Insurance & Financing

I am curious what entails and how long it takes before I can actually schedule a date for surgery with medicare. I am on disability. I have been doing a supervised diet with my DR. Will I have to also do another one with the bariatric surgeon? I have no idea what happens and am looking for some input. Thank you.

Does anyone know what the requirements are for them?:thumbup:

Hi everyone, I am so upset. I had my surgery on Thursday 10/22 and it was scheduled for outpatient meaning I could stay in the hospital if it was less than 24 hrs. I had waited almost a month for the drs office and the hospital to agree to outpatient only. The hospital used to not allow lb procedure as an outpatient. My drs office said they finally agreed to do outpatient procedures as of Oct 1. Well my lb procedure took longer and the surgeon had to repair a severe hiatal hernia, and do a liver biopsy. I endured terrible pain, nausea, vomiting, etc while I was in the hospital the whole time but they let me go and I had been on the unit for maybe 22 hrs. When I was rele…

Hello everyone! I'm calling the insurance company next week but wanted to see if anyone here has some experience with the United Health Care coverage for AZ State employees? When I looked into LapBand in 2008, they required 5 years med history, 6 month supervised diet, BMI over 40 or over 35 w/2 comorbidities. They just changed coverage this year and was just wondering if anyone knows if this is has changed? :thumbdown: I appreciate your help! Thanks!

I need help writing an appeal letter to Tricare; When my information was first submitted; I weighed 219.5 and am 5'6". It was denied. My doctor resubmitted my information on my frame size which is small and my new weight of 228.5; I gained weight after having surgery on my leg and being off for 6 months. Anyway, I am now according to Tricare over 100 pounds and I have HBP, diabetes, infertility, hight cholesterol, arthritis, acid reflux. Where do I start? What do I say? If you have any examples you can send them to delta27@earthlink.net or attach them to an email on here to me. Thanks

Here's the thing....I just saw my surgeon for the first time last week. I haven't even decided if I want this surgery...but have decided to go ahead with the approval process. I would be looking at a Mar-May surgery date if I decide to proceed. However, the Dr.'s office has already scheduled me (this week) for things like EKG, sleep study, chest xrays, etc. They assured me these things were a copay situation. When I got to the hospital I was informed that they are a deductible situation. That is a big difference. I wasn't wild in the first place to have testing for an approval for an insurance that could change at renewals in December. But if it was just a co…

About a year ago I went to LapBand appt...I was qualified, yet UHC didn't cover it (my plan) However...now I am on Anthem..is there any users out there that have or had Anthem and your thought on that? I will call insurance to see if it's covered, but I thought I would check here as well to see if I can get a heads up. Thanks in advance Angie

After spending a considerable amount of time searching for information regarding Kaiser Southern California and Lap Band surgery. I sent an email to my PCP (via www.kp.org) and to Member Services. My PCP's nurse referred me to the Positive Choice department and today I received the following detailed information from Member Services: "Members who meet the medical criteria and are interested in having bariatric surgery enroll in 'Options', a 24-week bariatric surgery preparation program that prepares them physically and emotionally for surgery and for post surgical recovery. There are complex medical and emotional effects of gastric bypass as a treatment for obesity. Our…

I have been going back and forth with my insurance after my "denial" in August....after giving up for a little while and deciding to go South of the Border and "self pay".....I put down deposits, bought airline tickets and was prepared to do WHATEVER I had to do!!.... Then...it hit me....I AM SICK.....I have had a heart attack (at 30yrs due to migraine medication), I have high blood pressure, and horrible pitting edema and was being looked at for possible congestive heart failure...I am 35 years old..... I decided I WOULD NOT let my insurance NOT help me....I called....dealt with a wonderful woman at my insurance company directly....had all 86 pages of my med hx resub…

I just heard from my surgeon's office and UHC - my VSG has been approved on my 2nd appeal... now it is just waiting to schedule a date. Whew - this will sure make the weekend a bit easier to relax!

