Insurance & Financing

Hi all! This is my first post. I recently learned--quite by accident!--that my insurance company covers lapband surgery. I meet all the criteria the provider, United Healthcare, set to qualify for them to cover the cost of surgery. Anyone on the forum have experience with United Healthcare in NC and coverage?

This is a public service announcement for those of you that have Aetna insurance. When I started this process, I looked for a specific post like this and couldn’t find one. I hope this is helpful to someone. I have been approved from Aetna for the lap-band by completing the 3-month multidisciplinary program. This is what I did: Month 1 Compiled 5 year weight history from various doctors (just one visit per year that documented my weight during that timeframe) Psychiatric Evaluation Got Support letter from PCP Met with Bariatric Surgeon Met with Dietician Met with Exercise Therapist Month 2 Attended Lap Band Support Group Met with Dietician Met with Exercise…

Does anyone have Premier Health INsurance?

Okay...here is the exact wording from my health insurance policy. (This is one of the requirements, but it's the only one I'm worried about.) (2) History of failure of medical/dietary therapies (including low calorie diet, increased physical activity, and behavioral reinforcement). This attempt at conservative management must be within two years prior to surgery, and must be documented by an attending physician who does not perform bariatric surgery. (Failure of conservative therapy is defined as an inability to lose more than ten percent of body weight over a six-month period and maintain weight loss.) I have done lots of other things in the past…

I'm considering lap-band does anyone have any experience with National Benefits Admin in Charlotte, NC. National Benefits, Inc. and it also is Compass Point Medical so I not sure who would handle it? Help. If i do self pay anybody has any ideas? Thanks

I have deceided to have the lap band surgery and the only problem I see on the horizon is my PCP referral!! I have had the same PCP for almost 14 years and when I discussed it with him he shut me down instantly...he wants me to go on a diet for the 25th time or better yet he also stated that he himself trained for a marathon and he knows how to get some one to loose weight (now keep in mind i have been on every diet know to man including starvation and also have a degenerative problem with my knee which i already had surgery on last year and my surgeon basically said loose weight or dont walk) at that point I hung up with him and cried! I know he wont give me the referral…

:wink2: I am so thrilled................found out I was approved and my surgery date is 11/11 Wahooooooooooooooooooooooooooooooooooooooooooooooooooo

Will anyone with federal BCBS share their timeline with me? I just began my journey with Lapband. I cannot have a consultation until the doctor's office verify and receive a referral number. I just want to know how long it maybe until surgery(if it's approved). Thanks!

So my paperwork is being faxed to Diversified Group Administrators today. I was told it could take 1 to 2 weeks to get approved. I called today to see if they had it yet and they said not yet. So we will see. Does anyone here have this insurance and had luck with it? I am praying I get approved. I have several comorbids and I started at a weight of 419. Down to 392.5 on the 6 month diet they required. I hope it goes through quickly.

OK, so here's my story: My paperwork was submitted on Sept 8. They finally accepted the paperwork Sept 26th(ish) - they never could give me a straight answer to why accepting it had taken so long, but that is neither here nor there. Every. Single. Day. I have called to see if they had an answer yet and every day it was the same thing, "Any day now!" :w00t: Well, today I woke up frustrated and I spoke to a represenative, who transferred me to a medical manager, who transferred me to the main office in Cali to speak with an outpatient manager, who transferred me to the crankiest woman who was the outpatient manager of the DC area , who gave me the number of the head nur…

Has anyone who has been banded through Tricare (Triwest) been approved for the surgery without hypertension or diabetes as comorbidities? I am 100lbs overweight with a BMI just over 40%. But I do not have high blood pressure, diabetes, or high cholesterol (as far as I know...waiting on lab results). My TSH/T-4 levels are also WNL. The only health issues I can really relate to being a fatty are depression, shortness of breath with moderate exertion (stairs kill me), and some acid reflux. But only the depression is documented. The other stuff I just deal with and/or treat with over the counter medications. I recieved the referral to see a bariatric surgeon and I…

Has anyone been able to get the lap band surgery despite that fact that there insurance excludes the procedure, credit is bad and cant get financing, and no co signer? I seem to be in this situation, and as much as I want/need the surgery....I think the dream of getting healthy is slowly fading bc of the financial issue. I guess this really isnt a question, just me venting. thanks for listening. :wub:

