Insurance & Financing

Hello Everyone, My girlfriend is wanting lapband surgery and I will be financing it for her. We will be using Dr.Ortiz of the Obesity Control Center in Tijuana. We've checked him out thoroughly and like him. Anyways, I contacted Welcome to Citerra Financial and they needed my gf's name and info as well. They said they the banks they apply to require the patient information. I have good credit (700+ credit - was approved for a 150k mortgage a few months ago, didn't take it due to some other circumstances but was approved), and hers is not so good. They said all the banks rejected the applications due to this. I am trying to investigate what other options we have. I kn…

It's almost open season again, and I don't want to make another mistake switching insurances to something I think will cover lap band, but doesn't. I can't seem to get a straight answer from my current insurance, Mail Handlers Benefit Plan (MHBP), though others have told me that they are great only for bypass. I have firmly decided on lap band. Does anyone with Federal experience have any suggestions on switching health plans within the government plans offerred. I only plan to look at the national plans, but, in case it makes a difference, I live in Houston, TX.:help:

My spouse is Army National Gaurd. We just got Tricare (the army health insurance) because we were told it covered Lap-Band. I went to my seminar today though and was told that they "cover" it but they pay "zero". I'm beyond stressed. I turn 29 this month and have been "obese" for the major part of the last 12 years. Yo-yoing up and down. My BMI is 38 so I was stressed enough about getting approved. Cause Tri-care says you have to be 100 pounds over and I'm 5'6 and 237 pounds.... I don't know if that's 100 over. It's 100 more than what I'd like to way but my healthy weight goes up to the 150's so that would mean I'd be in the 250, not the 230's. Weight gain has never been …

I just found out that my husbands company may be changing insurance companies...we will be going from Cigna (after 10 years) to Allstate. Does anyone know anything about Allstate?? I have put so much into this and figure why would Cigna cover such a surgery if we are changing anyway...I will not be done with my 6 month diet until Dec 16th and we are changing insurances January 1. What crappie timing!!!!! I am soooo upset!! Thank you for any help...Kimberly

I tried to make an appointment with the bariatric surgeon my PCP referred me to, but they have twice now told me they really think I should look into working with doctors that are at a Cigna "bariatric surgery certified" hospital, which they aren't. I told her on Cigna's website that it says you do not have to get surgery at their certified hospitals...but once againg the lady at the surgeon's office said they know that Cigna might not cover near as much of the expenses if I don't go to one of their certified hospitals. None of the hospitals in Denver are certified, so i would have to go to Colorado Springs. Anyone recently get surgery that has Cigna insurance? Did…

Hey guys, I have just started the process and the insurance I have is Empire Blue Shield EPO. I am trying to gether as much info as possible before going to my first appointment on Thursday. My insurance covers the surgery (if I get approved) at 90% with a $1000 yearly maximum. My BMI is 48 so I don't think that I need any comorbidities but I am still nervous. I really don't want to do a sleep study becuase in Idaho, it can take months to schedule. Do you know if Empire REQUIRES a sleep study? I am good with every other appointment that I need to go to but I don't want to wait for months to get in. Thanks! Christina

Hello! My surgeon's office just called to let me know they sent my paperwork to BCBS IL today!!! They said I should know something in 2 -4 weeks... gosh, the waiting is agony, I am sure!! Also, they said they weren't sure what to expect because, I have only completed April 25- August 1 (technically 5 months), of my supervised Weight loss plan with my PCP. BUT, I started Weight Watchers meeting in January 2008, and have stayed on that until present, so I am hopeful that will mean something! Worse case scenario---they deny me and tell us we need one more month, and I do that, and hopefully then get an approval!! Everything else should be okay...BMI for 5 years and all of th…

Has anyone been 'banded' under CareFirst BCBS PPO (Owings Mills, MD)? According to CareFirst, my plan provides benefits for lapband surgery. However, they consider the procedure an outpatient surgery, and state that they do not pre-approve outpatient procedures. After the procedure has been performed, as claims are received, they are reviewed for payment. I am aware of the requirements before proceeding with the surgery, and have satisfied each (except psychological exam): morbidly obese, psychological exam, structured diet program, weight requirement, etc. The surgeon I plan to use if out-of-network, but the hospital is in the network. Has anyone been approved by CareF…