I am on month 3 of my Pre-op PCP Appts.. (So I have had 3 appt's so far) Well I just got a letter in the mail from my PCP showing i owe 65 bucks cause the Insurance didnt cover anything on my 3rd visit.. Has this happened to anyone else before? I will have to call the insurance tomorrow.. I cant afford to pay 80 bucks for 3 more appts BTW I have PPO Blue insurance

It's open enrollment and I'm thinking of changing insurance form Cigna to United Healthcare. I am a teacher in Georgia so I am under the state plan. Has anyone been banded under this insurance? What was your experience like and what were the requirements?

Hey all, I just wanted to know if anyone with Medi-cal has had their surgery approved or denied and the reasons why. also, how long did it take from start to finish for you? i have medi-cal and am trying to find out as much as possible about the process with medi-cal.

This is the type of insurance I have. No waiting period--needs authorization from Dr. What has been your experience with this company? Many thanks. LINDA

I am a Health Insurance Broker and a fellow banster. If you have insurance questions I will try to help. Just know with so many carriers:eek: and many more plans:eek::wub: ( i.e. Individual, Small Group, Large Group, Riders, and Exclusions) I will not know what the specifics of your plan are, but I can help you to navigate the nightmarish rollercoaster that is insurance.

Hello everyone! I just registered here today, but I have been reading the forum for months – since I started working with my doctor to go through Lap Band surgery. Anyhow, I have Aetna Choice POS II and thought that I’d share some of my experience. I think this will be a long post, but I hope it’s helpful to those of you who are trying to get approved. I began working with my doctor four months ago to prepare for the surgery. We did the three month pre-op routine. Over all, I went to both my primary care doctor (who also managed my diet) and the nutritionist four times – The initial visit plus one each month of the diet. I also was advised to have a psychiatric evalua…

So I have been denied by Aetna and exhausted my appeals. My weight wasn't high enough for the last 2 years and I have no comorbidities. So at the very least I figure I can be miserable for 18 more months (I hit 40 BMI 6 months ago) and then reapply. But quite interestingly, my BP has shot way up. Like really bad high. If my Dr. says I now have high BP can I go ahead and reapply?

I was wonder if any one has Anthem blue cross/blue shield (OH) as their Ins. Company & if so what all did they require you to do be you was approved. How long did it rp get approved?

Has anyone had to switch insurance after they were banded? I have had Tufts for 15 years which paid for my surgery but next year our company is switching to Cigna. My bigest fear is any complications that could arise after the switch.

Hey all! I've taken another step in my journey! So far things have gone very smoothly (although I'm still in the very beginning!) 10/02/09 PCP referal to Bariatric Surgeon. 10/13/09 WLS Seminar at Surgeon's office. Next... 10/20/09 1st Appt (H&P) with Surgeon Psychaitric evaluation PCP to start three-month diet (I'm running low on vacation time so I'm trying to squeeze as much into a day as possible! My question now is: For the three-month supervised diet, does that literally mean 90 days or does it mean one visit a month for three months? My insurance literature doesn't specify and I haven't had much luck with the BCBSIL reps over the phone. Has anyone e…

:confused: I don't know what to do!!!...... I just called to make my first consultation and they want to know if I’m going to be self pay or covered by insurance. WELLL the problem is I have Cigna and like most insurance comp. they don’t cover the VSG "YET"! I have heard rumors that in January that there MIGHT be a pass and the sleeve will be accepted by most insurance. The problem is what if it doesn’t get passed and I’m in the same boat now, having to pay myself but only now i wasted 3 months?? The other dilemma is what if it is passed? I’m not even sure if they will cover me because my BMI is 37 not freakin 40! And I don’t have any health related risk (that I know of).…

Hi All! One of BCBS of IL's requirements for insurance approval is a 24 month history of weight loss attempts with results (that is my understanding of it, anyhow. I requested a list of requirements from BCBS a week ago today and still haven't gotten anything, I'll be calling them later). Has anyone else had to do this? What format did you use for the 24 month diet history? I'd like to go ahead and get a rough copy started so I can work on finalizing it. I want to make this process as smooth and quick as possible!

