Insurance & Financing

Hello everyone, as yall can tell I am a new poster. I am a 30year old male 6 foot tall and weight 285. I have asthma, highBP, GERD, gout, fatty liver, depression and high triglycerides.(spelling?) My insurance is BCBS of florida,blueoptions PPO. It states in my booklet that:weight control services including any service to gain,to lose, or to maintain weight regardless of the reason for the service or whether the service is part of a treatment plan for a condition is EXCLUDED including but not limited to weight loss programs,appetite suppressants,bypass,etc. etc. My question is this Will I have a fighting chance to get approval for the banding? W/my doctors help? I live…

At this time I do not have insurance and I called to speak with someone with the Realize band and they told me to shop around for insurance and ask if they cover Bariatric. Well, the few companies that she did would tell me no. After telling them I saw online that they did they would say well how much do you weigh (which i don't really feel comfortable telling someone who just said they don't cover it). Finally, the only person that I could get an answer out of was a guy from Aetna and he said they do not cover it in an individual plan, only group. My work offers insurance once a year and I was not around for the enrollment date. I'm unsure of where to go or what t…

I have a low BMI of 33. However, I have diabetes, sleep apnea, high blood pressure and high cholesterol. I'm on United Healthcare Choice Plus. I was turned down before I was diagnosed with Sleep Apnea. What do you think my chances of getting approved now? Should I try again?:cry_smile:

I got a packet from my insurance, Kaiser Colorado Springs, which had a couple pages of questions. But this means I am one more step closer to being approved! The next step is their doctor reviews my medical records and will either approve or disapprove. But I don't see why they would dissapprove...praying. I am just glad that another step has been made. They said I can go to a doctor her in colorado springs or Denver. I heading towards the doctors in denver, because I have heard so much about them. It will be a drive, but it will be worth it!:thumbup:

I just got notice that my primary will no longer be in my network as of Sept 30th. My 6 month diet will be over in October. Will this affect the process at all?

Hello everyone, :smile2: I am in the process of preparing to get banded. I have completed all of my pre procedure stuff and have been submitted to by insurance co. I was sumbitted on July 11,2008. I have BCBS FEDERAL GA. It has been about 6 weeks and I still don't have an answer. I am getting so impatinet and nervous. I actually called today but still no answer. The customer service rep told me that I didn't have to actually get an approval before I have my surgery becuase my plan does not require it. I am not too comfortable with that. I will probably have the surgery then they will deny me and I will be stuck with the bill. I don't think so. Is anyone familiar with…

I went to the seminar last night and they were so helpful regarding different insurances. I have B/C B/S PPO now and they said approvals are pretty easy with them except they require the 6 months and of course I'm ready to jump on the operation table tomorrow, lol. We are at the end of the year where I can change my insurance from my dh's to mine, we have United Health Care, I was told from someone here that I should ask others on United since I guess some had problems. My problem is they said with United you have to have a 40 BMI and I rock back and fourth from 37-38 with medical conditions. United does not have the 6 months. Then of course I would have to wait …

Carefirst Blue Choice approved the lap band surgery for me in June 2008, but are denying the fills - even though I've called them and was told that so long as Carefirst approved the surgery, they would cover the fills. Has anyone out there dealt with Carefirst - Maryland? Any help would be greatly appreciated!

I am soooo excited. I was just approved, my surgery is on 10/8/08, so soon! Any advise on what to expect and where I can find a good diet?:biggrin:

I am just starting this journey, and while I have UHC, I don't have high hopes for approval. I have a BMI of 35.6 with arthritis, asthma (is that a co-morbity?), borderline hypertension, and possible sleep apnea. I'm trying to consider what my possibilities may be if insurance is denied, however DH and I have a bankruptcy that was discharged in 2005. I saw that someone else had success with medicredit, but they do not appear to be taking new applications at this time. Anyone else with a bankruptcy had success with financing their band? (My last resort option will be to wait until next year and use a combination of flexible spending account and 401k loan, but I am h…

Hello everyone! :bounce: I just recently started learning about the LapBand surgery and am very interested in getting it done. I am 24, 5'7 and about 305lbs. I am currently on my mother's health insurance which is Anthem Healthkeepers by Priority Health Care Inc. I am unsure if I am wasting my time because I cannot afford this if insurance doesn't cover it. I live in Virginia Beach, VA. Does anyone have any idea if they cover the lap band? I am so confused by the insurance exclusions, but I'm guessing since they mentioned "obesity" in the exclusions that they don't pay for anything?! Please help me out. Thanks! :angry

