Insurance & Financing

Ok got a really serious question hopefully ill get some help. I have Aetna Choice Pos. I have to do the 6 month supervised diet. Now heres my question i have been told by both my pcp and the surgeons office that the first visit to your pcp counts if you got weighed and discussed a diet and execise plan. Yet i have have been reading on the forum that the first consultation does not count. I called the insurance company and nobody knows anything. Second question i did gain some weight on the diet. I started off good then fell off. Its hard when the wife is pregnant and cooking up a storm. Plus along with some financial issues a diet really took second fiddle. So will that g…

Does anyone have this insurance company? If so, did you get approved? How long was the wait?

I started the process with my Dr to get the Lap Band. I was really super excited and went to the seminar at the surgeon's office that would be doing the procedure. At the seminar, I learned that while the procedure is "covered" by my insurance, the cost out of pocket for me is $11,000. The cost of the entire surgery is $18,000. My insurance will only cover $7,000. I am a single mom of a four and six year old. I can't afford to ge the surgery. I don't know what to do. I can't even barely cover my bills now, so financing is not an option. Just wondered if anyone has an idea I haven't thought of for paying for this..... any help/suggestions would be greatly appricia…

My insurance has an exclusion for all obesity treatment. Which means that if I want to do this I will have to self pay $17,500. That will cover the first year of all post op and fills. My concern is, if I'm self pay and I have complications during surgery or even a couple of years after and the band has to be removed, will i have to self pay all of that too? I need help. I posted a similar post on the general discussions board, but I thought I would post a few different places to try and get more response. Even though I'm not sure if anyone can help me. I'm just really disappointed. :faint:

I recently decided to get the lap band upon approval from my Dr. When I called my insurance company (Anthem) the said they provide 0% coverage on any Bariatric Surgery. I am in KY. Has anyone here in KY with the same insurance company had any luck appealing this? If so what is the proper way to go about getting approval? Please Help!!!

For anyone in or near Norcross, Ga Gwinett medical Nutritionist do take Peach state for the nutritionist eval for the surgery!!!:cool2:

Hello Everyone. My insurance will cover lapband if obesity has persisted for at least 5 years. Does this mean that I needed to have over a BMI of 35 for 5 years? I have had over a BMI of 30 for at least 5 years. I have only had over 35 for about a year. Anyone know? The insurance company couldn't answer. Thanks!

I've read on a couple of post here that BCBS has changed their policy and doesn't require the 6 month diet just a list of diets you've been on. Does anyone know if this is the case for BCBS of OK. I've completed 4 of the 6 months already. And last year (while pregnant) saw a dietician and weekly weigh in's for gestational diabetes.

Has anyone had experience with BCBS of Utah and RIO Tinto employee?They want 12 months supervised weight loss by a physician before they consider surgery even if you have serious health problems.:smile2:

My WLS office sent my lap band in for approval with Tri-care prime. Some people are saying they got approved right away and some people are saying it is impossible to get approved for lap band with tri-care. My nutricianist said being 5'4, 273 lbs. with no co-morbidity i should get approved but reading some of the resposes on Tri-care is a little discouraging. Hopefully things will go well.

does insurance cover any part of the cost of fills?

Hey everyone! My name is Katie, I'm 21 years old and live in New Jersey, though I have BCBS of California insurance. I'm brand new to this site and just had a few questions that I thought you guys could answer better than any doctors or insurance companies. I have been interested in lap band surgery for a while now; I have been dieting every since I was eleven and could never lose weight. I am now 278 pounds with a BMI of 42. Though I am a young girl, I have been through many diets and procedures, such as Jenny Craig, Diet Center, Weight Watchers, hypnosis and many personal trainer's and gyms. My doctor has been telling me for years that I have to lose weight or I will …

Does this count? I was looking at my records today and I have been to the Dr monthly or at least 2 times a month for the last 5 years seeing my Dr. and each time we talked about diet and excercise and she charted each time that we spoke of this, what program I was using and my eating habits and how much I was working out. There is 5 years worth of this documented. I have also been to a nutriounist 2 times and she has documented everything as well.. My Dr also gave me a 5 year weight chart that shows all my weights. I have Highmark BCBS PPO if that helps.

My insurance is Health Alliance. They cover RNY but not the lap band. Is there any insurance companies that cover the lap band? Does anyone know of any type of "push" to get the procedure covered. It's 1/2 the cost of the RNY and a lot safer. I would think insurance companies would jump at the opportunity.

