Insurance & Financing

My insurance BCBS WY said my wife and I have to have a documented five year weight history in order for the surgery to be approved. It's not in their policy which I have a copy of. We both meet the reqirement in the policy, but the five year weight history is not in there. I've been denied once, and my wife has been denied twice. We are young so we haven't really been to the doctor at all and we haven't has insurance until this past two years. We are getting ready to go to the state insurance board. Can anyone offer any ideas? This is ludacris. My wife could have a heart attack or stroke in the next five years...but she despretly wants kids and I want to be a good…

:scared2: This is my first post. I have Aetna insurance and have been told by Aetna that my type of insurance does cover lap band surgery. I have gone to the initial lap band seminar. I have had the pysch eval, the nutritionist consult, and an appt with the nurse practitioner on staff. My hospital here in NH has never dealt with Aetna for this procedure so the insurance liason is not very clear what the expectations are for Aetna. We are reading the clinical policy bullitan very carefully, and yet some of it is unclear. There are clearly 2 options; 6 month and 3 month. I would love to do the 3 month option but am unclear about the exercise regime part. It says you must wo…

Had my follow up visit with my doctor (Dr. Umbach) today to make sure I have everything in before we submit to insurance. I have Anthem Lumenos and the requirements seem to be pretty easy in comparison to others I've heard about. Now it's in god's hands and I have to wait to see if I'm approved or not. I'm 5'4" and weigh 238 pounds. Has anyone else had experience with this plan? How fast were you approved? I've read that some are getting it back pretty quickly but the Dr's receptionist said 2-3 weeks. I'm really hoping for a surgery date in September. BTW anyone looking for a Dr. in Vegas - I LOVE Umbach, both he and his staff have been amazing helping me start my jo…

I just talked to the clinic and they said my co pay after medicare would be over 7000 for lapband and over 10000 for gastric? Is this normal?

I just learned I weigh enough but I'm not sick enough (one comorbidity not two) for my insurance (CIGNA) to pay. I'm determined to get this done. How have some of y'all jumped this hurdle? financing? Where? How long did it take you to raise the money? Do you have any ideas on how to raise the money? Thanks:crying:

Does anyone feel that WLS is going to be harder and harder to get approved. I know some plans have dropped requirements; but, I just have an inkling (is that really a word) that after the frist of the year, things are going to start really tightening up. No facts here just my intuition kicking up a little bit. LOL I would certainly try and get it done ASAP if you are really interested. Just my opinion. What does everyone else think?

well folks looks like I won't be able to get the lapband surgery cause the u of w said my copay after medicare would be 7000 dollars. I guess medicare doesn't pay for much of it:crying:

Has anyone had doubts? I went thru the 3 mo program to qualify, the whole time thinking I didn't have to make a decision on whether or not I wanted it until it was approved. I sorta expected some problems for approval. To my surprise, they approved within days of my paperwork submission. Now I am having second thoughts. I have started my liquid fast and am preparing, but I am seriously unsure I want this. Anyone else relate? Anyone know someone who was approved and changed their mind?

My surgeons office sent in my paperwork last Friday. It has been a week and when I call the insurance company they have nothing in the computer as of yet. They said this doesnt mean they didnt get the information, it is probably over at medical review which they are the ones that review it then decide on approval or denial... Was this the same for you all when you called the insurance company while they were reviewing it? That they didnt have a record but it was probably at medical review? I have Anthem BCBS PPO... I am just worried...I need all the prayers I can get... Thanks!:thumbup:

I'm on pins & needles waiting for approval. My doctors office was suppose to submit it on 5/15/2009. It's been 10 days. I'm getting impatient... Anyone with Highmark? How long did it take for approval?

Hello everyone, Just wondering if anyone has had any experiences with Anthem BCBS in Indiana? I have a consultation soon with a bariatric surgeon and am hoping to get the approval from Anthem. My doctor recommended I have the procedure done and I have a really high BMI of 53. Thanks, John

Hi everyone: I have been approved for my surgery by my insurance; but,I am changing surgeons. I just can't work with this surgeons office staff. I have an appointment with the new surgeon and their office said that all they do is call the insurance office and tell them that I have changed surgeons. It is not a change to a surgeon in the same office.They said I would not have to get reapproval because their doctor is also an approved surgeon with my insurance and they have done this before. Does anyone know about something like this. I have all my records except the psych exam and dietian report which I will have to get from the old surgeon. What problems can you for…

I was just told by my insurance (BCBS WY) that i need a 5 year supervised diet through my dr. in order to be approved. I supplied 5 years of weight records because I was told they would only need that and proof that my bmi is over 40.. My bmi is 55. Please help.. Has anyone heard of a 5 year supervised diet??? I feel like i don't have 5 years...

