Insurance & Financing

Did anyone have a problem being authroized for the lap-band with Cigna HMO? I am doing my 6 month diet, have high blood pressure and asthma. I am hoping not to have problems being authorized for surgery. :smile2:

I was denied by my insurance, Southern Health. They said I have to start my 3 month diet over again. I lost 15 lbs the first time, but they said the documentation provided by the doctor was not thorough. They also felt that my diet wasn't strick enough and I didn't exercise enough. I am so sad. :crying:

OMG, I just got a call from my Nurse assigned to my case.....I have been approved. I am so excited!!!! Now I just have to wait for the date.:thumbs_down:

Hi...just wanted to know from you guy who like me have GreatWest as their insurance carrier how are they when it comes to approving the surgery. Let me know about your process and their requirements. Thanks,

According to B/C and B/S l don't need prior approval for lap banding, yet my surgeons office states l need prior approval.... l even called the insurance company back several times just to make sure. l feel like l'm left in limbo, but this time by the surgeons office...Naturally the person who does all the insurance billing for the surgeon, was out sick today...another long week of waiting, hoping and praying that this would all work out...:thumbdown: My surgeons office seems to be so disorganized...

I would like everyone who has Humana PPO to let me know what experiences you had with them. Are they quick to approve do they try and give you a hard time? Please let me know. I am on my fourth month of supervised dieting with my doctor and I hate to do all of this and something go wrong with the paper work. Thanks, Cheryl:unsure:

My paperwork was finally submitted to Bc/BS il today. Though my hopes of approval seem small, it was an exciting moment considering all the appts and tests I have been through in the past 8 months. I did get a tenative band date of 8/25/08!! Keep your fingers crossed. Tamara

If anyone cares Highmark BC&BS of PA started approving the Lap Band in March. The process was simple. I was originally denied in 2005. My surgery is scheduled for next week. Good luck to all, and remember fight these B**tards to the end!!!!!!!

I've been fighting with the insurance company since February. If I even get approved, it will be a year until surgery. I recently was approved for a Chase Private Loan. This will not need to be paid off until I graduate, and I can go make some real income. Right now I'm working part-time and can't spare any money to a care credit bill every month. Did anyone else take out a bank loan to afford surgery? I would love to hear experience.

Hello I am so upset. I had my surgery date set for July 29. They called me today and said I was denied because over the 6 months I gained 8 pounds and I am not allowed to again 1 oz. BUT at the doctors office they kept telling me not to worry that they would fix the numbers for me, but I guess the girl that sends in the paper work didn't get that message. I called in an appeal today, but they told me at the doctors office that it is usually denied. I am so devastated, I am done everything, all my tests, classes, and not to mention all the money in copays, and all the extra money since I have a crappy 80/20 plan. Oh any advice??????? Deana:frown:

hi I have been waiting for my ins, to aprove me,any info on how long it can take and if their is a time limite , when they have to get back you buy, any info really apr:smile:. thank you

I have BS HMO and just filled out the "weight loss surgery education criteria checklist" with my PCP to see if they will accept me into their program. If they accept me, I'm to join their 6 month weight loss class and simultaniously attend wls education classes at the medical group. Apparently the educators will then submit a psychological profile on me to qualify me for surgery. I must attend all sessions, comply with all assignments and exercises as determined by the counselor, show that I will be able to practice necessary post op lifestyle changes and not have any significant psychological problems. I looked at the website of my medical group and the next weight l…

in desperate need of help. I am a cardiac patient. I had a heart attack in feb 08, and have severe medical conditions and am obese. My cardiologist wrote a letter stating it is most critical I get the lap band, My insurace is WELLCARE. I called them and they said the will cover it if it is life and death, which my cardiologist pretty much clearly states. Now. i cant find anyone to take my insurance that there isnt a one year waiting list. I wont be here in a year at the rate it is going. This is most critical. Please. help needed. I am also filing disability, and am unable to work due to my heart condition, Microvascular Disease, Coronary Artery Disease, Hypertension, …

I found out today that my doctor had submitted a request for gastric bypass, not the lap band. I don’t know whether to blame her or the woman who does the authorizations. I must have said lap band a million times when I was in the office, so I can’t believe my doctor didn’t know that was what I wanted. I spoke with someone representing my service provider and was told that Pacificare HMO will not pay for the lap band because it is “a foreign body.” This woman, who was very nice, suggested I talk to someone in the Human Resources department at work, which I did. I can’t change to a PPO until next year, because open enrollment is over, and even if I did, the deductible i…

I found out yesterday that my loan has been approved. I dont know all the details yet. As far as my payment amount etc. I am excited and pretty sure we will be okay. I am desperate for my surgery. I have had much encouragement from the self pay people My husband is supportive me and is willing even though he like me is a little weary of payment at this time in our life. but I want to extend my life and be heathy. thank you to all who have been praying for me. Renea:Angel_anim:

Hi: I am curious to know if anyone has had to switch insurance companies during their lapband process (i.e. one company for the surgery, another company for the fills). Here's my problem: I got approved for surgery right before I got a great job offer. I had the surgery before I left my old job (BCBS insurance) and my new job has a 90 day probation period before I can start my new insurance (Aetna). During the interim, I will do COBRA, of course. But will I have to get re-approved by Aetna once I start that insurance so that I can get fills in the future? How do I go about doing this? And have you ever had to do this yourself?