Hi all I have a question for you and would greatly apprecaite it if you could help me out. I want to get the lap band am doing the 3 month supervised diet for my insurance Aatna. I have a low BMI of 37 but was told I could probably get aproval since I have a Psuto Tumor Carebri and have to lose weight or I will loose my eye site (it's complicated I know) My question is has anyone else been approved for the surgery because of this condition? I am getting a little concerned after I reading the insurance blogs. I have been going to Emory for my Dr. supervised diet and will finish my 3 months around the middle of Oct. I have already lost the 10lbs. I need to loose and hope I …

can anyone help me. i had lapband surgery in august, during the surgery my heartrate dropped and the anesthesiologist stopped the surgery. I had 2 incisions and the procedure was started but stopped there. My insurance is Aetna POS and I am wondering if they would pay for the surgery to be finished even though they paid out the benefits to the surgeon, hospital, and anesthesiologist! My surgeon's office has never had this situation and I have been cleared by a cardiologist and he assures me he will resubmit but I am wondering what my chances might be. I am bitterly disappointed! Help!:thumbup:

I have a BMI of 36.8 and 2 health issues i'm almost done with all my test and my doc will be sending over all info to ins in about 2 months.Is there any one out there that was in the same boat as me get approved by Cinga?

:w00t:Just called my insurance company and they overturned my appeal and I'm APPROVED!!!! YEAHHHHHH... Someone please tell me how to put one of those "ticker" things on my account!!! What a way to start a Friday!!!!:thumbup::thumbup:

I have Blue Cross of MA but live in Texas. I picked out a surgeon and was hoping to start the process but was told that I needed a 5 year history to document my obesity. I had already checked with my insurance and they sent me a copy of their medical policy dealing with WLS. I met all of the requirements. Nothing in their medical policy said anything about getting a 5 year history (which I don't have). The surgeon's office said that since I live in Texas, they have to follow the guidelines of Texas, not Mass. Has anyone else had this problem of living in a state different than their insurance (i.e., Texas vs. Mass.). I don't know what the BCBS of Texas guidel…

So today I had my psychiatric evaluation. Everything went well besides the fact that I had to answer about 1000 psychological questions on the compter and paper tests, literally. After 3 hours finally I met with the psychologist and he immediately questioned my weight. He said he loves numbers and it jumped out at him..(he was a weirdo)..well he compared my weight which is 262 with my height to the bmi chart and said "well im not sure that you are obese enough, your definitely obese but your insurance is probably not going to approve you". What the crap...not obese enough! That cracks me up and pisses me off at the same time! Obese is freakin obese!! First of all when I…

I am not sure if this has already been posted or not but I thought I would share it anyway in case it hasn't. Tricare didnt update it's patient handbok when it started to approve the lapband procedure so they are refunding anybody who was a self pay between the date the procedure was approved and when the handbook was reprinted w/the correct information. Just thought i'd pass it along :0)

Im soo frustrated with my insurance right now i could scream!:frown: Ive called them about 6 times now and they say the same thing every time. They say they cover for morbid obesity only. ok...so yes im morbidy obese! ok so i wanted to find that in writing. I searched through all the papers and couldnt find anything talking about bariatric surgery or weight loss surgery. It does state that it doesnt cover weightloss programs???? What the heck?? But everytime i call they tell me its covered for morbid obesity. Ive gotten the booklet from my husbands HR department and it states nothing about WLS. What should i do? They are telling me something i cannnot find anywhe…

I got a call today that I was thank g-d approved for surgery which will take place Oct 6th G-d willing. I am soo excited and can't wait!!!:thumbup:

Hello, I was wondering if the 5 year history can be just one Dr. visit a year with weight recorded or what the standard is. I have a two years with a couple of office visit's but the other 3 I refused to let them weigh me. Also, I have a record for each 5 years and all but one of the years I am over the 40 bmi - for one year I am at 39.1. Any one dealt with getting denied for having just one year that isn't at the 40? Not sure if I qualify for co-mid's, but I have high cholesterol and back and neck pain, and my PCP has noted in his recommendation letter about those conditions. I'd love to hear someone else's experience with this - I am stressing out that I'll get …

OK I did the psych eval and my primary care doctor hadn’t received anything, so I called the psychiatrist back, making sure he had the fax number so he could send the results. I called again last Thursday to find out if my doctor had received anything. Yesterday I got a letter from the physicians’ group saying that they want office notes from my doctor, dealing with my attempts to lose weight. I’ve talked to her about the things I’ve done, but I’m not sure how much she’s documented. I’m going to call her tomorrow to find out, but I’m wondering if anyone has any suggestions as to what I can do if she doesn’t have anything on paper. I was feeling very hopeful because t…

I have UHC choice plus and im dying to know if they will approve me. My BMI is right at 40.1. Im 230lbs and 5'3" and should weigh like between 113-135 according to ww. so im 100 lbs over weight!! The only thing is i dont have any co morbidities. I have gerd, depression, arthritis in my hip, and back pain but no "co-morbidities" like high blood pressure, diabetes or sleep apnea. does anyone thinik i have a chance?? Im soo sick of being fat i cant stand it.