Someone help!!!! My job is changing to uhc choice plus and I've read posts saying that they do cover the surgery. However, when I look at the exclusions of my policy weight loss surgery is one of them. Anyone else have this problem or give can any advice. I don't have a number yet to call them because I don't have a card yet. Thanks for ur help!!

So, my insurance won't cover lap band. I am having to find a place for financing but have horrible credit from a divorce. Anyone have any info or places that would help?

I found out at month 6 of my 7 month pre-op diet that my particular BCBS plan (AL) does not cover any bariatric surgery. Wow did I feel stupid for assuming it would. After a little emotional breakdown, my husband and I started looking at options and found that his insurance plan BCBS (AL) does cover the band. So, things are pushed back while we wait for open enrollment with my new insurance going into effect in January. My question is if anyone has ever done this, and what happened? I'm going to keep up my doctor's supervision so that I'll have had continual dr supervised diet well over the requirement. Do you guys think they'll make me start all over on the new p…

Wooohoooo! I'm approved for surgery! I have BCBS of Texas through the school district (TRS Active Care). My paperwork was submitted on Tuesday, looked at on Wednesday. The insurance company requested better copies, the surgeon's office overnighted the paperwork. Paperwork was received by BCBS on Friday morning, forwarded to the medical review board after I called for an update. I called after work today and got the news that they had just sent out a letter of approval! So, 6 days from submission to approval. Thank you, BCBS!

Good morning! I am exploring the possibility of banding. I live in the Atlanta area and have CIGNA. What have your experiences been with CIGNA and are there any in network doctors in the area? Thanks:mellow:

Hello, Need some advice i am nearly at goal weight and will need what i hope will be classed as reconstructive surgery!:biggrin: fingers crossed on that one but if any of you have any ideas let me know! I believe Dr Coc kburn at the Wesley is a good surgeon.... My biggest question is through our company we can choose the insurance company... Can anyone suggest the better insurer to go with? Thanks for the help! Cheers Tricia

Hi, I was wondering if anyone knows the approvel process for medicaid and medicare, I have the white forward card Im not sure if that helps any. I live in Wisconsin. I am just wondering about a time frame and how the process works with both the insurance and the steps. I am signed up for the informational seminar, for September 14th. My Primary Care Doctors, Suggest I should have the surgery and I agree. They said they were going to send whatever documents they need to. and are backing me up 100%. I am having health issues and Im on disability already for a bad back. I know that losing all this weight can greatly improve my quality of life. Im sure they are going to tell …

I just wanted to let you guys know that I have BCBS of MA that I got approved with having a high BMI and hypertension. They took 24 hours to approve me and 100% of the surgery is paid. It took so long for my dr's office to get my paperwork over to them, but I meet the surgeon on May 27th and we will then set up my surgery date. Good luck to all!!:tt2:

Hi im from quebec and was wondering if anyone from quebec had the lap band procedure done and if their insurance private or quebec insurance covered it? My consultaion apt is Oct 13 and I just want to know before if its something I need to pay for or will my private insurance ( la capitale) or quebec insurance help or pay for all?? Thank you for any information

Hi everyone! I was wondering if anyone could let me know if they've been in a similar situation or if you know the answer to this question. As of right now my BMI is 41.6 and I am 5'3 236 pounds. Last summer I went through the process with my surgeon's office of getting approved, at my last visit for my supervised diet they said "oh we forgot to tell you that you have to get your 5 year weight history to submit." I didn't know about this before and it's not a problem because I can get the documentation from previous doctor's visits, but I haven't had a BMI of 40+ the entire 5 years, although I was "overweight". I am 21 years old, with a family history of high blood pressu…

Hello, im trying to see if i can get approved through my insurance co. Im hearing different from my nurse/surgeons office and my insurance co. I was told by the nurse that anthem website said i should go through 6 mo diet, 3yrs of bmi of 40 and psyc eval and nutritionist.plus sleep apnea test. my ins. says to have the psyc eval and nutritionist eval and show other non surgical methods of weightloss.. Does not mention 6mo physician supervised.. Im confused and discouraged that im wasting my time.. can anyone help?

My docs office submitted to Aetna a week ago yesterday. I called yesterday afternoon, and they said that it was "sent to the Medical Director". She said that if I didn't hear anything by next Tuesday, to call back and to see whats up. I am so nervous about this whole thing! Really, if they say no, then I will just need to complete the 6 month diet regimine instead of the three. At this point, I am well into the 4th month, so I guess if that's the case, its just 2 more months , right!? WELL, I just would like to know one way or the other! I am so impatient. OK, I just had to vent!:thumbup: Have a great weekend all! Jodi

