Insurance & Financing

Here is a little history of me… 1) BMI right now is at 40.5; however, the past 4 years it was between 35 -39. 2) In the past 5 years I was pregnant 3 times and each time I had gestational diabetes (which the doctor said I have a high chance to develop type 2 in 5 years) and it is also runs in the family 3) I have Gerd. 4) My cholesterol is right at 200 This month is my last month of doing the nutrition stuff; however, I have gained instead of losing due to the medicine they put me on for shingles. I have done all kids of diets since I can remember. I have done LA Weight Loss since 2001 and today I just called them to get my history …

i may be getting a job with Do.County and wanted to know if anyone works for the county and if they knew what insurance they have.this is probably may last chance of getting the surgery.so i am hoping it will cover the surgery.i think it may be with blue cross/blue shield of Ga.

While reviewing the benefit changes for 2009;I noticed this is the last year that Fed BCBS will allow the procedure without precertification. Fed BCBS has also increased the amount of co-insurance you owe in 2009. Keep in mind you owe everyone co-ins:the physician, the facility ect. So with this being said, if you are seriously considering having gastric bypass you might want to think about having it done this year. Has anyone in Kentucky with Fed BCBS been through the process? How long did it take? Did you have to jump through hoops?

Hi, I'm Christine and I'm just starting the Lapband process with Kaiser, Richmond. My 5 hour orientation is tomorrow (11/25) and I'm so excited to get the ball rolling and be on my way! Just wondering if anyone else is currently going through Kaiser and how your experiences are so far. They have told me that it's about 6-12 months from orientation to surgery, but if I'm able to call and take cancellation appts and lose the required wait that I could be as soon as 4-6 months...I'm hoping for 4! Anyway, I look forward to meeting you all!

I'm just wondering... has anyone had to wait to complete a 6 month diet plan or whatever? With FEDERAL Blue Cross Blue Shield Basic or Standard? From the first time you saw the doctor... how long did it take you to have the surgery and what was the process?

Has anyone had the same issue that I am having right now? I had BC/BS through COBRA and was approved for LapBand immediately, had the surgery, am doing fine... but now my COBRA is expiring and I cannot get anyone to insure me because I have had the surgery!!!! Even BC/BS, who paid for the surgery in the first place through a group plan, is turning me down for individual insurance! Anyone else have this problem? Any ideas? Thanks, Nikki

Hi. I am in the researching process and wanted to know if anyone have dealt with Great West? I have a BMI of 38. I have read what they require as documents, but I wanted to ask first hand to a patient...who has either been accepted...or is still trying to be. Thanks!:wink2: Chris

i just got a letter in the mail today that i am loosing my hmo thru medicaid in 2 weeks. i can get united health care thru work but its very expensive and i don't know if i can afford the 20% of the surgery. or if they will even let me continue without starting all over. do any of you remember how much out of pocket you spent on united healthcare as far as the 80/20 or the deductable or were they combined? i am in month 4 of the 6 month diet and hoped to have surgery by march 09, now i don't know what i am going to do. i am going to the welfare office tomorrow to see if i can apply for new jersey family care. but with my luck i make to much money. and don't have th…

Ok I just had my 1st consult witht he Dotors office..Got my information or my Physc Eval...But I called them and they do not take Tri care...They said I am the same as having no insurance to them and it would cost me $704 to have the eval done.....WOW... I don't have that kind of money. Its all I can do to come up with the $398 program fee for the Dotor as it is. Wonder will the doctor allow me to go to a Phych. that is covered by my insurance.

does anyone havce BC/BS of Ga.did it cover the lap band?

I am so freaking excited right now. I would say you dont know how excited I am but obviously you all do! It only took about 6days (not including the thnaksgiving holiday)and it felt like a month but the wait is over now I have to get the surgery sched. I am so excited!!!!

I have been to several seminars and honestly did not think that I could get approved through my insurance. and I was afraid of the procedure. I dont have $16,000 for a self-pay but I am worn out from being overweight. Sick of feeling depressed and unattractive. I want my life back.:frown: Last year I went to a "fat doctor" in Lansing for about 3 months and again this October. Taking Adipex I lost about 30 pounds then gained back about 40 pounds. The year before that I went to Dr. Gumpta & Dr. Aveilio ( i am sure i misspelled his name) in Chicago 2 months each. Maybe lost 2o pounds combined. I do not have any problems other than depression and aniexty from they const…

I have BCBS Fed and my paperwork was sent to them on Nov. 26 I called them yesterday and they told me that it was in review. What does that really mean? I'm new at all of this so I have no clue.

I currently have a BMI of 36 with co-morbid conditions: diabetes, hypertension, high cholesterol. I can document my past weight, but several times my BMI has been under 35. I am always dieting. Do you think this will be cause for a denial. I am assuming that the co-morbid conditions qualifies me for having this done medically.

Does anyone have any idea if Tricare Prime will cover the Lap Band procedure? I have heard no way but then I have heard that they do as well. I have made up my mind to do this so if I can have them cover it, it would bea lot better. Also if they dont cover the whole procedure do they cover any of it at all? Any help would be greatly appreciated. Thanks :help:

Do you know if tricare covers fills? Is there a copay? Do you have to qualify for each fill like you did for the surgery? I haven't had my appointment w/the doc yet but wondered if anybody else had any experience. Thanks :0)

I REALLY CAN'T STAND THIS! Ok so I am 5'9, 264 lbs, bmi 39, every time I have tried to get a referral with pcp with KAISER in the last 5 years, i get denied. OBESE BUT NOT QUITE OBESE ENOUGH.Last time I even burst myself in tears in front of my doctor and all, I said I am very depressed, it's not easy to just say oh exercise and eat healthy coming from a petite oriental doctor standing in front of me, she was just numb and telling me about all these rules that Kaiser has and she just can't give me the referral at all at my current weight. Meaning I would have to eat more to be a candidate? Even then, if I was to increase my BMI to 40 + I would have to have high blood …

I was recently denied by Cigna for lap band surgery due to "lack of medically necessity." My secondary insurance, Tricare Prime, has advised that they will deny me as well for the same reason. I've decided to self-pay and plan on submitting the bill to both carriers after surgery to see if I receive any reimbursement at all. Has anyone tried this and been successful? thanks, ML cw 280 gw 60

So I already have my referral from my PCM and I am supposed to go see the surgeon on 12/3/08. I am a little scared cause I am at the borderline mark and I am scared Tricare won't approve. I am 5'2 small frame and weigh 194 and I have PCOS. Does anyone know if tri-care considers PSOC a co-morbid? (I think that is what they call it) Also, what do you think the chances are that tricare will approve my lap-band. Any helpful information that anyone has regarding having this surgery through tricare at a military hospital would be much appreciated. We are stationed at Ft. Lewis and I will be having the surgery at Madigan if Tricare approves it.

So I am not very far in this whole process. The only thing I have done is the the consultation and the pschy evaluation. Anyway I received a statement from my insurance (BCBS Federal IL) saying they paid my consultation in full. Then a few days later I received a letter from they hospital saying I needed to pay for the consultaion. I asked my husband what he did with the paper from the insurance and he said he THREW IT AWAY! Sooo today we get another letter from the insurance saying they don't cover the consultaion. I am going to call first thing in the morning but I have no idea what is going on.

I have BCBS of Louisiana and it says that weight loss surgery is an exclusion. We talked to someone at a seminar and they said that if it was an exclusion then more than likely it could not be over turned in an appeal. Has anyone found this untrue? Is basically my only option is to self pay?

I have just signed up for this insurance plan. Does anyone have it, was surgery covered?

And then file an appeal and then get approved? What did you include in your appeal? I need this done, but got denied, because I have not been over BMI of 40 for 5 years, only 2 years. Any ideas?'Thanks!!:biggrin:

I'm just starting to look into possibly getting lapband surgery. I have a current BMI of 36 and have the comorbidity covered since I have had high BP my whole adult life. I also JUST got my first high cholesterol test. Looked at my insurance coverage and one comorbidity (oh what a lovely word?!) is all I need w/BMI of 35 so this should be covered. I have to do the medically supervised diet (Aetna), but that's OK. I don't mind spending some time thinking about this. My mom had this surgery a year ago and I know it is not easy. OK, so my question is that when they look at weight history, do you think it will hurt my chances of being approved because I have had per…

I live in arkansas and have anthem blue cross ppo (california) and was wondering what process you had to go through before you got approved for lap band surgery. I was also wondering, will it be different for me living in Arkansas? Email: everettedeborah@aol.com

My ins. Horizon BCBS of NJ is requiring 6 consecutive months of doctor visits where diet is being monitored medically. Here is the question. I have 9 months of weight watchers. I sent my 9 months of weight watcher weigh in documents to my doctor. He wrote up a letter document the consecutive weigh ins. We also wrote up monthly notes about diet, exercise, behavioral changes which they also want. Do you think the insurance will accept this or will I be denied since I did not actually go to my doctors for 6 appts. Will they be able to tell this? I do go every 3 months for treatment of co-morbid conditions. If this is grounds for denial I am thinking I should start this month…

Ok I have Cigna Open Access Plan and I called them today and the rep. told me that my policy doesn't say whether it covers WLS or not. He said that whatever Dr. that I choose would need to call them and get Pre-Determination of Medical Necessities paperwork, fill it out and send it back in and then we can go from there....Anyone know what this means? Also, what is the 6 mnth period that most ins co's make u do and what if u loose weight during this time? Does it mean you are no longer eligible for ins to cover u? Someone please advise...

