Insurance & Financing

i started this journey back in 9/08 on nj medicaid Horizon NJ Health. well last month i get a letter sayin my medicaid is expiriing this month 1-09 so now here i am with no insurance? so i go to the welfare office to reapply and they deny me - tell me then it goes up to the state level- so i call the state program but she couldn;t tell me much until they recieve my application. the thing is when i look on the website (njfamilycare.org) the form says something about a family of 2 can make up to 28,000 a year (but with copays - no biggy). i make 26,270 a year. my ins. at work does not cover wls and is too expensive for me to take. is there anyone on here that works…

Hi- I recently found out that Gary Viscio passed away in July. I also found out that he never filed an appeal for me that was supposed to be done in November 2007. His website is shut down, phone disconnected and no one from the office ever notified me of his death. He had all my medical records and legal file. I am at a loss as to what to do now. My chances for a second appeal are lost. Is anyone else in a similiar situation or can offer some advice? Thanks

I currently have Aetna insurance (on cobra). I am eligible for Medicare on June 1st. Aetna has told me I will have an 20% copay for the surgery. If I have both Medicare and Aetna at the time of surgery, will both be billed? Will Medicare pay the difference (the 20% copay?) Or should they submit to Medicare first? Does Medicare typically pay 100%? Since I have started the process with Aetna insurance. Will I have to start over in June for the Medicare insurance? Help me! I have so many questions and it's all overwhelming and confusing. But I know I need this done for my health.

Has anyone had any experience with getting approved with BCBS KS? I'm wondering how strict they are on their requirements? I have BMI of 37.7 and no co-morbidities that I am aware of. I've done WW and the gym thing and didn't hardly lose anything. Any suggestions or experiences would be great!

Has anyone used either lawyer to get reimbursed for WLS? I am on my third and final appeal to my insurance company and it is time to hire some "big guns". If you know of a good lawyer that you could recommed, please let me know that too. I tried to get a lawyer here to help, but they say the bottom line is that to fight it would cost WAY more than the surgery. These guys are my only hope!!!! Thanks for your support.

I had my surgery last June, was told in March I had already met my deductible by Medicare and that if I was outpaitient I didnt have to pay a thing, if inpatient $1200. Yesterday, I got my medicare statement and they show me owing $31,000!!! It says procedure is not approved. OMG, has anyone else had this happen? No way I can pay this amt. And, to top all of this off I had to have the band taken out in December, it was making me sick. HELP!!!!!!!!!!!!!!!!!!!!!!:smile:

Hi guys, I really don't know what to do, the insurance(which I conveniently lost the day after I got my appointment with the surgeon) which I had through my job denied me due to my weight. They told me to try the ca high risk insurance but that would cost me about 300+/month -which being unemployed I don't have. I'm wondering if any of you know of any insurance groups in CA that will except overweight people and cover the lap band procedure. Thanks guys, ~Natasha:rose:

I am self employed i work with 2 other people. We are in the process of getting a group policy we are a bit overwhelmed. We all want BS of so cal but are not sure which ones are better. We asked the broker and he gave me 4 books that are over 2" thick each on whats covered and not. I dont have the time to read all that. Anyone have BS or Aetna in socal? We would prefer HMO because of cost but i know some HMO do not cover lapband but some do. Any info would help. We need to have this b4 May 31. Its when our cobra runs out from our old company that downsizes us all. Thank you all Kar PS if you know a GOOD broker in LA area send me that tooo

Hey everyone! I am new to this forum and have a few questions.:tt2: I have Aetna Open Access Plan, the surgery is excluded from my plan but if it is Medically ness. then I have a 50/50 of getting approved. I have done a 3 month supervised diet and had a consultation with the surgeon and he said that I was a canidate and also my PCP is behind me and even wrote a letter to back me has well. I have artiritis in all joints throughout my back and I have to have injections in my hip to help me walk and function clearly because the pain gets so bad. Also am a broder line diabetic which runs heavy in the family on both sides. So I was just wondering if anyone had any advice or an…

:tt2: YIPPEE!!! I just talked to my insurance United Health Care and I was approved on Monday the 16th. As soon as the dr. receives the letter I can meet with him to set up a surgery date and start my 2 week diet! I am sooooo excited!!! Hope to be and April bandster!!! I just love reading everyones post! I have retained lots of info on many experiences good and bad. I am ready to experience them too. Thanks guys! - Val

anyone have this insurance...waiting to be approved.... problem gained wieght on 6 month diet, but lost it back to original weight. doctors office said i might be denied because i did not do well on diet. do have problems bmi 40 sleep apena high blood pressure borderline diabetic. you think that might help me get oked. thanks

I am so scared to even call my insurance company to see if I qualify. I am afraid they might say no. :confused: I know you can fight them but ARRRGGGHH. I need some encouragement!