TRICARE APPROVED ME TODAY FOR SURGERY! The Dr. office just submitted everything yesterday. This is the best news!!! I am sitting here are work doing the happy dance in my seat. I get to meet with my surgeon today at 2, have my pre-op appt friday Aug 8th and surgury Aug 18th at 7am.....I can't wait:w00t:

My COBRA insurance with my husband's group plan will expire in March of 2009. Can anyone give me any suggestions as to which/if any insurance companies will cover me after having lap band surgery. I am one year post op and weigh 196. Thanks for the help!

Anyone from Washington state that has Uniform Medical? Tell me your experiences. Terri

Has anyone had to use OBESITY LAW . COM How much was the cost ? was it affective in getting your surgery?

does anyone know if mass health covers the surgery? has anyone that had the surgery on masshealth. were they hard to get them to cover. please any info would help ... thank you

Is this a world first? The NSW state Australian government has announced that it will pay for people with BMIs greater than 30 to have lapband surgery! Damn, I had my band put in last Thursday!! (only kidding, at least I will have beaten the rush) Read more in the newspaper here Health - Life & Style Home - smh.com.au

I'm APPROVED. I've been checking the Tricare South website every few hours during the day since Wed when my "Cancelled" turned into a "Pending". I checked this morning and nothing. I told myself not to check again until after business hours. I just did and theres my A - APPROVED. I can't belive it. I cried. I haven't told anyone yet except you guys just now! Now, to broach the subject with my husband. Now lets just see if I can get the A from him. I'll do it tomorrow! Thank You Tricare!

OK, I have been trying to get approved since March. Finished my 6 month supervised diet and everything then. Well the insurance coordinator at the surgeons office called the insurance and found out there was and exclusion on my policy, to make a very long story short I was getting the run around from the office staff and finally in at the end of June they just got tired of me calling and said you can only proceed as a cash patient call back when you have the money, basically. I got the financing ready to pay cash, have final consult with surgeon, he said why were you denied? I said I wasn't your staff never sumitted it to the insuance due to an exclusion, he and I go to…

Okay, so I started this journey in May 2008 after getting my PCP to agree that lap band is definitely something that I should consider, even though I had no comorbidities. I had done a 6 month diet with my PCP (I had missed 2 months), nutritional consult and psych eval and had documented my 5 year weight history. Everything was submitted to Cigna - within 6 weeks I was denied due to BMI being 41.5 but not for 2 years and lack of 6 month diet. I resigned myself to the denial, but shot off a quick, emotional appeal letter (unbeknowst to my surgeon) that basically stated I know I missed 2 doctors visits, but that was only because I was losing weight and yes, my BMI fell b…

:confused:I was just wondering if anyone could tell me what their Dr supervised WLP was like? I just finished mine and all my pre-op testing. My surgeons office should be submitting it to insurance soon. I am now really starting to worry after reading some stuff that my PCP did not have a clue what he was doing for my supervised WLP. He told me to follow a 1800 to 2000 cal diet and walk more/ exercise he did not tell me to visit w/ him each month only to weigh in every 4 to 6 weeks. I did visit w/ him 2 times over the 6 mo period and spoke w/ him about diet but both times I had come in for other things also (pap visit one time& back pain the other). Also I did not…

Hi everyone! This is my first post. I've just started the 6 mo. diet plan. My BMI is 40 w/no comorbidities. I have Aetna, and I'm afraid they won't approve me if I lose wieght and drop below a 40 BMI. I'm also worried that I won't be covered if I don't lose any weight during the 6 months. Anybody have any insight? :biggrin:

I'm due to be banded Aug. 20th. I have a meeting with my surgeon on the 8th. I was told my insurance will cover the whole procedure and assumed this would mean fills as well. But I have read that some people are responsible for there own fills. Is this something that would have been addressed to me automatically by my surgeon. If filss were not covered they would have told me right?