Greetings everyone! I just heard from my surgeon's office this morning that my insurance is requiring me to attend a support group meeting, which I understand......but also to get a consultation from an Exercise Consultant? Hmmm? What's that? Even my surgeon's office said that's a new one, they haven't ever had to do that one before. I have Definity Health, which is really a United Healthcare program. The insurance is usually really good. But an Exercise Consultant? Anyone heard of that or had to do that? We don't even know what form to fill out! It appears that those are the only two hoops I still need to jump through. I had my Upper GI this morning. It wasn't bad a…

I actually had Gastric RNY back in 2001 (Went from 440lbs to 215 and stayed -but never got skin removed yet) My Husband has decided that he wants to get the lap. We tried last year on his insurance and they do not cover this at all. I am currently looking to go back to work full time here in the KC MO area and wanted to know if anyone could give me some companies that actually cover it. Even if there is alot of paperwork etc. He is 450lbs, has been on breathing machine for over 2 years now, and has all the hard core Dr documentations for several medical reasons. I have retail, corp, tech, and sales background (Sprint/ Verizon etc) But really , any help on comp…

I am starting this whole process. I go to a seminar sept. 13 and was wondering if anyone has had any luck with Anthem of Virginia? My book says they cover weight loss surgery as long as its "life or death" I wasnt sure exactly what they want...:confused2: I have very high cholesterol, my BP is borderline, I was at one time on med for it, I weigh 272 and BMI is 46. Any help or advice will be wonderful! I am so worried I will be turned down. Thank you ..

have anyone been approved by blue cross blue shield of texas?

I am with Hills Physicians group, Healthnet iunsurance--Sacramento area. Anyone had any experiences they can share? Thanks. Also, ayone had any experienes with Dr. Koura with methodist Hospital?

My insurance will not cover my surgery and I'm going to be a cash pay patient. My original plan was to use a combination of 401k loan (I pray it's still worth something!) and a healthcare FSA. My husbands employer is now offering a choice of either having a Flexible Spending Account (FSA) or a Health Savings Account (HSA). They are putting some money into the HSA account if that is the selection we make. Can I use an HSA to pay for my surgery? I'm very familiar with how FSA's work, but not at all with the HSA stuff. Can anyone enlighten me? Thanks!

I'm looking for someone with Anthem BCBS Virginia to give me some information. I'm just exploring signing up on my husbands plan because my insurance does not covered it. I'm wondering if anyone knows how good they are for approving the procedure. He is in open enrollment now but would hate to sign up and have that expense if I can't get it when my insurance is covered 100 percent with my company. Just doesn't cover lapband. His does......

Well, I was just rejected for the second time. The rejection letter said that I met all of the requirements, but other options had not been pursued. I'm thinking that my surgeon's office knew both times of more things that should be done but chose to take my money for extra office visits instead of telling me what I might do to be approved. The more rejections.....the more money for them. So I will be changing surgeons and trying again.

I am jumping through the lap band hoops..haha..I made a funny. ~Anyway~ I have a serious question. I am hoping that someone on here has had the lapband surgery in San Diego using Tricare Standard and can provide the name of a PCM to give me the referal that I need to UCSD for the initial consult. In a nutshell, if you can answer yes to the below questions and then still have an aswer for me, please respond: -Did you go through the lap band process?:w00t: -Do you have Tricare Standard? -Does your PCM know how to do the referal to Tricare in a timely manner?:thumbup: -Could you please tell me who your PCM was? Thank you, Mahalo, Gracias..etc diane

Hi! I'm at a total loss:cursing:. I'm trying to find a company in Cincinnati that I can get a job at that will cover the lapband. My surgeon's office suggested a few and I'm in the process of contacting them, but you guys are the quickest and most accurate source of info. out there! HELP PLEASE??!!

I faxed my medical records to the surgeon's office today around 12:45pm (they sent them to me instead of my doctor) and I had an approval by 4:00!!!!! I thought it would be a week at least. I already have an appt. with the pychologist next week! I have to see the dietican, physical therpist and my surgeon once more and I will have my date. My surgeon's cordinator said I would have my surgery within the next 2 weeks!!! YEAH!!!!:thumbup: I'm still in shock!!:drool::lol:ll

Hi All! Obesity Law has agreed to take my case for an appeal after Cigna rejected my surgery. Has anyone had any experience with this process and/or firm? How often are they successful? How long does it take for the appeal process with this firm? Sooner:confused2:

Did you have trouble getting medi cal to approve ur surgery?

