Insurance & Financing

Good Afternoon Everyone, I am new to this site and made my first post this morning. I am incredibly frustrated. I was so excited yesterday after my doctors appointment and taking the first step towards finally getting healthy, only to be told by my insurance company that they did not cover WLS. I am sure I am not the only one that has run into this problem. Does anyone have any advice they could give me. Self pay would be impossible for me with out some kind of financing, but I am not above borrowing money to save my life. I am just not so sure I would qualify for any kind of loan seeing that I have way too much credit to begin with. Thanks everyone.

Just received the great news i was approved by Aetna PPO for lap band surgery on May 18th 2009! :thumbup: I did the three month program through Columbia/St. Mary's /Dr. Regan. I was afraid of my final weigh in since i had gained all the weight i had lost for the first two months back. But, i pressed in and did a protein diet/exercise for the last ten days and dropped all that weight plus another 3 pounds!!! The approval went through in 2 days!! I am very happy, since i was fearing that it would take a couple of weeks and i had heard conflicting stories about Aetna... The staff at St. Mary's/Columbia really know how to coordinate and get approval, i would recommend t…

Insurance told me that i need to do a program called healthy roads wich i only need one more week to complete but the dr's office told me that i the insurance requires me to do a 6 month supervised diet by my regular dr, i called insurance and they told me i dont nee to do that and dr keeps on telling me something different, what do i do?

Hi, I am here in Atlanta Georgia, my Lap-band was just approved today by humana tricare south, we are prime. You need at least 2 co-mordbitites and 100lbs over, mine were HBP and Joint Pain. I am approved. I weigh 260, and I am 5' 9", do not give up. If you are 200% overweight, you need no co-morbs. My referral was put in Thursday approved Monday. I barely made it at 260 to be approved, 249 was my Metropolitan Life chart number. Anymore questions just reply.

I currently work as a civilian for the Marine Corps and have Aetna insurance as my primary. I also have Tricare coverage ( hubby is retired) that will act as my secondary insurance. I know that I have to meet the Aetna requirements but was wondering if anyone else had a similar set up and if so, what, if anything, did you end up paying after your surgery? I am trying to be prepared for the unexpected costs. Thanks for the help. Elgrad

My papers were submitted to my insurance co. on May 14th and I still have no word. I have called them myself & all they keep telling me is that it has not been authorized, its being reviewed. How long can they review it??? whats to review, all the papers are there.......I am going out of my mind....I am feeling that this IS NOT A GOOD THING...I will be devestated if they deny me..... Has anyone else had to wait this long???? My insurance is Hudson Health Plan....anyone else have it?????? Thanks for listening... Waiting NOT so patiently anymore..........ARGHH

I'm going crazy waiting to hear from tricare on my appeal. It has been since the end of April and still no word. I call every week and they say they are still working on it. What is the longest anybody has had to wait. I might have to have them add insanity for a new co morbity....

I weigh in at 223 and am 5'4'. I have had a foot of colon removed, had the bag and then reversal, resulting in several hernias and with out those core muscles my back is hurting. I am on 7.5 norco,Valium, and muscle relaxers to cope with my bulging disk in the lumbar area. I found a center of excellence with a doctor that takes Medicaid. I talked to my doctor and she is willing to do anything she can to help me get Medicaid to pay. I Also have fibromylgia, osteoarthritis and may cholesterol is over 240. My plan is to get some weight off and not have more spinal surgery{I just hand VERY extensive neck surgery, which Medicaid paid} Without core muscles in your abdomen you…

My insurance has a WLS exclusion and under no circumstance, will they cover this procedure. How much money am I looking at paying if I find financing? And how exactly does the financing work? I know every situation is different, but how did yours work out?

I am new to this...Can anyone tell me does N Cal have the 24 week options course like so cal? Also if we are in Socal can we have our band done in N Cal?:wub: What is the wait time in N Cal? Or how long did you ahve to wait in n cal? thanks Stacy

Hi, I have Aetna POSII plan and am trying to get approved for lapband surgery. My BMI is only 37 but I have sleep apnea. Now the surgeons office is telling me that I might have to be on a six month wt loss program. I have been working on getting approved since Feb. and now they are telling me ugh. The insurance hasn't denied me yet but the surgeons office told me I need to start the exercise program just in case. Aetna's wt loss requirements are really confusing and I need all the help I can. I saw that some people have done a 3 month wt loss program and was wondering what all I had to do. If anyone has gone through this and can give me some advice I would appreciat…

Hello I live in Chicago and I am having Lap Band surgery on June 5 (3 days YAY!) I am 299 lbs (was 310) and my insurance (BCBS-IL HMO) approved my surgery. At work we have short-term dissability which in the 8 years I've been here have never ever used. My HR person thought that I would be able to use it for after the surgery because I only have 2 sick days left. Well they just called me back and said that if this is an elective surgery that they will not approve my leave. I wasn't sure what to answer, I mean I asked my primary care doctor about it, I brought it up, but he immediately said he thought this would be the best way for me to lose the weight I've battled w…

