Insurance & Financing

Hi everyone! I recently found out that my insurance (BCBS of Texas) is requiring me to do 6 months of medically supervised nutrition. I'm one visit in and cannot seem to wrap my head around waiting 6 months to finally have my sleeve surgery. It's so discouraging to make such a big life decision, be eligible, and then have to wait half a year to begin getting healthier. Does anyone have any tips or words of encouragement on how to make it through such a long wait? Thanks so much!

It's been almost two weeks and I'm still in pending status. Im so nervous!![emoji30] Sent from my LGMS210 using BariatricPal mobile app

Ok, I'm getting down to the wire for my final nutrition appt (July 31st) when I'll be weighed. This is my last requirement before my surgeon's office can send everything to insurance for approval. I still need to lose 8 lbs! Does anyone have any advice? I've been doing well, but just in the last day if my vacation, where I have not been as diligent about diet and exercise as I'd hoped. I've put on a few pounds instead if losing the last 5 I needed to! I have until Monday to drop the weight. I'm willing to do ANYTHING at all - including not eating for the next 4 days, if that's what I need to do (although I doubt that would be the most effective method). Any advice? I'd a…

I was wondering what some comorbidity diagnosis that people were approved for through Medicare & Medicare Advantage? I can't seem to find out. Thanks for your help!

Claim denied after the surgery because I didn't have the procedure done at the preferred provider hospital Received a disturbing phone call today from the hospital where my procedure was performed. They said because the hospital was not on the preferred providers list with BCBS. The claim was denied AFTER the surgery was done, even though they initially approved it. They hospital asserts I should have had it done at the other hospital in town which is the preferred provider. Prior to my surgery when going over all the paperwork, most of which was the information of all that could go wrong...like dying in surgery, I came across a waiver form which was explained to me …

I have Aetna and I have been going to the Beaumont weight loss centers since May doing all my visits, Drs, Nut, fitness and physic. I was so excited when they said it's time to see the surgeon and get approval. I went to the Surgeon August 7th they submitted my info August 8th. I had my 4 month appt August 8th with Dr,Nut and fitness... August 11th I got denied by Aetna for not meeting the 3 months 90 calendar days program. Apparently it's not really 3 months it's 90 days so I need that August visit submitted and they didn't. Surgeons office if now saying they will see if they can submit it to them or if they have to appeal it. I am so irritated. I wanted to be able to h…

Before even going to the seminar ALWAYS make sure that your insurance company covers the cost of the surgery. I remember my surgeon saying that he has had patientswho qualify for the surgery but then come to find out their insurance doesn't cover it. So if your plan doesn't cover it switch to one that will.

Hello I have First Choice Medicaid SC. I have been approved. It took about 4 days to get my approval. I'm so excited.

I started this process back on June 16, 2016. I was denied first in August of 2016 then again in December of 2016 after I tried to appeal by myself. After that I was getting frustrated so I decided to use Lindstrom obesity advocacy appeals. They sent out the appeal letter to OPM on March 9, 2017 and I was approved on March 17, 2017. I just wanted to say if your having a hard time do not give up hope! Also you might want to talk to them if you have been denied as well.

I had soooooo hoped that I'd make it through this pre-surgical hoop-jumping without any major problems. But I called my insurance company today to make sure they'd gotten the pre-authorization and to see if they could give me an idea when they'd make a decision. Nope--they don't have any pre-auths on file for me. So I called the surgical team, and after being passed to 4 different people and leaving a message at the last desk, I got a call from someone who told me they couldn't send in my pre-authorization because I still had to be cleared by "the team." Who hasn't cleared me that needs to? I asked. Well, it looks like I still need more NUT sessions and another psyc…

I am new to this site and I have the Healthy Indiana Plan State Plus with Anthem BCBS. I was finally able to get my family doctor to refer me to St. Vincent's in Indy. I have my consultation Aug. 17th. I know I can and should be covered by my insurgence. But I am wondering if someone might know how to answer these questions. What all did you have to do for Pre-Op? How long did it take to get through Pro-Op to have your doctor send for approval? How long did it take to be approved/denied? How long did you have to wait to book your surgery? I know these are a wide range of questions. I am trying to see if there is a time frame that I could hit. I wa…

Any experience with this? My bmi is slightly under 40. I'm wondering if there is any way to have them approve without a comorbidity. Sent from my SM-G920V using BariatricPal mobile app

I was sleeved in December and now my daughter is trying to get approval for the bypass. Our first appointment was March which counts toward the 90 day supervised diet requirement. She missed April due to being away at college and had her second appointment this week. Does the March appointment still count since she missed April? We're hoping to get it done early July before fall classes start!