Does anybody have Great West PPO? What was your experiance? Do I have a chance with them? Thanks, Paula :thumbup:

:dita: Hi ! I have a question. has anyone had Lapband while employed at Bob evans? I'm wondering if their company offers it . I'm approaching this whole thing by finding a part-time job that has insurance that will cover it. The office manager at the Surgeon's office mentioned it to me when I asked about companies that cover it. Thanks for any info.:biggrin:

Hello. I have an Anthem BCBS of Ohio Preferred PPO. They sent me information about what is covered and it comes down to the "medically necessary" issue. My weight puts me at a medically necessary level but my question is about Part 2 - previous attempts as weight loss and speaking with my doctor. :thumbdown: Can anyone tell me what information they provided about previous weight loss attempts - Please? It does not mention anything about a time frame but wanted to know if they were verbally told one. THANKS FOR YOUR HELP!

My Dr. office just call late this afternoon, New Medicare rules Now I must take another 500 question psychological test at a different Dr. office before my paper work is submitted to medicare. Has anyone else run into this ?

Hi, I am newto this site....needed someone who knew how I felt. After months of jumping through hoops, following procedures and paying out of pocket Cigna decided no. Iam depressed and frustrated and feel like I was led astray. It seems that if I were to wait for more complications from my Diabetes or Asthma they will cover these charges without question. Yet proactive.......NO. I guess I will appeal, but really felt like this was my last real hope. Thoughts Anyone? Prayers?:thumbup:

Hello: Anyone mind sharing the total cost of your self-pay Lap Band? Who performed the procedure? Glover3516@msn.com Thank you in advance

I went to my doctor and got a referral for lap band. BMI is 39 with HTN and high cholesterol. Do any of you guys have blue care network? I live in Michigan. I got their criteria and I have to jump through hoops. Six months of dieting and exercise? Anyone have any suggestions? thanks:sad::thumbup:

I have applied with a couple financial institutions and been denied for both (I have an 8 year old bankruptcy). I don't want to ask for a co-signer. I am in Arizona and have applied with Capital and some other bank. Does anyone know of a bank that will approve "sub par" credit? Is anyone else facing this issue? Any advice on this issue is greatly appreciated. Thanks!!!:help:

I have Aetna PPO. My BMI is just shy of 40. I had a sleep apnea test last night, only to realize that I have major sleep apnea issues. I have no co-morbidities. Do you know if this will help me get approved for lapband surgery??

I am wondering if anyone included a personal letter when their surgeon submitted information to insurance? My insurance has been helpful but the coordinator at my dr's office seems to really not know my insurance's policy. I would like to just include a letter that summarized a co-morbidity (hypertension) and points out that I have switched doctors for the six month diet (the insurance said that is fine) because I am having problems managing the hypertension (meds are not working) and two other obesity related problems (issuing sleeping and edema in my foot). This would also sort of point out that the dr is changing my bp meds to a more expensive (covered) med and that…

I have a friend that has been banded for over 2 years. She is at her goal weight, her cholesterol and blood pressure are perfect and she has no health problems. She inquired about increasing the amount of her life ins policy and was told that the cost was approx. double now that she was banded! :bolt: Anyone had this experience or heard of this? We can't figure out how this could possibly be true and if it is really a common occurrence. Thanks for any feedback you might have.

I've been banded since 2003, prior to joining UHC. I recently had to go in for several adjustments. To later find out they they are not covered under my medical plan. My plan simply states that there is no coverage for Morbid Obesity. I didn't think that the adjustments would fall under surgery. What are my chances for having an appeal overturned? Is it even worth appealing?