Dr Ihde in Arlington Texas only acceptes traditional medicaid. :frown:

I was told they will pay all but $150.00 but they say it's all up to my PCP to prove I need it. They can't tell me what they require as proof. Does anyone know? I have an appt. with my PCP next week. I hope he sees it my way.:mad:

My insurance doesn't cover the surgery. I was looking others options, somebody told me some doctors offices ofers payments options or self payment programs. I was looking one of those in Virginia on hamptom area or north of Virginia It is others ways to paid the surgery?

I live in Los Angeles. My surgery was approved by my Blue Cross of California. Both the doctor and the surgery center were contracted by my insurance. The surgery center refused to do my surgery because my insurance does not pay them enough to make it worth their while. I have tried a couple of other hospitals and they, although contracted with my insurance, will not do it because BC does not pay enough. I called BC and they said that yes, the hospital/surgery center has the right of refusal. Is there ANYPLACE that accepts the miniscule payment of BC of California in or around the Los Angeles area? Along with several co-morbitities I have spinal stenosis. My fe…

I am so happy, one step closer. I had my appointment with my pcp today and he gave me a letter of med necessity. Now I have to call for the semminar and go from there. I know it's a long road ahead but It's a step in the right direction.... my bmi today was 38 so I'm at the low end of getting approved.

ok im not sure if all approval letters look the same but i just received mine. on the coverage timeframe my letter states 5/25/09-5/25/09, which makes no sense to me because that's the same day and i received it today. now is that date supposed to mean that you are only approved if your dates are between those two dates. it's after hours so i can't call right now. i was just wondering if other aetna letters looked this way or should it actually be different dates there. thanks

If ther any where I can get a "form" letter to give my doctor so he will have all the right information in the letter. Or an example of a letter that the insurance will be looking for? tia Deb

Hello everyone, I am new to this site and have been looking through to find help with appeals. I have been denied 3 times by Anthem BC of California. I have a BMI of 59, high BP, diabetic and they keep saying telling me I don't meet their criteria. Is there no hope as long as I am with them? I have not seen anyone talk about success with them just the horor stories. If you have had success or can give suggestiong about appeals I would greatly appreciate it because I am getting discouraged. Thank you in advance d

Does Kaiser Richmond, Ca do lap band or sleeve surgery? Two years ago I had gotten about 2/3rds of the way through the process when I developed chronic kidney stones. I dropped out at that time. Since living with the chronic stones for two years now it finally occurred to me that with or without the surgery I will still have the stones so why not go for the surgery. In 2007 Kaiser was only doing the By Pass surgery but if the lap band is now available it would be a better option for me. Anyone with knowledge of this?

My Dr's office called me this morning saying that Kaiser requests that I attend a weight loss surgery class "prepare for success".Has anyone attended this before? I'm assuming Kaiser puts it on,since they require this.AFTER I attend this class I need to call back my Dr's office, THEN she can resubmit my referral for the lapband..GOOD NEWS is she asked the (Kaiser)lady that already had my first referral in front of her..if she saw any reason for why it wouldn't be approved she then told her with my BMI so close to 40 & with me having hypertension, she see's this getting APPROVED and everything running SMOOTHLY!!SO..I'm scheduled for the class on June 30th & keeping…

I'm looking for people with Lockheed Martin and Aetna. My husband just switched contracts to Lockheed (aetno ppo 300) and we should get the enrollment papers this week. The problem is I've already inquired with our current insurance and they cover the surgery so I'm anxious to see if Aetna will. They of course won't tell me yet because I dont' have a group number today.

My surgery was set for June 1st. It has now been cancelled. Why? Because Blue Cross of California refuses to pay what the Surgery Center of Santa Monica asks for, so the Surgery Center flatly refused to do my surgery. I only found this out on Monday when my doc office called to tell me. Blue Cross of California pays less than a third of what the surgical center asks. It was hard for me to phathom how they could be contracted with BC and then REFUSE to fulfill their contract. So, if there is anyone out there that has BCBS/Blue Cross of California be absolutely sure that the surgical center will accept your insurance. I am scrambling to find another surgeon (the su…

I am Tricare prime and have been trying to get through this journey. I started talking to my original PCM about four months ago. He kept trying to discourage me and tell me to diet and exercise. The doctor I work for is a weight loss specialist so he did this great diet plan for me and I gained weight. I went back to my PCM and still wasn't getting anywhere. I switched to another doctor and on the first visit he ok-ed me to meet with w/ a WLS. I wasn't comfortable with the surgeon Tricare sent me too, so I did a free consult with another office. I am 103lbs overweight. I have HTN and knee pain. I am 5'11 and 244lbs. I qualify and the surgeon said it shouldn't be a proble…