:biggrin: I just got the call from my drs office after two denials. We resubmitted a new claim due to an increase in BMI, and I was approved!!!!!!!!! The insurance submittals have been going on since March and I thought it would never happen. I feel so BLESSED!!!!!!! My only question is I am a nurse and will only be able to take a week off from work, will that be sufficient. I mean it has to be sufficient. I had planned to have this done over the summer as I was off, but I guess it was not supposed to happen that way. Any advice would be great. thank you.:thumbup:

I have BCBS Texas UT select. Any one else have this and what was your experience with them. I go for my first consult today.

Ok, I have been going through this for a little better than a year now and am sick to death of playing BC/BS of IL. games. I was denied the first time because they said my doctor wasn't specific enough in her notes about my 6 month diet and she didn't put her signature on a required 5 year history form - It had the letter head and was included in the packet of information, but it wasn't signed. I went through another 6 months of dieting and my doctor writing a book every time I seen her and she signed the 5 year form only to submit everything (once again) on June 2nd and be told on June 18th that it's still sitting at BC/BS and "they" are not sure why it hasn't been …

Hello everyone! I know there are a ton of posts out here regarding IL BCBS and their 6 month weightloss requirement, which I think I have probably read thru ALL of them... lol Here is my question. I have been going to WW since January 2008, and started seeing my PCP monthly beginning in April 2008. So right now, I am 3 or 4 months into my 6 months (depending on how you count the 6 months), and that is starting when I started to see my PCP. Do you think there is a chance, they will count January thru April as my 6 month weightloss too? I am sure hoping, otherwise, I have another 3-4 months before surgery...and I am growing increasingly impatient like many others here...…

Hi, I just got back from the sleep study doctor and he has informed me that I have a mild form of sleep apnea that does not require a CPAP machine. I have two prescriptions from him--one for Flonase and the other for an appliance from a dentist to keep my air passages open. The study found that my snoring wakes me up 22 times an hour! The snoring is caused by my being overweight. My BMI is 37.9. Does anyone know if this type of sleep apnea counts as a comorbidity? Thanks! Lisa :biggrin2:

I am in the process of shopping for personal health insurance. Which insurances are most low BMI band friendly? Any thoughts or suggestions?

anyone know if this company's health care plan offers lap band surgery? I may be starting there soon, and would love to have the surgery. thanks!

Are there any Microsoft FTE here that live in WA (work in Redmond, Sammamish, etc...)? My hubby is possibly up for a position there and if he gets it, we plan on taking MS insurance. I heard it's BCBS...is that true? If so, have you had problems getting your surgery? What were the requirements? TIA! :teeth_smile:

I have BCBS of AZ and they require 6 months of supervised Dr visits, weekly visits to a nutritionist && documented proof of excercise at least 3x's a week. Really!! Ok, the 6 month wait I can uderstand and even the proof of exercise but weekly visits??!! We have lives!! Luckly I'm going through Scottsdale Bariatric Center in Scottsdale, AZ, and they have a physician on staff who is also a nutritionist and so for a fee I can get both done at once. And my boss (he's great) thinks it will be ok for me to leave work in the middle of the day 1 day EVERY WEEK so I can drive 25 miles one way!! But what about going under the 40 BMI? Has anyone every experienced being d…

July 14th all paperwork submitted to insurance and just received a packet of insurance claim forms for doctors to sign, I took this as a positive sign?? Any thoughts??

OK i am so happy i was finally approved and my surgery is this Thurs.:thumbup: but my insurance will run out at the end of August :crying: Now i know with people who self pay fills are usually covered for like a year. Is that the same with those who have insurance. Im going to call the hospital admin to find out. I will hate to have the surgery and then not be able to afford the fills. anyone in a similar situation :confused2: ~Justice

I'm just getting started, and I hope to be able to have surgery in September. I plan on making my appts as soon as possible...and getting everything done ASAP...I was wondering how long it's taken on avg to get their approval? My doc told me it can take 3-6months...Way too long for me to wait!

