Insurance & Financing

My dr.'s office called me last Wed and said they had all the paper work ready to fax over to my insurance. I was so excited. On Friday I called my insurance to see if they needed anything more from me. They said to call back in a few days since it takes time to get it in the system and then can take 7-30 days for approval. I called back this morning and my insurance told me they have not received anything from my dr.'s yet:mad: I don't know if I should be pushy and call the dr.'s office or just keep waiting. I'm upset they made it sound like they were sending it that day. I know I need to wait, I'm just so excited to get my approval. Of course I'm worried they wil…

Does anyone have University of Alabama BC/BS. If so, does it cover lap band?

Curious... My coordinator just called and said she submitted all my information to my insurance company (aenta)... I'm curious to know how long some of you waited for your approval.. but most of all ... how did you deal with the wait???????? I'm so excited and nervous all wrapped up in one!!! I can't wait to get approved.. but at the same time it's like ... "what if I don't??" GOING NUTS HERE!!:help:

Well, I went to a symposium today to find out about the lap band procedure (tho i really didnt learn anything new as i had investigated it already). What i WAS surprised by was the program fee they charged...apparently from reading some of the posts here, this is a normal process? This group charges $1250. To be honest, i was dismayed at this - im struggling financially as it is - to take on another bill is too much..yet...i want this procedure so much that somehow i do have to come up with the money. They did have Care credit brochures, so maybe thats an answer. So...am i to believe then - that this is pretty normal - this charge - for follow up care and such?

I have blue cross blue shield of alabama for insurance. I have already checked and they do cover lap band with this criteria: 1) Complete BMI 2) Medical records for 3 yrs. 3) Medical records must document a medicallly supervised weight loss program. At least one attempt during one (1) year prior to the request and documented participation in the approved weight loss program for six (6) consecutive months. 4)No smoking 5) obesity for 3 yrs. My problem is: I meet the criteria in every way but the 6 month weight loss program I only went in to get weighed 2 times within the first 7 weeks. From my understanding it has be be 6 consecutive months meaning every month. …

Can anyone give me an idea of how long it usually takes to get an answer from Horizon BcBs of NJ? All of the paperwork was faxed last week and I have surgery planned for Dec 13th. This has got to be the worst of all the waits. thanks!

I tried checking BCBS' site and can't find the info I'm looking for. Is anyone familiar with how it works in NY? I am on a PPO plan. I have over 6 month documentation from my nutritionist. Do they have a BMI limit? Thanks for any info you can provide me with.

Just thought I'd post so this info. can get passed on to someone who might need it. I'm not an insurance person, but this is what I had confirmed today by the insurance expert at my surgeons office. Highmark PPO Blue requirements: - Must submit these: 1. Letter of Medical Necessity from PCP or referring physician 2. Six months of Consecutive Medically supervised diet/exercise visits and logs within past 2 years (from surgery date). -Must be 6 mo. in a row, so 7 visits total incl. start -Logs must show progress of both diet and exercise (Weight, calories, min. of exercise, etc.) -Logs must show education/discussion is taking place -Can do this with your PCP or Die…

Has anyone went through CHAMPVA and been approved? What did you do?

Oh my goodness:w00t:! I was so excited about moving forward in this, I get a call from the office person and she tells me that with my insurance I still have a $7000 out of pocket amount, $4500 that is for supportive care post op that is not charged to my insurance at all! The coinsurance & deductible I get, but the non-negotiable pay before surgery $4500 is so much. Is this normal? Can anyone elaborate, is this what everyone does?

Hi everyone Welcome to my struggle- I just got approved through Care Credit for 98% of the cost of the surgery. I super want this don't get me wrong, but now that I don't have to work for anything anymore I'm freaked out! I make no sense. I'm worrying now over things I wasn't before the what if's what if it goes bad- what if I need to removed- Slippage etc- can I REALLY afford this? Should I just wait, be miserable and see if SOMEDAY I'll get insurance? Is it stupid and compulsive of me to do this without insurance? I've been trolling in the life without the band forum getting all worked up too- Then I call care credit and she told me that they can't tell me what…

Hi, my name is Tiffany and I'm new to this forum. I have a question about my insurance. I logged on to the Humana Military website and checked under referrals and authorizations. It said my referral for lapband was cancelled. Does anyone know what this means? I'm so confused:crying:! If you have any answers I would greatly appreciate them! Thanks- Tiffany

Well lots going on. Found out that First Care, my insurance now, and BCBS, second insurance offered by my empl. will NOT cover this unless hell freezes over. I went to a seminar given by Dr. David Hall, here in Lubbock. Your right lots of info there. He has been doing Wt loss surgery for about 28 years but only doing lap bands for about 3 now. I have been looking for individual insurance pol. and dont know how to judge them. Most come out and say they will not cover this. But a number say they will. Has anyone heard of TeamCorp.com/ACI? They say they have been around for 27 years. They offer medical, dental, glasses ect. They told me that 1. If I take their ins…

Has anyone else experienced a denial from GEHA? The letter stated the hospital my doctor chose was not a "Center Of Excellence". Can they deny for that even though they participate with the facility and pay for other procedures at the same facility? Sounds like a ploy to not pay or discriminatory at the very least. Any advise? Thank you

I have BCBS of Texas Active Care (am a teacher). Everything, including BCBS indicates that the lap band is covered as long as I jump through the hops. I went to TLC Edge today and was extremely discouraged because a) I was the largest I've ever been according to the scales. :eek: The PA came across as an idiot. Though I figure I might as well keep jumping through through the hoops, as it will be easier to decide not to do the surgery than it will be to stop and start again. Anyone else at this point? It would be nice to have a friend -- or someone a bit further along.

Anyone having problems with bc/bs of ga? Just a little impatient with the wait time and all the scheduling.

I'm a Newbie (2nd post) and I need some help (sorry in advance for the length, but I'm hoping someone can throw me a lifeline). I'm 49 and have been successfully dieting for 30+ years...so why am I fat (I'm the Yo-Yo Queen!). My health started deteriorating at age 45, it became harder to lose, and I started giving up hope, which isn't like me. My family history (4 siblings and I'm the "skinny one"), is a nightmare of obesity related issues- Diabetes, Stroke, Heart Attacks, Hypertension, sleep Apnea...etc. I can feel myself "circling the drain". But I don't have a diagnosis of any of, what I'm learning are the "Big 4" comorbidities---Did sleep study-neg., borderline choles…

My drs office is telling me that all B/C B/S PPO is required to do the 6 months and my insurance mailed me all the info and it does not say anywhere in there that I have to do the 6 months so I called them and they yes I did need to do the 6 months and then they started looking at my policy, put me on hold and came back and said it doesn't say it anywhere. Has anyone had them and not had to do the 6 months? My drs office said they can go ahead and submit it and we could try, all they can do is decline it I would guess then I would just finish out the 6 months. They said I could fight it since it doesn't say it, has anyone ever done that and won? Thanks. If I have to d…

I'm just wondering what your experiences are, and what kind of uphill battle I may be facing. :rolleyes2:

Oh no..... I am 3 weeks POST op and NOW the insurance is saying I didn't have the required 6 months supervised diet. My surgeon's office handled ALL the insurance paperwork and I didn't even find out until the day prior to surgery that I was "good to go" as they put it. I had called the surgeon's office to find out if they had heard anything from the packet they had faxed to the insurance company a week before. The insurance coordinator said they had not heard yet, but she would give them a call and get back to me later in the day. She called a couple hours later to say I was "good to go" and that I didn't need anything else. I see where the hospital has submitte…

I have not posted anything in here in awhile. Was thinking I was going to get Insurance through work. But, that didn't happen. Anyways I am to that boiling point where I am needing to do this for my own sanity. What I am wanting/needing to know is- Where did you have your surgery? If financed, What are your payments (pretty please)? Also if financed where is your financing through? Anything else that might be helpful would be GREATLY APPRECIATED! I live in Texas so I am leaning toward Mexico of course but I am looking at Dr. Kirshenbaum as well. Thank you for your time everyone.

Hi I have had a HMO for the past two years and have tried to get referred for the Lap Band three times and have been denied every time. I just finally filled out the paperwork at work to switch to the PPO. My doctor said as soon as I get my PPO finalized, that I can call her and she will will write me a prescription for the Lap Band. Now that seems so easy. I have had almost a year of discouragement with trying to get the Lap Band. Does anyone know what my process should be once I get the PPO? Anyone know of any doctors in Ventura County or San Fernando Valley? Thanks!

