Insurance & Financing

Hi All, just wanted to let you know I have Indiana Anthem BCBS and I have been APPROVED!! I did have to get the Phyc eval, 6mo.supervised dietwith my PP, a 5 year weight history and consut with dietician. Having turned in all the required info was approved in about 8 days!! I am going with Lutheran Hospital Baritric Clinic in Ft. Wayne, In. WOW what a wonderful group to work with they walked me through evrything. Excellent Pre-Op and Post-Op care plan. Highly reccomend if you live in that area and are considering bariatric surgery!! Good Luck Hoosiers!!:)

i've been doing so much research lately and i'm left in tears... every hospital i've contacted in the cleveland, ohio area and i don't know what to do. one hospital quoted me $22,000. another one $27,000. being self pay, i can't afford that! so let me ask you... some of these hospitals quote their fee of $10,00 plus other hospital, anethesia, etc. fees. do the hospitals in Mexico do that or is it the flat rate of $8,500? i'm getting so upset that i don't know what to do!

I am looking for a good qualified surgeon in North Carolina that accepts Tricare. Any suggestions?

:thumbup: I just talked with my insurance company, BCBSNC and the have approved my surgery. I am so excited. Now I just need a surgery date. Woo!! hoo!!

Texas Medicaid covers the Lap Band! YEAH! IF you live in San Antonio or in Texas contact: NIX WEIGHT LOSS SURGERY CENTER 414 Navarro, Suite 800 San Antonio, Texas 78205 Call: 1.877.468.1262 or 210-579-3315 THERE IS SOME OUT OF POCKET EXPENSE BUT IT'S WORTH EVERY DIME AND THE SACRIFICE! I'm just starting the process and I', so excited!

I am thinking about purchasing a policy through bc/bs, the ppo plan. I was wondering if anyone else out there has done this and if the band surgery was covered. I can't call until Monday so I thought I would see if anyone on here has done this. Also, is there a waiting period for these policies? I know some policies you have to have them for like 12mos before they will pay for a big procedure. Any info would be appreciated!!! Thanks

Hi, I am attending a lapband seminar this monday. I have been looking over so many threads to find answers and have read so much info that has helped. I have Aetna PPO and I have looked in the benefit book and this is what it states: Medical Exclusions: Charges for surgical weight reduction procedures (such as stapling the stomach) and all related charges, unless a physician certifies that the condition is potentially life threatening and and all other courses of treatment were unsuccessful. I really just want to know as much info as possible. I have read some threads about having 5 year medical history about weight. Has anybody gotten approved that didnt have that…

I know I am going to self pay and I know which doctor I am most interested in. He has two financing options listed on his site--do I apply for financing first or talk to doctor first?

Okay so while I was @ work today my niece @ home got a phone call from the Kaiser surgery facility in Fresno.She didn't inform me of this & by the time I got home (5:03pm), they were closed! My question is does Kaiser typically call you to inform you if you were denied? I am hoping for the GREATEST news EVER that I was approved.BUT I won't really know til Monday morning when they open! My understanding is that if you were to be approved they would call to set up appointments & if you were denied you would get a letter & NOT a phone call. Can someone PLEASE put my mind to ease by answering me..I have ALL weekend to wonder about this & it's going to drive…

so.. I got a call from someone @ Kaiser saying that Modesto patients & I guess surrounding area..are now going to Fresno instead of Fremont! I'm attending Fridays orientation & I AM SOO EXCITED =) :biggrin: I feel I'm moving somewhere with this now..How long from the time of orientation till my actual surgery date?

wls is excluded on the healthplan for all uhc employees. (cheap ba$tards) i am exploring self-pay options. i really appreciate the wealth of information i've found on these forums:cool2:

Oh HAPPY DAY!!! I got my approval today on the phone. I have been approved through UHC. Surgery is scheduled for the 26th of August. I hope the worst is over I waited 2 weeks to hear those magical words. Wish me luck!!! If you have any advice let me know. Thanks

I had my surgery in 2007 with BCBS of Massachusetts (the best insurance company ever by the way!), but in 2008 our employer switched to United Health Care (booo!).. I went to the doctor for fills all last year and never had a big bill, so I figured they covered adjustments. Just last week I got a bill for around 300 dollars, saying they don't cover the injection (the fill). I called and they just kept repeating that "medical treatment of obesity is not in your policy". I asked why they paid all last year, but they seemed to think it was a mistake and kept repeating what was in my policy. I need some help here, is there anything I can do? I know 300 isn't much in the g…