This my first time posting. I'm currently in the 12 week class through Kaiser. I'm on my 7th week. Today at work we were notify that are Kaiser plan will be changing to have deductibles on Sept. 1. My original plan didn't. So with the deductible and plus they say I'll have to pay 20%. Has anyone had to thru this. I'm so bum. Im so close. Now if it true. Surgery will be delay until I come up with money. Sent from my SM-J700T1 using BariatricPal mobile app

Hello all! I'm new to this forum and just started my journey. I had my consultation spot on 7-5, my Upper Gindine today as well as my psych evaluation and first nutrition appointment ( I have to have 6 consecutive months). I'm very nervous because I want to get it don this year because I've met my deductible and out of pocket maximum so my surgery will be 100% covered! I'm scared because my last nutrition appointment will be 12/13 which is cutting it close!!! Anyone experienced these? Can you give me words of encouragement??? Thank you in advance!!!!

Does anyone have health insurance through Wells Fargo? Anthem BCBS?

Hi, This is my first time posting, but I have stalking this site for quite some time. LOl. I have a BMI of almost 36, and I have a few comorbidities. High blood pressure, high cholesterol, and am pre-diabetic. I am also going to be going in for a sleep study within a week. I do not take any medications for any of my current diagnosis' as they are all recently diagnosed. I am wondering what everyone's experience has been with Medicaid in California. I called my insurance and they told me that they will cover it, but I have to wait. I am Yo-Yo dieter and my fear is that I will lose some of the weight in the process and might drop before a 35BMI. I know the weight will …

After two weeks, I received my approval today

Anyone with Blue Cross Blue Shield Illinois willing to share their experience with getting approved? What were your requirements? Did you pay out of pocket? Thanks in advance!

Hi! I have molina in Washington State. So I just got the email from the weight loss surgery clinic to complete the seminar. I did it online and I'm now waiting:) I was doing research and I see the requirements are 12 of each nutrition, mental health, and physical therapy. I have fibromyalgia and I have already been doing physical therapy for that, plus I go to counseling and have been going to weight watchers. Will I be able to use this to meet my goals or do I have to do it all over again? Thanks so much Morgan

For anyone who has Caresource in Ohio, here is their policy as it pertains to Bariatric Surgery as of July 2016: A. SUBJECT Obesity Surgery B. BACKGROUND Surgery for morbid obesity, bariatric surgery, and gastric bypass surgery is a major surgical procedure with significant risk of surgical and post-op complications that should be considered medically necessary only as a treatment alternative when a concerted effort a conventional and conservative management has failed for those who meet the policy criteria below. Prior authorization request for Morbid Obesity Surgery and supporting information must be submitted by the surgeon intending to perform the procedure. Further…

Hi All! I just completed my 3 month insurance requirement for Cigna. My nurse coordinator submitted me to insurance for approval yesterday. She mentioned that I should call everyday in order for a speedier approval. I am not sure what to ask when I call. Can anyone offer any tips? I have Cigna insurance.

Hi All! Has anyone gone through the insurance process with Tricare? If so how was your experience with approval? I am completing my final pre-op testing next week and then it's off to Tricare North for approval. Thanks!

I have done everything.. I have passed all the tests. I have jumped through all the hoops.. The only thing I do not have is 1 year of my 3 year documented weight history. I didn't go to the doctor in 2016. I was told I would be denied the first time I submitted and that it was normal. The insurance coordinator told me I could submit dated photos for the missing year. That was almost two weeks ago. My surgery has already been set for June 15th. Has anyone else had success using pictures for weight history? 5'10" CW 328 BMI 47

Hi all, I had the lap band for 13 years (two of them, actually, and two additional surgeries to correct constant mechanical failure). BCBS denied me twice to revise to the sleeve due to the one surgery per lifetime limit. I had the band removed and I still want the Sleeve. I am planning to enroll in Aetna through my company. I confirmed the offered plans include one Bariatric surgery per lifetime. Does anyone have experience with this scenario - could they deny me based on previous bariatric surgeries with another company? My BMI is 41.

I received approval from Aetna! (Aetna POS II). I did the 90 day Multi-disciplinary approach. Technically I started in December, but I had a little hiccup and missed one of my appointments with my Primary Care Doctor in January. All I did was tack on an extra appointment with him in April, and all was good. When I first started I was so confused about Aetna's requirements, so I wanted to share for those that are taking the same route. Here is what I did to get approved. December: I met with the Surgeon and bariatric coordinator. I was intimidated about the process because of the insurance requirements. I started a journal to help keep track of my appointments a…

So my doctors office sent in all my required paperwork for my surgery authorization. Cigna sent a letter to them and me stating they need more info. The info they need is everything they already sent in. It also looks like they only need info to approve an overnight stay in the hospital. Anyone else get this? Is my surgery approved?

So I'm just starting the process of trying to get approved and I'm concerned I may get denied. My current BMI is 38 and per my insurance requirements a BMI under 40 requires one comorbidity. I do have degenerative disks and other issues in my back and had Gestational Diabetes while pregnant but as far as I know I'm not currently diabetic. I don't know about high cholesterol or sleep apnea but I know my blood pressure is fine. For those that have been through the process and have has similar circumstances what was the outcome? Does the doctor give a full medical workup while you are going through the process to quick for some of these other conditions? It's definitely poss…

Was wondering have anyone got denied from amerigroup.. and how long did amerigroup takes to approve/denied Sent from my Z820 using the BariatricPal App

Panniculectomy

Hey Guys & Gals ! Today was my last NUT appointment and I'm officially psyched and nervous at the same dang time. My surgery date is August 7th; i have to wait 15 days to wait for my approval, but for some reason I'm nervous they won't accept it. I have the Empire Plan (NYSHIP/United Healthcare) has anyone had any experience positive or negative with this insurance ? I'm open ears ! [emoji4]

Hi there, has anyone out there has any experience with MVP in Rochester? I'm curious about what their pre qualifications for the sleeve. Thank you!!

So I have been freaking out because im at the 39.9 area with no comorbities besides the GERD I was diagnosed with at my EGD appt. I have United health care, I would like to know if im just wasting money and time

After years of consideration I am finally ready to change my life with the gastric sleeve! I will be joining my husbands insurance plan (MVP) in January which does cover the surgery (with approval) but my current plan does not. I am scheduled to go to my first seminar on July 27th as I want to learn more from the surgeon team who would be performing mine as well as get this ball rolling!! Has anyone had experience with this? Can I start the process now (NUT and other appointments out of pocket) and then have my new insurance cover he surgery at the new year? Also, re: the BMI requirement. Is this based on your BMI at the beginning OR after pre-op diet requirement? In oth…

Anyone get approved with a 35 bmi and no severe comobibtities? I have anthem bcbs ohio, in my 4th month of supervised diet... (so nervous and praying I'm not waiting my time ) Sent from my SM-N920V using the BariatricPal App

I am at the very beginning of this process and wondered if anybody else had their surgery approved through Tricare Prime? When I spoke to them they told me the requirements and I meet them except for the monitored weight loss. Does anybody know if this is for 3 months or 6 months? Sent from my iPhone using the BariatricPal App

Hi everyone. I've posted in the gastric sleeve section and have that listed as my surgery in my profile. How do I change that? The reason I ask is that I just found out that the sleeve isn't going to be an option for me due to my having mild reflux. Looks like bypass will be my only option that won't make that worse. Bypass, from what I've read, actually helps in most reflux cases. So my question is two part: 1) How do I change my surgery in my profile to bypass, and 2) Have any of you been approved for bypass with reflux or GERD? Oh, and I looked everywhere to see where I change my surgery in my profile and cannot at all seem to find out how I change that. …

