Insurance & Financing

HELLO EVERYONE!! I WAS WONDERING HAS ANYONE BEEN THROUGH WHAT I AM GOING THROUGH? I SUBMITTED TO MY INSURANCE COMPANY (UNITED HEALTH CARE) AND WAS DENIED DUE TO NO CO-MORBIDITIES. MY BMI WAS 36 AND I HAD JUST LOST LIKE 25 POUNDS THAT BROUGHT MY BMI DOWN AT THAT TIME. MY DOCTOR WROTE ME A LETTER TO APPEAL IT AND SHE HAD ME TO WRITE A LETTER ALSO WITH ME EXPAINING MY FAMILY HISTORY TO THEM. MY DAD IS A THIRD GENERATION DIABETIC AND ALSO HAS HIGH BLOOD PRESSURE. MY MOM HAS BLOOD PRESSURE. MY GRANDMOTHER AND GREAT-GRANDMOTHER DIED FROM DIABETIES. THAT IS WHAT I EXPAINED TO THEM ALONG WITH MY PAST ATTEMPTS AT LOSING WEIGHT AND RE-GAINING IT BACK (AND THEN SOME!) I ALS…

So, i just called my insurance provider (Indepentent BCBS PPO out of PA) and was told that there are no in-network providers in my area ( I live in MA). I'm totally bummed about this. i'm just getting started and all ready there is something in my way. Anyone have this insurance that has had the same problem? Anyone in MA that has an out of state insurance that this has happened to? HELP!!! :thumbup:

The surgical coordinator kept saying that I had the 6 months of office visits. I kept saying I thought it was only 5. When I have the "last" appointment (by my count 5 and her count 6), she submitted it to the ins. It ends up, she was counting the letter my dr wrote recommending surgery. He put the wrong date on the letter. How screwed am I? Should I have the doctor write a note pointing out HIS mistake? I asked the surgical coordinator at least 3 times what appointment she was looking at for the 6th apt and she wouldn't tell me. grrr

I was wondering. Has anyone ever heard of someone being denied by Aetna Insurance (or others) for losing too much weight BEFORE surgery? The surgeon said qualification is based on your weight on the day you first meet with him and enroll in the process, not your weight at the time of surgery,....but wanted to know if anyone has heard otherwise?

Ok, so I called my Primary care MD's office to see if they had the results back on the two tests my surgeon needed that doc to order prior to being submitted to insurance. Turns out the results were back, and they were in the process of being faxed at that moment (so the assistant said, and you could hear the fax machine do that "fax done" beep in the backgroud, so SOMETHING was being faxed). I called my surgeon's office to see if the EGD had to be done prior to submission, or just prior to the actual surgery. The insurance coordinator called me back about 5 minutes later, and said she missed my call because she was sending paperwork on several patients to my insurance…

I have to say now that it has been over a month since my surgery....I am impressed with the coverage that CIGNA gives. We only paid $850 out of pocket for the entire surgery! Very impressive. My husband and I were planning on having to pay more, but it turned out very nice. Just wanted people to know that insurance comes through, even though we might have to wait forever!

Hello my name is cyndi and i have been thinking about the lapband surgery alot. I have medical problems and this weight needs to come off. But i have a few questions if someone wouldn't mind answering for me. I am suspose to be added to my husbands insurance soon. But in case i am not approved does anyone know how much the surgery is in south carolina? What is the death rate with the surgery and what are the side affects. I have no energy,my feet and legs hurt,i don't sleep well and i feel like miss piggy. Please i need help in sc. Thanks

Hello Everyone, I got my papers Oct 24 saying I was denied due to the fact I did not meet my 6 months weight loss criteria threw Blue Care Network. Something is not right because my doctors office just called me Oct 23 saying they had just faxed my medical records over to the specialist to be processed and the denial papers I got were dated for Oct 20 something cannot be right. My doctor told me Oct 6 that she had everything covered so that my paperwork would go threw. My question to the forum is when I speak to the doctor and especially Blue Care Network what do I need to say and do so I can get this done correctly and reapply and get the lapband because I really ne…

Hi, I'm currently waiting on my 2 year medical history inorder to send in for approval for the surgery. I have been waiting 3 months now for this to be completed by my family doctor. I'm a little worried because next year when my insurance renews, it will no longer cover bariatric procedures for people under the age of 21. I was wondering if anyone has Empire BC/BS in ohio, that got approved rather quickly. I was under the impression that it took a couple months. Any help or advice would be great. Thanks.