I met a woman today who said she had a division of Blue Cross that denied her until she had been with their insurance for six months. Has anyone heard this? Is this common? Thanks

My appeal was over turned and finally got a surgery date this morning. I am set to have lap band October 17th!!! I am so excited. So does this make me a "Smashing Pumpkin?" hahhaah:thumbup:

I finally met all the requirements and my surgeon's office said they sent all of my info in on August 7. Then on August 18 they said they submitted a little more information. In the middle of September my DH called the insurance company and was told the information was received on September 2. HUH??? That was almost a month after the first submission! So he called the surgeon's office and was told that they sent it on August 25. Why did they tell me, to my face in the office, that it was sent in earlier? So he waits a week and called insurance again (Sagamore) and was told it was sent for outside review. It's been 12 days now! I'm so discouraged and fearful of being reje…

I just started a new job, so my new insurance became effective on 8/1. Lapband is covered (yay!), I am still confused as to exactly what I need to do to give to insurance but I am working on that...my question is can they deny me since I will have only had my insurance for a couple of months? It is Anthem PPO CA if that makes a difference...thanks!

After driving the insurance coordinator at my Dr.'s office, my insurance company, my best friend, my husband and myself crazy for the last week in anticipation of possible declination of coverage... I finally got confirmation today that I am APPROVED!!!! Yeah!!! I am so excited I can barely stand myself. I called my surgeon's office to set up my next appointment and schedule a surgery date but no one has called me back yet. I am sure I am in more of a hurry than they are but hopefully in the next couple weeks I will have a banding date!!! I will keep everyone in my prayers who is waiting for approval and those of you who are fighting appeals. Tracie

Hi - I am considering lap-band surgery, but I am not sure about the cost. I have BC/BS PPO in NY. I don't know where to begin. Anyone have any ideas/suggestions on getting started? Thanks! Gilta

My surgeon's office is submitting my paperwork for approval today. I'm cautiously optimistic and very excited all at the same time. I'm hoping I have no issues since I've been told that the appeal process takes 6mths and I don't know that I could keep this momentum going that long when I just want my surgery like last year (lol)!!! Just wanted to put it out there and get some prayers going for me to be approved quickly! Hope springs eternal... :girl_hug: Nat

this is what I found on the carefirst website....does this sound good? Medical Policy 7.01.036 Obesity and Morbid Obesity Original MPC Approval: 04/01/98 Last Review: 03/13/2008 Last Revision: 03/13/2008 Description Description Obesity is an increase in body weight due to an excessive amount of body fat. Morbid obesity is also referred to as medically complicated obesity. According to the National Institutes of Health (NIH) Consensus Conference Panel, patients who have serious morbidity directly related to their weight are considered morbidly obese. Some examples of co-morbidities include hypertension, diabetes mellitus or cardiopulmonary conditions. Patient…

So at this point I'm a little disheartened. I had the seminar and I knew going into all this that my insurance covers no part of the lapband. So I know that I have to be self pay. I contacted the financial counselors that go along with the program that I am doing and they gave me some options. Basically I was told that it has to be all up front payment or they do a med card which is basically a credit card that I put all this on. The surgery alone is going to be $16,000, then the anesthesiologist is another $5000 and then something else but i can't remember. I for one don't know that i want that much on a credit card b/c im sure the interest is outrageous and it woul…

Hello, I am brand new to the board. I see that people are getting the procedure covered by their insurance companies but I have also seen that some people say you need to make sure that your policy has the weight loss surgery rider. I want to start shopping around for insurance that I would have to pay individually because I am an independent contractor. I was going to look into getting Anthem but this leaves me at a loss because I have no way of knowing if these individual plans have this or not. financing as far as I know is not an option for me (due to credit score and rating) at this time but anything is possible. I would like to get insurance just because it would …

My doctor's office submitted my paperwork for my 6 month observation, and all the other requirements by Cigna August 22nd...I followed up Sept. 3rd to make sure that Cigna had everything...they did. I haven't recieved a rejection letter...and it has been a month...should I call Cigna to see what's going on?

Hi all - Well, I'm very disappointed - I was denied by Aetna. I haven't been obese for long enough so I either have to stay at this BMI for another year and a half or go self pay. I am also looking into obesitylaw.com - has anyone here been successful using them to help in your appeal? I have 3 co-morbidities and a BMI of 35, but aetna requires a minimum bmi of 35 for 2 full years before they will approve it. Very frustrating.

My insurance company for the hospital i work for denyed me 7 times. My doctor Dr. Neal olympia washington got me a free obesiy lawyer based out of california and we WON!!!!!!! it was a 9month process butit was worth it. they are called obesityadvocate. Contact me if you need info.:clap2: