Insurance & Financing

They called me today and told me I am approved! But they said I have to call the hospital and see what my out of pocket cost is and that it has to be paid before my surgery... my insurance is One Net PPO. Does anyone have any idea of the cost? I called and left a message at the number they gave me but I'm a nervous wreck that it's going to be more than I can come up with before my date - which is the 23rd of this month - I'm between YEA! and OH NO! lol :sad:

hello i have a question regarding coverage for citigroup employees in texas with aetna......im currently employed somwhere else and my current job is with aetna and covers the band, but im worried that when i start with citi group....they might require me to work there a certain amount of time, and i have already been going to my monthly visitis......i would really appreciate it if anyone who works at citi who had the surgery or knows a citi employee who had the surgery if one the company covers the procedure, and two if u have to be employed for a certain period of time....luckily benefits start day one...but i dont know about citi's restrictions and allowances when it c…

I have Medicare and Medi-Cal. Anyone know a good doctor who will accept me for Lap Band surgery? I am becoming exasperated. My primary doctor has agreeded that this is the best route for my health but I am having a difficult time finding a local doctor in or about Riverside, CA.

As you can see from the title, my doctor has not been sending in my records in to UIC (my hospital) and it has gotten my dander up. I've asked for my records more than a month and a half ago. I know she is violating IL HIPAA and also her ethics. I really don't know what to do, other than call my insurance and tell them that she is not giving up my records. I've even asked for them myself, but no go. And I've talked to UIC and they have exhausted all options. Does anyone have a clue on what to do next?:smile: Thanks, JRG

Hello. My insurance policy does not cover WLS. It has a specific WLS exclusion stated. I want to know if an exclusion means that the insurance company will never pay for WLS or is there a way to "fight" your insurance company's exclusion policy? Has anyone on here ever been successful in getting an exclusion reversed? If so, HOW?????

So after switching jobs with the hope this large company (in the health field) would offer an insurance plan that would cover lap band surgery, I have only just discovered there is not now nor will ever be a covered benefit for WLS...I am so totally bummed, cause the job is stressful in itself and I thought I could endure it for the sake of "the benefits"...now I am financing through the md office for the surgery...this does not even include the anasth and surgery center and it is already 18K...argh! So frustrated and just wanted to chance to vent! The only positive thing I can say is my sister in law is the billing person for this MD office and might be able to get me …

This is my first time posting, and recently I've decided the lap band might be my best option. A year and 1/2 ago I was on my way to losing weight after having a baby. I went from 230 to 179. I tore my meniscus working out. X-rays revealed I had degenerative arthritis so my doctor did not send me to an orthopedic surgeon immediately. You can't see a torn meniscus on x-ray. He basically told me take ibuprofen. Needless to say my meniscus was torn six months before I had surgery. In any case, it's been a year since my surgery and my knee has never been the same. I was able to maintain my weight for a year but recently I gained 15 pounds a couple of months ago…

Hello all, any help would be appreciated. Have BCBS of Massachusetts coverage is 50% coinsurance , $10,000 Lifetime benefit for bariatrics deductable $200 , max out of pocket $3000 approved first try bmi of 43 , high blood pessure pre-op fri 13th (ooooh scary) surgery wed 25th non-insurance; self-pay cost with my surgeons group is $17,000 anyhow after finding out my coverage i contacted surgeons office , they told me that the surgeons office would be billing my ins $5000 and said that the hospital would bill ins for everything else not related to surgeon but could not give me any approx figures. I asked her how much the band itself cost and after chewing…

I am driving myself nuts trying to figure out if I am going to qualify. I called my insurance company (Aetna) and was told yes, my policy does cover banding, but the only other thing she would tell me is to read the Clinical Policy on the website--she wouldn't answer any questions:glare:. My drs office says "turn in all your paperwork and we will let you know". Well getting it all together is a pain just to have one simple question lead to a no. And I have to gain 5 pounds to meet a 40 BMI which I am working on! I will be pissed if I gained 5 more pounds and then am turned down. Here is the confusion: The Aetna Clinical Policy says: (bolding mine) And I h…