Just left my soon-to-be surgeons office. I am using Dr. Dewitt in Birmingham. He is sending all the info to BCBS tomorrow. Hopefully the approval/denial will come fast so I can get on with the next step whatever that is. I guess now the waiting game begins and that part may drive me nuts

So I have Anthem of CA which covers surgery as long as it is approved and my dr. is a provider at 70% after I pay my $2500 deductible. The dr. I have met with so far and really like isn't a provider, but will be within 6-8 weeks. I really wanted to get surgery prior due to my job being right in the summer. I wanted to have time to recover before and give myself a lot of time to heal. So here are my options...wait until they become a provider and use my insurance (still pay about $6k out of pocket with deductible and remaining 30%) Use them as an out of network provider and my insurance will pay 50% of the amount allowed but i have no idea what that is. Pay the dr. ou…

.........I'm starting to feel like a broken record was looking into Dr. Alanis (Houston) called his office asked the woman who answered the phone of they take Care Credit, yes she said. Dr. Alanis is $9800.....Emailed his office with some questions and I get this back- "Unfortunately the facility that we are affiliated with for that price does not accept Care Credit. The facility that does accept Care Credit is our Sugarland Hospital and their price for the band all included is $12,100" Thanks, just wasted my time- So, back to the drawing board- TLC Edge is in Dallas, is $9990. I live around Houston. Will go there if needed but there HAS TO BE someone in thi…

I just called my insurance checking to see if they paid for lap band. The lady told me they paid for surgery and fills but not for doctor visits before. Can anyone tell me about what doctor visits at one of these surgeons should run me?

Has anyone in st.louis/il have cmr ins.??? I have a list of qualifications. How picky were they about the 6 month exercize and diet plan??

I just read a doctors website and this was his quote "Bariatric surgery is a non-covered benefit for all Ohio Medicaid products that we have encountered. " Has everyone experienced this? If you have medicaid in Ohio and have been banded how did you do it?? THANkS!

Has anyone ever been approved with this BMI?

Well, got the news that I was denied. Was told that you have to be 100 pounds overweight and have certain medical complications. I'm 80 pounds overweight and have hypothyroidism,IBS, high cholesterol,arthritis,RLS and suffer from depression. I take medications for all this and said that my conditions were all under control so I have no reason to appeal this matter. So I feel that Tricare has really screwed me. Don't know what I should do. Any advise would be welcomed. :thumbup:

Hers what Im worried about. I have BCBS-IL. and they say yes if your morbidly obese (100lbs or more which i am barely) and if you have a verified proof of weight going back five years. Im over 100lbs over weight now but when I go back five years I wasnt. maybe 75 or so... My point is do I have to have been obese for 5 years or morbidly obese for the entire five years?

My sister has Humana and I was wondering if anyone has any idea whether or not humana will approve any of the bariatric surgeries? Thx 4 the info.

Hey Everyone! I had heard Aetna was one of the more difficult insurance companies to get to approve this surgery so I was really nervous! I didn't even know that my doctor had already requested coverage for the surgery and I all of the sudden got a letter as of 3/9 that I was approved! I am so thrilled. Just so you know...I know there is a lot of talk about what Aetna requires 3 or 6 months supervised diet/exercise......I did 3 months and was approved. I am pretty sure that as long as the hospital/clinic you are getting it done at has a specific program they make you follow before the surgery, then Aeta will approve without having to do 6 months. Just thought I woul…

My husband just told me that he's renewed our annual travel insurance. He told them that I have a gastric band and the lady went away to ask someone about it. She came back and told him that they will renew our insurance but I won't be covered in the event that anything happens relating to my band. Now, I read something somewhere about the gastric band being treated by some companies as a 'pre-existing condition' but I am still not clear on what the position is. I wonder if they treat women with breast implants in the same way????!! Do any of you bandits have experience of getting travel insurance post-band? Did you declare it? Were you still covered? Did you have to p…

Anyone out there been approved from BS of Ca with BMI of 37?

Has anyone in OR. had surgery in Mexico? Did you have trouble finding anyone to do your fills? My insurance won't pay for it and I can't afford to self pay $20,000 + , so am looking into going to Mexico. Would you recomend this, and who did yours? Any help would be appriciated. Thanks, Shelley:)

Hey there...well here is the situation...i am currently employed with a company where i obtain my aetna pos II, and im currently in the process of the 90 day prep....the job that im switching to is another big bank also....and they do have aetna choice pos II also....but im worried if aetna with the new company will make me do the doc visits all over again...my start date is 3/23 with the new job and i have one of my monthly visits on 3/27...luckily my insurance starts day one with the new job, but im just wondering if anyone has experienced this and if any of yall had problems...i called my case mgr at lap band solutions and she sd they usually just let my stuff roll ov…

My highest weight was 244 when I was 19. I lost down to my lowest weight of 145 by the time I was 21, and it's been coming back slowly but surely. I've had a BMI over 35 for the last two years, but as I don't know if I have any health problems (haven't had a physical in many many years) I can't guarantee that will be enough. I am almost positive I can acquire my doctor's records from my heaviest time. I also should have records with a rheumatologist I saw that will have my weight for parts of the time while I was losing -- and I can get my gynecologist's records and those have my weight from the time I was 18 on until now -- except for a few years gap when I moved ou…

I'm hoping someone can tell me how to find out if I was approved or denied on the website. All my appointments were approved but, how do I know about the lapband?

Does anyone know what happens if someone needs to have a lapband removed due to complications? What would happen if something happened later on down the road and I didn't have insurance that would cover weight loss surgery? I don't anticipate that happening, but it's only normal to think about the "what if's" Also right now I have 90% coverage with my insurance, so what will fills cost me? United HC currently. Do I pay just the copay?

Just curious if anyone has been recently approved by BCBS of IL as a member of the United Airlines group? I have been jumping through the BCBSIL hoops for close to a year. First denied for lack of documentation of the 6 mo. diet. Got that straightened out, now denied because they say UAL has a Lap Band exclusion. No explanation why they didn't tell me this before now, but if it's true, it must be very recent. In that case, I will petition to be "grandfathered" as I started before the exclusion. Any input you can provide would be very helpful and much appreciated. Thanks ....Dan.

Well after deciding to have this surgery. Going to the seminar and starting the paper work I found out that my employer has a exclusion policy on the Lap band surgery. I'm very upset right now :thumbup:. Now I'm going to have to find another way. I know there is no way I could pay for this on my own. What now. If anyone can help or give me some advise please do. Thanks Kimberly :w00t:

Has anyone had Healthcomp for insurance? If so what was your luck with them.:cursing:

Tonight, I went on BC's website to check my status, and it shows "disallowed". Does this mean I have no chance? I was expecting either "approved" or "denied", so I'm not sure what to make of disallowed? I've put in a message to my dr's insurance nurse, and I'm sure she'll get back to me tomorrow, but I needed to vent somewhere that I knew I would be understood. I can't fall asleep and I'm so upset. All this after loosing the required 10% and doing all of the other requirements. Today, I had the pre-op class teaching me how to eat before and after the band, and have my surgery consult Monday. They told me to start the pre-surgery healthy eating diet tomorrow (shake …

I am looking to have lapband surgery done. I have Kaiser, and I have heard it takes a long time for the process. I figure it is a year of doing something positive vs. another year of wishing I was not as heavy as I am. Trying to take this angle at it. I am wondering, can you tell me how long the process takes? I think I will have to loose about 35 lbs. Do they give you some help in doing so (dietician and so on) ? I keep hearing they may not do lap band anymore? does anyone know? Any other help would be appreciated. Michelle

I am just starting to look into lapband sx..i haven't started the process yet but my insurance will soon be anthem and was wondering if there is anyone who has used them and what the steps are that i will need to take i am in ct.. Thanks kim

I regularly visit my favorite resource as given in my signature link, Today i found one new section like Lap Band Surgery Insurance, it's having decent information and also beneficial for you guys as well. Please see as it of any help.