Hi all! I have a question about the Cigna 6mo diet requirement. I had been seen by my PCP June 2003 - December 2008 and was prescribed diet pill - Adipex - each visit with the exception of 9mos during my last pregnancy (8/06-4/07) I stopped going to my PCP 12/08 due to the fact that he had been prescribing me excessive pain meds as well. I entered treatment for opiate addiction & started seeing an addiction specialist in a clinic at that time & then switched to his private practice around April. We have been discussing weight loss programs on most visits, however not 6 consecutive. My BMI has been well over 40 for atleast 3-4 years. I read on the website th…

I can't believe it....Seminar Aug 1st, Psych Eval Aug 13th, Dr/Nutirionist Aug 14th, Approved Aug 24th, Pres Surgury Appt Sept 10th and Surgery Scheduled for Sept 21st. My only advise would be to be very organized....ask for names of pyschologists/nutritionists and make appts yourself, get dates for paperwork submission, then followup with those offices to make sure their deadlines are kept. I'm excited and nervous at the same time. Oh, I self pay for individual insurance so my copay will be my max annual out of pocket of $4k, I have a health flex spending plan through my job so my portion will be $800.00 plus the $250.00 for psych eval and $140.00 for the nutritionist…

Hey guys!!...I just got told this afternoon that I have been "denied" due to no "supervised weight loss" for 3 years with my PCP....talked to my surgeons office and they said that denial after first submission is very common....and they will gather everything needed.... My question is....has anyone else been denied and later been approved and what was the approximate duration between denial and acceptance?? Many Thanks

Hey all, I got a call yesterday that everything was submitted to BCBS of NC yesterday for my approval. I called BCBS this morning, and they said they dont know if they recieved it or not, it may take up to 48 hrs to show that its been recieved. I know that I need to be patient, but I am so not good at that and am ready to just KNOW!! Im so nervous! Anyone else have BCBS of NC? How long did it take you to be approved?? thanks

Well I finally got a decision and it isn't good. I was denied because of my 2 year history. No co-morbidities with a BMI between 35-40. At least none of their co-morbidities. The fact that I am disabled because of severe foot issues aggravated by the excessive weight means nothing. We will appeal. I will get more letters from my doctors and my podiatrist. Until then I will cry.

<p><p>I am on the verge of a breakdown. I used to be a party girl back in the days, o now trying to get financing and because my bad credit can get nowhere?? Any suggestions people, please I am depress and by far trying to deal with the finance co. Have no results yet.... Can someone help!!!! Thanks again.... <img sr

I was denied by Tricare Prime west region (triwest) for gastric bypass. I am OVER 100 lbs overweight and a bmi of 42 with NO comorbidities. I plan on appealing but what can be my fighting arguement since i have no documented health problems, no diabetes no hbp etc.. ? I do not want to give up, do i have to finally get to the point of becoming diabetic for them to approve me? Iam disappointed, but if anyone can give me any pointers or tips about how to make my appeal It will GREATLY be appreciated. Also, does triwest automatically go by the medium body frame on the metlife chart? Or can my surgeon simply state iam small framed, if so i meet the 200% over requiremen…

Hey all,, yes, the waiting game for approval seems like it will be harder than the 6 months of pre-approval criteria the insurance company said I would have to do. I finished all of that last week and it's now on it's way to Cigna for approval. I was just wondering if anyone here has Cigna insurance? And if so, how is your process going. I'm praying for a speedy and non eventful waiting period:thumbup:

Hi, Anyone that has been approved and is 100lbs overweight and has a comorbodity, what was the procedure for informing tricare of the comorbidity? I heard that the person from the surgeons office will call you and ask, and if you say yes then thats it. If this was true for you please post your experience here! thanks!:smile:

Hello, I was wondering if anyone has PHP/Cofinity of Michigan and has either been approved or denied and if they have could you please tell me what surgeons you had at that time? Thanks :thumbup:

This will be the third time information has been submitted to BCBS of Illinois so I'm anxiously waiting for a yes and not another denial. I don't understand why some of us have such a hard time getting things approved......In my BCBS of Il. group contract WLS is covered with the normal conditions attached. My doctor has done the 6 month diet, etc...with several people a year for several years and has not run into a brick wall until my insurance company. BCBS stresses the need for a 6 month medically supervised diet and in depth notes at the monthly visits - we have done this twice with no luck. This time I added 10 months of Weight Watchers to the packet al…

I have Cigna through my employer but they excluded weight loss sugery from their plan. :biggrin:. I was just approved for BCBS of GA PPO plan and want to start my process for surgery. Does anyone know if I will have a waiting period before I can start the process? I have been on supervised diet from a doctor for about two years. HBP- and a bmi of 41. Will I be ok?:sad:

i dont even know where to start. i know some people get them to pay for the sleeve but i dont know how. it would be my first wls i dont know if that makes it better or worse. what do i have to do to get them to pay for it. what does the doctor have to do? i feel so lost. empire plan approved but they did not. they did not approve because it is invetigational. how do i show them that it is the best thing for me and that it has been around for a while. this is going to be hard. i dont even know how to research it.my eyes are bad so this will take me forever and a day. if anyone can point me in the right direction i would really appriciate it.