I am new to this whole process & already feeling overwhelmed & alone.. The lady from my doctors office told me she sent Kaiser all my paperwork & is just waiting to hear back from them,does anyone know how long this could take? My BMI has not hit that 40 mark(38.9),but I do have other factors..I am only 27 & I'm on blood pressure medication,my joints hurt,my knees & ankles pop,and my emotions are up & down ALL the time.That's just listing a few! Is luck even on my side when it comes to Kaiser accepting my referal for the lapband? I want this sooo bad..not just for me but for my family.If there is anything I could be doing to help move this al…

I was denied by Cigna because they said my bmi wasnt over 35 for the last 24 months I went to the doctors 1 time in 2007 and my bmi was 34.7. I have appealed the denial I call them every day to see what the stats are and they keep telling me they are still reviewing it. I have high blood pressure,gerd,hyperlipidemia and my bmi now is 38. So my question is has any one been in the same situation that got denied and got approval after appealing?

I know many insurance providers require documented diet attempts and others do not. The reason I'm asking is because I'm worried about qualifying. I'm waiting until after the seminar to question my insurance, though. I have United Heathcare. Most of my previous weight loss attempts have been through calorie counting and exercise and not through a doctor. I've lost like 15-30 lbs at various points. I was also on a weight loss drug trial, through my endocrinologist, but I think that only lasted around 5 months (I dropped out, maybe it was 6 months). I've also tried Atkins. Not really anything else because I didn't have the money to spend on fancy things like Weigh…

Help! I was approved for the I Can Change program through Tufts on Friday. Does that mean I am approved for the surgery as well? I know its a 6 month program that I need to complete but thats all I know. Is this like a test? Also, my PCP contacted Tufts directly and then informed me that Tufts had approved it. Do I need to call Tufts to begin the program or will someone contact me? Any information about this program will be greatly appreciated!

I recently went to True Results and was told that my insurance would cover me 90% if my BMI was 40+. But, my insurance had the following conditions. A weight history for 5 years. Do they mean a BMI of 40+ for 5 years? The person from True Results told me that it had to be 40+ for 5 years. or 35-39 with two co morbid conditions for the past 5 years. Does this sound right? I have a BMI of 40 but only for the last 2 years and I was in the 35-39 range for the last 5 but I have no co morbid conditions.

I am working my way through the process of getting banded and I have been doing a lot of research into the whole band versus by-pass question. So, for those of you that have also done your research, can you give me five reasons why you have chosen the lap band over gastric by-pass? I have issues which could make either choice reasonable. I just wondered what has made any of you make the decision to go with the lap band. Thanks. Elgrad

Hi everyone im new to lapbandtalk.com my name is Angel. Ok so i just finished my six month diet, and all of Aetna requirement but their only one problem they want a two year weight history i didnt have insurance in 2007 so i didnt go to the doctor i have no record of my weight that year. well i know it was above 40 bmi but i dont have proof. But i do have 2005,06,08, and 09 records all over 40bmi do you think they will approve me or will this be a problem please help, im stressing out here.:grouphug:

So i'm currently unemployed and have been looking into paying for my own health insurance. I wouldn't be so worried about it if it wasn't for my expensive follow-ups/fills with my surgeon every month. So far I've only applied to Geisinger only to have them reject me because of my weight. I guess an obese person doesn't deserve health care these days. Yeah, I'm a little bitter. Has anyone else had this issue? Any insurance companies you guys could reccommend?

I have been looking into getting the lapband done for while and finally found the doctor I want to use, but my insurance has denied any help that has to do with obesity. I was going to be able to pay for the surgery with money I had saved but in March I had kidney stones which totally dried up the money pool. I can't afford to finance through a bank either as I already have a loan out for my car and with three kids (the oldest of which is 5) money is tight enough already. However, I feel that my body needs this surgery in before the onset of diabetis or blood pressure problems become and issure. So what I was wondering is if anyone had any other suggestions on a meth…

Hi Everyone I just recieved my denial letter and the reason why I was denied was and I quote, "The information received does not indicate the presence of morbid obesity that has pesisted for at least 2 yrs, whiich can be defined as either (1) body mass index (BMI) exceeding 40 or (2) BMI greater than 35 with any of the following severe medical conditions....well my BMI this year was over forty however last year its highest was 37.20 and for 06 is 38.2. I do not have any other medical conditions besides my weight. So the reason that I was denied was that I did not meet the weigh requirement for 07. I lost and gained weight this is the story of my life. So now I dont k…