How long did it take for you to get an answer??? My paperwork was submitted today and was wondering how long I need to stress out!!!!!:rolleyes2:

Has anyone used TRS Active Care 3 to cover their lap band surgery. If so what were the items that they required you to submit in order to be approved. Thanks for your help, Z's Grammy:thumbup:

I have Aetna POS II. I am gaining the 5 lbs I need to reach the 35% BMI. I have high blood pressure which is controlled by a Water pill. I also have high cholesterol but that doesn't seem to be one of Aetnas other conditions to qualify. My primary Dr is the one that suggested the lap band and said he would write the letter of recommendation. I go next Thursday to the orientation. I have lost and gained the same 20 lbs over and over. I have been heavy my whole life. I am 5'5 and weigh 205 lbs as of this morning. I would hate to gain even the few pounds needed to get to the 35 bmi just to be told no by Aetna. Does anyone have any thoughts on my qualifying? Thanks

I have Antem BC/BS of California. I spoke with a sales liason who has helped me with many issues and he read my policy and informed me that it doesn't say yes and it doesn't say no as far as obesity treatment goes. It's kind of a gray area. He said that it will have to go through the managed care department for approval and it will have to be viewed as medical treatment for morbid obesity but not just obesity treatment. :smile2: I have the BMI (46) to qualify but at this time I don't seem to have any other comorbidities. I am living with chronic pain due to low back pain and a herniated disc much of which would be resolved if I lost weight. Not sure if that would count…

I have gone the 3 months that is required by my insurance company (Atena POS II). Kept all my appointments, had my tests done and have my appointment with the doctor on May 6th prior to a surgery date. BUT......I am missing a weight from 2005, 2008 and 2009 plus now the insurance company wants a note from another doctor stating the surgery is medically necessary. What is being over 100 pounds overweight, if not medically necessary?? I am and have been very non-compliant with going to the doctor. I am just beside myself over this. The worst part is that I realize it is due to my own stupidy!!! Does anyone have any suggestions for me??? Thanks a bunch Dot

I am doing the 3 month multi-discipliniary program through Aetna POS II. I've never had a problem at all with anything with my insurance and have my fingers crossed it stays that way. The surgeon I am using is great and his office does ALL the paperwork, submitting etc. Which is nice on my end, I just have to show up to appointments. So, to get to my point/question, it says a physician supervised diet and "Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional". My insurance contact told me I didn't have to do this. Yesterday was my first appointment with the nu…

I currently have Cigna Insurance and was told by Customer Service that my policy does not have any coverage for bariatric procedures. :thumbup: I work for the school here in Texas and am considering switching from my husbands insurance to TRS Active Care 3. According to the enrollment guide I am looking at they cover Lap Band surgery, but I don't know if I would qualify immediately or if I would have to wait some extended amount of time. I was thinking I could go ahead and start with the 6 month diet/Drs. visits etc but just wondered if switching Insurance carriers at an extra 175.00 a month would be worth it. Any thoughts? Thanks so much.:ohmy:

Hi, I'm new here. Hope someone can help, I am becoming very anxious. I called my doc office today and was told that BCBS is giving my application for the lapband surgery "further review". Should I call the insurance company or should I just wait? I have several comorbidities including type 2 diabetes, sleep apnea, high blood pressure, asthma, spinal stenosis, arthritis in my knees and hips, BMI=40, 150 lbs overweight. BCBS requires six months weight loss supervision by a medical professional. I have been doing this with my therapist. I keep a personal journal AND a food journal tracking my weight and my feelings. I am not sure if BCBS will accept this. Anyone ou…

Let me fill you in a little about my past. I tried gettin my insurance to pay for lap band last year, well they denied me because my BMI wasn't high enough. So I've been trying my hardest to lost weight, and have acutally gained 15 pounds, how, I don't know! In that time have I had my back looked at. I've had accident when I was a kids, falling outta tree, off horses, ya know kid stuff. But this was the first year I've had back pain like this. I had it checked out and come to find out that my lower vertebrae(sp?) is slipped about 10%. They put me on Celebrex to help, which it did. Well last weekend went for a ride on my mule, and for some reason he reared up, and I flew o…

I was just wondering if anyone had BCBS of IL. and was trying to get their surgery done at the Weight Loss Centers (Top Surgeons) in Beverly Hills, Ca? I wanted to know if anyone has had any issues with getting approved by BCBS with them. Any out of pocket or surprise costs? Any info that can be provided would be appreciated. Thanks, Divis :laugh:

I had such an easy time with Aetna covering the lap band surgery...was wondering if anyone who has Aetna knows if they cover the Tummy Tuck or not?

My husband works for Rio Tinto and they have a rider on the insurance policy about weight loss surgery. does anyone out there have experience with this?

