Insurance & Financing

Looks like I'm going to be self pay. Just called Aetna and they said I'm not covered what-so-ever. Anyone else have a similar experience with Aetna or another insurance company? If so, how did you finance it? What are your payments like? It looks like I'll need $18k. Any assistance would be much appreciated.

Hello! My name is Joanna and I am at the early stages of Lap band approval. I just got approved for the initial appointments today. I just have a question about the qualifications for Tricare. My current weight is 273. Im 5'5 so my ideal weight range according to metlife chart is 127-141 for medium frame. Does that mean I atleast have to be 254 (127x2) to qualify for the 200% or will they do the make it 282 (141x2). Sorry if im confusing. I think im reading too much into things and confusing myself! Any help would be appreciated! thanks :smile:

I paid for my surgery (4/16/09) with Care Credit financing, $13,000. Saturday I received an EOB stating that they paid on $5,000 surgeon's fee. I was so shocked and THRILLED! I had the surgical center bill insurance as well. Who knows if they'll pay or not. But any amount that can be taken out of financing would be awesome! Now I have to wait to see what happens with the Center's claim and find out how Care Credit will get a refund.

I have BCBS of FL through my husbands work ( PPO) and was wondering who if anyone, has been aprroved. I meet the requirments with a weight of 320 and a height of 5'5. Anyone info would be great!:redface:

Hey Guys, I'm feelin really bummed today :thumbup:. I decided to get the lapband, I went to the orientation here in Fayetteville, NC and completed all the required paperwork. My doctor was even in my corner, she completed all documents needed and wrote a letter of recommendation stating that my BP is elevating due to weight gain, it's not quite high yet, but due to the weight gain it is elevating. On the paperwork it has that my BMI is a 40 for approx 4 out of the 5 years, but based on the surgeons office that I was going to go to the insurance person for that office said it wasn't good enough, and that my insurance co wouldn't approve it because based on their scales m…

Hi, I just got Neighborhood health plan, and I contacted them and they said that they do cover the surgery, but from stuff I have read on the internet I heard that you have to go through alot of different things before you get approved. Has anyone gone through lapband with NHP? How did the process go for you? Thanks!

OMG yall, i can't believe how quickly i was approved....my case manager submitted on 5/12 at 2pm. and I received a call from Aetna directly at 1pm today that i was approved....!! I was told the approval went so quickly b/c my job...(2nd biggest bank in the U.S.) has reps at aetna that just handle my employer's portfolio of aetna accounts...so i guess working for a big company pays off even though the top CEO doesn't know u from left or right.....!!! The slight disappointing thing is that my surgeon is going to be out for 2 weeks, so i won't even be able to meet with him until 6/4/09 :crying:..meaning im probably not looking at surgery date until mid to end june!!! blah…

Whoo hoo! And they emailed me all the requirements, which I meet. So, next stop is finding a primary care physician who will refer me. Has anyone had a PCP not want to refer them because they don't agree with WLS? I'm a little paranoid about that :thumbup:. I have a medical group, but I don't yet have a PCP. I guess when I call the group, I should ask the receptionist if they have a PCP who is WLS friendly that they can make the appointment with? I don't know anything about any of the doctors in the group.

I am looking to get the lapband surgery and have Cigna. I have read the hoops you have to jump through to be approved. One hoop appears to be a 2 year BMI history. However, looking online at cigna documentation, I don't see that stip. This document from cigna was put in place on Jun 15, 2009. What are your thoughts? http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

Does anyone have insurance with Tufts? If so, were there complicationns with them? I'm looking into the lapband but I'm worried that they will give me a hard time approving the surgery just from what I've read on their web-site.

Hi all, I am brand new to this forum... though obviously, not new to weight management (and failure thereof!) I *finally* made the 7-year in the making decision to get a Lap-Band. All things considered, this is the correct WLS for me. Here's my stats: F/41 Ht: 5'6" Wt: 350 BMI: 56.5 I have struggled, on the "books" with my weight, since about 1980. So... past medical history is with me. I've been over 300# for about 13 years. I decided to go and see a Surgeon in my area that came highly recommended. He does 2-3 Lap-Bands/week, and actually has a band himself. When I went in for a consultation, I presented my Insurance Card, which is BC/BS Mi PPO, and th…

Alrighty so I tried asking my NP if she thought I had a decent chance of getting approved through tricare(triwest) with my stats and she was no help at all! So I thought I'd ask you fine people your opinions. Be honest... I'm 21, been overweight all my life. 5'2" 235 pounds, small framed. My comorbs include elevated cholesterol, back and joint pain, skin sores, and sleep hypopneas(not apnea.) Unfortunately I don't have their exact list of comorbs thats my biggest worry. However since I'm small framed I can maybe squeeze into the 200% over my ideal weight catergory, depending on how Tricare sees it. So anyways, I'd greatly appreciate all your guys' input. I've heard lots…

I am just starting my journey and I was just wondering if anyone else out there has gone through First Health Insurance and how it went? Any suggestions or stories would be appreciated. Thanks!!

