Insurance & Financing

Aetna insurance denied or any other insurance..did anyone have a peer to peer done by the doctor and insurance and won???

My insurance is due to expire Nov 30th and my pre surgery checklist will be completed on Oct 27th. I'm concerned about how long it takes for ins to approve the surgery. Thanks

My insurance is due to expire Nov 30th and my pre surgery checklist will be completed on Oct 27th. I'm concerned about how long it takes for ins to approve the surgery. Thanks

Hello all. I am a little disappointed at this time. My insurance has switched from Medicaid to Medically Needy and my surgeon does not accept this. Does anyone know of any surgeons in the South Florida area who take Medicaid share of costs or Medically needy. Thanks,

I have share of cost Medicaid. My primary said they’d pay for it but reading everyone who says their insurance doesn’t pay makes me wonder if I would really be covered? Monday I’m getting lab work then the Bariatric center will be calling me to schedule my first appointment.

Does anyone have Blue Cross Blue shield of Illinois PPO? Was wondering requirements and if approved or not. Any information will be greatly appreciated! Thanks

Does anyone know if losing weight after insurance approval will cause any problems with surgery coverage? I was losing and then found out at my consultation that my BMI was too low so it's where it needs to be now but I see the surgeon tomorrow and they'll use that weight to submit to insurance. However, if approved I want to start losing before surgery but I don't want to mess things up.

I am currently in month 5 of my 6 month program before my doctor submit's for insurance approval, and I am starting to get anxious. I have UHC, and they require 5 consecutive years of a BMI >40. Well, in 2015 I was breastfeeding and lost a ton of weight, bringing my BMI down to 35. I gained it all back in 2016. I am so worried that I am going to get denied. Anyone have experience with this? Thanks!

Omg im so excited but at the same time so sad today i saw my doctor for the first time and the said that they will see if the insurance takes my case i am 35 on bmi and no conditions just a high blood pressure history but i don’t have it anymore. They just diagnosed me with joint pain i praying that the insurance takes my case my doctor also send me to do a sleep apnea study. I dont know if somebody have gone thrue something like this please help and excuse my english

Can anyone with Highmark BCBS of PA tell me their experience with insurance approval?

So I'm going through Oband. They are they only ones that want to try to get me approved for surgery since it's an exclusion on insurance plan. Has anyone with an exclusion for bariatric surgery still get approved through the appeals process? There isn't a lot a I can find on this subject. I called my insurance company probably a million times and each time there's a different answer some say yes it can be done and others say not it can't . I'm confused . I just need more info on this.

I just attended my first appointment with my surgeon i new to all this and would love a friend to talk to during this amazing journey!!! Sent from my LGMP260 using BariatricPal mobile app

I have completed everything. During my 3 months of Nut appointments, my weight fluctuated. I lost 3 lbs and I gained 3 lbs. My end weight was the same as my start weight. My net gain was 0. Aetna denied me because I gained weight. Once I lost the 3 lbs, I had to keep it off. In phone conversations they tell me it’s because I fluctuated, the denial letter says I gained weight. They Aetna reps also tell me it’s not a lost cause. These things usually get overturned on appeal. The peer to peer appeal was denied. The doctor is in the process of filing the second appeal. Aetna tells me I can resubmit my initial claim in October if the appeal is denied. I have no other appoi…

Hey. I’m in Mississippi and insured through my employer. My PCP stated that she had patients to be approved with my exact same insurance. Have you guys heard of it or know anyone that has this insurance and has been approved? I’ve been denied already and looking into self pay in Mexico.

The road to revision is littered with minor annoyances. My GP is a diet doctor that I made my GP so I could just pay my insurance co-pay for visits, but I gave up on prescription pills because nothing worked. My surgeon gave me a quick form for him to fill out, and first totally refused to fill out, then said he would take it and do it later. His office then mailed it to me instead of faxing it to the surgeon's office as directed, and he listed my BMI as 39.9. Did he just totally derail me for insurance coverage? I just input my info, and my BMI is coming out as 42. I'm so irritated right now!