Hey every one. Im new on here and I just switched companies, and found out my new Company Veolia Enviornmental Serv. uses BCBS-IL. I made a phone call and they said that currently my company has no exclusions on it and BCBS-IL will cover gastric banding but not bypass and with a few conditions. I was wondering if there is anyone else out there that has had bariatric surgery of any kind with BCBS-IL and what their experience was pushing the paper work through the insurance co? Thx James

Those of you who have BCBSIL, how long did it take to get an answer from the time you submitted your paperwork? I know they have 30 days to decide, but I was curious how long it took for the rest of you?

This is the insurance I have and I am so frustrated and confused. I contacted my insurance company three times before my seminar to see if I would be required for the 6 month supervised diet so I could get started with that ASAP and they said NO. So I went to the seminar, met with the surgeon, met with the bariatric nurse and today I meet the nutrionist. I have my psych eval scheduled for April 8th. So yesterday the drs office secretary calls me and says I need the 6 mos diet I was like Um ok but my insurance says its not required. She tells me they are wrong :cursing: So I call insurance back get forwarded all over the company and again I am told no I just need 40 BMI (…

I was told by my patient advocate that they sent in my paperwork to United Health Care on April 16th. I called UHC on Monday the 20th to make sure they received it. They said they received it on the 17th and it was "under review" they said it might be ready today the 22nd. Well I have been calling twice a day, and it is still "under review" I call in the morning and I call in the afternoon. Is that too much??? I just can't stand to wait!!! I just need to know yes or no!!! Of course I am hoping for a yes. I will post as soon as I know something. Send the positive approval vibes my way!!!!

Long time reader, first time poster, as the phrase goes. I have Aetna EPO, and live in NY state. I am a LPN, so I was pretty careful to do my research, contact my insurance, make sure that lap-band was covered IN MY CONTRACT, got my letter from my PCP, went to seminar at my prospective surgeons office....and then hit a hurdle. I have been 'basically' the same weight for 9 years. I am 5'7.5 and currently 275lbs. However, the issue is, I have been pretty persistant in attempting to lose weight. I have done Atkins, WW, all that fun stuff. I tend to lose weight very quickly for a short period of time...and then crash and burn and regain it all just as quickly. Case in p…

I CALLED THE DOCTORS OFFICE TODAY AND THEY TOLD ME THEY SUMMITTED MY PAPERWORK AT THE BEGINNING OF THE WEEK. SO I CALLED TO CHECK WITH THE INS COMPANY WHICH IS UNITED HEALTH CARE SELECT PLUS PPO WITH THE CITY OF MEMPHIS. AND THEY SENT ME TO ANOTHER DEPARTMENT THAT HANDLE THE LAP BAND OR SURGS. AND SHE TOLD ME I WAS APPROVED AND THEY MAIL OUT THE LETTER TO ME AND THE DR OFFICE YESTURDAY. GO UHC FOR SUCH A FAST TURN OVER. NOW I HAVE TO WAIT ON THE MAIL MAN...... BUT I ALMOST CRYED I WAS SOOOOO HAPPY.

Well...I've done it! I'm finished with my six months of supervised weight loss (lost like, a whole 8 pounds..woohoo). I worked my booty off this year gathering up all the information I thought Cigna needs to approve my surgery. As far as I know, I've "checkmarked" their list off and I've got/done everything they require. I have no co-morbidities, but my BMI is over 40, so I'm not really worried about that. My question is, I just called the lady at my surgeon's office who submits the insurance stuff, and all she wants from me are my six weight checks from the doctor and my psych evaluation. I spent $50 to get my medical records from Kaiser so I'd have proof of my w…

Can anyone walk me through the process they had to go through with BCBS of IL. PPO? Everything from start to finish, please. I am still in the middle of my 6 month medical supervision and I want to make sure that both my doctors and I are doing all we should. Please spare no detail, even if you think it is something that might just have applied to you. I really want to get the lap-band and I don't want to give the insurance company a reason to deny me. I know many people have had issue's with BCBS so anything you can help me avoid would be soooooooo great! Thanks, I'm all ears!! Divis :w00t:

:thumbup: Help, I need some advice. I have UPMC insurance, and have been seeing doctor's at UPMC hospital in Pittsburgh PA. Unfortunately UPMC insurance is very strict, and does not cover any band surgery unless a BMI over 40, even with comorbidities. The one exception, which my doctor told me, was sleep apnea, which I have, although it was diagnosed 2 years ago. I am going through the 6 months of Dr. dieting, and my last appointment is next Friday. My problem is, I lost 10 pounds and gained it back within the 6 months. I have not gained any more than I weighed in the first place, but I've read people get denied for gaining weight during their 6 months. Does anyone have…

Hi I was wondering if anyone out there was self pay and how much it cost you? I'm trying to get my insurance to go thru but just wanted to know a round about cost of different dr's? Thanks!

I am waiting on approval from them. I fit the very liberal criteria they seem to have. Anyone with any info? good , bad, ????