Just wanted to let people know that Pacificare was so wonderful about paying for my band. I'm 41, had a 39 BMI, two comorbidities: high blood pressure and asthma. I went to Dr. Johnell in Greeley and once they submitted the paperwork, Pacificare HMO approved it within hours! They have paid for the surgery and for fills. I can't say enough good things about Pacificare!

I am soooo happy. I called today to check the status and they approved it!! I am so ready. I cant wait until MOnday so I can call the dr. and schedule a surgery date!!! I can't belive this...I have UHC and I was wondering what they were going to do. I am soo happy!:)

Hi All, I'm genuinely heartbroken this evening. I just got the call from Dr. Enochs' office that I am NOT covered under Aetna for Lap Band surgery. Apparently, my policy excludes weight loss surgery all together. I really feel defeated here...I don't have $23K to drop for the surgery, but I genuinely need it. My BMI is at 47.6. I don't have any other health issue, but under Aetna a BMI of 40 and higher was all I needed. I've submitted a letter to my HR dept. I'm not sure if that will help, but I don't think it could hurt. I know open enrollment is coming up soon. I inquired about whether they were looking to move to another carrier, and if so will they be excludin…

If you were to be in charge of naming an organization that awards grants for wanna-be bandsters to get this done when their insurance says no and they can't otherwise afford it, what would you name it? Ready... go! :tongue2:

or... anyone have insurance that does not cover fills? I have BCBS of CA (Anthem).

Hi, My first time here. I was wondering if anyone has dealt with BCBS of NJ. I am going through the 6 month diet period. My doctor has already wrote the letter of recommendation saying I'm pre-diabetic, my family history, my weight history, etc. etc. I think the only exception is that you have to be morbidly obese which I am by about one pound. I hope I don't lose one pound and then the insurance deny me because now I am no longer morbidly obese. I hope I don't go through all this and then they deny me. Any advice would be great. Niecey

I was wondering if anyone was denied by their insurance co...my case CIGNA and resubmitted the claim a year later. I was only a 38 bmi when I submitted in March now I am a 40 and thinking of starting the whole bloody process all over again. Would really get depressed though if I went thu that again and was denied again. Was wondering if Cigna would go for that...if anyone has anything to offer it would greatly be appreceiated. Going thru a 2nd appeal process now...with kELLY and walter at Obesitylaw.com in the meantime this summer with all this excess weight is really taking it's tole on my soul. SOOVERIT!!!

QUESTIONS... QUESTIONS...QUESTIONS.... Ok, I have Blue Cross Blue Shield through my full-time employer .....they do not cover the weight loss surgery at all. I'm going back to my part-time federal employer who has Federal Blue Cross Blue Shield. They will cover the surgery and I plan on having it ASAP. Once I have the surgery...and I get tired of working my part-time job a year later and decide to leave. Would my Blue Cross Blue Shield from my other insurance cover the fills, etc.?

Does anyone know what code I should ask my PCM to use after surgery to get my authorization for fills?

I am so frustrated! I have now gone through more than half of my hospital's lap band program, had a zillion appointments, getting close to actual surgery (after waiting for over a year) and now my husband's company has switched to Tufts. I was all set with BCBS. Tuft's does cover lap band but requires a specific 6 month doc monitored diet in Boston. I am not sure if all I have done will count towards that 6 months and I can't drive back and forth to Boston. I feel like I can't go through another 6 months of all of this either. :laugh: Has anyone else used Tuft's? What was the program like? Thanks Everyone!

I submit my paperwork to Aetna at the end of this month. At my job I cannot take any extended time off from November 27 til January 11th. What are the chances of me getting approved in time to get my surgery before that day? I could work my set days off to have about 4 or 5 days off in a row, but that means I'll be working 7 straight days before and after my surgery. What is a best case scenario for how long I'll be waiting for approval?

The surgeon's office submitted all of the paper work the 16th of Oct. I am scheduled for surgery the 10th of November. Should I call the insurance (cigna) to see if they received everything? How long until I know if it is approved or not? Thanks!

was sent to the RN 30 minutes ago...I am soo excited!!! I wonder how long it takes from the RN. Does anyone remember how long it took from the RN to get an answer. I am soo excited!!!:biggrin::tongue2:

I have been wanting to get a lap-band since the day that i heard of them. My BMI is 39.5 and i have sleep apnea, extremely high blood pressure, and asthma. As of now, i have no medical insurance and my credit is below average. Does anyone know of a financing company that will accept below average credit? I would get insurance, but i dont want to wait only to be denied. I will finance if i can, i just dont know who to go through. Any help would be great! Thanks!

I am just starting my process. I have an appt with the nutritionist tomorrow. Does anyone have Blue Cross in PA. If so can you give me any info. I am just worried that I will have some problems. Thanks, Irish10

Hello Everyone, I need a support group! My friends are sick and tired of me talking about the procedure. Waiting on approval this 4 to 8 weeks is gonna drive me crazy. Somebody give me some advice to take my mind off things because I want this so badly! Your friend Bunni

My surgeons office is submitting the paperwork to the insurance company on friday. I have BCBS of Minnasota. The office said that it will take 4 to 6 weeks to get an answer. Is that about how long it has taken for the rest of you. It seems like a long time. Just curious if that is an accurate estamate. Thanks for any info. Karen

I currently have Kaiser insurance in Maryland. I was told that they cover the lap band on a patient by patient basis. I can not get a direct answer from anyone on how to get them to approve the surgery. I am SOOOOO frusterated!!!! Does anyone else have Kaiser? Did they cover the surgery? What steps did you take to get it covered. I have met with a dietician, psychiatrist, and now I do not know what to do from here. PLEASE HELP:(

How does one start the process to get the lap band covered by CHAMPVA?

I have Aetna PPO and can go in or out of Network. I find that the best thing that you can do for yourself is to find out early on EXACTLY what your insurer has to say about weight loss surgery. Is it covered? Under what circumstances is it covered, and once you meet those circumstances, what is needed in order to be approved. Before I seriously considered having the surgery, I found Aetna's policy on WLS. I knew I met the BMI + comobidities, so I knew I needed to fulfil their 6month verification requirement. My dr. submitted my paperwork less than one week before surgery and Aetna requested only 2 additional things: notes from my dr. indicating my weight on a dat…

Does anyone else have this insurance? just wondering how long it takes to get aproval with them

i just received my 2nd denial letter from cigna stating i had not shown a bmi of 40 or 35 w/1 co morb for 24 months, during my 6 months of physican supervised weight loss last year one month my bmi went down to 33.8 , i am type 2 diabetic so i should fit in the 35 bmi with one co morb catagory, I can not find in cigna guidelines if my bmi for 24 months was prior to physician weight loss or if is from now, does anyone know? can you drop below the 35 bmi during your physician weight loss or do i now have to wait until ive been over the 35 bmi for 24 months and redo my physician weight loss and not go under 35

Hi I am knew here and have a question. Yesterday I went in for my first visit. I am at 41.1 BMI and if I was to even lose 7 pound in the 6 month weight loss program that Cigna requires I would fall below 40. When I first made the appoitment the lady told me we always go by the first weight in but yesterday the nurse said I should stay above 40 to make sure that Cigna would not use it to deny the surgury. So my question is how important is it to say above 40. I really want to get started eating right before the surgury. I have already cut out coke in the last month and don't ever miss them. I want to start eating better but I am afraid to lose over 7 lbs. What are your tho…

Well, it’s official, I was denied, because I didn’t have the six months’ attempt at losing weight. Before that it was that I didn’t have five years’ proof, or the psych eval. I’m really depressed and feeling like there’s no one to help me. Pacificare, or at least the physicians’ group I deal with, gives me reasons, one at a time. I know that if I really want this I’ll have to keep fighting, but right now it really sucks! I know that I can appeal, and I know that I will, but I’m just so sad right now.

My surgeons office just called and they had just received the approval paperwork. I AM SO RELIEVED! My pre-op physical is Monday, my appt for post-op nutrition is on Tuesday, Thursday I meet my parents to drop off my son to go to Florida for a couple of weeks with them, and then the next Weds (the 29th) I'll be banded. I AM SO EXCITED!!!

My first appt with the surgeon was in February 2008, by the time my paperwork was sent in to my insurance - they make us go through a 6 month wait. I finally completed it on October 2 and was finally given a surgery date of 11/19th. Boy was this quite the journey. My surgeon does not require a 2-week pre-op liquid diet but he will not operate if we gain any weight. As usual, I avoid the scale so now I have to tackle it because I have 1 month to get ready for this.

I know no one really wants to hear a cry baby, but I need to vent. So, in the beginning when I was filling out my 800 page application (after the seminar) one of the requirements was to call my insurance and get my benefits details. Apparently I spoke with the town idiot. She told me that my bariatric deductible was $1,500 and I was responsible for 20% of everything after that UP TO my $2,000 annual MAX out of pocket. So.... here I've been thinking I only needed $2,000 for months now. Well things are getting close to wrapping up and I was talking to one of the nurses at the surgeons office, just making sure I understood the financial part completely. She said tha…

I have supplemental insurance through aflac. My primary insurance excludes WLS. I called aflac to see if they would approve wls surgery. It is not excluded in my policy unless it is elective or cosmetic (aflac). I told the rep that my dr. said it would be medically necessary. I wanted to know how I would go about filing a claim to get approval or denial for surgery. She said that I would have to have surgery first, then they would review my case to see if it was covered. ??!! HUH that doesn't make sense. Why can't you review my medical records and go by my dr.'s referral. I asked her if I had to have life threating illness, diabetes, overweight by 100 lbs or more or bmi o…

UPDATE: Great news, I was aproved this afternoon at 5:00 pm. I am hoping I get a surgery date tomorrow. Well I think I am also most there. I have BC/BS CALpers Net Value Hills Pysicians and the surgeon's office sent all the paper work in yesterday for insurance appoval. The doctor's office states with my particular insurance that I might have an approval anywhere from 24-48 hours. It would be nice to find out by Friday and not have to fret over the weekend about it. I hope, I hope, I hope!!!!:wink2:

Did you use Tricare and if you did, are you prime or standard and what was your bottom line cost out of pocket? Thanks

Hi everyone, I have been unsuccessfully trying to find someone at Tricare that could answer a few questions for me about qualifying for lap band surgery. I was wondering if anyone has had any luck with getting their surgery approved if you don't quite make the 100lbs overweight part. I am 5'5" and weigh around 223 but also take medication for high blood pressure, high cholesterol and insulin resistence. I've tried to look at weight charts but there are so many different ones out there I can't figure out if for my height I make the 100lb requirement. What a hoot...for once in my life I'm worried that I'm not fat enough. If anyone can help me with this is would be much ap…

Cigna denied my surgery, they said they didn't get all the information. So I went through my doctor and nutritionist's notes that were submitted (for my 6 months of medi. supervised weight loss program) and see that not all of them state that diet AND exercise were discussed, so now I have to get them to basically re-write their notes with all the required information, because we DID discuss both diet and exercise at all of the appointments, they just didn't document it! AGHH...... Insurance and doctors are so frustrating and my PCP is so by the book, she may say she can't alter her notes. I just hope I can get all of this information and submitted soon, so I don't lose…

Just wondering if any Australian people have recently submitted applications to APRA for release of super funds. I put my application in on 12 August and still haven't got a response. I have now started to phone every day. Had a small glitch this week with some wording but resubmitted the relevant letter yesterday and after speaking to them today it hasn't reached my file yet. Just wondering once APRA approve how quickly will they provide information to super fund for release of funds. My surgery is in 3 weeks (4 November) and I'm starting to stress that the money won't be through in time.:thumbup:

Hi Everyone! :laugh: Just got banded (self pay) last Friday evening in TJ and feeling great! I had a question that I was hoping someone might be able to help with. Coincidentally, I am also fairly new to UHC (so might be considered a pre-existing condition?). What I was wondering was, if I went to my Doc. and/or insurance and said oh btw, I have this gastric band that you should probably be aware of.... Do you think they would cover check-ups or fills? I think my pcp would probably refer me to a nutritionalist because I am still no where near a goal weight lapband or not, but it sure would be great to have the fills covered too! I've been reading here for quite some…

Hi all!!! I a newbie here (as in I just found this site TODAY)!!!! My question is: Has anyone been approved with BCBS Of Florida PPO?? Any information I can get will certainly help!!! Before I asked the question I did search within the threads and I did find useful info, what I was looking for as far as Florida was a few years old and I was looking for info that was more recent!!! Thanks in advance!!! :tt2:

Hey everyone, I just got word from my insurance company yesterday that I am approved for the lap band procedure and I am so excited to start my new life! The only thing that concerns me is that my surgeon requested that there be two surgeons in the room during the surgery. Himself and another surgeon. My insurance company denied the request for the second surgeon. Is that something I should be concerned about? I have my pre-op appointment scheduled for next tuesday. I know it would depend on if my surgeon is comfortable doing the surgery on his own (obviously with his assistants as well) Has anyone else had this happen to them? If so, please tell me the outcome? Did the s…

So I submitted my paperwork (Just posted a thread about it earlier) but I was going to see if this has happened to anyone else. Well I had all my tests did my 6 mo weight loss w my doctor and I was trying to get my 24 months history of 40 BMI for Cigna but my insurance specialist said that they did not require that anymore. I found that very weird, but it is in my benefit because I have had such a hard time finding an acceptable weight because I had lost 120 pounds in 2005 and have progressively put it back on over the past 3 years but just got back up to a 40 BMI. Also, my doctors office shreds records after three years so i had no way of proving my BMI besides pictures …

So we submitted all of my paperwork on Tuesday to Cigna. I think I did everything right, so I will hopefully get an approval on the first try, but we all know how shady insurance company's can be. Errr. Pray for me and cross your fingers! I will let you all know how it goes, until then I will be biting my fingernails.... AHHHH!

The hardest part of all this seems to be the insurance!! At the seminar I was told BC/BS PPO had the 6 month pre diet and United Health Care does not but you had to have a 40 BMI and mine is 38. So I called BCBS and they mailed me all the info, it does not say I have to wait 6 months so my dr office said I might be able to fight that, who knows. I did find out that I have a $1500 dec and they pay only pay 75% so I am going to have to pay a lot of money. Does anyone know if that has to be paid up front or is it like when you go to the hospital and then they bill you? If I have to pay it up front then I guess the 6 months is fine since I will need that time to come …

I was approved by Tricare with no problems then the docs office called and told me that he charges $5000.00 for the surgery and insurance only pays $992.00 so he wants me to pay $4008.00????? I am insurance approved and now will not get my band because of this. I just cant believe it:mad2::smile2::mad2::wub::mad2::mad2::mad2::mad2::mad2:

My insurance co (UHC) states that in order to prove morbid obesity I MUST have a diagnosis in the actual medical records for the last 5 years. Proof via height and weight (in a medical chart, of course) is not sufficient. It must be mentioned in the notes and I must be treated for it. i.e., at my OBGYN appointment each note should state that I am morbidly obese and it caused me some sort of problem. To me, this is splitting hairs to the nth degree and just an easy reason to deny procedures. Does anyone else's insurance require this detailed level of documentation?