all only some of it?

:confused: So after 7 years... yes... seven YEARS... without insurance that will cover this, I finally got a county job with amazing BCBS coverage that includes WLS! I had to work VERY hard to contain myself and not do a happy dance on the table in front of me- including some very funny moves- in employee orientation when I saw the line for Bariatric Surgery! Because of their policy, my benefits don't kick in until the first day of the month following a full calendar month after my first day. A whole lot of fancy words to say I started in November, add a month puts it in December, then the next first day is January 1st. New Year. New chance! Couldn't be more perf…

Does anyone have Empire BC/BS PPO and willing to share what the process was like getting approved? I am at the very begining of what I am sure is a long process and have no idea what I am in for as far as the insurance is concerned. Thanks!! Heather

Anyone have Hardvard Pilgrim Navigator and any issues getting approved? Any answers would be appreciated. Thank you!

Hey so i went to the doc on Monday and she put in my refferal to get the lap band. I know its only been 4 days but im iching to get things going. Im 200% over my ideal weight, High calisteral, high tyroid, and pre diabetic. I dont think i will be denied i just wondered how long it normally takes for them to approve it.

My surgery was Oct 8th. I followed 3 mo. plan required w/Aetna. I"m just now seeing figures on my Aetna acct online for expenses. They're still denying the psych consult costs because now they said I needed a preapproval thru ANOTHER company. There was nothing in any papers, phone conversations, medical plan booklets, etc that said I needed preapproval thru another source for psych consult.I dont know how they expected me to pull the name & number out of the air as to who I was supposed to get approval thru. I read what was sent to me regarding requirements for weight loss surgery. It tells what is required in order to have the surgery but does NOT mention they…

Hi what are my options in Australia, mum was telling me today that medicare might be covering it, I know there is finance for surgery's these day and i have even heard that you can use your super because its considered life saving surgery, can anyone back any of these? thanks:smile2::biggrin:

Tricare is proposing new regulations in regards to LAP-BAND® and other weightloss surgeries. This is a good thing. They want to use BMI as a means by which to assess acceptance rather than just "100 pounds over weight". Until December 28th they are requesting comments for this change. All you have to do is go to Regulations.gov and then click submit comment towards the center of the page to leave your thoughts. You don't have to give all the address and govt agency info unless you just want to, that's just voluntary extra stuff. For more info on the topic check out page 14 of the November 16th edition of the Navy Times. It's in the section titled FastTrack.

Finally! After 2 + years and literally 100's of pages of weight watchers logs, monthly physician reviews, etc.... I'm approved. BCBS denied me three times - I wore them out I'm sure. Yay me!! Now what? I was so caught up in the fight I forgot what's next - how funny.

I am wondering if I can still have my surgery if I change doctors. I have tricare prime(south) but have moved to Virginia which is tricare (north); since I have been approved in the south can I just find a new doctor and not have to go through everything again? Or should I just go ahead and have surgery in South and find doctor to fill in the North?

Hey there. I'm just curious if anyone else out there has Blue Cross and Blue Shield for Federal Employees in Ohio? And if so, how hard are they to get approved for the surgery? I've done the seminar, called them, found out what they want (no one mentioned the 3 or 6 month doctor supervised diet). All they SAID they want is a letter of medical necessity from the surgeon and the CPT and diagnosis codes. It just seems a little too easy. I haven't met with the surgeon yet, but I'm anticipating that the insurance is going to be the hardest part. Suggestions? Thanks!

Tomorrow is the big day for me... last nutritional visit and they submit to insurance. I wrote this letter back when I first started w/the process. Not sure if I should change anything. A letter like this is not required by insurance, but I am including it to put my low BMI in 2007 in perspective. Thanks in advance to anyone who can give me feedback on this. I am so nervous about the stuff being submitted to insurance tomorrow. Yikes! ***************************************** To Whom it May Concern: I am writing today to give you some background w/regards to my personal struggle w/obesity and what I hope to accomplish by having adjustable gastric band surgery…

Anyone in MA have experience with Harvard Pilgrim Navigagtor insurance?? Have my first appointment with MD in December! Thanks!:tongue_smilie:

Does anyone have independant health and what are their requirments?

:confused1:Has anyone ever appealed through a union? I'm currently will be sending some info to the union for my appeal, but they wont review it until January when they have their meeting. I had an exclusion in my plan so I had to go that route. I'm still baffled as to which surgery I should get. I really wanted the duodenal switch because of the 98% cure rate in diabetes and sleep apnea.I'm just nervous about the malabsorbtion, and deficiences with the surgery. Then if I get the sleeve I'm worried I will gain the weight back,as with the ds surgery your chance of gaining weight is really low. When I send this info in they will want to know what surgery I want, and I keep …

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

I have been working on my file since beginning of September and it was finally submitted to BCBS TX 10/22. Today they informed me that they won't even review my file regardless of my multiple comorbidities due to exclusion. My Dr. said they will appeal and they are positive I will win on approval. However, the Insurance company states nothing will change their decision. I have been fighting my weight forever, so waiting won't change much. But am I fighting a battle with them that I can't win? Any help or information is much appreciated. WAITING.......:sad:

hello i was wondering if anyone eles has hip medicaid and if you do what was the process like of getting lapband ? what i mean is what do they make you do such as all the tests and how hard is it to get approved basicaly all the info you got is great lol thanks

Has anyone had to have a 6 month diet? Pre op Surgeon Consulataion? Psych Eval? Nurt Eval? If so how long did it take for approval after submitting the paperwork? Thanks:tongue:

I started my process in June of this year and currently have Keystone Health Plan East. My company is dropping them and my replacement choice is Anthem Blue Cross PA. My surgeon wanted me to get clearance on her suspicion that I had an enlarged thyroid and sent me for an ultrasound. Lo and behold and do. I am in the final phases but I have to have my thyroid removed (11/11) which is going to of course cause a delay. She told me I need to recover and get my hormones at a proper level before getting the WLS (approx 6 weeeks) which is of course going to take me very close to the end of the year and it looks like getting this done before 1/1/10 when my new insurance kicks in…

Does anyone know where to get the new qualifications that BCBS of IL started as of July 1? I was told by my physician there are new qualification that are better.

My doctor sent my records to BCBS of Georgia last Monday (6/18). I called BCBS today to see if they had received them and if a decision had been made yet. They said that they just received them yesterday (6/25). When I asked how long it would take to get an answer, the gal stated that she did not know. They didn't even give me a rough timeline. So, will it be 5 days or 5 months? I wonder if they just take their time? I am going nuts here- wondering when I will get an answer. Does anyone out there have BCBS of Georgia? What were your experiences with them? Help!:confused: