Insurance & Financing

Anyone have Cigna? If u do, what were u told as far as the coverage for WLS...How can I find out of the Cigna I have covers WLS? I will have insurance thru Cigna with my new company in 2 mnths. Please advise!:biggrin:

Hi everyone. I am in the process of getting the Lap Band approved through Cigna. I went for a surgical consult a few weeks ago. They told me that Cigna requires a 6 month physician supervised diet, I had done that already last year. They also told me that they require a letter of medical neccessity from my PCP, I have got that as well. I also have to attend a nutrition and psych evaluation. I have done the nutrition already and I go for the psych eval tomorrow. I am 30 years old, 5'6 and weigh 255 pounds. My BMI is 41. I also have diabetes as well as hypertension. I was just wondering how long it takes for Cigna to approve the surgery and if I am denied, how many times ca…

Hello, I have California Field Ironworkers insurance and they have an exclusion on weight loss surgery, they told my surgeons office that there was an exclusion for weight loss surgery and there was a 95% denial on the procedure. The surgeons staff basically said well, when you are ready to pay cash, call us. Well lets make a very long story short, I took matters into my own hands, kept calling the insurance company until I found someone there who was willing to tell me the requirements, gathered all the required medical records (200 plus pages) myself which took months, made an appointment with the surgeon told him the whole story, he took my huge folder of records and…

Greetings all, Any luck or insight into the Anthem Blue Cross PPO coverage for lap band? I researched seminars at UCSD, but their info clearly states that they are not a ABC PPO approved facility. Help is appreciated! I would love to join the throngs of happy and successful lap-banders! :thumbup: -paige

I am new to this has anyone have Tricare insurance. How long did it take to get approved?:frown:

I was denied by Empire - BCBS yesterday because my BMI is only 38.5 with no UNCONTROLED comorbitites. But BCBS never said that that was there requirements to meet when i called the to see if they would cover it. the Insurance person that I could call for reconsideration, have a peer reivew or appeal. I don't know what the reconsideration or a peer review involves. do i need to call the insurance company to handle this or what? I called the doctor's office to talk with the person who handles the insurance but they haven't been alot of help. she talks forever to return calls and then we just play phone tag. she said that she would talk with the doctor but didn't know …

:tt2: Why do we have to wait for over 6 months to get this lap band. Especially if our BMI's are over 40 ??? This really makes no sense. You would think that since we are morbidly obese, that we would be rushed through the process so that we can start losing the weight. I mean they make it so hard on people who are truly trying to better their situation. Think about it, we will be more of a financial liability to them if they keep us FAT!! With diabetes, Hypertension, Cancer ect ... in the long run it will be alot cheaper to help us lose this massive amount of weight!! Don't you think?? It's just so frustrating !!! I want to be healthy and thin !!!!!!:smile2:

what are the requirement for uhc I called them and they said that I am covered but did not tell me what are the requirements such as Aetna has a 5 years weight history and 6 month Dr. exercise plan someone please help before I get my hopes up high my bmi is 42:help:

Aetna's requirement is that you have a bmi of 40 for at least 2yrs. Does anyone know what Aetna consider 2yrs? Do they consider the current year as a part of the 2yrs? Or are they looking at the past 2yrs such as 2006 and 2007? I just want to know if I consider having the approval/surgery in 2009 are they going to look for my bmi requirement in the years 2008 and 2009 or 2007/2008.

My insurance doesn't cover the surgery, and i have horrible credit. It looks like i dont have the means to get this surgery done. I am so disappointed, i feel like my world just came crashing down. Did this happen to anybody? Any suggestions?

Hi all, i am trying to find out what the medicaid requirements are for lap-band. I have already found the surgeon and all of his info. Thank you in advance for any help. Shelly :thumbup:

I am just wondering how long it took from the time you submitted all of your paperwork, until you heard back from insurance? I have BCBS Connecticut. The lady told me that I should know within a week or so. I think she submitted it last Friday. I am so nervous, and just praying that they will approve me. My BMI is 41 and no health problems! WISH ME LUCK, I COULD USE IT!!! Staying positive! :thumbup: Kim Seminar :confused_smile: Consult :crying: Ultrasound :eek: Psych Evaluation Nutritionist Referral letter from my primary doctor :thumbs_up: Approval :confused:

Hi..I have been reading this site on and off. Well GOOD NEWS ..My insurance covers my procedure....BAD NEWS.....I have to go for 3- psych checks, 3 group meeting, 3-4 other specialists(cardio, pulmanary etc) THEN I must see a dietician and council FOR 6 MONTHS BEFORE they will approve my surgery!!!!! Now I am 41 yrs old my BMI is 46...they will only approve 40+, I am at extreme risk for Diabeties, I have bad acid reflux, I have had 2 back surgerys, and 2 ACL surgerys, and 2 scopes on other knee. Do these people want you to die !!!! I recently gained this weight due to the last back problem(about 2 yrs)..I was always around 220-240. Now I am pushing 320 !!!! I have been 30…

Does anyone have Health Net HMO? I do and when I went to my PCP 3 months ago to ask about the band weight loss surgery he told me that I have to have 6 months of diet and nutrition classes (thank goodness they're free...but their not in my town...so gas....at $4.50 a gal....not good). It was explained to me that the 6-month diet classes are required by my MEDICAL GROUP/Dr. and has nothing to do with Health Net, or the Dr. that will eventually put the band in. I have been faithfully going to the classes now for two months now but suddenly got a horrible thought that maybe the surgeon himself will also have long term requirements (like another 6-month diet) or may…

Has anyone heard if Kaiser Southern CA does lap band surgery? I am interested in getting the lapband done and have not even approached my doctor yet. I am 26 years old, 5'8'' and 245lbs. I have had issues with acid refulx, high blood pressure and borderline diabetes. My BMI currently is about 38. I also have the open enrollment for my job coming up where I can switch insurances and my other choice is Aetna. Has anyone had any experience with that? My biggest fear is to get excited about this tool that will be so beneficial to me then come to find out that I don't even qualify for it. Any help would be great!

I was denied by UHC last week. My BMI is 38.7 w/ no comorbidities. The doctor I saw in Tyler, Dr. Babineau, said they cannot help me. I must go to my regualr doctor and "find" some comorbidities. I don't have a doctor b/c I don't complain about things! I have pitting endema, a severe weak bladder, back and knee pains..... none of this documented and no doctor to go to. Does anyone have any recommendations or suggestions on a new doctor. During my initial consult, the insurance lady said they would fight to get you approved. I was shocked at how she just blew me off and told me they couldn't do anything. HELP!!!!!

I am really getting frustrated. When my surgeons office first called to check on my benefits they were told no prerequsites.. no psych eval, no diet, nothing... Now they are demanding the results of my sleep apnea test, as well as 5 years documentation of my weight. I got a form letter today, and it appears that they also require 6 months of dieting....has anyone NOT had to do this??? I am getting so flustered and frustrated. :biggrin:

I am just taking the first steps in having the surgery. Going to a seminar on September 11, 2008 through realizeband.com with Dr.Alexander D. Abkin. I am having the feeling that get insurance approval is going to be a nightmare. I have gone through and read a few of the other threads about BCBS and feel the approval process is sometimes a breeze for some and sometimes a pain for others. Just wondering if anybody with the POS plan has been approved and what your experience was like? Has anybody contacted the NJ Insurance commisioners office to complain and advise them of BCBS stalling and see what they can do to help? I am getting a little ahead of myself but can any…

:crying:I just found out that I have been denied by tricare i meet the hundred pounds over weight requirment however I dont have any co mobilities or whatever the heck they are. Although I am 10% disabled from the army for my back, but they never found anything when they did mri's or x rays. Maybe its artritis maybe not but unless it is I cant get the band. My band dr is now sending me for a sleep study maybe that will turn up something but the way my luck goes it will probably come back normal. I am so upset apparently being fat as heck doesnt validate surgey.I have to have diabeties or heart problems, i wonder if they remember that being fat causes diabeties and hear…

Hey everyone! I have been hearing here and there about some insurance companies excluding LB when you switch to a new insurance co because it was to treat a "pre-existing" condition. Does anyone know if Aetna does this? Did anyone switch to Aetna and then have LB? I'm currently with Blue Shield HMO and have started the process, the six-month diet, etc. and my PCP knows I'm switching to Aetna due to work. I'm worried that I'll be doing my part and then when I apply to Aetna to approve it, that they'll deny me based on the pre-existing... However, my BMI is 50 according to one calculator, but without any serious comorbities (yet!!). I could lose 50 pounds and …

If an insurance says all treatments for obesity are excluded, does that include WLS? My employer's insurance excludes WLS but specifically says surgery is excluded. I was thinking of getting a supplementary student plan through my university and found this under the list of exclusions: "For treatment of obesity, regardless of the history or diagnosis, including, but not limited to the following: weight reduction or dietary control programs; prescription or nonprescription drugs or medications such as Vitamins (whether to be taken orally or by injection), minerals, appetite suppressants, or nutritional supplements; and any complications resulting from weight loss treat…

:welldoneclap: hi, newbie in tn, just at the begining process go to first appt. in oct 3 2006. I have medicare/medcaid just curious how the process is? and how long? any info would be great. thanks!!!

Hello, I have Aetna Open Access HMO (Federal Employee); Am searching unsuccessfully thus far, to find out which 2008 health insurance plan in Illinois will accept lapband without six months medically supervised diet / 5 yr weight hx. I have sleep apnea. Does anyone have any advise? Is it really too much to expect to find out ahead of time which Federal Employees Health Insurance companies will cover WLS... otherwise, I'm seriously thinking of trying to afford self-pay. Will also need to convince DH - really! Thanks

My Cigna insurance has a 90 day pre-existing. I was active as of 7/1/08 - they wanted to see is I was treated for this since 4/1/08. I don't think that I was. I guess I am not understanding the "pre-existing" to deny the claim when they are also wanting a 5 yr medical history to approve the surgery!!

I got approval from BCBS in July. I got fired Aug 18th and my insurance terminates at the end of Aug. I will definitely do Cobra if the approval is going to carry over. Does anyone know if an insurance approval will carry over into Cobra? Thanks for any info, Jamie

I was denied this week by UHC. My BMI is 38.7. I have pitting endema, weak bladder..... My insurance said I have to have more comorbidities. Any suggestions as to what I should do? Thanks!

I need to know if you can switch doctors after getting insurance approval? If you can, was it hard to do?

I went to see my pcm on Thursday the 21st of this month to get a refural for a consult or a surgeon. I got call and a letter from Tricare the following monday the 25th....Less that a week after the doctord visit......WOW that was fast. and i am so happy.... Is Tricare always that fast? I hope so... Now I just have to wait untill Oct to see the Nurse of the surgeon!!! Is it Oct yet? Check out my time line so far in my Sig....WOW...but now it all slows down....

I wrote this in another post but wanted to copy it incase anyone has anything they can suggest I do... I have not posted in a while too because my insurance is dragging their feet. I have BCBS of New Jersey. My whole process started in Sept of 2007. I did my 6 month diet and I'm borderline diabetic. Everything was processed in March then in April they came back and said they needed more info about the 6 month diet. Everytime they ask for something they say it's another 30 business days. So by the end of May they said it was still being reviewed. I asked why it was taking so long and called every other day. They said they would have to send an email and that response wou…

Hi, I am just beginning this process of learning more about the lapband and thought before I went any further I should check my insurance to see if this will be covered. The insurance booklet says no bariatric surgery will be covered. So is that it? Should I not even go any further and get my hopes up? Its BC/BS PPO of kansas city. My bmi is over 40, I have been between 60-100 pds overweight my whole life, and I have high blood pressure. What in the world am I going to have to do to get this approved?

I have Healthnet through Hills Physicians. So far the hoops I've jumped through are, 6mo nutritionist and Dr. weigh ins, and the pshych eval. I'm not sure if the psychologist approved it or not but pretty sure he did because the Drs office said that they'd submitt the paper work to the insurance today. So know what, how much longer from here if I get approved by insurance? How many more hoops will I have to jump through and what are they? :smile2: Appreciate any info. Thanks

I just found out that I was denied lap band surgery. I am borderline... 38 BMI. Any suggestions? I am heart broken and don't know what to do.....

I have this through the state of PA, w/ the insurance I have (unison) it says something along the lines of they don't assist w/ weight loss. i was wondering if it was medically neccisary if they would cover it.

does the lapband? Do they give free consaltations? or would my PCP have to refer me some where if medicare covers? I just feel really weird calling up my PCP to schedule a appointment specifcally to talk to him about this. He's a little cold and really not no helpful.:cursing:

Hi All, This is my first post, and I'm interested if my insurance would ever cover the lap-band procedure. I'm in S. California and have Blue Cross Blue Shield HMO through my work (I know yuk). I'm a 5'7 , 41 yr old female and weigh 280lbs. I currently take 2 types of high-blood pressure medicine (for the last 4yrs and RX for extreme heartburn). I know my BMI is over 40. I'm also noticing more muscle aching and issues with energy, etc. (the usual over-weight issues).. I have to take control of this issue as it's just ruining my day to day life and I want to be around to watch my 10yr old grow up. I have a long record of weight loss procedures I've followed b…

Hi everyone, I was wondering if someone could help me. I really don't know where to start I definetly need help and don't know where to turn. I'm a 27 yr old stay at home mom of a soon to be 3 year old. I am depressed, I feel worthless, I don't even look in the mirror anymore. I'm to embaressed to take my daughter to places, and even better myself and find a job. No one will want to hire me. I believe I'm on Medicad if that is goverment insurance through tje state. I'm probably close to 300 pounds I'm a border line diabetic and only 5 ft 2. I guess what I'm asking is will medicad (if that's what I have) help me pay for this? If I was to try to get someone to help me pay…