I am considering Gastric Sleeve and my insurance plan at work lists it as an exclusion. I was considering getting an individual plan as a secondary to help with the cost. Are there any individual insurance plans that cover WLS? DR Potential Sleever

How does this plan work? Does anyone have experience using First Healths network as a secondary insurance? Ik my plan won't cover surgery, but going within their ppo network would that take a portion off?

Ive submitted my information to three different surgeons and no one has gotten back to me.

I inquired with dr Clayton Frenzel. His office offers a cash pay price as low as $5000 if your insurance has a general surgery clause. Has anyone ever heard of this? How does it work?

I just found out today I have go through a 6 months doctor supervised plan. I am so disappointed because my deductible is met and I was hoping for surgery in July. I won't start the plan until June 22 and I'm scared I won't meet the deadline before the year ends. I just don't know what to expect now. Anyone has any insight on end of the year approvals?

Hello all, I am new here. My PCP broached the subject of bariatric surgery recently. I am pretty interested. Has anyone dealt with this insurance company recently and bariatric surgery? When I called they told me the first step is to do 12 months of a documented weight loss program before anything else related to surgery. Timing wise, I found this a bit discouraging- as I have time intensive goals next september. Anyone have experience going through Horizon NJ Health? Thanks.

Soooo...my BMI is 40, and I dropped a bit of weight, and got weighed at a scope procedure, and it was under the 40 BMI.....My question is this, does anyone know if you need to stay over 40 to qualify ? Or do they generally go by that initial weight? For the group I am using, you need to go to several support groups, meet w the nutritionist, etc....and in 3 mos from initial appointment you can get the surgery. I am concerned about not being covered, if my wieghts show a BMI that varies from 40-30~something. Do I need to hit up Dunkin Donuts to stay fat enough for the 3 months? I have a sleep study coming up, and I am hoping I have obstructive sleep apnea,…

I am looking to change health insurance..what health insurance doesn't require 6 month weigh ins in ny for gastric sleeve Sent from my LGMP260 using BariatricPal mobile app

Anyone have any experience with this insurance and their "Blue Distinction Network"?

Hello just wanted to drop a note to let anyone who may be wondering about insurance requirements for Highmark BCBS in Louisiana. 2017 benefits no longer require the 6mth nutrition program. I just completed my last nutrition appt (started process in DEc) , psych eval and PCP visit today..now just hoping and waiting for approval. Tentative surgery date set for March 20th. Sent from my iPhone using the BariatricPal App

So far I have went to a new patients group meeting and I have my meeting with the head of the weight loss surgery dept in a week... At what point do they go thru the approval process? I have BCBS-IL. The reason I ask is currently have PPO+ and I would have to pay almost 3k out of pocket, but we can change our health plan for 2018 and if I switch to PPO+ Premier, I would have no co-pay but a higher monthly cost by only 135

I have Anthem BCBS of Virginia and everything seems to be going well. I had my consultation, and first visit with my surgeon already. At that meeting I met with a coordinator who gave me a list of appointments/testing to complete before I see them again in six weeks. The coordinator told me that I am probably going to have the surgery in October or November. I asked the coordinator if I will be required to complete six months of supervised diet before approval, and she said all the insurance requires is to meet with a nutritionist twice within a six week timeframe and that I won't have to. I don't want to get my hopes up, so I was wondering has anyone had experience with …

Does anyone have Independence Blue Cross (IBC) insurance? I am told there are no time frame requirements for medically supported weight loss or nutritionist appointments. How long does it usually take to get approved? I am looking at gastric sleeve.

I have Cigna. Here is a little background. I had the lap band surgery in 2009. Initially went from 252lbs to 149lbs and now and back up to 202lbs. This past Friday I had my initial consultation for the sleeve revision surgery. The nurse practitioner is concerned that because my BMI is under 35 that insruance won't cover the sleeve. I called my insurance and they said my plan definitely covers bariatric surgery. They gave me this link. If you look at page 4 it talks about the revisional surgery. I don't see anywhere that it states my BMI must be 35 with a comorbitity. Do you ? For an initial surgery yes (page 2) but not the revisional surgery. You can take a look at t…

I've been on the road to revision from Band to RNY since October 2015. It's a loooong story. Here are the best parts: After finally qualifying with my surgeon for revision surgery in November 2016, I was denied coverage by my insurance carrier (BCBS IL) on 11/30/2016. My surgeon did a peer-to-peer review on 2/1/2017 which was denied as well. Since I only had 180 days from the original denial to file an appeal, I knew I had to do something drastic. In April I hired Kelley & Walter Lindstrom from the LINDSTROM OBESITY ADVOCACY group. They're lawyers who have specialized in WLS appeals. From April to June we had to go through a 2nd level of appeals which was a…

Can anyone who has had weight loss surgery with Healthchoice as their insurance explain to me what healthchoice's requirements are? I know on their website it states you must be on a healthchoice plan 12 consecutive months prior to surgery. I was on healthchoice 2015 and 2016 and last option period global health came out with their $0 Co pays.... So I thought I'd try that cause my bills with healthchoice were stacking up... Type 2 Diabetes, neuropathy, heart palpitations u name it, all things related to me needing weight loss surgery. After I had already enrolled into global health for this year I learn that Bariatrics would be a covered benefit with healthchoice, but…

HealthChoice started approving weight loss surgery Jan. 1st 2017. The weight loss doctor's office called to verify I'm eligible with my weight, BMI, health issues due to obesity, etc and my doctor's office said I qualified. At that time began all the classes etc that insurance required. Now, after all of that and spending hundreds on all these classes and additional doctor's appointment insurance is saying it's not medically necessary due to my BMI being 34 and the fact I'm type 1 diabetic and not type 2. My doctor's office appealed the decision and after speaking with the doctor at HealthChoice my surgery shouldn't have been denied and they would approve it for sure. Aft…

My insurance has to be renewed every 6 months and am required to do 6 monrh documented weighins my imsurance should be up by october but i have appointments set up for oct,nov,dec, and hopefully surg in january im hoping to get my insurance renewed asap but do you think this will affect me? Anyome had this happen to them? Also i have uhc.. Sent from my LGMP260 using BariatricPal mobile app

All my information was submitted to insurance on Friday (9-1). I know it is a waiting game at this point and have been warned it can take 2 weeks to a month for my insurance to make a decision (BC.BS of Michigan GM). to my suprise I was called today to tell me I was approved! I was not prepared to get an answer so quickly! I have my 2 hour nutrition appointment tomorrow and will get my surgery date then. They still have openings this month!

So I have Anthem BCBS and I have SEVERE anxiety about this pre op 6 month diet because I was denied 2 years ago. So far I've been 2 times (the initial appt and a follow up) and I've maintained but not lost anything. I'm going to be honest, I started back at school and wasn't really trying. Now my anxiety has really set in. I'm walking now and monitoring calories. My fear is that they will still deny no matter what I do. How much weight do I have to lose? How much did you lose? Help please! I'm walking 3X a week for 30 mins and taking in about 1700 calories. (MyFitnessPal) Sent from my iPhone using the BariatricPal App

If there is a weight gain in one of your appointments during your 6-month diet plan, will you be denied even if overall you lose weight? For example, say I start at 300 lbs, lose 10 lbs in the first two months, gain 5 lbs during the third month, but then I lose 20 lbs over for a final weight loss of 280 lbs, will I be denied? I have Anthem BCBS and I just wondered if they focus on the month to month or overall accomplishments. Gaining weight over the holidays seems to be a logical scenario, but I wondered about anyone else's experiences.

Can anyone tell me how hard it is to get approved with UHC in Maryland? I know I have to do one visit to dietitian, one visit to psych, and also going to the surgeon once a month.

Anyone have 1199 ?? Just started the process , curious to know if anyone could share an experience! I have Aetna as a secondary. Sent from my iPhone using the BariatricPal App

I had to have my band replaced because of a leak is there a way to get the manufacturer to reimburse me for all of my out-of-pocket medical expenses?

I had to have my band replaced because of a leak is there a way to get the manufacturer to reimburse me for all of my out-of-pocket medical expenses?

I am looking online & I see no information about bariatric surgery with medicaid. I am 23 & have a bmi of 56. I don't have any problems like high blood pressure that I know of. I see my family dr Tuesday to find out more. My dumby self never asked if medicaid covers it. I'm hoping to find out more information before I go to the doc.

I am so disappointed because I thought I met all the requirements for gastric sleeve surgery, received a surgery date and two days ago was notified by my surgeon's office that insurance (FEP BCBS) denied my pre-certification request!!! My surgeon said I had quit smoking for 2 months before my surgery, which I did (Yay me!!). However, my insurance company requires no smoking for six months. I've spent hours researching and haven't found any other doctor or insurance company that requires you stop smoking more than two months prior to surgery. Has anybody had this happen and is it something I can appeal? I wasn't even a heavy smoker! Any advice about an appeal would be…

Hello! So I've got a bit of a pressing issue at hand here, aside from the being severely obese. I'm in need of a stem cell transplant (acute lymphoblastic leukemia) which, understandably, my doctor refuses to go on with until I lose "significant" weight. I am 31, 5'7", 430lbs. He has recommended that WLS is a viable option. Without a SCT, I have been told my leukemia will likely continue to relapse. I'm in the beginning stages of doing all the pre-op requirements. I have UHC gold in the state of Indiana. Anyone else have a similar experience? Feeling a bit hopeless. Thanks!

Guys i need some help. I have tried getting more specific answer from UHC and they literally only spit out the policy at me verbatim. My policy states i need 6 months minimum before surgery for dr visits and/or weight loss logs from a structured program. So my question is, how far back in my medical history can i go to get 6 months? Also, it says and/or weight loss logs so does that mean i can getapproved on 4 months dr visits and 2 months worth of weight loss logs? Ive gotten no help in clarification from UHC and the bariatric coordinator at my surgeon is hell bent on 6 straight months of dr visits and she dont wanna hear anything about my weight loss log…

According to NYS disability, you need to be employed by a covered employer for at least 4 consecutive weeks to be covered by disability insurance. Has anyone here been approved or denied disability insurance for your post op recovery period?

Hi! My very first appointment is next Wednesday and I've been reading everything I can about the different procedures. I already called my insurance company to find out the criteria for getting WLS and it appears I meet them all already! My question: is there a difference between a medically supervised weight loss program and a structured weight loss program? I see people talking about their 6 month medically supervised diet, with weigh ins and nutritionist appointments. When I called my insurance company they told me that I just had to have done 6 months of a structured diet program any time in the last two years. Either 6 consecutive months or at least two 3 month…

Does medicare pay for surgery????

Is there anyone out there with Emprire BCBS (NY) know if I would be disqualified for losing weight during my 6 month supervised period? My surgeon said no, but I'm not sure that's right and there doesn't appear to be anything on empireblue.com that seems to indicate. When I started the process I had a BMI of 40.2 and fatty liver disease, high bloodpressure (at least in the doctors office), and a high A1C as comorbidities. I want to lose weight before the surgery but I'm concerned that if I drop below a BMI of 35 the insurance company will not approve.

I just heard today that my request for VSG was denied because during the past 5years there was one dip in my BMI below 35. There was a doctor's visit where my weight put me at a BMI of 34. I wrote and submitted a letter of appeal as in all the other years where a weight was recorded my bmi is above 35 and currently my BMI is 42.4. Does anyone have experience with the UHC appeals process and how much time it took and if it succeeded or failed?

So my insurance will be changing September 1 from Medicaid to Cigna. My first appointment with my medical provider related to weight management was June 8, second July 12, and third was yesterday. The first appointment with the bariatric surgeon was 8/9. Will Cigna count my first appointment for weight loss or the date with the surgeon to start the 90 day waiting period? I'm not sure where to start with this question so I wanted to ask those who have gone through this process about your experiences. Could my sleeve surgery happen as early as October or as late as December? I've already completed labs, EKG, Chest X-ray, and two support group meetings. I have schedule…