I have good credit. Like in the 615's not great but not bad. I am trying to have surgery before I end up tipping the scales past 256.... I have tried to apply for care credit, surgeryloans.com, etc. but no one will finance because I have too many inquiries. I have tried with co signer (mom, dad) but they have worse credit than I do. I want to know if there is any one out there who is willing to co-sign for me. I know its a huge risk and I have a likely chance of zero but I am desperate and insurance said no twice and I can't seem to get it on my own. If it helps any I have a great job and work overtime and very dependable we could even make a contract to make sure it does…

I got the approval today from Triwest! No surgery date yet..... My story.... While stationed in Italy I started the process however at that time only bypass was approved... I found out that I couldnt have it done at the base we were stationed at because there was no aftercare... DH and I talked about it and when we got to the USA I started Optifast at a weightloss clinic ALL OUT OF POCKET... I had a lot of success. I lost 100 lbs in 6 months.....had gallstones and had to have that removed...I spoke with my surgeon at the time and he said.. please do not do bypass... IF Tricare ever offers Lap Band then look into it....now a year later 60 lbs have crept back on... afte…

:ohmy:I have been working on getting aproved with uhc, i started my process in april, submitted to the insurance in tuesday on got aproved today, i am like in shock because i have so many mixed feelings about the whole thing, but i have to stay possitive and be ready for this.:thumbup:

Okay so I have BCBS of IL. and I wanted to know if anyone has gone through the the psychological evaluation yet. Can anyone tell me what it entails? Was anyone on antidepressants? Has anyone ever been denied because of it?

Hi there! I'm working on my insurance appeal letter. I have a lap band that's failed (slip plus pouch dilation) and want to revise it to a VSG. I was denied on three counts. First, the removal of the lap band was denied because it wasn't deemed medically necessary. I figure maybe the insurance clerk who decided this ought to come and offer to hold my hair during the 4-8 hours per week I spend bent over the toilet sliming :-). They denied revision to VSG claiming that VSG was investigational. That makes no sense because I have Federal BCBS who have been covering VSG since 2008 and I just think that's an error on the local administrator's side. And they also denied it bec…

Hello, I am eagerly awaiting the decision from Carefirst BCBS. My documents were submitted on June 12th and still nothing yet. I work for a public school system and was informed the 6 month supervised diet was not a criteria with their policy. AH....this waiting is driving me crazy. How long did your process take????

I finally got my approval:w00t: It has been a long few years of wishing I had the band but not being able to. I finally was at the right place in my life and the insurance company denied me:frown: I sent my appeals letter in and I just got a note in the mail that their decision had been reversed and I was approved! I have been grinning from ear to ear and also crying a bit:tongue: I left a message at the Bariatric Center and cant wait to hear from them on Monday to get the ball rolling again! Thanks for listening:biggrin: And I hope all that are still waiting for a decision get their answer soon. Waiting is awful! Debbie

I am finally approved!!!!!!! It only took a week or so. I am so excited and scared all at the same time!!! The only dark spot is that the determination is only good for 60 days so I have eight weeks to get the surgery scheduled and done or a new request will have to be submitted. But everything else is completed so it should be no problem!!!!!!!!:Banane01::purplebananna:

I have my first consultation for VSG in less than 2 weeks and I'm so excited! Unfortunately, my insurance doesn't cover the procedure so I need to somehow pull the money together myself. Since I don't have anywhere near enough cash, I was planning on putting a portion of the cost on a credit card. However, I just started noticing different companies that provide surgery loans. So I was wondering if anyone had used one of these companies, and if so, do you have any advice for me? Thanks!

Just got word from the insurance co that they do not require a six month supervised diet. I am so glad, i want to get on with this and start my new life!!

When providing my 5 yr. weight history, just how obese do I need to be? My 04 weight was 193 on the page the doctor's office copied for me (BMI 34.2). I'm sure I was heavier later than year. This was in March after I had been sick. In March of 05 I was up to 258 (BMI 45.7). Do you think that I should ask the doctor to look for a page in my chart that shows a higher weight just to be sure, or do you think I should be okay? If anyone has had a similar situation, I would be really glad to hear. BTW, my BMI is 50 now, and I have UHC John Deere Select.