I could really use any advice or suggestions for my current predicament! I will try to make this as quick as possible...I have been jumping through Aetna's hoops since Septmeber of last year. I completed the 6 month medically supervised diet in the beginning of March. During that time I gathered all of the info needed, including nutrition consults, psych evals, and previous years weight history. I submitted all of this info to the surgeon's office and was told that the patient advocate/surgery scheduler would handle the insurance end of things. I did not actually witness my '06/'07 weights because they were faxed directly to the Doc. I had my surgical consult and a tenati…

Doing the Bunny-Hop Here!!! Da-da da-da da da...DA DA DA! I'm an April Bunny for sure now...they're stuck with me!!! 'Cause I'm approved!!! It took only about 48 hours! I have Highmark PPO Blue (BCBS of Western PA- Pittsburgh). My BMI was low, but I didn't go below the 35 BMI minimum for my 6 mo. diet (so I only lost 9 pounds). If anyone else has this insurance and needs help, just send me a PM and I'll be glad to share. Off to hop around some more!!!

I have Aettna Insurance and it does cover the Lapband Surgery. I have done my 6 months at my doctors, had the phych eval, saw the nutrionist, and had all the bllod work done for this precedure. The problem is with my Primary Care physician. Seems the notes she has faxed over to the Surgeon are very sketchy.. Like "was seen here for weight check. Going to have lapband surgery" This was just the appt I had 2 weeks ago.. Some of the notes are ok, but a couple of months are very empty. The surgeons nurse told me this will get denied because of this. I dont know what to do. I have followed everything to the T and made sure my end was fulfilled and now I get hit with this. Has …

I am right on the edge right now. BMI is 39.2 or something like that. I am hoping I can reweigh next week and get it to 40! But now I am reading stuff on Aetna and am wondering if the 40 has to have existed for 2 years? I have been overweight for more than 2 years, but not over 40 BMI. I don't have any of the other comorbidities that go with the lower BMI to qualify.

Has anyone out there completed the 6 month program that Tufts requires you to complete? If so, how did it go?

I need help, brand new to this board. I have Tufts Health Plan and am enrolled in the iCanChange program. I just finished a one year long program which is very similar but of course I had a different insurer. I want to try and get the length of the program reduced. Tufts says the iCanChange people need to send in a waiver form, the iCanChange people say I have to send a letter to Tufts. Please email me privately. I am very concerned as I don't want my BMI to drop below 40 and have worked hard this year to lose. Red Sox Nation groupie

My co-worker wants the lap-band, but when she checked with her insurance (BCBS of AL, Blount County Sheriff Dept), it covers WLS, but only at 50%. Do any of you have an idea of how much that might be? Or even better, does anyone else have this coverage and might have an EOB we could see?

yes guys im guilty of gaining weight during these past 3 mnths of my pcp doc visits..usually its been a gain the 5-7 lbs of my original weigh in at my 1st consultation which was 243 and now im at 250...my bmi is right at 40 at 243...and im scared to loose weight so i have been trying to get in some pounds to get to like 41...but now im wondering if they would deny me for gaining....1 point on my bmi.....if so....ill try to do a lil fast/speed diet to help me loose these 5lbs before my final doc visit on 4/30...just wanted to know if anyone was denied or approved with a weight gain showing on file. thanks!!! i also skipped a month on this 90 day thing...so i ended up…

OMG, I can't believe it! I just got a call from my surgeon's assistant, and she sent in all my paperwork this morning and got a call just an hour later approving me!! She said they have never had anyone approved so fast. Gosh, I guess the insurance company really thinks I desperately need this, huh?! I have CareFirst BlueChoice, btw. And I didn't have to do a 6-month diet because I had done Weight Watchers for the last two years and was able to get records of my attendance to show the insurance company. So there is hope for a quick process! Never in my wildest dreams did I think it would be approved SO quickly though! I'm on cloud 9! :glare:

So my surgeon's coordinator submitted my paperwork to Cigna for approval last Monday, and I called them this morning just to see if they had received the paperwork. I told the girl that I was calling to see if they had received the paperwork for approval, and she said that they had received it NOT for approval but for pre-authorization. She went on to explain that pre-authorization was just to find out if it was a benefit that was offered and paid for by insurance, and that authorization is when the doctor calls in for an authorization number and then sends in the Cigna-required documentation (6 month supervised diet, psych eval, etc etc). She said these are two differ…