Is there anybody with great west healthcare? I just wanted some insight on there approval rate.

Hello Everyone I am new here and this is my first post. I have only realized recently that I need major help to loose the wieght. I have been looking into bariatric surgery and have decided the sleeve is right for me for many of the same reasons many of you have. I work for a internationaly well known "Clinic". They have their own insurance company for their employees. It is pretty good and does cover bariatric surgery as long as it is done at any of the "clinics" campuses. However I just got off the phone with them and I was told that they have the usual criteria for open and laproscopic bypass and gastric banding (bmi >40 or >35 with comorbidities). B…

Hello my question is does anyone have any experiance with Highmark Blueshield and what there reqirements are thanks for any input.

I am at a loss. I am trying to keep this as brief as possible, so forgive me if you get lost in the muck and the mire. 1. Decide in August to have lap band done w/ Dr. Liu. 2. UHC rep says won't be authroized b/c Dr. Liu doesn't accept insurance. 3. Confirmed by rep 2. 4. Rep 4 says no way. Will be covered at 90% of what's eligible. Must turn in predetermination request. 5. Ask reps 4 & 5 and coordinate w/ Dr. Liu staff what is required (just paperwork from his office. Submitted. 6. Denied. Not a covered benefit. 7. What? That's not what reps 4 & 5 said! 8. Oops. You're right. Denied because no proof of morbid obesity for last 5 yea…

So, as described in another post, I will soon be switching to my companies insurance policy with UHC which DOES cover wls . I called UHC today to get the specifics on getting it covered. Here is what the very nice gentlemen said to me: 1) it must be done in network, in patient at a hospital (thats fine, I kind of wanted to stay one night anyway), 2) must be over 21 years old (I am turning 25) Anyone else getting excited yet, sounds too good to be true huh... 3) must have a BMI over 40 (I am at 44.4) and "you have documentation from a Physician of a diagnosis of morbid obesity for a minimum of five years" Ok, so here is my problem. I have been morbidly obese fo…

I just checked the Triwest website and there it was! my APPROVAL!! I haven't been on LBT a whole lot lately because I was beginning to get discouraged but now that I have been approved I have so much to look forward to! Oh and for others with Tricare...the authorization was submitted August 5th and I got my approval August 8th...it was really quick. My initial consultation was back in March, what took so long was the surgeon and hospital I'm using. When I went to schedule almost every single appointment, my wait was outrageous. Tricare has been nice and quick with referrals the entire time. I wish others with Tricare the best of luck!

Is there anyone else whos insurance will pay for the surgery but NONE of the appointments post or pre op???? I have Magnacare!!! I think its ridiculous...is there any way around this?

Hello all! I am 29 years old and 342lbs, BMI of 46.2 or so. I have elevated blood pressure (not diagnosed as high yet), no other co-morbidities (cholesterol is excellent, glucose above average according to fasting tests), and have been at a BMI over 40 for about 8 years now (overweight since 8). I don't eat fast food, junk food, sweets, sodas, ice creams, sugar-free stuff, any of that...think of my diet as a clinically approved food pyramid about 3 miles tall. I eat all the right stuff, I just eat way too much of it. I'm self-employed and can't get healthcare (denied by every carrier known to the state of VA due to my weight), but my wife just got a job about 4 mon…

Finally got all 6 months 'weight loss management program' done...I gained 12 pounds over the 6 months. Only had verified weights from 2002, 2005, 2006 (Aetna requires 2 year history). Submitted by surgeon on Friday 7/31....APPROVED for lapband 8/3. I'm excited. LOOOOONG road since Feb 2nd when I saw the surgeon for the first time. Scheduler is on vacation this week, but is calling me Monday to schedule surgery!

My husband is going to basic in October so we will be getting Tricare. (Not sure which one yet) My question is how long do I have to wait before I can apply for the Band? I am 34, 5'3" and 240 I have arthritis in some of my joints due to the excess weight. I am pretty sure I qualify for the surgery. I am willing to go get the surgery the day my husband leaves. I have been doing the research for a few years now. This isn't a spur of the moment decision by any means. Feel free to share your experiences with me. I find you guys inspirational. Thanks, CK

The only thing I could find in the exclusions of my policy (I have harvard pilgrim PPO) was: Commercial diet plans or weight loss programs and any services in connection with such plans or programs Does that mean I wouldn't be covered for lap band?

As I understand it, we have United Health Care, but when our HR guy called to inquire about coverage, he was told that our policy excluded this procedure. Does this mean that I am screwed? I am certainly a good candidate for the surgery, but I don't want to pay for it myself. Anyone have a similar situation? Thanks.