I recently started a new job and as of 11/14 Cigna is going to be my insurance company. I have heard good and bad about this insurance when it comes to WLS. I have the Open Access Plan and was wondering has anyone ever had Cigna to cover the lapband? I am not at all interested in the Gastric as it seems to be covered by more insurance companies. My in-network is 100% so that is good! Any advice?:biggrin:

Hello I'm new to this but anyways. I am having trouble getting my lapband surgery paid for. I don't have insurance and my husband is self employed and doesn't have insurance eighter. No one wll insure me because of my weight I am to high risk. Does anyone know of insurance that might cover me? Or a possible financing plan or doctor that has in-house financing?? In need of help thanks:sad_smile:

Hello, I am new to this forum so bear with me. :cursing: I am Tricare Prime (TriWest), assigned to an MTF. Does anyone know what steps need to be accomplished to get approval for Lapband? I am at a BMI of 40. I have talked about this several times w/my PCM prior to it being a covered procedure. Once I found out it was covered I talked to her on the phone and she put in some referrals. I can't into an actual appointment w/ PCM until the end of the month. I have referrals in place and appointments with right now: Nutrition Psychiatry General Surgery and I am registered for 2 "Therapeutic Lifestyle Change" classes But my referral to Case Management was denied a…

I currently have Medicaid and in the process of my six month supervised weight program for bar iatric surgery. They said that in the fifth month we will get a surgery date. And as long as all the insurance information goes through, that will be the for sure "date". But my question is.... does Medicaid deny people a lot the first time around? I’m afraid of the whole deny and appeal process, making the time for my surgery even further away. Don’t get me wrong, ill wait. I just want to be prepared.

Do i start the process with my regular doctor? i am clueless! I also have seen a few post saying Federal BC/BS is fairly easy to get approved. IM soooo excited.

Okay so my coordinator told me my insurance pays 80% and I am responsible for 20% but no more that $4500. How much is the surgery in NC and will I my out of pocket be $4500. The info sheet says NO PAYMENT ARRANGEMENTS.. All costs must be paid before surgery. So how can they charge for a surgery before you've had it..I have united health care. Can anyone give me a gestimate or how much you've ended up paying.

Curious if anyone works fo Valero Energy Corp.... in SA, TX. We have their insurance.... but although it's Valero insurance, Aetna handles the claims... so I assume we follow the Aetna rules? Anyone?

So I have been filling out applications for a couple of places this evening and low and behold I've gotten approved for 8 grand through Care Credit- But I do have to say the acceptance page or whatever you want to call it as quite quick and generic. Is that what everyone gets? Am I just going to wake up tomorrow and get a Sorry, we have denied you email? Anyone with this experience? Thanks!

Does anyone know if when you put money into an HSA, can you use it for your adjustments? I know the uses have to jive with what the government says you can use it for. Is this an approved expense? I would ask my insurance company, but if the procedure doesn't have a code I don't know if they will even know.

I rec'd my first denial from the insurance. Anyone have any input on an appeal? I am not quitting yet!!:tongue:

I had secured coverage approval from my insurance before surgery. The doctor told me that he charges $5,000 and the hospital charges $10,000. Well my insurance said they cover up to $10,000 on the surgery, so that would leave me with the rest which I was prepared to pay. Well I check with my insurance company today and they said the the hospital billed them for $27,091.72, and that they are only going to pay $6,413. The doctor billed for $5,000 like he said he would and the insurance only paid $1,840 of that bill. Is this a usual practice by the hospitals and insurance? Does this bill get negotiated down? That amount does not include lab work,anesthesiology, or the o…

It seems like I have been on this journey for so long, and now it seems to be paying off. My wife got a phone call from my Dr. on Friday and the insurance company finally approved the surgery. I have to call Monday to see what the next step is. I am so relieved. I had to fight tooth and nail with them to get this far.

My Dr at Kaiser says my BMI is not high enough for the LapBand. However according to this site it is. My Dr insists this is not the right approach for me and stated that my BMI has to be 50 for my insurance to cover it. What do I do now? How do I get them to see my side and agree this is the right choice even though my BMI is not 50?. Thank you.

I was approved! My doctor submitted to the insurance on Wednesday, it showed up as pending on Thursday and was approved on Friday! I called my doctor's office and they don't know when he will be able to get to me... he begins doing the surgery on June 9 and is full on that day... not sure when the next surgical day will be. So hopefully I will be banded by mid-June.

I am currently working on receiving benefits through the VHA as a combat veteran. I know that Tricare started approving the lap band this year, but does anyone know if the VHA covers it, as well? I went to the VA website and read that they do gastric bypass, but not lap band procedures. However, that was from a post in 2004. I haven't been able to find any new updates about the lap band through the VHA. Does anyone have any information at all? Thanks in advance.

I guess i just need some advice on what to do next, or just to vent to people who have been where I am now. My insurance denied my wanting the lap band. I am 29, my bmi is 38.5, I'm 5'6", and weight 238, so I'm borderline. I'm as healthy as could be, which is why they are dening me. Don't get me wrong i'm glad I'm heathly, I'm just overweight, and sick of it. I was insulan resistant 3 years ago, but went away when I had my last child, so I'm ok on that part. The only thing wrong with me right now is I'm on Wellbutrin for depression. I have a family history with high blood preasure, high cholesteral, heart attacks, back problems. Both my parents are over weight, and thats …

Just wondering how long it took and if you had to do any of the 6 month diet with a doctor? Or any other things to get approved.

Well, I visited the psychologist today. She saw me for an hour and approved me-well, mentally, anyway! That was the last hoop. My doctor needs to get everything in to the insurance company for review and then, hopefully, they will approve me. Wish me luck!

Hi All I have a question and I am waiting for my surgeons office to call me back but figured would see If I could get some answers here.I have Aetna QPOS and the band is covered when precertified so I am going through all the steps required.I had my first appointment with the diet/nutrition center on 9/30 and my second is today 10/28 and my third in on 11/25 - now yes these are 3 appointments one per month for three months, but it does not equal 90 days? Is that going to be a problem when they send in my paper work for the approval process?I am just not sure and want to make sure i am doing everything right? I assumed when I made the appointment it had to be three month…

Just wondering if any NYU patients who have Cigna PPO have had this happen - I went to the information session in Feb 08 - began my 6 month med. supervised weight loss program in April 08, had psych exam and nutritional assesment , completed my 6 months med supervised weight loss, submitted dr.'s note. and two years of medical history. I have a 41 bmi and 2 co-morbidities. Now NYU is saying I need letters from the dr.s from 07 and 06 saying that they recommended lapband. I didn't even know about lapband until late 07. Has anyone had this happen? Because I don't have these letters I can't get appt with the surgeon - Dr. Ren. Any thoughts?

I couldn't figure out why i have to do this 6m diet because bcbs hmo il said there are no prereqs besides the referral from pcp. found out on obesityhelp.com in an old forum that the med grp actually decides if you will have wls and they have their own check list/prereqs. i guess they have an agreement w/bcbs. anyone else know about this?

I had my lap band surgery February, 2008 and have lost 100 pounds. My port is starting to show and it is too high and is hitting my ribs. I wanted to have a smaller port/low profile port put in February, 2009 and have Anthem Blue Cross Blue Shield. They paid 100% for my surgery but was wondering if they would also pay to have a smaller port put it. I will be calling them within the next couple of weeks but was wondering if anyone knew anything about this. I am thinking since they paid for the surgery that they would also pay to have a smaller port put in. What do you think?

I just got this from the insurance coordinator at a surgeons office: The criteria requirements are as follows: 1. a 6 month structured weight loss program 2. Lab results from: Hpylori, TSH level 3. Pulmonary clearance 4. Cardiac clearance 5. Psychological evaluation 6. Nutritional evaluation My question finally was answered and I am very disappointed to know that I have so much time in front of me before I can hope for surgery.:smile:

So, I called the insurance company yesterday and they told me that I needed to have a BMI of 50!!!! I called the surgeon's office and they told me that whoever I talked to didn't know what they were talking about. Has anyone else gone through this? The dr's office also told me that I only need 3 months of the diet and consults with psych, cardio, pulminary, and nutrition...oh and 1 support group meeting. I am 2 months into the diet and still need to do the consults but my BMI is only 42 not 50. I would appreciate some help from anyone who knows what is really going on. Thanks!!!

It has been awhile since my first post months ago. I started this process in June and after a bunch of crap from the insurance BCBS of GA I am finally approved. It took 2 and a half months from the day my paperwork was sent in for me to get the call this morning saying I am approved. WOW!!! I had just about given up hope. I just wanted to share my exciting news!!! Will probably be getting banded on November 3rd. So woo hoo!!! Thanks for letter me share.:biggrin::eek:

Ok so I have a few questions about tricare. They aren't completely for the surgery. I have a set of claims that were actually one day of bloodtests for my hypothyroidism...they were denied because 136 - SERVICES DENIED BECAUSE WE CANNOT DETERMINE PRIMARY INSURANCE PAYMENT. PLEASE PROVIDE EXPIRATION DATE OR COMPLETE PAYMENT INFORMATION. I also had a bill from a visit with my doc for the same reason. Then I have a few claims from my surgery that originally came up as paid..they are now listed as RETURNED. Can anyone make any sense from this?

Credit is not the best, does anyone have a suggestion where I could get the money. I am going to pull the money out of my 401k to pay it off in Feb 09. But I really wanted it done over Thanksgiving Holiday.:biggrin:

I was denied and the letter doesn't really specify why. My dr office will do a peer to peer this afternoon (so my dr or nurse speaking to the dr that denied it). Should I wait and let them do that or call the insurance myself and find out what exactly the issue is?