So at my initial consultation today I was told my insurance requires a six-month wait. Is this normal? What is the point? Thanks, Sydney

I had a physical last Wednesday and talked to my doctor about Lap Band surgery, he said I was a candidate. I've been on Weightwatchers for 5 years and lost 50 pounds. I have been under direction of a dietician/nutritionist. I live in Northern Cal and work for UC Davis and have Healthnet. I received a call from my doctors office and was told that I was approved...wow...didn't expect that to happen so fast. I am waiting for a call from Dr. Waldrep in Roseville. Wooo Hoooo I'll keep everyone posted thanks

Has anyone had difficulty getting approval? this is my insurance. it is a ppo just curious if anyone has had trouble getting approved. TIA Dawn

Hello, I just joined the forum. I was just about to go for my consultation and the doctors office called and advised me that BCBS of FL will not cover the procedure. I work in NJ but my home office is out of FL. I spoke to my HR person and they advised that there is nothing they can do. I'm sure I'm not the first person to run into this problem. I have heard the story of people appealing the decision, but its already stated in my policy that the procedure is not covered. Has anyone been in my situation and had any success of getting approval from health insurance? If so, who do I contact and what supporting information would I need to get them to approve it? I a…

Tri care pays for Lap-Band. I recently had surgery. the initial cost out of pocket was 700.00 It took 3 days to get appoval with tricare standard tricare prime takes a little longer. Go to Military.com for more info on what they will pay for my initial visit was 8/25/08 and I was approved 9/1 and had my surgery on 9/28/08 good luck. I am a military spouse. My daugher is also using our insurance and will have the surgery 7/11/09.:tongue2:

Has anyone had a band placed in Mexico and then had Tricare pay for fills. My PCP is military and they (military place lap bands). I made an appointment with my PCP but wanted to have some idea of others experience. I have a low BMI so Tricare would not have approved me.

I want to give the lapband a 2nd try i previously had to have it removed because of problems but i know i didnt treat my band right. This time around I would self pay. Can anyone tell me about the cost of the after care like fills/adjustments? Anything you know or have experienced related to the financial part of after having the lapband placed will help. Thanks

I know we have all heard of "bandster hell" but I am caught in "insurance hell". My doctor's office tells me that they sent the info required for pre-cert/authorization over 2 weeks ago. My insurance company says they have nothing. So, I call my doctor's office. The patient liaison states she will re-send. I give it a couple of days, call the insurance company and ...nope, they don't have anything. This is getting frustrating and I don't know who to be mad with. I feel like I don't have any way to just jump in and get this done. I know they told me to be patient, but this is ridiculous! I will return you now to your regularly scheduled program and apologize for …

I went to see my PCP last week and they called me two days later to give me my appointment to attend the seminar at the bariatric center. I've heard that this is just an informational session and I will be scheduled to see a surgeon after this. My insurance is Aetna POS II, and I've read in my plan that they will require either the 6-month supervised nutrition and exercise plan OR the 3-month surgical preparatory regimen for patients with a BMI over 40 with no co-morbids. These are my questions: Does anybody familiar with Aetna know how they determine WHICH program you must complete? I called the insurance company and the rep wasn't much help. Also, since the semin…

I just received the call that the surgery has been approved!!!! I am so excited. My surgery date is July 16th. I am looking forward to starting my new life as a healthier and thinner me.:thumbup:

So.. I went to my MANDATORY meeting @ Kaiser a few weeks ago & called them last Friday to get an update on my referal. They told me it was being reviewed..Is this typical? & does it usually take Kaiser a few weeks to approve/deny referals? The waiting game is killing me!! I meet EVERY one of their "guidelines" to have the surgery approved by them!! As for now I'm still waiting with my fingers crossed

My insurance bcbs al requires weight history for 3 years but i have no documentation of any weights so they said i could send dated photos ....i was wondering if i had to send my originals or if i could just send photo copies...has anyone had this experience?? Thanks

Hello all... Thanks for taking a look at this.. Okay here I go.. First of all I am 27. (This will matter when you continue to read) I started this lapband journey about a year ago.. My insurance requires 6mo. supervised diet (as about all do). Well I had my consultation with my surgeon and he says that because of my PCOS I may only be able to lose 50 lb. He just wanted to know if I would be satisfied with that outcome. He continued to persue lapband for my surgical choice. My husband works in the "coal mining" industry and if anyone has watched the news, you can see that it will probably not be around in the future, meaning that we will NOT have the same insurance tha…

Hi all, Well thanks to the great help from folks on the boards, I've got my appeal letter ready to ship off to BCBS. Anyone want to take a look? Offer me some advice? I've posted it here: http://vsgappeal.blogspot.com/2009/06/introduction.html ...and would love to get your in feedback. Thanks, Britt (forgive the multiple posts, not sure which areas get the most traffic)

I talked to my care coorindinator with United Healthcare today. They should call them i don't care. Anywho, i couldn't really get an anwser on specific requirements. I have no comobities(sp) and my BMI just dropped to 39.9 when i went to doctor Monday. I'm currently taking adipex. I'm going to use Clark Memorial in Jeffersonville Indiana and I was wondering how much leg work will they do for me? I'm really concerned I'll be denied.:wub:

Hi, I am a new member to the site and would like to see if anyone can help me out on some questions I have. I have considered having wls for over 2 years now and have finally made up my mind to do it! I went to the seminar to start that the surgeon requires. I know I was told there would be some pre-qualifications my insurance would require before approving the surgery. The insurance dept at the drs office sent me the paperwork saying I had to have 5 years of weight history with my bmi over 40 or my bmi greater than 35 w/co-morbidities. My situation is that my bmi has only been over 40 for 2 years and greater than 35 with NO co-morbidities for the first 10 years. Is there…

I was denied by Cigna OAP because I needed to prove that I had a BMI of 35 for 2 years and in 07 I only went to the doctors 1 time and my bmi was 34.7 so now i need to get a letter from my PCP and I need to write a letter myself to the ins for the appeal. So my question is does any one have a copy of a letter from your pcp or a letter you wrote to help with getting Ins to approve you for the surgery?

OK. I've been in this process since 2/09. I have Aetna POS II insurance. I am doing the 6 month diet w/my PCP, per Aetna's requirements. In addition to this requirement, Aetna requires 2 yrs proof of obesity. Here's what I have in my medical records (I requested all of them for the last 8 years). 46 BMI 2002 (from doctor) 46 BMI 2002 (from nutrionist), stating in the Dr's transcripts "Patient states he has been this size since he was 17 years old". I was26 at the time, I am 32 now. 46 BMI from 2005. (doctor's visit) 46 BMI from 2006 (doctor's visit) 46 BMI from....2/09...to present. ou I didn't go to the doctor from 11/06 to 2/09... Do you think this…

I am just starting the journey and wanted to find out as much info as I can about Empire BCBS diet history requirement and approval procedure in general (was it smooth?) Any and all comments woudl be appreciated. Thanks!!

Just need to vent a minute. Thought all my bills had been received and processed. I recently got a bill from the surgical assistant looked called UHC and they told me it was denied because the surgeon hadn't sent them his bill. Contacted the assistant and the surgeon's office it was resubmitted and they paid $553 of a $2000 bill and indicated I was responsible for the rest....mind you I paid my max out of pocket. I called again and they said that the auditor caught it and that my max had been paid so it was resubmitted. I got an email today that a claim had been processed and looked at their site today and now they are paying none of it and the site says I'm respo…

On June 2nd 2009, i completed my 6mo supervised diet with psych evaluation and EVERYTHING else Cigna required. Dale, with Dr. Wade Barkers office sent out my paperwork on Wednesday June 3rd.Well....On Monday June 7th, I called Dr. Barkers office just to make sure that the paperwork was sent off and everything was in order. Steve(the other insurance guy) said that my paperwork was returned from Cigna saying that i was not covered and that i needed to get with my HR dept at work. I was so pissed but we discovered that someone put the wrong medical ID number from my insurance card on the paperwork. Actually i was told they didnt have a card at the time of making my file so…

My boyfriend was denied care credit. anyone have any other resources, or information? He does not have insurance at this time due to being laid off. He needs help loosing weight to get into the police academy. Thanks

I just got finished with the seminar at a place where I think I am going to have my surgery. The thing is I am on my parents insurance first my dads then recently beginning of this month switched to moms. I gave them my insurance info and they looked at it and said that I needed to provide a certificate of creditable coverage. Does anyone know what that is or have you had to provide one before. If so what was the outcome did you get coverage from the current insurance company? Plz let me know its killing me to think they may not cover it.:confused:

Has anyone been approved through either of these ins companies? I know the requirments, but I'm wondering what the success rate has been for approval.