I have BCBS of Iowa. When I took out the policy 8 years ago, they made me sign a weight loss "waiver" or they declined to insure me. I also had to sign one on my Rhumetoid Arthritis but they now have dropped that as I have had no issues. They also now cover my husband colonoscopies (which they had him sign a waiver on) but still no luck when I tried to get the lap band surgery approved. What must I do to try and get them to cover. My Doctor has even sent a letter to BCBS over 2 years ago requesting that I have weight loss surgery (but was also declined then). Do I have to build a case? To me, this seems like discrimination that they can do this and get by with it. Any hel…

All the steps are now completed and I am waiting on approval from BCBS - Mountain State. Has anyone on this board had any experience with their approval process. I suppose I am getting discouraged because of all the hoops I have had to jump through, starting with my PCP losing the paperwork, not filling it out, filling it out incorrectly and finally after 8 months finally getting it right so that everything could be submitted to the insurance company by the surgeon's office. I hope there is a light at the end of the tunnel because I want to get this party started!!!:cool2:

I am 36 years old, prediabetic (and gestational diabetes) high cholesterol, high BP and stess incont. My BMI is 36. I got a letter today saying I have been denied. HELP!!! I need some sound advice and encouragement!!!!!!

Just wanted to know if you knew the process there, about how long everything will take. I went to the orientation today and will turn my application in on tomorrow. Then what shall I expect? I was a little confused today, I have BCBS of North Carolina and I was told in the meeting today that they don't BCBS ask for a 5 year weight plan, nor a Dr's recommendation, all you need is a BMI of atleast 40. Maybe I misunderstood them. Help me understand.:thumbup:

I do not have insurance and really need to get the lapband surgery in the next couple of years. Would it be cheaper and better for me to find a insurance company that would cover the lapband and get it or just get a loan and pay out of pocket? Also if I get insurance how long does most insurance make you wait before you can get a big surgery like that after you start getting the insurance? Thanks :thumbup:

I was wondering if anybody had experience with the 6 month Dr. supervised diet required prior to approval of the lap band. The wording in my plan states that you must have been on a Dr. supervised weight loss plan for at least 6 months in the last 2 years. So.....starting in April of 2007 I started seeing a doctor for about 5 months. I then stopped for 3 months, started again for another 4 months and then saw him off/on over the last year. I saw him a total of 16 times in a 20 month period but never for 6 months straight?!?!?! I've read a lot of the posts and looks like it just kind of depends on the provider but I submitted my documents three days ago and am startin…

Has anyone else had issues with ins. not wanting to cover when you clearly qualify? My case is now with the advocates. I was wondering if anyone could share their experience with them so I might know what to expect.:thumbup:

I finally made it. It felt like I was never going to get to this point when I started this journey back in November. Everything was submitted to insurance last week and today I got the phone call from the surgeon's office that I was approved. I was worried since I have a BMI under 40 but I do have co-morbidities. I am scheduled for the lap band on June 3rd. I already feel like this is the beginning of a new me. For all of you just starting out stick with it...jump threw all the hoops that the insurance company requires...what a wonderful feeling when the approval finally comes through.

Did you insurance cover the psych eval and dietician? I went to a center that does surgery and they want me to pay $1500 to cover the psych eval, dietician, pre/post op support and filing the insurance. Is this normal?

Hoping somebody can share their experience! The only co-morbidity I have is high blood pressure, and it's actually well-controlled without medication now. It was high last year, and I took meds for about six months. Came off the meds, and I've been within normal limits since then. Does anyone have any experience getting insurance coverage with a co-morbidity that's successfully treated without medication?

I just got the phone call from my surgeon's office. Tricare has now APPROVED ME!!! Surgery is Sept 30th

My Doctor gave me the option of choosing the regular lapband versus the realize band. I have been researching info on both and my daughter has had the regular with excellent results. So I am unsure which one to go with. The realize band I like because of the online support and tracking they give you. Does anyone have any input on this?? Surgery is probably going to be in beginning of July. Doing all the preliminary work now. :cool2:

HI! I am new here, and I am from Central Texas. My doctor just sent off my stuff yesterday to BCBS of Texas. Has anyone had any luck with them? My fingers are crossed!!!!

I am considering having the lapband procedure with Dr. Change in Victoria, TX. Does anyone know what the price range is for self-pay patients? I had the lapband surgery last year in Houston & had to have it removed because of slippage after only six months. I'm ready to try again! sandy

I had my surgery on 4/28 and the claims are starting to hit my insurance company. I don't know if all of them are in but the claims are so far over $28,000. Luckily I only have to pay about $750 so far. But, here's what I'm wondering..If cash pay is $15,000 for my surgeon, but so far my insurance claims are $28,000 and climbing, are they just milking the insurance company or is there another explanation? I'm just curious and don't want to ask the surgeon a question like that LOL