My surgeon just spoke to the medical director @ UHC and they said they need an accurate height and weight b/c I have too many listed that are different. I need to gain 5-10 lbs really quick and I don't know what to do.... like before 9am in the morning. Please help and it doesn't need to be obvious..... I live in Texas so I can't wear 3 pants and sweaters.... HELP!!!! Any advice????

I can't believe how quick BCBS Minn approved me. It was submitted Thursday afternoon and they approved me today, Monday. I am so excited. I go in next Friday for pre op an should find out my surgery date tomorrow. I hope approvals come as quick for the rest of you. Karen

Has anyone been approved with one comorbidity? My BMI is 46.6 and when my insurance paperwork was submitted, they accidently only listed one comorbidity. The doctor's office said, "well, it's done now, so let's see what happens." What are the chances that this will actually be approved? :redface:

I'm on my husbands insurance now, B/C B/S PPO and I really do not like it. He went in the hospital for a couple of days and I guess since I have never had a PPO I didn't understand that it is not just a one time co pay like I'm used to, we are getting large bills from the hospital and eveyone that works there it feels like. So, I thought of changing to my insurance, I haven't even checked yet to see if they cover this, United Health Care seems to be a good insurance. Now my problem, I can't change until Jan. 1st of course so will I need to wait to start everything for Jan. 1st or can I start with one insurance and complete it with another? I'm just worried that my …

Hello, is anyone able to share prices for self-pay of lapband? I was able to find out the cash pay amount for Midwest bariatric in Chicago. But everywhere I've been calling in Illinois - is quite expensive. And am thinking of trying careone GE credit to finance. Just trying think my options through.

Just Starting journey, Insurance(State Health Plan of SC) will not pay sugestions on financing would be appreciated. My primary Medical Care is with the VA they do not perform the procedure. Help?

I just received a letter today from my insurance company authorizing my lap band!! I have a BMI of 37. My comorbities are joint pain, sleepless nights, and history of diabetes. Nothing really significant or documented. My PCP is awesome and really supported my decision. I also submitted a letter to the insurance company with my medical history stating why I felt I needed the surgery. I am so excited! I am hoping to lose 80 pounds! Hopefully i will be able to schedule my surgery soon. I can hardly wait til Monday to call their office!

Hi everyone. I'm new to this forum and I am in dire need of advice. I have BCBSIL insurance and as many of you know, they require a 6 month diet. I did that. However... My Dr. kept telling me that it wasn't really necassary to come in every month for an actual visit, that I could just come by and weigh and he would record my weight. I explained to him about the insurance requirements and he assured me he would cover everything in my chart. ( I know, I should have stuck to my guns!) Now, I am in the process of getting my paperwork together to submit to BCBS and surprise, surprise.... my 6 month diet record..... CRAP! I do have a consecutive 8 month record, but ther…

hello, i am going to be a self pay for lap band surgery...and i was curious...do patients have to just thru as many hoops if they are self paying? such as tests, history, etc?

she didn't listen and was so confusing. I told her several times that I have hypertension and that my insurance may approve it based on my record of being at 38% BMI and she kept asking for records of being 40%. I don't have them. She also kept telling me that my ins said I need two comorbidities and she even called the ins and they said 'no, just one' and when she hung up, she kept asking me what the other comorbidity was. She also told me I need to show two years of records. I have stuff from 2005 (and earlier), 2007 and 2008. She said I will get rejected because I need 2006, 2007 and 2008. Finally, she told me to not take my meds for hypertension as "controlled" …

My employer is switching from BCBS to Cigna in Jan. My dr's office secretary told me that Cigna requires more "hoops" to jump thru than BCBS. I don't know if I will have all the prereqs done by the end of the year. I'd appreciate any advice on experience with Cigna and LB surgery approval.

I was denied by UHC w/a 38.7 bmi. I have appealed and now have several comorbidities and a 40.3 bmi. What are the chances that they will reverse the appeal? How soon should I start bugging the insurance company after the receive my appeal by fax?

Gee I don't know what to do at this point. It sure is disheartening to say the least. I haven't gotten the letter. I guess I will appeal. Maybe I'll try that obesity law thing I don't know. M:thumbdown:

My weight had fluctuated from 36-40% BMI but one time (all doctor's record) it dips down to 34.6%. Will they hold this against me? I can't seem to find a record of it being higher around that time. I have hypertension and cigna so, hopefully, I won't need to be 40% for that time.