I am considering so many things... here they are: - use a lawyer to help with appeal with unsurance - self pay with Dr. Kirshenbaum in Denver CO - self pay with Dr. Ortiz in Tijuana I called the lawyer that posted on this site (Viscio) but have yet to heard back... not sure if I can take another disappointment in this process. Anyone use this lawyer or another lawyer with success?

Hi all :crying: I'm new here and I swear I've gone through about a million pages of threads looking for this information. I'm trying to find out if anyone with BCBS of ARIZONA (PPO) got approved or denied? I want to know :wink2: Good, bad, or whatever! Thanks so much!!!:thumbup:

Hi all, I was just invited to sign up for insurance benefits with my employer (Office Depot), but after checking out the benefits website and calling for more information (and before signing up for the insurance, thankfully...) I found out that O.D. does NOT cover this type of procedure. So I need to find some sort of outside insurance. Blue Cross/Blue Shield seems like a potential carrier, but I'm a little worried by the first entry under "Things we don't cover": * services, supplies and treatments that are not medically necessary I've heard arguments on both sides saying that it is and is not a "medically necessary" treatment - I'm under the impression that it …

I live in OH and anthem does cover the lap band, but my BMI is about 38 and it has to be 40 or over to be covered, or you have to have co-morbid conditions. The problem is I don't have any co-morbid conditions and don't get me wrong I am very happy that I don't, but I feel just because I am a few BMI points aways I can't get help to lose weight. Have any of you every been approved with having a BMI under 40 with no co-morbid conditions? Also I do have depression and have been treated for it for years now does that qualify as a co-morbid condition? I also have a long history of heart disease and diabetes in my family. Let me know what you guys think.

today I decided to do more research into the lap band, and before I get too excited (self-pay isn't an option right now), I called the dr to see if I could even get it (I had pyloric stenosis surgery at 1 mo old) and they said yeah, it should be fine. Then I called my insurance co to see if they "cover it", and yes they do- but we need a "predetermination letter" before you are approved. I have Principal insurance-anyone have any experience with them? last year I went to a plastic surgeon who "just knew' I would be approved for a breast reduction- and they denied me....so.... I am nervous about what hoops I might have to go through, or if they will just reject me imme…

I have been reading as many posts as I can to get information and one thing I have noticed is that the prices people are quoting for procedures are really low. When people say the cost is 7k or 18k, are they referring to the physician portion only? The hospital where I am having my surgery quoted the bill for surgery and outpatient care post op at 48k (I have insurance so that is what is billed to them). I am curious to see if the major difference is that the quotes are from private pay banders. Also, any idea how much the anesthesia will bill? I called the anesthesia group who will handle my surgery and they told me they couldn't give me an estimate because the…

A few days ago I called and found out that yes, the Band is covered by my insurer (Lucent, UHC Choice Plus), and the only requirements, I was told, were a BMI > 40 and/or co-morbidities and a five year history of weight loss. Currently I'm 5'8 and about 370lbs, with a BMI just under 57. Also, next week my blood work results come in, but at the moment I'm only aware of the beginnings of hypertension. My question is, what exactly have your insurers required as far as the five year history goes? Physicians records, just a personal list from yourself? Would having such a high BMI make approval more likely? I've lived in three states in the past five years and haven't bee…

hey i've been waiting 2 weeks for approval. how long does it usually take. i have the empire plan NOT blue shield blue cross. does anyone have it? i appreciate your answers in advance! thanks!!!!!!!!!

I am interested in what it takes to get Tricare to approve Lapand. I have scheduled my first appointment with my PCM on base. I am 100 lbs overweight and had Gestational Diabetes with my third and last pregnancy. I also have a huge family history of Diabetes. My mom just passed away at 54 years old from complications of diabetes. I just don't know if all of this will be enough to get approved. I know that Tricare requires a person to have some sort of health problems along with being 100 lbs overweight. Does anyone have a similar experience? Can you tell me what I can expect to hear from either my PCM or Tricare? Also will I be referred to the HAWC before anyth…

Has anyone changed insurance companies after surgery and before your first fluoroscopy fill? I had my surgery under one insurance company (Cigna) but I am now changing to Blue Cross of California. I am wondering if Blue Cross will cover my fluoroscopy fill and any subsequent fills. Isn't lap band surgery a pre-existing condition? I sure hope they cover the fills, because my doctor's office told me that the fluoroscopy fill is about $1,000 and the office fills are $500 each. My other choice is to keep Cigna by paying for COBRA at $500 per month. Any help or advice would be appreciated!!