Has anyone had any experience with approval through Healthnet/First Health? My company is based in CA and I am on the east coast...as such it is my understanding that First Health is the contract provider for healthnet since I am remote from my corporate HQ. I have been trying to get an answer on what the criteria are and I am not sure they even know. I have gotten 3 answers literally from representatives of First health and Healthnet. The least stringent was a phone conversation where the rep said 100 lbs overweight or under 100 with co morbidities. The worst said that I had to be twice my ideal weight and 5 years worth of morbid obesity records!! Has anyone actual…

Today I talked to a woman from our HR Dept or Risk Dept and she said that "all WLS are excluded because insurance companies didn't want to be responsible because they are considered high risk for complications and death and people were suing insurance companies." She also stated "that no insurance companies will cover any WLS." WHAT????? From what I've been reading this is not true. WLS have come a long way and there are proven facts and research that show these procedures to be beneficial. I know this rider was put in our insurance most likely because of the cost to the company. I think I'm going to ask her to put it in writing as to why we don't have the coverage for WL…

OK so I had to call tricare to see if I could have my pre-op testing at the hospital where I'm getting my surgery or have it at the base and I asked the lady if tricare covers the fills and I think she was confused and didn't know what those were, she told me it covers only up to 6 weeks after my surgery?! So does tricare cover fills? If so who do I call to ask and get this clarified? I have TriWest Prime in case that helps.

Hi everyone I am scheduled to be banded on July 8th (NYU). Im a virgo so of course i am waiting for the other shoe to drop:tongue: . I havent heard anything from my insurance (HIP) but my BMI is 44 and i have High BP and diabetis. I didnt do a six month diet plan with a doctor bc i was told i didnt have too. Im just wondering if HIP makes you jump through hoops like the others thanks guys Justice :thumbup:

Has anyone been approved from Aetna using the 3-month pre-op plan? The surgery is covered under my plan, but the paperwork says I have to do either the 6 month supervised diet or the 3 month pre-op plan. My Dr. (Morton, Nashville TN) wants to do the 3 month, but I’m worried I will do it, then Aetna will turn around and say I have to do the 6 month. Any advice?

My surgeon and I thought for sure that I would be approved by Tricare. I have two major comorbidities. I am 3 pounds over the low end of the Met life scale...but Tricare told me today that I am 6.5 pounds under the requirement! You have got to be kidding me!!! So, do I try to gain the 6.5 pounds?? or just give up and go on ANOTHER diet!!

Hi! I'm a newbie. This question has probably been answered many times so I do apologize, but outside of Insurance (my insurance will cover the surgery) what were some of your estimated out of pocket expenses? I have BC/BS of Oregon through for state employees with a ded. of $1000 that hasnt been met yet, so I was just trying to get an estimate. Thanks!! -Rachel

I can't beleive no one has had Lapband getting approved by MDIPA:confused2:

Hi Everyone, I have started looking for a Surgeon that will take Tricare Prime. I am thinking of have the Lap Band done If you have any sugestions I coould use your help. I would like to have the surgery in San Antonio. Thanks so much !

I am a government employee and I have MDIPA and I wanted to know if anyone has MDIPA? I wanted to know how are they with approving the band surgery, or do they give you the run around?:tongue:

I have an application in with BCBS of Minnestota Does any one hee have BCBS MINN? Any In put how long it takes them? All ears in Lousiania....................... Thanks Tink

Hi Anyone have any experience with BCBS of Minn.? I am in thee 6 mos waiting period, BMI just 35.5 with 3-5 confirmed co-morbidities Not sure what my changes are for getting approved, but my doc says are good. Any feedback?

What do they require you to do to get appoved? Special diets... other things...ect...please fill me in thanks!!!!!:confused2:

Scared???? Tricare approval... Ok. I went to my PCM and she referred me to a weight loss specialist for the Lap Band. I went for my first appointment on Wednesday. I am so scared that I am not going to get approved. These are my stats: Height: 5' 3'' Weight: 226 BMI: 40.1 Medical conditions: Depression, PCOS & GERD. I don't think that any of those are the medical conditions that they state that you must have. My doctor said that Tricare has a thing where the patient has to be 100 pounds over weight. I am wondering if any of you have any advice or any dealing with Tricare. I had to pay 200 dollars yesterday. I have a physc.. appoint on the 3 of sept. w…