I'm insured through Americhoice of United (Medicaid) and would like some input on the requirements for surgery. At 4'10 and 190 lbs, I qualify for surgery but have non-threatening co-morbidities. Is the six-month weight loss program mandated? How long is approval? Yadda yadda yadda :-):thumbup:

Well today I got the bad news that I was denied through Tricare Prime. I am sooooo upset. I cried for about 30 minutes straight. I don't know how I am typing this b/c I can barely see. Anyway, I am going to appeal; Can someone help me with this process? I am 220lbs.. My BMI is 36- I have high blood pressure, high cholesterol, acid reflux, diabetes, joint pains, and infertility. Why did they deny me? Someone PLEAAAAAASSSSEEE HEP ME.

Hi; I have tried multiple times to get the horizon bc/bs reps to send me the policy and requriements for bariatric surgery and have gotten nowhere. Here is a link to the application the doctor fills out, and lo and behold, there are the requirements. Happy surfing... http://www.horizon-bcbsnj.com/SiteGen/Uploads/Public/horizon_bcbsnj/pdf/3684.pdf

Hi, I was just told by the Doctor I planned on using that I was denied. I hadn't been to any visits or anything yet this was just the pre-approval. The Insurance person said usually when they are told it's Denied up front it's because it's excluded from my coverage. But, she told me to call and ask questions. Has anyone been in this predicament and been approved? If so, can you offer some advice/assistance. TIA for any help offered.

Hey Everyone, I've been reading through the rules for deducting the cost of lap band surgery on my taxes and my only question is: If I am paying for the cost of surgery with a credit card (CareCredit) can I still deduct the cost? Since it's basically a loan I wasn't sure if that still counted...I know this may be a stupid question but I just wasn't sure. Thanks!

:thumbup: I was just wondering if anyone on here had cigna? I am on my dads insurance and I know cigna covers gastric bypass because both my parents had it done last year. I am just wondering if anyone has tried to get approved by cigna for the VSG yet ?

This is my first appeal. Any feedback welcome, and if it is helpful for anyone, please leverage! UnitedHealthcare Appeals Unit P.O. Box 30575 Salt Lake City, UT 84130-0575 Fax: (801) 938-2100 APPEAL REQUEST Service Ref # XXXXXXXXXXXX Specific Coverage Decision being appealed: Clinical evidence in published peer-reviewed medical literature is insufficient to show that a gastric sleeve procedure by itself is a safe and effective treatment for morbid obesity, thus is an unproven procedure and not covered by benefits. I am requesting an appeal of this decision based on the following: The UnitedHealthcare Bariatric Surgery Medical Policy document approval dat…

I called Aetna today to ask them some questions about the surgery coverage and the lady said that my plan does not cover it. But in the same sentence she said that it still could. Has anyone had Aetna say their plan did not cover but ended up covering it?:thumbup::confused:

Does anyone know of an insurance company that will take over and cover, i.e. the fills for my lapband, etc? We lost coverage when my husband changed jobs and I'm wondering if there's any coverage out there that's affordable that will cover my fills? Thanks for any info!

Hi guys! I've been reading around and haven't been able to find much information on Cigna PPO. This is my first post... not completely sure if I'm posting on the correct thread. Okay, open enrollment at work is coming up in Nov (09) and I would like to know what you guys would recommend as to what insurance would be better and/or easier; should I keep kaiser which seems to have a long wait time, or switch to Cigna in hopes of getting banded sooner? I'm pretty much aware already of the requirements for Kaiser HMO and how their approval works, I'm not so sure on Cigna PPO, is approval difficult? Any thoughts? Opinions? Suggestions? Experiences? Any and all informat…

I just had to share my news. Called this morning and finally got an approval #. I was denied once before but, did the appeal. I think if you can handle the waiting game. Then we can surely work this band. When we get it.:frown:

Yes that's right! aenta ppo approved me today. My paperwork was submitted last tuesday and i was approved today (Tuesday). One week exactly!! very fast. I only did 3 months of a weightloss program and my BMI is over 40. I did have to provide 2 years or weight history also. Im sooooooo excited!!!! My surgery is Nov 11th. Finally! yay!!

Hi, I started my 6 month supervised diet in January of this year (the end of January actually) and was going at the end of every month (about 30 to 31 days apart). At the end of June, my doctor was on vacation so my next appointment wasn't until the first week in July. My question is, will I have to start over since, technically, I missed the month of June, although I picked back up a few days latter in July? My other appointments resumed during the first week of each month there after. I am nervous because I don't want to start over or pick up from July; then that would be the second time I would have been set back because of dates. HELP:confused:

So my insurance is Aetna POS and I'm pursuing the 3-month multi-disciplinary program. Does anyone have any idea what qualifies as the proof of the exercise requirement?