I am in the process of being aproved for surgery, i am a little confused because my max upt of pocket is $4000 with $750 deductible, however the doctors office tells me i just need to pay my deductible before surgery but then they changed it and told me i need to pay $2000, but the insurance tells me i only pay deductable and i have to wait to be billed after surgery, any advice?

I made my initial consultation today and my BMI was 41.5. I have Cigna OAP and have taken the time to read many of the posts on this site to prepare myself for everything. I have a couple of questions and hope to find some advise in order to limit the amount of time that I waste with Cigna. I have a 2 yr weight history of 39-41 BMI with my PCP and I am hopeful that I will not be denied. It seems to me that many people have had to have their PCP write a letter of recommedation before they are approved. Should I make an appointment with my PCP and begin the process with him prior to beginning the weight loss program or just wait? Secondly, if Cigna denies me, like they seem…

I am just starting this process and I am already annoyed. My husband has "great" insurance BCBS of Wyoming through a coal mine here.. Ha!! First I found out I had to wait a year to try and get my WLS. I understand that they consider being morbdly obese a pre-existing condition. Whatever!! I am getting close to my one year wait being over, I called the insurance company about 2 months ago to make sure I didn't have to do a supervised diet, so that if I did I could get it started. The first lady told me no, so I just let it go. Well now that I am getting really close I called again to see what all they would require. The second lady I talked to seemed to indicate that they …

I am waiting till June 3rd to see the surgeon, but I know tricare can be very picky about the weight and such. I am 5'4" 239 lbs I have 1 co morbity Hypertention. And I have been over weight for my whole teen and adult life. I have found many different hight and weight charts and everyone seems to be different. If anyone has any info just let me know. Thanks Jennifer

Ok, I have Tricare Prime, and I need to know what is your "ideal weight" if you are under age 25?? Im 22 years old, and I think I meet the 100lbs over, and I had my PCM write a letter for joint pain, recurrent abcess and asthma. I wanted her to write "severe arthritis of weight bearing joints" but Ive never been diagnosed as that. Tricare says they dont use the Metro Life chart (which is for individuals 25-49 years old)!! They (Tricare) said the surgeon has to say that it is medically necessary!! (Yea I know that but what ideal weight does Tricare use?) Ive spoken to a handful of reps and Im tired of calling! :w00t: Someone please help, any advice is appreciated. I kn…

:wink2: i currently live in southern california and my insurance is trough kaiser. i have to go through six monthsof classes before i even get a consultaition with a surgeon. thats an awfully long time to wait to change your life. i was wondering if any of you break down the process for me and let me know in actuallity how long everything took. from the start of the classes to getting a surgery date. and all the things yu had to do in between. i would appreciate it!

Hi everyone, I plan on being banded soon, but I am still going through the insurance process. My insurance (anthem blue cross northern ca) requires a BMI of over 40 because I do not have any co morbidities. I can't lose any weight before my consult as I am borderline already. I am wondering if I lose weight before the day of surgery if it will affect my insurance coverage. I don't want to be weighed in that morning and have anything cancelled for a BMI under 40. Especially since many doctors require a diet before the procedure.

Hey everyone, I am sooooo pissed off right now, it turns out that the "authorization" numbers given to me by the rep at my insurance co. were NOT authorization #s they were reference #s. I HAVE NOT BEEN APPROVED YET, they are requiring MORE testing to be done:cursing::wink: I am distraught. I pray everything works out..!! & that ALL that I have been thru & done so far will not be a waste. Thanks for listening..........................

Hi, I'm looking for a recommendation of a Bariatric -Lap Band doctor in MD, VA or DC. Getting information from Insurance is difficult, I have CareFirst Blue Choice (FED) and the list of Gastro physicians within the network is huge and I don't know how to make a selection. Do all Gastro physicians do Bariatric Surgery? I've spoken to several people that have had the procedure in my area but none of the doctors are within my network. Any advise is really appreciated! I just want to get started.

I have my last nutritional visit in one week and they will send my stuff off to insurance right after. For this whole time, I've just been cruisin along, doing what I need to do, not really worried. But, now that its coming down to the wire w/insurance, I am getting really nervous. I got all my bases covered (two cormids - longstanding high bp not well controlled w/meds and sleep apnea requiring CPAP) and my BMI is around 38 now and was 35 in 2008. I have a long long history of failed diet attempts. The only problem is that I was successful on WW in 2007 so my BMI was below 35 for that whole year. I have weights past 2 years that show I was 35+ previous though. I …

I'm trying to figure out what my out of pocket expenses are going to be and I'm having a hard time getting an answer from the doctors office...Can any one help? or even give the slightest idea of what to expect??? Thank you!