Hi guys!! I need some words of support this evening. I had my info sent to the united health care this week and im biting my nails with worry. What im worried about is the 5 years of being morbidly obese and thats is one of the major requirements my BMI has been in mid to high 30's but in the last year just hit 42. Im not really worried about anything else just that I know they have denied people in the past. If im denied i will fight it belive me but I dont want a fight but I will cross that bridge when I get to it. So someone please tell me their experience bad or good. I want to hear it. thanks

Hi All, I am not currently insured (lost my job) but I wanted to know if it would be wise to go ahead and have a consult and start with the 6 month diet plan some insurers require so that when I do get a job I will have already done this? If I do this could the insurance company say it is a preexisting condition? Has anyone done this before; used a weight loss program from before they were enrolled under their insurance company?

Right now I have Tufts, but I'm considering changing companies if it will make this process faster/easier. My choices are BCBS of MA, United Healthcare, Harvard Pilgrim Health Care, or Tufts. I have heard good things about UHC, but idk for sure. Any info on any of these companies would be much appriciated.

The Weight Loss Surgery Insurance eBook! Has anyone read this? My insureance has an employer exclusion for weight loss surgery. This ebook claims "Even if a policy has a direct exclusion of coverage for weight loss surgery, there are still ways to have it covered. I know what they are." I have searched the internet for weeks. This guy claims to know something that is not posted on the internet anywhere??? $30 for an ebook is alot of money for me. So I wanted to know if anyone else has read this and can say whether is lives up to its promises or not. I know it says money back gurantee but I've never been able to trust those…

I had my band paid for by insurance - but we have since changed insurance companies and our new insurance says specifically it does not cover any surgery for obesity - now it covers all other dependancy problems - drug, alcohol, smoking - any other addiction -but it will not cover obesity - don't you think that is discrimination based on a person's weight - and don't you think a lawyer wouldn't have jumped all over this before now? I have always just wondered if anyone has ever tried to sue an insurance company for discrimination based on denial of benefits -

Does anyone have this insurance? If so, what are their requirements? What do they pay for? How hard is it to get them to approve the lapband procedure?:tongue_smilie:

I had my band 2 years ago -and my insurance covered it - we have since changed insurances and now my new insurance says it will cover nothing that has anything to do with wls or complications from it - I guess my worry it now what happens if I should ever have any complications and require more surgery or band removal? I really don't have enough money to cover thousands of dollars if I would need emergency surgery or even something small like a port revision - should this be a consideration for everyone who is getting the band - even when it is covered by insurance - that one day your insurance may change and anything arising from the band would not be covered? I guess…

Hi, my husband's insurance is changing to UHC in Jan. and after my consult I was informed I will need five years of proof of morbid obesity. I think my BMI was betweem 34-35 for one of the years do you think this will cause me to be denied? Does the five years just need to show you have been overweight or actually morbidly obese category? I was wondering if anyone else has gone through this? Thanks

I get my taxes done at H & R Block. I called them last week and asked them if lap band is considered a tax write off. She said it is as long as you have a dr's. note. Anyone had experience with this? Did it help at tax time? I haven't even talked to my PCP yet, but plan to soon.

Hi, I am just starting this process and this forum has been a great help. I have a question about lap band approval. I know I need to get approval from Tricare for the surgery and that my surgeon will submit that information. But I went to my seminar last night and they were setting up consult appointments and I am unsure if I have to get a referal from my PCM for tricare to cover this? If so how long does it normally take? And has anyone paid for this out of pocket? If so how much did it cost you? Thanks so much for any help you can give on the tricare process. I don't think I will have any problems getting approved due to my BMI and hypertension but I am excited to get…

Please forgive new thread-but i have been all over this place for hours. WHA THE??? Just spoke w/ins and the rep said it wasn't flatly denied. A conference call w/my dr is requested within ten days. Also there are appeal options. Has this happened to anyone else? :thumbup::mad:One would think that the CEO's enjoy large enough bonus's that the ensured could use a covered benefit when medically necessary and not have to have your surgeon plead your case during a conference call-how demeaning for them. No small wonder dr's are abrupt, our insurance companies are telling them how, when and on whom to practice!!! Infuriating!! I pay for insurance!! Legal theft! Should be in j…

Has anyone gotten approved through creditcare with a low credit score?

I just wanted to come on and let everyone know that I received my approval today from Blue Cross Blue Shield of Illinois.... I want to post my situation, so that anyone pursuing this can see a positive outcome from BCBSIL. I am doing to the Realize Gastric Banding Procedure. I have had a BMI around 40-48 over the last 5 years, have tried several diets over my lifetime. I don't really have any severe comorbities, except infertility issues and elevated blood pressure. I had about 12 months of documented Weight Watchers journals, but still had to do the 6 months of medically supervised diet/exercise. I started that process April 25, proceeded to go in May, June, July, Aug…