Hello all, Newbie here from SE virginia (Hampton Roads). Wife of a retired Navy Chief, who is looking for information on how to start the process for the lapband. I went to my PCM who told me to look up who the tricare prime approved doctors were in this area, and then find a seminar to go to, and then come back to him and he would put in the referral for me. My questions are; Is that the correct procedure to start this? and if so, how do I find out what doctors are approved to do it, and then where do i find the seminar to go to? Anyone in the HR area have this done recently. if so could you pm or email me to let me know the steps to go through? Any info will be …

I'm paying cash for my lap band in January 2009. If I have a complication at some point in the future that requires additional procedures (i.e. slippage, erosion, etc.), will insurance cover those costs?

so I have to pull my credit up before I can get financed and it is going to take me a couple of months. I have a 600 now and want to get financing. I got turned down. For those of you who got financing from Capital one or any other medical financing what was your credit score? thanks in advance!:thumbup:

What if you have a BMI of 46, age 54, have not only Medicare but Anthem BC/BS (Virginia) too? BP is creaping up, borderline Diabetic, swelling feet/ankles/legs, Asthma and other things getting out of hand. I know from the seminar that there are things that neither will pay and I think I can come up with the $$$ to handle that up front. May have to wait till tax refund time but that should finish it up. Anyone have any idea what my odds will be? I know dumb question, but I am scared that I am wanting something that may not be within my reach. With all the other bills that we have on us any extra bills are out of the question right now. So private pay is not an option.

I was told by a Cigna rep that all WLS surgery was excluded unless medically necessary. I currently dont have any health problems except anxiety and depression but I do have a BMI of 48. I also took my 1st step and scheduled my consult for 12/4..I am sooo excited.:smile2::cool2:

So I am going to my seminar on Decemeber 1st to start the process of getting my surgery. I was curious if anyone had Blue Cross MA PPO insurance that can tell me what they had to go through to get approved. Thanks for any adivce given.

I called into my insurance company today to check on my approval before the holiday to find out that I have been denied. They said that the only thing they could tell me was "not medically needed". So how can I prove it is needed. Should I get my PCP and surgery DR to help the the appeal letter. Does anyone else have BCBSNC and been denied? How many people usually get denied and the win their appeal? I am just so confused and want to get the appeal process going.

I work in the health industry, and this article came across my desk today... it's an opportunity for you, the patient, speak up regarding their proposal to NOT cover surgery for patients whose BMI's are under 35 who are dealing with diabetes. Their argument is that it won't make a dramatic difference in a person's health. CMS Proposes Covering Bariatric Surgery to Treat Diabetes Written by Stephanie Wasek Monday, 17 November 2008 After an extensive evidence review, CMS has announced a proposal to revise its existing coverage policy for bariatric surgery to include type 2 diabetes as one of the co-morbidities CMS would consider in determining whether bariatric sur…

I am 20 years old. My BMI Is 39.9. I have no comorbities (sp?) I have scheduled a consultation with the surgerion already i just wanted some advice before i meet with him. i contacted my health insurance co. Highmark BCBC and they will do it with these requirements. 40 BMI 35 with 2 comorbities. Proof of Failed Past Diet. 6 Mnth Nutrition Class & Psych Evaluation. $250 deductible they handle the rest. so what do you think my chances are of getting it done (nervous) :thumbup:

What company did you finance through?? What were the interest rates like?

I was wondering if anyone has Horizon Blue Cross/blue Shield and if they have been approved for lap band surgery. I have had all my testing done and will be attending my last appointment with the dr. mid-July. They will then submit everything to the insurance company. I am getting very nervous that I have been all through this and someone can come back and say NO disturbs me! Also did anyone have their primary write a letter to the insurance company? My surgeon requires approval from primary but was wondering if a letter might be better. Someone else said that they personally wrote a letter to the insurance company explaining why they want the lap band. Has anyone do…

Hello, I am new here. I have been thinking about the LapBand for awhile and made the first step by going to a seminar about it last week. They took my insurance info and called today to tell me that under our plan that LapBand is an exclusion. I had asked them that if it was an exclusion if an appeal can be done but they said that if it is listed as an exclusion that I could forget about having them cover it, even with appeals. Is this true? What should I do from here?

Yesterday I got my letter of approval for the surgery. I was so happy. I call the Drs. office this morning to let them know I sent it over to them right away. How about they have not even called to say they got the fax or to even give me date for the surgery. Do they wait to call u days later for a date or what ? I am still happy about it. That took alot of work. They could have called me and said we are working on a date. I know they got it because I called to make sure.

Has anyone in the Houston area used NeWeigh to assist with the insurance coverage to pay for LapBand? They state on their website that there is not a fee for those searching for help with morbid obesity, but I can't help but think there is a catch somewhere. Perhaps with medical tests etc. The program looks so comprehensive with pre surgical and post surgical support.

So. my name is sarah and my boyfriends mom had lapband done and she has done GREAT and ill admit im jealous. we were the same weight 240 lbs and my bmi is 39.9 my insurance company is highmark bcbs ppo and she had it done at mcgees womens hospital in pittsburgh. im currenlty on the diet pill from my doctor xenical and its not helping. i been big all my life but its getting worse. my dad just had a heart attack at 44 and it made me really see what im getting myself into and diabetes is a big issue my dad aunt uncle and pap so that also scares me.i know im only 20 but i really want this. not for looks but for health im just looking for advice and would i be covered? and jus…

My insurance pays for WLS, but I need to find a PCP in the Ft Walton Beach-Pensacola area who will refer me. Any idea??? I guess I could go further if needed.

So I just found out today that after my FIRST try I have been APPROVED by Cigna to cover my surgery! I am grinning ear to ear! As soon as I heard the words "approved" I immediately broke down in tears because I never thought I would ever see this day! This has been a long, stressful, and tiring process but today all of that hard work was totally worth it! I am lucky enought to only pay a total of $800 out of pocket including my co pays and what I owe after their payment! I am so blessed!! I had been a little discouraged by reading others who were denied and I know that some of you may be feeling the same way that I was. I just knew they were not going to approve me. Nu…

I have lurked on this forum for a while and have decided that I would be a good candidate for lap band surgery. I went to an informational seminar last night. My insurance provider is Anthem Blue Access (PPO) in Ohio. I called them this morning and was told that my policy excludes any bariatric surgery, although it has been successfully appealed if it is medically necessary. My BMI is just under 40 and as of my last check-up about 18 months ago I do not have high BP or any other co-morbidities. I do have a family history of hypertension, diabetes, arthritus, stroke. In the last year I have developed stress incontenince and have had a back injury. I'm wondering if a…

Hi All, I was approved for a loan through Med Loan and was ready to sign until I got my loan papers. The loan officer said I qualified for $11600. But when I got the paperwork it said I need to pay back 15,000.:thumbdown: A nice even number right? Well on the paperwork the $3400 is the "Provider Adjustment Amount" I called Med Loan and they said that was added because it's not a secured loan. Not sure what that means. Maybe cause I didn't use our house as collateral? I called my dr's office and they said that Care Credit would also have an additional fee. Can anyone explain this? I was wondering if I could get another type of loan to avoid paying this fee. My credit …

The OAC is excited to offer “Working with Your Insurance Provider: A Guide to Seeking Weight-Loss Surgery.” This guide is designed to provide individuals with the knowledge needed to successfully work with their insurance provider and become an advocate for change. It offers readers information discussing the effects of obesity and morbid obesity, tips for working with your insurance provider, detailed information concerning the treatment options available for morbid obesity and much more. This is an excellent tool for people who are morbidly obese and seeking weight-loss surgery. People rely on their insurance provider to assist them in the process of seeking acces…

I have my first appointment on Thursday with Dr. McKeen in San Jose. I hear that Blue Cross covers this procedure no problem. The only thing is this Dr. is "out of network". What does this mean in regards to coverage? Do I have to pay a huge chunk? My BMI is 35.4, I'm 5'3'', 200 pounds. I have been told I will be approved by the Dr. no problem. I also have mild sleep apnea, back pain, a dieting does NOT work. I've done all my homework, and am ready. Anybody have any thoughts? Insurance is pretty much a foreign language to me.

I am curious to see if there is anyone else here that is a TN state employee with UHC River Valley and what you needed to submit to be approved for the lap band. Any help would be appreciated!! Thanks, Michelle

Today both my husband and I got approval from Nevada's Anthem Blue Cross Blue Shield (we live in Idaho.) He's 6'5" and 475lbs I am 5'2" and 215 At our weigh ins we were 506 and 224, but since we've been on the 700 calorie diet we have lost some weight. (With cheat days!) Operation scheduled for 12/8/08!