Hi everyone I will be getting an insurance in may so I can get my lap band procedure covered, I called the insurance and they do cover lap band surgery and they are also in network with the dr that I want, but since i'll be new to this insurance they said i need to wait 6 months to get any kind of surgery done, I have dr's appt on may 27th for consulatation anyone know if i can get my procedure covered sooner than 6 months since im close to morbid obesity???? Please helppp!!! thankss! :smile:

im new to this and hope any1 can i have priority health insurance and they said i needed to do 6 months of weight mangement which i h ave done and lost 17 pounds thus far im waiting for my approval to come back so i can go see my sureon hw long does this usually take and what else must i do please help:lol:

I am so EXCITED!!:rolleyes2: The surgeons office actually gave me my "tentative" surgery date, June 3rd. I am at the end of my 6 month weigh in visits and I have all my ducks in a row. They are submitting to insurance but don't foresee any problems. I feel like I am finally coming into the homestretch of a long 6 months. Lets hope that I don't hit any hurdles in the final stretch....:crying:

Hello everyone! Dr has sent in a referral for the LAPBAND. Yippee! Was wondering if anyone out there has been approved under this insurance Anthem BC HMO. If so, how long did it take and what procedures did you have to take. Thanks:smile2:

As of Jan 1st 2009, if you have BCBS MI individule plan you are NOT covered for bariatric surgery. Evidently this was covered before then but they have decided to unilateraly change the terms of their coverage without notifying members. FYI, medical equipment isn't covered by this plan either so now I have to buy a CPAP machine out of pocket for my sleep apnea. I knew I shouldn't have let them talk me out of purchasing a group plan for my business. That will change monday. I plan on increasing coverage and ringing the bill up as high as I can whether I need it or not

After yanking me around for almost a year, my insurance is balking at paying for my surgery. The surgeon I've been consulting with charges $17,600 for the surgery itself (hospital stay, anesthesia, band and supplies, etc) then he charges $300 for every fill. Does someone know - Is there a less expensive surgeon in Kentucky? I think it would be cheaper if I found someone who even does it outpatient as opposed to an overnight stay. HELP!~ I'm at my wit's end!

Hi I need help. I'm trying to find a Dr in So. Cal that is a perferred Dr with Cigna. I'm trying to keep my out of pocket costs low if possible. I call Cigna and they don't have Dr's separated by specialty. They are listed under surgeons. So i have to ask for each Dr. by name. This is time consuming and I haven't found one yet. I've seen afew I'm interested in talking to, but they aren't in the Cigna system. I appreciate any help you can give me.

I have just been approved by bcbs,my primary, and I have cigna as a secondary. I was wondering if cigna would pay the 20% that bcbs does not cover. Any comments are welcomed! Thanks!!!

I sometimes think insurance companies do things in hopes that you give up. My wife and I are trying to do this together. I have been approved. She has not. First off, our information was submitted early Feb. We thought there was a 30 day waiting period before a decision would be made. Wrong. They wanted 45 working days! We did everything right. I called and verified they received the paperwork and followed up each week. I confirmed the due dates that an answer would have to be given. For what ever reason, my approval came early. Nothing on my wife. When I called them back up and asked them about her, they said they had no paperwork on her at all. Impossible! They had …

Hi all, I'm just trying to find folks who have had their WLS approved (or denied) by Anthem Healthkeepers HMO. I am about 99% sure that they will cover it as long as my PCP thinks it's necessary, but I'm a little overwhelmed by all the steps involved. Any info is appreciated! Thanks!

Is there anyone here from GA that can shed a little light for me and tell me how long BCBS of GA usually takes to give a response? I am on pins and needles waiting to hear something. Also, does anyone know if BCBS of GA cover fills? I am going through True Results with Dr.Hart. Anything would be helpful.

So BOTH of my insurance carriers will pay for the lap band surgery. I have plenty of funds in my healthcare account to cover any incidentals and fills, if need be. The only thing I'm missing is a surgery date! The local surgical group is scheduling surgeries for in the FALL. That's like 6 months away! Is this common? I'm thinking of going to another surgical center that could get me in faster - I just need to make sure I can go see a local doctor for followup care - fills, etc.

Okay. I was denied on 3/5/09 because my Doctor didn't send in all the information, so they denied it. I appealled on 3/13/09 with over 15 pages of documents that showed I did meet the criteria. My docotr talked to the appeal people after 3 days of trying to get their information last week, only to be told that they had 60 days and if they want they will take all 60 days. That they can call after 5/15/09 to get the results. Has anyone had it take this long? I am afraid they are going to come up with some reason not to approve it and that I will have to start the appeal over again. Any ideas to help pass the time? thanks jen