I'm 27 bmi 37 I have mildly elevated cholesterol, asthma, depression. I just had 4 hernias repaired on 1/17 and gallbladder removed when I was only 14. I have considered the sleeve for a few years and my weight just keeps climbing and I'm not successful at losing and keeping it off. I have Medicaid and I live in Houston Texas. If anyone has any info or tips that would help I would greatly appreciate it! Thank you

Hello everyone! I'm in the last two weeks of my last month of diet before I go to insurance for approval! I'm super excited and also super nervous because idk how long it will take to get insurance approval, or if they will even approve me at all. Anyone else have WellCare KY and can give me advice? Sent from my iPhone using the BariatricPal App

Am a week until my surgery just wondering about this topic.

Going through the WLS process.. Any pointers or experiences out there with Priority Health Ins. HMO in Michigan. Any way around their 6 month Managed Weight Loss Program? Thanks, John

I'm finding this whole insurance thing pretty convoluted and a little confusing. I've had Kaiser for my whole life, so dealing with networks, medical groups, referrals and yada yada is a new thing for me. Hopefully someone can clarify this for me: I'm interested in a particular surgeon, Dr. Quebbemann in Los Angeles. I don't have a primary care physician yet. I have Medi-Cal (with LA Healthcare) though, and Quebbemann does take Medi-Cal. I just spoke to an agent from LA Healthcare and she said it's unlikely that Quebbemann would see me if my PCP isn't in the same medical group as him. Is my best option to call Quebbemann's office and see what Medi-Cal do…

Hi all. I'm brand new here and brand new to the whole surgery thing too. I have a BMI of about 60 and also have high blood pressure. I haven't yet spoken to my primary about weight loss surgery but I know she'll agree. I am just having a hard time finding out if it's even worth it. There is zero chance I can self pay and I have medicaid in Colorado. Does anyone here know for sure if Colorado Medicaid covers bariatric surgery? If so, any chance someone knows the procedure they require? Thanks.

Just wanting to let people know that The Alfred hospital in Prahran do weight loss surgery as a public patient. Re Gov reals you need to do an 8 week food and exercise program which just entails writing what you eat for a week and a little about exercise. This is not being done to make you lose weight rather to educate you. I was put on the waiting list in April and my surhery is on July 22nd. Cant wait

So not every one will qualify but go to insure.com and I can't remember if you email or what but look on there your insurance may cover some protein shakes for you! I know alot of people are on a budget and even 4 months out this is a big help to me! Just want to pay it forward as another member on here told me about It! Even my Dr office didn't know they just ask your insurance info and some Dr info progress starts in the mind

Had my last pre-op appointment and just waiting for my doc to put in her clearence. Then i will wait for insurance to approve! Anyone also awaiting approval?!

I was wondering if anyone gained weight during your 6 month supervised diet? My initial weight was 322 and I lost 15 points the first weigh in and 4 pounds the second weigh in. I am afraid so may have gain 2 or 3 pounds for my third weigh in and I am terrified that it will I pact my approval for the Surgery. Has anyone else gone through this? Sent from my SM-G935P using BariatricPal mobile app

My doctors sent my paperwork through to the insurance company today (Blue Benefit Administrators of Massachusetts)... I live in Western New York, but my employer is headquartered in Boston, MA. I had my first appointment April 26th. I was given a list of several appointments to make including: 1) sleep study, 2) occupational therapy evaluation, 3) endoscopy, 4) psychologist evaluation, 5) exercises classes, 6) a dietician evaluation and 7) blood work scripts. I managed to make every appointment needed in the month of May, and ended up having 2-3 appointments a week. I had my follow up appointment with the surgeon on June 2nd and they just submitted my paperwork today (J…

Ohp Trillium doesn't cover surgery unless you have type 2 diabetes. The lady at my surgery center is going to try to get Ohp to take into consideration that I am taking metformin and have prediabetes. Has anyone been in the same situation? If so how did it turn out? Thx!

Anyone have McLaren Medicaid in Michigan? Can you tell me about your experience with them? My surgeon's office submitted my paperwork to them on Monday January 4th....still haven't heard anything. Also, it was so unclear how long I was supposed to do the supervised diet . It said a minimum of 6 to 12 months....that makes no sense to me!