I was just wondering if anyone has gone through surgeryloans.com for financing for lb surgery..if you had not so great credit and what your payments are. I am looking at dr.kirshenbaum in denver area and he charges around 10,000 self pay. just looking for some advice and maybe what to expect. thanks!

I have been looking into the lap band and decided that because our insurance is such a pain that I would go self pay in Mexico but after researching I think I may try and get approved thru our insurance anyway and if that doesn't work then I'll go self pay. Anyone with Tricare Prime insurance have an easy time getting an approval?

I have heard that some people had to submitted documentation that they completed an exercise regimen. I have heard people say they went for three appts and this met the requirement. What kind of an appt? With a personal trainer? My ins co said to document exercise along with the 6 month weigh ins. If it would help to actually make an appt with a professional who could write a letter pertaining to an exercise regimen I would be willing to do this. Anyone familiar with this?

I read on a thread here that most insurances would pay for a breast reduction. I'm wondering if anyone is aware if this is something Tri-care has paid for or pays for. Any help would be so greatly appreciated. Thanks in advance.

I have Aetna and noticed that their clinical policy bulletin for obesity surgery (Obesity Surgery) is up for review on 2/12/2009. Not that far off. Should I be worried that they will change it against my favor. I have my BIG appointment w/the bariatric surgeon's office this Friday (2/6). Should I push to get all my paperwork together and submitted ASAP? I still have the physician supervised diet to complete, but Aetna will approve pending the completion of this diet if you submit prior to completing it. What do you think?

Good morning! I had a question as to what the difference is between the three and six month diets that you must complete for approval using Aetna insurance. Thank you very much :confused3:

I have just been informed from my employer that the beginning of 2009 we will be going on BCBS of TX PPO...I am moving from United Healthcare (which turned me down for my lapband) please could someone tell me if I have a better chance this time and what do I need to do....Thank you all so much:confused_smile:

Does Tricare Prime (for retirees) ever approve plastic surgery? And, if so, what should I be doing now (band is in 3 weeks) to start documenting a "need"? Thanks for any info :thumbup:

I filed with my insurace bcbs nc last monday and was denied on wednesday. When my surgeon got the denial letter it stated my denial was b/c my phsycologist letter was not detailed enough and that was the only reason for the denial. My surgeon said that they will now resubmit the info with a new letter does this now mean that I will be approved b/c I have made the needed changes or can they come up with a new reason for denial even though there were no other reasons listed??

I just wanted to update on a post about losing my bariatric coverage post op. I was PANICKED about fills. After a few e-mails to my insurance BCBS of MA Blue Elect I finally got an e-mail back, and I was very pleased! Hopefully this post will come up into someone's search if this happens to them and they are wondering...but the coordinator was very kind, and said that I would have fills covered for life since I got the surgery during the four month period they covered bariatric surgery *whew* I can take a breather. I know how difficult some insurance companies can be...so I only hope for others some companies start acting like this!

Anyone have a sample of a letter that they wrote to the insurance company on behalf of themselves. I have heard that it can help to have your own letter sent in with all the other documentation when seeking insurance approval. Right now I think the more I have to send in the better.

So about a week ago I got the call saying Tricare wanted more info. Well I couldn't get into my PCM until Wed. I got a letter from Tricare today saying that my banding was not approved. (by the way there's still nothing on the triwest site, I've been looking since it was submitted). So, can anyone give me advice on how to appeal? They wanted a letter from my PCM stating that the joint pain from arthritis was interfering with ADL's or X-rays showing arthritis. However my PCM didn't want to do the X-rays because even with arthritis the X ray may not show abnormal and he agreed to write the letter. Should I get records from my dermatologist who prescribed me Enbrel f…

I have CHAMPVA insurance through my husbands VA benefits, I was wondering if there is anyone out there who also has the same insurance? I am wondering if they give alot of hassle? I meet the requirements not only for the bmi, weight and the medical part. I have the initial consul with the surgeon on Monday morning :sneaky:. Just wondering if someone can give me heads up or help with this. Amanda