Instead of getting a statement of covered services, I get a cc of a letter BCBS sent to the hospital to request more records. Are they trying to justify the charges the hospital sent, or could they be trying to back out of the coverage? This is scary!

I was wondering if anyone knows what requirements Aetna Managed choice POS makes you do before approval? We just switched to this insurance and I know they cover the Lapband but don't know what requirements they make you do. I wanted to get my band before the end of the year but with what I am reading I am guessing that is out of the question.

Was just wondering what insurance people have, which State they are from and how long it took for their insurance to approve or deny for the Lap Band......THANKS! I will start: California-Blue Shield PPO And I am still currently waiting to hear any news from the insurance company or Surgeon's office....

Group, I was scheduled for surgery on 9/24 with Dr. Metz, in Denver. His billing clerk called today and said that she called a 5th time today to my insurance, Federal BCBS. She spoke with the pre-cert dept this time and got an R.N. on the line. The R.N. said the VSG with CPT code of 43843 was not covered. I called twice and the billing clerk called twice before this and we were both told that it was a covered service. I am extremely depressed and upset. I refused to have my guts re-routed or some foreign part in my body. (sorry to be so blunt) I am completely confused as to why 4 different ppl would tell us that it is covered and then pre-cert R.N. says no.…

I am looking for a psychologist on long island - preferabally one that take Aetna and is familiar with the lap band requirements. I am hopefully being banded by Dr. Geiss this year as soon as i get approval from Aetna. Thanks

What do you think of this carecredit company? Are they easy to deal with? I need some input before I feel comfortable enough to apply. Angie

I knew this would happen, that's why I waited to check with my insurance to see if I'm covered. NOPE what else is new. I'm sad today & now a little depressed. This totally sucks. Sorry just wanted to vent. I haven't given up yet. Jenn

I was told by the coordinator that I have good insurance and I MIGHT have to pay 1,500 when I get approved. Just wondering what out of pocket costs everyone has had? I don't like surprises!

NJ Plus (Horizon)?

I don't know what the problem is. I understand that the "recovery" time for the band is 3-5 days but I needed to take a medical leave from work and now the snotty *&^%$ at the surgeons office wont fill out the FMLA paperwork. What does she care ? Its without pay so it doesnt cost my employer anything !! I am a nurse on a high stress unit (Alzheimers), I work nights, and there are six of us women and we are a serious group of foodies (potluck every tuesday, sundae night first Saturday of the month etc...) If I go back to this high stress, trigger-filled environment a week after banding on a liquid diet Im in trouble. I need to adjust to all of these changes before I ju…

Just wondering if anyone knows how Tricare Prime north calculates the 200% body weight. I saw a link on here for Triwest but haven't been able to find any for Tricare north. If anyone has the link that would be great or has used it. Thank you so much.

I have been accepted into the program. What does this mean? she said I have to attend a introduction and a support group and they will tell me from there what is going to happen. I am so confused, does this mean Tricare approved for me to get the surgery or just that I can have an appt? I am going through the hosp on post and I have Tricare Prime, hubby is active duty. I can't bring my kids to either appt and I don't know anyone here. I hope hubby can get off a little early to watch the kids. yikes.

Does anyone have HealthNet? I'm waiting for my approval. Surgeon's office sent it in a few days ago. I don't know how difficult they are. Let me know. Thanks. Emily

Hi, I was wondering if anyone has ever been approved with Blue Shield of Ca HMO? This is the insurance that I currently have. I have insurance coverage through my husbands company and our open enrollment is in November. I am planning to switch to Anthem Blue Cross PPO, that will give me an effective date of January 2010. I had my seminar on Sept. 12 at Dr. Feiz' office in Beverly Hills. I explained my insurance situation to the office manager, so now its all about waiting. I know that having Anthem Blue Cross PPO, I will have a better chance at being approved because it is a better insurance. I am SO anxious!!! SO, I just wanted to know if anyone has been approved with …