My insurance is BCBS of Michigan MESSA. I am a little worried about providing a weight loss records from doctors. I haven't gone to a doctor about a my weight loss because they said that even though I was overweight I was still basically healthy and in good shape. What will they do if I don't have a doctors record? What else do they usually ask for? I am going through a doctor who has his own insurance specialist team and can usually get it approved; however, I"m going to be WAY bummed if I can't get the procedure done for another year. I"m not sure I can live like this for that long!

I am in one of the last stages of having my pre lapbanding. But I can't find a surgeon who accepts CHAMPVA insurance. Is there anyone in WA that has CHAMPVA that also have this problem or seen a doctor that accepts the insurance? I just need a letter stating that if I loose weight that my ankle and knee pain/problems will go away. I am open to where the doctor is, at this point we will travel for it as I have called over 100 surgeons this morning being told they all do not accept CHAMPVA. Can someone help? lol

I have Aetna. From what I am reading (this is a great site!) I will be doing a 3-6 mo. change of habits thing. I am at 38 BMI but am almost completely disabled at this point by severe foot pain and problems that the weight contributes to. I have had all the surgeries on my feet they can do and the only hope I have left is to lose the weight and keep it off. I am hoping that is enough of a co-morbity to qualify me! So I am pretty limited on exercise. I can do upper body stuff while sitting down. I can't walk--physically I just can't at this point without causing further damage to my feet. Certainly I hope as the weight comes off I will be able to. What will I …

Hi- I am going to self-pay for the lapband surgery and was wondering if anyone has ever negotiated the price if they too self-paid? The current price I was given is $15,000. Any thoughts?

Hello. I am just starting on my journey to health. My mother and I are both having the lap band surgery. Her dr. recommended she have the procedure done at Mt Carmel West (Cols., OH). She has Medicare and her costs will be covered 100%. I have UHC, but will probably be denied b/c of an WLS exclusion policy. I am going to go the self-pay route. Has anyone else had lap band surgery in the Columbus, OH area? If so, who was your surgeon and what was the cost? THANKS! :wink:

Hello. I was reading the threads about insurance & financing when I read one bander's thread and it got me to thinking. Her insurance wouldn't cover WLS, but it would cover her hiatal hernia repair. She discussed this w/ her surgeon and he agreed to put a lap band in place while fixing her hernia for a much reduced fee. I have seen other threads posted on here that talk about having hernias repaired while also having the lap band put in place. Many people (including the surgeons) look at the procedure as WLS w/ the hernia repair "tagging along for the ride." What if it was looked upon as a hernia repair w/ WLS incorporated??? It is worth a shot for us self-payers to s…

I've just had my physical with my new Tricare Prime pcp and now I'm super ready to get approval for a band. My second appointment is comming up and I'm not really sure on how to approach the question with my doctor, especially not really knowing her yet. I mean, is it up to her to decide weather or not to submit a request for approval? What if she just says get on a diet (which I've tried and failed at numerous times)..Is her word final? I know I fit the guidlines that Tricare has layed out. I'm a hundered+ lbs over my ideal weight, and have to take medication for high blood preassure. Am I just worrying too much? I wouldn't be surprised if I was:P

The subject says it all I guess... I am just looking for opinions and experience on calling insurance and how many times per week/month/etc you called them. My surgeon turned in the paperwork on 3/13, they show they it as being received on 3/20 - I called on 3/23 to ask about it and actually got a higher up phone person that had access to the "queue" and so she dropped it into the queue for the approval department to review. I called again yesterday and they said to wait a couple of more weeks to call back because it takes "up to 30 days". Should I call back and start annoying them? Do they record that stuff, I wonder? And if so, will it delay them just because…

Can anyone who has Oxford United Healthcare tell me how the process was for them. How long approval/disapproval took, requirements, etc.? Im in NYC if that matters. Thanks for the help. https://www.oxhp.com/ -Chris :confused:

I just checek with my insurance... It is through Principal Financial, but somehow affiliated with Aetna as well... i dont really understand it... But they gave me the run down on what is required in order to gain approval: - History of Obesity for 3 years - Current BMI and comorbities - Psychological Visit (my surgical team requires that as well) - Written plan for follow-up post surgery - 6-12 month Physician supervised weightloss program *Dietician visit every Month *Physician visits every 3 months *Documented exercise program I'm feeling quite discouraged after all that. Mostly in regards to the 6 month diet. What exactly are they looking for?…

Anyone have Med Mut Plus? If so, how have they been? What happens if your bmi is over 40 when you start but under 40 when you do your pre-op diets?

OK, I have Anthem and the doc just told me my out of pocket costs would be around $6000. I live in the Bay Area. Can anyone advise on this? Thanks, E :smile2:

hello everyone, im kinda of new to this but i desparately want some more information on this lap band. Here is my dilemna that my BMI is only 42.1. Now i read I have to have co morbidities to have kaiser pay for this surgery. Not sure if i have any. Im not quite sure what that is exactly. How do I go abouts getting tested or diagnosed to see if i have co morbidities. Any advice/assistance/guidance is much appreciated. P.S. anxiousiosly awaiting...

Hoping that someone knows a doctor that will accept medcaid in the greater chicagoland area!!! I was told that Illinois state medical card will cover the procedure but need help finding a doctor that accepts the card. Thank you in advance for any help you can give!!

I am a poor college student, on a very strange health plan called "Consolidated Health Plans". It says it doesn't cover weight management of any kind, but it never states that it doesn't cover WLS. If it doesn't cover WLS, is there a loophole. I have generalized anxiety disorder, and a few other things (co-morbidities) that are traced back to being overweight. The health plan offers treatment for these, but can the treatment be WLS? Please and Thank Yous - Jean

I am wondering how long it takes to hear from the insurance company after everything has been submitted. My doctors office will have everything May 1st. Hopefully they will submit it right away. I am concerned because my employer is talking about making changes to our healthy ins by July. I don't know if I will have an exclusion. The surgeons office said they deal with all different insurance companies and they said that BCBS NJ-PPO does not reply before 6-8 weeks. Has anyone had a different experience. I was hoping to hear back in 2-4 weeks so I could definitely have the surgery before July. I really think I meet all the standards for approval and it is cut and dry but t…

HI myname is nora, i had the lapband before and i took it off december due to complications , i want the sleeve has anyone had the sleeve with dr le porte

I am currently in the 3 month multidisciplinary option with Aetna Insurance. I have done the nutritionist thing, the exercise thing but am wondering what fulfills the behavior modification part of the plan. Has anyone else gone this route and if so, what did you do to fulfill that requirement? Thanks in advance for any info you can supply. Elgrad

Well, my dr's office has submitted my paperwork for approval. I am very nervous and excited all at the same time! I have been praying and leaving it in Gods hands! If i do not get approved I will have to wait till next year. I would love to ask everyone here to pray for me too! Thank you guys for all the support and answering all my questions!!!:tt1:

:thumbup: I thought I had done my 6 months.. come to fnd out it is only 5 and I am on Medicare and Medicaid in Iowa. Medicare would approve now but Medicaid requires 6 mo dr supervised diet. NOW they get my notes from family dr who has about 2 lines per visit and says it may not be enough and may have to start all over but I have to see him once more in April to submit notes to insurance. I am SOOOOO frustrated at this point. I had start the surgeions pre diet and lost 9 pounds in 2 weeksd and a total of 16 over the last 5 months but basically gave up this past week out of frustration and stress. I am so ready for this but kow I cant lose the weight without the band as a…

I have an appointment with a surgeon in a week and a half. I have Aetna and have verified that I have the WLS rider. However, I have a question about the co-morbidity requirement. For the past 5+ years my bloodwork has indicated high cholesterol and elevated sugar levels, but I am not on any medication for those conditions. In fact on my last fasting bloodwork my glucose level was 129, which in doing some research appears to be in the diabetic range. My PCP has never recommended anything but diet changes, perhaps because of my age (30.) I also routinely have high blood pressure when I go to the doctor's office. Do you have to have a history of having your co-morbidities…

Morning, everyone! I'm 38 years old with a current BMI of 41. The lap band is covered by my insurance, Aetna PPO NAP. I can prove 2 years of obesity, inlcuding previous BMIs between 35.0 - 37.5. Do I still have to prove comorbidities because of the lower BMIs even though now my BMI is over 40 (just recently by the way)? Any opinions/experience? I have hypertenstion (153/98) but it's untreated. My PCP doesn't seem concerned about it but he is supportive of my pursuit of the band. Should I ask him to put me on meds? I've had a lot headaches in the last few months and wonder if the BP is the cause. If he puts me on meds and my hypertension resolves...then it doesn't co…

I was wondering if anyone know which insurance company cares a policy that includes obesity surgery. I was banded on friday and now my best friend really wants to get banded. she is not insured and has been shopping around to find a carrier that includes obesity surgery in their self insured policy. Any help would be greatly appreciated. Thanks so much.

I just heard back that Medical Mutual is requesting proof of additional Weight loss attempts. My PCP ent a letter listing the different drugs that have been precribed over the years...Redux, Xenical, Meridia...I also Included a letter listing every diet plan I have ever been on...probably close to 30 (see my journal). The only supervised weight loss plan I was ever on has been weight watchers, 4 or 5 different times over the past 20 years. I know the approximate dates and I listed them, but I have no other proof because WW says they only keep records for 4 months after you stop going. And I threw away all my old stuff, and I only keep bank records for three years, so …

I am new and starting the process of lap band surgery. I have MM insurance and was wondering how bad it was to get approved by them. I have read others posts about other insurance companies and it seems some are hard to get approved by and others are not.

Well I have insurance that pays the majority, but I am young so I don't have 2k for my copayment. So I started saving up from my parties, and in 3 months have it all! Plus some for the hotel room to stay in the bay. I joined Passion Parties, with the hope just to pay my car payment. And stay home with my daughter, but since we are booming with the slow economy I now do not have to worry about surgery putting a negative number on any of my ccs or bank. I make 40% plus my bonuses. Passion parties has soo much opportunity. Everyone is still having sex, so in need of my services:D If you want a way to supplement your income, pay for your co payment, or just get…

I just called my insurance (BC/BS of CA Federal program) to talk to them about co morbidities (for a reminder, my BMI is 37ish and I have several "small" cormobities such as hyperlipidemia, prediabetes, infertility, and suspected PCOS (awaiting a call to be tested) but nothing really BIG) so anyways, I was telling her I wanted to know the criteria for approval because I don't want to have to pay the out of pocket expenses for the nutritional eval and other expenses, just to find out I don't meet the criteria.She said the surgeon can submit something called a pre-service review talking about medical necessity etc and my history and from there I basically will get a "pre" a…

"Barix Clinics offers an Advanced Payment Option" Could anyone explain this to me? I have been looking around online and I have not found anything. I am going to be a self-pay. I have no insurance and I am trying to look around for the best option as far as financing. Please let me know if you have any info on this - or if you have gone to the Barix Clinics.. Thank you in advance:smile2:

I was wondering if anyone had any suggestions for places for loans. I will have to pay out of pocket and my credit isnt outstanding but it also isnt horrible. Any suggestions???

I have Personal Choice insurance and live in PA. I went for my initial consult on Feb 19th and am awaiting a date for pre-op testing. My BMI is slightly over 37 and the doc said with my joint pain, back aches, etc I should get approved easily. Does anyone have a similar situation? If so, did you have to do the 6 month diet or were you approved right away? Also, my endocrinologist is in the middle of adjusting my meds for hypothyroidism. I recently had a baby and it caused a flair up so my numbers are REALLY out of whack. I wonder if this will delay things. I have been waiting 2 weeks just for answers from the doctor about a pre-op testing date and this is killing me…

lol jk! Aetna received my paperwork on Friday, 3/13..I'm wondering how long I should wait before I call them. The rep said it takes about 15 days for the decision process...I hope she doesn't really think I'm gonna wait 15 days!!! My question is...how long did you guys wait before calling them to find out the status? I want to call SO badly right now.