Hi guys....hey does anyone have a sample letter for insurance i can take a look at? I have UHC Choice plus. Ive been hearing different things so i am hoping and praying i get approved. Just incase i dont, id like to have a letter prepaired for appeal. any infor or suggestions would greatly be appreciated.

I have Cigna with a 36/37 BMI and I am on my 3rd appeal. My Primary Care Physician who is studying to be a fill doc in Smithtown, NY told me she has many patients who were turned down by their ins co only to be reimbursed after they paid out of pocket. Anyone have this experience?

i have premera blue cross (heritage plus1) does anyone know if they well cover lap band surgery? i went into there site i cant find anything that says if they cover it or not.

Hello, My insurance sent my stuff in the middle of July. I have been calling to find out what the hold up is. I am assuming it can't mean anything good to wait this long. I had posted about this a while ago... I have Horizon BCBS PPO and it went to the medical director a week ago whatever that means. I do have TT2 diabetes, GERD, high lipids (metabolic syndrome), depression, infertility and pre-hypertension. All those are documented. My BMI is somewhere between 36 and 38. Is waiting long a bad sign? Thanks, M

UHC denied me with my BMI @ 38.7.... I recently have been put on medicine for a weak bladder and have pitting edema. Tonight I am having a sleep apnea test. I'm still hoping there is a chance that I will be approved for the lap band. Any suggesions out there on what I should do or on the sleep apnea test? Thanks!!

I just got back from the doctor, and I don't have sleep apnea. which is a good thing..... but... UHC denied me w/ 38.7 bmi.... I have since been put on medicine for pitting edema, reflux, and a weak bladder.... and my bmi is at 40.3 now. What are the chances that they will approve the surgery now since my doctor is re-submitting it. I haven't submitted an appeal yet b/c I am waiting on a letter from my PCP explaining the medical necessity.... words of encouragement???

I've been wanting to have the lapband surgery for while now. I have a BMI of 40 and have had that for about 3 years now. I believe with Blue Cross Blue Shield they require a BMI of 40 for the past 5 years or 35 with a qualifying condition like BP issues, which I don't have. I just realizaed that even 3/12 years ago I was barely a BMI of 35 so I'm worried I won't qualify. I can't wait another 2 years to have this surgery. I'm too tired of being fat. I feel so desperate to the point I may starve myself somewhat to lose this weight. I don't know what to do.

Loooking for a surgeon who takes tenncare americhoice, I thought I found one but I CAN NOT pay the 3000$ that Parkwest Comprehensive Weight Loss Center (DRs. Boyce and Williams) wants for the comprehensive weight loss program fee.

Hi everyone! I have been reading everyone's responses and posts and boy is there a lot of information! I figured I would introduce myself to the group. I'm 28, I have been overweight my whole life. The ONE time I was able to loose weight was when I was single, living alone, hardly eatting, smoking like a train and drinking like a fish. Not exactly your health-conscious way of loosing weight. I have since turned a new leaf and became healthier, and then I got pregnant. Since then I have fought SOOOOOO hard to loose weight. I am 5'9", 285 lbs. I wear a size 20/22. I am a single mom and I currently have no insurance for either myself or my child. I am the sole support…

Yes, I, after 11 years, am getting a job. rofl I went yesterday and got hired to work for an insurance co called Liberty Mutual, and one of the benies is I get BC/BS health insurance. not sure what division. Anyway, I figure this has to be better insurance than what dh has (his sux) and was wondering, how long does it take to get approved? Is it just a couple weeks across the bc/bs board? If so, OMG I am really thrilled about working there! lol Any help? info?

do they require, pre req's. Also do they give a lot of problems approving? I was advised only to call and ask if the cover Baratric surgery by nurse at surgens office. Not met with him yet, but have the referal and am scheduled for seminar 6th of September. But I guess I'm just paronid. I asked where I could find the details and she said on line looked and no online access. So now what, I'm afraid to call them and ask. Do I just wait till I go to seminar. :thumbup: My stats: 5' 0.5" Tall 219 (BMI around 41 or 42. I just weight in at doc 2 days ago lost 5 lbs this month so haven't checked BMI) I have sleep Apnea -Just recieved Cpap machine a week ago today! …

Has anyone had fills covered through BCBSIL? If you did, how were they handled? I tried to ask them about it, but I am not sure the person I talked to understood what I was asking.:redface: They said something about another letter of medical necessity.:frown: That just didn't sound right. Any responses will be greatly appreciated. Thanks.

I just received a letter from Cigna saying that they cant substantiate medical necessity for the lap band. It says that I need to send my clinicals to the insurance company for review. I now dont know what to do, I have no co-morbitualities or anything, and no I have had no tests, so I dont know what they are looking for. the last thing I had was an echo-cardiogram about 2 years ago. Any ideas???