Hello Everyone, I found out last week that my insurance would pay for me to have a band. I would rather have the sleeve. They won't tell me if they will cover that without me telling them the medical code for the sleeve. Does anyone know what the code for this is? :thumbup1: Thank You, Judy

Hi. I have recently moved across state to move with family and attend a new school to finish my nursing degree. I am a certified nursing assistant and while I was not actively seeking full time employment, I think I am going to now for insurance purposes. I originally intended to work for an agency and pick up a few days a week around my school schedule. Agencies normally have below average insurance so I do not think that is the right route. There are more than a few places hiring for a CNA so I was wondering would it be appropriate to ask specific questions about insurance prior or during an interview? I am also wondering if places like long term care facilit…

I am currently going through the process to have lapband. Starting my 6 month supervised diet this week. Done my sleep apnea, stress test, pulminary function test, and a few more. Waiting for results. I have aetna NAP choice POS II. I want to make sure since i am spending all of this money for these test and supervised diets (around $ 800) that i have every thing that aetna needs to approve me for the surgery. The only thing that i worry about is the proof of being 40+ bmi for 5 years, even though i have. There were a few years in between that i didn't go to the doctor (not even the female doctor ) so i not for sure if i can come up with these records. So i would just lik…

Hay yall! ( a little Paula Dean there LOL) I was wonder if any of PCP charged you for writing a letter of medical necessity. Well mine just did. I have never heard such a thing. Let me know? Thanks

Anyone use or heard anything about SurgeryLoans.com? CareCredit denied me. Thinking of using this company???

Hi! I am brand new here. ) I am SO close to getting approved by Cigna but they did deny me the first time. They said my best bet in order to get approved is to have my doctor call into Cigna to talk to their doctor. He called it a Peer to Peer something or other. Conference? I'm not sure. But, basically it is my doctor calling their doctor to discuss my case and see if he feels it's necessary for me to have the surgery. My question is: do you guys know what goes on during those conversations as in what they're going to ask him? Also, has anyone ever had to do this? What was your success rate? Thanks for your help!

I'm getting ready to submit the paperwork (& all the prep work) to HIP in NYC for pre approval. Has anyone on this board gotten an OK from them?

I just wanted to let everyone one know that I was Approved :thumbup: June 6th and my surgery is scheduled for June 15th.I am so excited to start my new life.I will keep you all posted on how my surgery gos. Thanks Holly

I currently have BC HMO in So Cal. I just got my firs denial letter. My BMI is 35 and I diabetes II, high cholesterol and sleep apnea. I have been through every diet program in the las 10 years. I have been cruising the boards and notice that most have better luck with PPO. I am considering changing to PPO which will cost approx. $200 per month for the next 10 months. I am trying to figure is it worth it and how much it would cost as a PPO. Is there anyone out there that can shed some light on this for me. Thanks much. Woman in weight "n"

Anyone use Davis Clinic in Houston and been financed through them? I have the dreaded exlusion and have been denied credit for the surgery. I have heard that the Davis Clinic actually finances in house (ie. payment plans) Anyone can confirm this?

I am just begining my process. Just finished the psych exam and was wondering if anyone has some experience with BCBS Federal Employee Program. Just wondering what they require and what time frame I can expect. Really want to get this done soon and I have a BMI over 41 and type 2 diabetes, high blood pressure, and high cholesterhol. Want to know how many hoops to jump through.

I am close to goal and I will need plastics once I am there. I have a pannis that is causing back pain and bad posture. However I dont have the funds to have it removed. I know that some insurers cover plastics following WLS, especially for tummies. I would like to know how those who've had insurance covered tummy tucks/panni removals proceeded. From the start. Most specifically, how did you prove need? Who compiled the documentation PCP, LB surgeon, Plastic surgeon, Yourself? Please I need details. Feel free to PM me.

My insurance has he dreaded WLS exclusion, I've been denied for financing....I don't know what else to do......so discouraged.

Ok so Aetna just denied me for lap band surgery they said because my bmi wasnt over 40 for the last two yes which is a lie i didnt have insurance for 2007 so i dont have proof any suggestions.

I was approved a few minutes ago by Anthem Blue Cross. Surgery date June 22... Doing the Happy Dance here!!!