Well, I attended my first class yesterday and found out that after the 6 month diet, I have to attend a 3 month pre WLS class as well. In addition to attending, in the WLS class you are required to lose 20% of your weight before they will approve surgery. Absolutely no surgery is performed without the 20% loss, no matter how long it takes you. That is on top of whatever weight you lose in the 6 month diet class. When I asked them if losing weight in both of those classes would make someone ineligible for WLS, they said that would depend on your starting weight and how much was lost, but yes, it could make you ineligible! GRRRR...these people are very s…

I finally got insurance authorization! The doctor said I will be getting the surgery some time in August. I'm so excited! I've been doing this whole process since December and finally the surgery is in sight. Wish me luck!!:biggrin2:

Has anyone ever been denied through Cigna? I have this insurance and wanting to be banded. I have PCOS, insulin resistance, fatty liver, high BP, acid reflux, and depression. I don't have a BMI of 40 or over, mine is 37 but I'm hoping I have enough problems to qualify me. :seeya:

Can anyone tell me if I stand a chance on approval if my policy says the following? I have Anthem Blue Cross Blue Sheild. The following section indicates items that are excluded from benefit consideration, and are not considered Covered Services. This information is provided as an aid to identify certain common items that may be misconstrued as Covered Services, but is in no way a limitation upon, or a complete listing of, such items considered not to be Covered Services. We do not provide benefits for procedures, equipment, services, supplies or charges: for bariatric surgery, regardless of the purpose it is proposed or performed. This include…

It's taken me almost a year and a half of work but it's over at least. This...meaning insurance approval with Cigna. I was Denied because I was shy a 40 BMI by 10 -12 pounds when I submitted everything they were looking for I jumped thru every hoop and paid out every last cent to docs. etc. but I should have know (and not listen to people on this site that said Cigna does cover with no co mobidities - NOT TRUE) they clearly state that they do not cover those under a 40 BMI unless you have grave illness that don't respond to meds.. Not only that but they will not approve any claim even related to this one in the future. Meaning if I gain 10 pounds in the next year.ev…

Hello everyone, I'm new here. I had my initial consultation today for lap band. I am 26 with a BMI of 36 and hypertension. I have heard from so many people that it is easy to get approval with united. Well, today I feel SO let down. I was told at my Dr's office that with a BMI less than 40 you have to have sleep apean. It is extremelly difficult to get approved with hypertension alone. I take meds for my hypertension but I don't have diabetes, sleep apnea, or high cholesterol. Has anyone else gotten approved with a BMI less than 40 and only hypertension as a comorbidity. I thought I was all set and now I just feel awful. Any suggestions or advice would be apprec…

Can anyone help me with an appeal letter. I was denied by UHC because I do not have a 5 year history beign at least 40 BMI. However, my records show that when I was at a lower weight I was on Adipex Rx diet pills. It clearly shows yo-yo dieting. I am 5'2" and weight 235#. I snore terribly, have joint pain from weight and have been fighting this for a long, long time. I appreciate any advise you could give!! Margo

I have Cigna and am willing to dot my i's and cross my t's, but could use some help. My BMI is low (low according to insurance..lol) I do have co-mobidities ie: herniated discs in my lower back, Gerd, Stress incontinence and knee and joint pain. I am afraid I am setting myself up for disappointment. I know I am the perfect candidate for this procedure (as does my PCP) but want to be prepared for submitting to Cigna. Anyone out there submit to Cigna with low BMI?? I have already begun my 6 month diet with my PCP just in case. Thank you in advance for any help you can offer. Kimberly