Insurance & Financing

Well I got my insurance approval from my insurance company in 3 days. I was told that my insurance would cover everything and I was told the day of approval they are changing our coverage to only cover $15000 total for everything. This means that once they reach $15000 they will no longer pay. I was told that it could cost around $20000 to $25000 for the surgery. That mean all the fills and follow ups is out of pocket. It also mean that if complication and have to have it removed or replaced they advised me if I am past the $15000 point it is all out of pocket. Well this sucks but here is the questions How much does a fill cost? How often do you have to go to …

Soo i found out today that lovely S&W doesnt cover lap band... so sad:sad:. Really:blush:! And of course i cant afford to pay it on my own soo im pretty much out of luck:cry_smile:. I mean isnt there anyone out there who has WAAAAYY too much money that they dont know what to with it except give it to little ol me??? Far fetched but it would be pretty awesome:thumbup:. Anyone got any ideas let me know I want this surgery so bad.

I just found out today that I am denied by my insurance company. They sent out the letter yesterday and the lady I talked to on the phone couldn't give me much information. I'm so sad and disappointed right now. Not only have I failed in being healthy, but I can't get any help from insurance to help me get there. I have Wellmark Blue Cross/Blue Shield of Iowa. We'll do an appeal, but the lady that does all that is out of the office until Friday. :smile: I had all my time taken off work, and now I have to try to fill in spots at work & hope that I can still get some time off when/if I get approved later on. I've just lost all hope today and really needed to ven…

:thumbup: Does anyone on here have United Health Care insurance? If so can you tell me if I'm going to have a fight on my hands? LOL My husband and I just picked up this insurance with his job and I'm not to sure on all the benefits.

Well, I saw my PCP today to talk to her about lapband and get a recommendation for a bariatric surgeon. I was halfway expecting that she might encourage me to just diet again instead, but she was totally supportive of the lapband. I told her that I was concerned that I might not be approved by insurance and she told me that with what she has to put in the letter for me, that she would be very surprised if I was not approved. My BP was up to 155/99 today (even though she just doubled the dose of my bp med a month ago). I have never been so glad to see it high, though. Its my only comorbidity that really 'counts' as far as Aetna is concerned. Anyway, I don't know why…

Hi all my friend called me and told me that her insurance which is Medica has denied her. I told her to call and find out why so she did and they told her that they do not cover lap band surgery. She had called ahead of time to see if they did and she was informed that they do. I told her to appeal and the lady is sending her that paperwork , but the lady told her not that its going to do her any good. Anyone else have a problem like this? Can anyone offer any advice on what she should do other than appeal... thank you Julie

Has anyone been approved throught BCBS of Ark?

Do they cover the surgery? I was on their website and can't seem to find out how to see if I am covered. Thanks!!! edit.... i was trying to figure out what state, and none of my paperwork or card tells. it just says anthem.com/chryslerfinancial lol

I called my insurance this morning since they said last week it was pending and should be completed soon. I was told it was denied but now pending again and they were waiting to hear back from my doctors office. When I called there they said they were already on it and in touch with my insurance. Later my dr office called and said it looks like they are going to deny me since my BMI is a 38 and they dont think I have enough medical issues. I dont know what more they want from me!! My PC dr wrote on the letter that I have pain with walking and so on. Dr office said she will give me the information to appeal it. I will appeal it until they approve me, I will not give up o…

My husband called UHC for me today to get information about them covering my WLS. The representive told him, after reviewing our plan, that they just needed a doctors letter saying that it was medically necessary. Is this common? This just seems TOO easy. We didn't know if we would be able to have it covered because my BMI is 35.4 and my only co-morbidities are PCOS and infertility. Any thoughts?

:closedeyes:I have gained weight, about 10 pds since my initial consult, thinking that the last weight would be used and not the first. now my insurance requires the 6 mos diet which shows that i have gined the 10 pds. i have hip ny does anyone know if the insurance company will deny me because i have gained instead of losing. i am very concerned about this and nervous. please help!!! thanks:ohmy:

Hey All, I live in Nova Scotia and am wondering about the process here . I know you need approval from your doctor and a letter gets sent to MSI and they may cover ebverything but the Lap band itself.Which if you have to pay for it costs on average around $4500.00.... Can you claim this $4500.00 only on your income tax or the whole amount $ approx 16000.00 if MSI covers it ? What companies do financing here in NS for surferies in NB? Also where can I find a list of requirements MSI need you to have in order fo r your doctor and them to approve you?? Thank you, Mlm

Like many, I still have several appts to complete for my 6 month doctor visits. In the meantime I decided that I am going to keep a positive outlook. Since 2009 seems to be the year that everyone is talking about "change" in our country. I decided that I would give myself a lap band "hope chest". Something like a bride gets while planning and waiting for her wedding date. My hope chest is a wooden box that I am filling with things that will be used when I am banded. This weekend I made a few small purchases for my "lap band hope chest". I brought a really nice diet journal. I brought some new tupperwares that hold small portions (2 oz). I purchased a cookbook with recipe…

Hello everyone I am going thru the process right now. So far I have done the 3 months of weigh in's with my PCP. I have went to the Psychologist. And now on Tuesday I go to see the Dietitian. My question is does Tricare pay for the Dietitian and Nutrition? Dr. Weaver's office in Memphis told me I have to pay for that and everything I read online on this web site Tricare will pay for it. I talk to Tricare and they said it's all in how they file it. Well what does that mean and how do I know how they will file it? So on Tuesday they want 350 dollars from me. Thanks:confused:

I am from Arvonia, Virginia and I am having my surgery in Richmond, Virginia and I would like to know if anyone has had any problems with the person in the doctor office submitting your information for approval. (Listen to my story) I went in September for my consultation and found out what i needed from my insurance company to get authorized. So I got a support letter from my rheumatologist, my primary care physician, and two therapist for support. I submitted all my Information to the coordinator including back and front of my card as she had requested on on Oct. 23, 08. So I have been waiting so long and anxious for the answer and on Dec.11,08 I received a denial from …

I am a little nervous today. I just bought my first scale and my BMI is 49.6. BCBS of NC said they will cover lap band with a BMI of under 50. 50 and over will need a more drastic measure for losing weight - like the bypass. I so don't want a by-pass. My first appt is Tuesday and I hope their scales are no higher then mine and the round the BMI down to 49.

:biggrin:Aetna Called me today and I was finally approved, I didn't think this day was ever going to come. I did the 3 month diet and submitted everything at the end of June. My weight history from 2006 was missing so I had to appeal and it took 2 months to go through appeal process. But it was all worth it today when they called me. After work I am going to go pay my $1000 down so they can schedule my surgery..If anyone else has Aetna there really is hope out there:biggrin: don't give up and be persistent it will happen as long as you meet the guideline.

Hi everyone! My name is Christi and I am a complete newbie to this site - this is my first post. I have been going to an endocrinologist for nearly 6 months, and my weekly appointments include consultations with a dietician, physical therapist, and psychologist. I have not had success so far, and my doctor has suggested lap band surgery as a tool for my weight loss. At first, I struggled with a sense of failure at having to turn to surgery in order to succeed at weight loss, but when I finally realized that it was a TOOL and not 'giving up,' I found out that our insurance doesn't include lap band surgery. I received the following from the HR lady at my husba…

It is going to take a miracle to get the Lapband surgery done.My insurance (Aetna has an exclusion) will not cover it.My husband new fulltime job want cover it either.I only was approved for 2000.00 with care credit.I am so upset right now.I just feel like I am fighting a battle that can not be won.To have the surgery here is 17,500.00..I do not want to give up but it seems as if i do not have a choice.Please pray for a miracle to come my way.I am congratulate all those who have either had the surgery or will have the surgery.

from United Health Care to Atena . I read in my info for the employer that our new insurance company is supposed to have better bariatric coverage but I dont know how it works when I have already had the band. Do I need to be re-approved with Atena to get fills? Thanks

I would love to hear from anyone that has gone through the approval process with BCBS (www.bluecrossmn.com). Thanks in advance for your input....any and all appreciated

As I've been looking into getting lapband, it occurs to me that I'd like to get my tubes tied at the same time. Anyone know if this is possible? And, if so, does it complicate the insurance? Like, what if my insurance covers the tubal, but not lapband... how does that work??? Any input/experience w/this would be helpful. BTW, I know I should tell my DH to just get a V already, but he is so doctor phobic. And, its not just about getting the V, but w/everything doctor related. So, I feel like my best chance of taking care of BC permanently is to just get my tubes tied when I get lapband.

I'm in Florida.. Any recommendations of a better creditor to inquire with? I have a credit score of like 570 because of a loan a family member has out on my name.

Hello everyone, I recently got Blue Shield of CA insurance and I wanted to know if anyone else here was able to get the procedure done with the insurance? What is the process to find out if I would be approved, what steps do I need to take? Any information is greatly appreciated, thanks!

Hi All I have been lurking for a little while, and have been so inspired and excited for my upcoming banding. I'm just now in the process of selling my old 1957 Chevy, to help cover the cost of the procedure. I just changed jobs and was already given my policy (Blue Cross PPO) of what it will and will not cover. My coverage doesn't start until August 6th, so I don't think I just call if I'm not a member yet?? It says it will not cover weight reduction surgery's, even if it is Medically Neccessary! UUGG!! So, my question is, for all of the testing that needs to be done before hand, will the insurance cover those? Or will they deny it because of what the testing is for?…

Does anyone have any experience going through any finance companies to pay for the procedure? I am considering the self pay options (as I am a canadian) in the pacific northwest states or in Mexico. Any info gratefully received...thx. :thumbup:

I have just started seriously considering lapband surgery. So, I have checked my insurance (Aetna) and have found that I have coverage, I've reviewed their documents and meet the qualifications (BMI>35 + comorbidity). I don't mind doing the 3-6 month diet. Its a drop in the bucket compared to what I've already done before. The only sticking point I see is that my BMI has not been consistently over 35 for the past two years because I have dieted and then gained back. But, I can show 5+ years of going up and down and around 35 so I'm hoping that will suffice (probably will have to fight for it). The high BP has been persistent for 10+ years and not very well contro…

Hello Everyone, Before signing on as a member of Kaiser I called their member services to find out more about the benefits and if the Lap Band surgery was covered. The benefits were explained to me and I was told that yes the Lap Band was covered. I was happy about this information and decided to sign up with Kaiser.Well after almost three months of being told that Kaiser would cover the Lap Band surgery and after I started the weight loss surgery process that Kaiser has. Now I have been told that they don't cover it. Not until I started asking for something in write did things change. I now need to know if anyone has gone through this with Kaiser and any information tha…

i didn't get all the details (that is coming in a letter) but i found out by calling my insurance that i was denied, and counseling is needed. the reason this bugs me is, i went thru 6 months of nutritional counseling. then i saw a psychiatrist and took the 2 psych tests (all out of pocket). i remember he left me a phone msg saying he was writing his evaluation, saying counseling is recommended, but not mandatory. i'll bet i have to book a few sessions with the psychiatrist again. which sucks - because my health insurance doesn't cover it. and i am totally broke and getting behind on bills. has anyone else had this happen? :smile2:

Anyone know if after you have a band you will have trouble getting life or disability insurance?

Hi. I have Aetna and am thrilled because my company added bariatric surgery coverage to our plan effective 1/1/09. I have already completed 6 months of a doctor supervised diet just in case the policy would be changed, and am now in the process of gathering my documentation to submit. I have a problem however which is that I have no proof of my weight in 2007. I was out of the country on a work exchange program for much of the year and did not visit any doctor who weighed me. I have proof of my weight going back to 2004 but am missing 2007. I do have a weight watchers booklet showing my weight from the end of 2007 but that is it, and I know that doesn't count for insuranc…

I finally got my approval from Aetna. I did the 6 month diet and it took me about 2 weeks to get approved. Just wanted to let everyone know that you don't have to do the 3 month diet. Thanks for everyone's support through this!

Hello,I am a newbie in my insurance will soon be atena Qpos starting 1/1/09,My question my employer has listed 6months with nutrients in doc...orginally i thought 3 months***please help has anyone had to go thru 6 mos instead of 3 mos with atena?if so how long for approval?:wink:

I have Anthem Blue Cross, specifically. I was denied because I haven't had a 6-month physician supervised weight loss effort and determination of my compliance with it. I have been on several vaguely physician supervised (Phen-Fen long ago, NutriSystem, Weight Watchers, etc.) diets. Has anyone gotten around the requirement of having to go through a physician-supervised 6-month program before being considered for the band? I have plenty of medical complications from my weight so I'm surprised I was denied.

Ok new here. Got a call yesterday about my referral to a surgeon. Have medicare and tenncare. They had to get credited or something. Was told that since my BMI was 42 that I wouldn't need a co morbidity. Called Medicare today to make sure. Medicare said I would have to have a obesity related illness. Was told High BP or diabetes. Asked if there was any others. Said no. Was she right? She was just reading from a list. And didn't spend much time looking into it :/ Really wanna know if others understand the process more. Thanks in advance!

I am on Washingtons GA X insurance its the better one. I am on it due lack of income, but i am over weight 275lbs 5.7 height. And i was wondering if anyone in WA state knows if they cover this surgery. If not i am getting financeing :tongue_smilie:

I have a question that I'm hoping someone can advise me on... I'm 5'7" and in February 08 after being on phentermine to try to shed a few pounds I had a bmi of 38.7. My PCP recommended a sleep apnea test & the results came back as "mild" so my Dr. sent a referral to Kaiser's Bariatric Dept. Because the apnea was only mild and the bmi was not 40 at the time with no other co-morbidites, I was denied acceptance to the program in April 08. I stopped taking the phentermine because I didn't like how it made me feel and I have gained back all that I lost plus a couple. I believe I'm now back at 40bmi which should allow me to now qualify. Should I ask for the referra…

Has anyone had trouble with their insurance not wanting to cover your surgery after you have had it done? I got a call from the Hospital today on my answering machine that they were having trouble with my insurance company and to call them. I also received a letter a month or so ago from the insurance company saying that I am responsible for $21,000 and that they are responsible for $0. If anyone has has this problem how was it resolved? Thanks for any info.

Ok, need advice! I currently am on the HIP Indiana Plan, which is a government plan that doesn't cover lap band. Husband doesn't have insurance, has been using a volunteer clinic. His work's insurance is very bad quality so we don't use it. What plan will cover us on an indivual family plan that will approve of the lap band? We are both way over the 40 bmi - I think I am like 48? Anyway, don't know which way to go! HELP!:laugh:

i live in berlin pa and i am on medcaid i was wondering if anyone knew if they will pay or not.i have two young kids that i need to do this for.

I was just contacted by my surgreons office on Friday, regarding the requirements for Lapband surgery. I was prepared for lots of work ie..psych appt 6 month dr weight loss even a nutrionist and 5 year history of morbid obesity, but she seemed discouraged already. She told me that if you go below the 40 BMI during that 5 year period you are automatically excluded. I was shocked and got onto the bcbsil website and read the medical policies on the srugery. It did not say that you could not drop below 40 BMI. I read it as they just wanted to make sure you had weight issues for years not just a short period of time. She continued to state in 2 1/2 years she had gotten only on…

:confused::thumbup::sad_smile::thumbup::thumbup::thumbup: Finally after 2 denials and 2 appeals, I got my approval letter from BCBSIL today!! YIPPEE!:shades_smile: I am absolutely ELATED! For a while there I had given up hope that I would ever get approved, but low and behold there was a bigger plan in the works for me! I have been in this process since 1/15 and am finally wrapping it up, it has been a heck of a year, but I am excited for great things to come in 2009!!

Hi guys, I haven't been on here in a while. I go for my info seminar on Dec 16. I have BCBSNC insurance. As far as I can tell by my policy, they should pay. I have a dedectible that I will have to meet before they will pick up, but I was wondering.... I know that you have to have alot of tests, classes, and things to do befor surgery is scheduled. Do you pay for those things as they come along, or is it included in the total bill of surgery? I know this is probably an extremely dumb question, but I'm REALLY new at this. Thanks!!!

I have medicare and my surgeon advised that medicare requires a 6mo supv diet. I just got off the phone with medicare and was told they do not show that as a requirement only requirement is bmi 35 and a related illness (diabetes, high blood pressure etc). Was told would have to pay a deductible of $1,024.00. and use a approved fac. Just curious if anyone has used medicare for their lap band

So my PCP did my referral and I was approved to see the specialist. The specialist won't see me until I have all the requirements met and sent me a list...a few on there were one's I didn't know about. If I need to make an appt to see my PCP again, which I think I will, I would like to try to take care of everything at once. 1. What is cardiac clearance? I don't remember my PCP mentioning it. Well I guess that was it...it says I need my PCP to provide a written medical history but I don't know if she did that so I will probably have to make an appt. I need to re-do my nutrition appt too because they person didn't take written notes and I now know I need that. …

My first question is for insurance to cover a tt you have to prove medical necessity. Would an infected belly button count? Mine gets infected all the time. I don't get any rashes any where else. The other I have two choices of insurance Aenta and United Health Care which is better to chose to get it cover? Any advice would be wonderful!

This is my last month of doing this; however, I have gained 9 lbs in the first 2 months because of the side effect of the medicine that the doctor put me on for shingles. Will they deny me because I gained weight? Should i continue the evaluation past 6 months to cover the first 2 months that I've gained? Thanks, Alisa

Help! I am just getting started. I have Aetna Insurance and live in upstate NY. I have been told by the surgeons office I wish to use that Aetna never approves the lap band surgery. My BMI is under 40 (38) and therefore they want me to have some comorbidities. If Anyone can help please.

I am really working hard to gather info. I currently have Horizon BCBS of NJ. I have a BMI of 36 with the following co-morbidities: diabetes typeII, hypertension, high cholesterol. My BMI has fluctuated from 34-36 in the past two years. So far I have a note from my primary. He also list the last 9 months weigh ins. I went for the psychological eval last week. I have an appt for the nutritionalist eval next week. I wonder if I should send all my daily food logs from Weight Watchers along with my 6 month weigh in notes. I am so afraid of being denied. My paperwork will show that I was successful on WW, I lost close to 30 lbs. but unfortunately I gained it all back in 3 mon…

Hello, Anyone with BCBS of NE with a low BMI? I am just getting started with the process, my BMI is around 35-36. As far as I'm aware, I have no co-morbities, but I plan to get a full work up from my PCP after the holidays. I do know that my cholestorol and blood pressure has creeped up the last two years, as I've had to complete a health assessment through my husband's employer to qualify for insurance. However, I am on no medications for such issues. Has anyone had experience with BCBS of NE with similar circumstances? Were you approved or denied? Frankly, I fully expect to be denied, so I'm trying to prepare for that. Thank you in advance.