Just wondering if anyone would happen to know this I can't find anyplace on line to check it out. Thank you in advance Good luck to all Kim

Well Tricare Prime (South) approved my surgery!! :biggrin: So I'm excited about that!! But from what I have read and discussed, Tricare has required an overnight stay and the surgery had to be performed by someone from the Center of Excellence. On my tricare authorization letter, it says 'General Surgery, Outpatient'. Has anyone else been approved and didn't have to stay overnight? I'm almost scared to call Tricare because I don't want them to say...oops we made a mistake and you are not approved!! I have more than 2 comorbids but little less than 100 pounds overweight. Also, Tricare hasn't said that I needed to have all of the pre-tests done (ekg, etc...) that …

I wanted my surgeon's office to treat the procedure as inpatient, because (a) my coverage would be 100% instead of 70% and (:smile: that forces the insurance company to pre-certify the hospital stay which means they agree to medical necessity prior to the operation, which they don't otherwise do. My doctor's office says that they can only do it as outpatient and insurance companies don't let them do it as inpatient. Is this true? Has anyone done it as inpatient with BCBS in the DC area? If so, who was your doctor? Thanks!

Hey all, I'm in the process of trying to get approval for surgery from tricare, already have the referral from my pcm...I just wanted to how everyones journey to getting approval went...And whether or not you had your surgery at an MTF or of post...Well hoping for a few responses thanks!!!!

My girlfriend is trying to get lap-band surgery. My insurance company, PHCS is requiring "the dread-ed 6 month diet". I am wondering if there is anyway out of this? She is ~250lbs, 5'8", and BMI ~39. She has other medical issues that is causing problems with this is the main problem. She has severe Fibromyalgia to the point that she is sometimes to tired or hurting to bad to get up and go to the bathroom and just holds it. She is pretty much bedridden now due to both pain and fatigue. Because of the fatigue and pain it is absolute hell for her to get up to go to doctors appointments and that is generally the only thing she leaves the house for. She misses those appointmen…

Hi everyone! You guys seem pretty experienced concerning the ups and downs of dealing with insurance companies. I'd love some clarification if anyone can help :tongue_smilie:. Here's my situation: My primary insurance does not cover lapband surgery, only gastric bypass. However, my secondary insurance (through my husband's employer) does cover the lapband procedure. My question is this: Would my secondary insurance automatically cover the lapband procedure for me (assuming I met all of their requirements) since my primary doesn't cover this procedure at all? Thanks :tt1:

I live in Laurel Maryland and am insured under Keiser HMO. I'm looking for a lapband Dr. covered under the Keiser HMO insurnace plan...any recommendations are welcom. I had been under CareFirst but the Metro Transit authority health and welfare pland did not include Lapband surgery. We switched to Keiser during open season because they cover the surgery. Now have a had time finding a doctor.

I have BCBS MN and am going through my 6 month diet. I haven't lost but a couple of lbs so far. My BMI is right at 50. Does anyone know what their requirements are? Do I have to lose a certain percentage or do they deny or approve alot? Just curious about your experienced with them. Thanks for any info! Karen

Hi all, I was banded in November 2007 (self pay), found the sweet spot after two fills, was loving my band, lost 50 pounds in 6 months, then a major slippage. I took 5 colace (stool softener) tabs, they must have stuck together, I then had a violent episode of vomiting, then noticed a slight difference in restriction and over the course of the next month, it became progressively worse until I had to go to ER as I had not been able to get down even a sip of Water and was becoming dangerously dehydrated. The doctor removed the Fluid from the band and immediately the symptoms disappeared. He told me that it was a major slip but that there was the possibility that the stom…

I have a surgery date for July 28th. Documentation was submitted to insurance company ( Anthem BC/BS ) on June 26th. Doctors office said we should here by this week. Does anyone else have Anthem, and how long did it take to get approval? Very anxious! Whole process was fairly quick. Consult 5/14/08, completed all required testing, Pre-op appointment 6/26/08 with submission of documentation to insurance. Liquid diet starts 7/14/08.:thumbup:

I have United Healthcare. I am hoping to get surgery approval. My question for others with UHC is if the surgery is covered, are the fills covered? If not, how much should I expect to pay for these? I have the HMO, so all of my normal doctor visits and such are on a co-pay system. For example, for maternity, it costs $100 for the hospital stay and $15 for the first OB/GYN visit...that's it. I think it is pretty good insurance, so I'm hoping everything will be covered. I would appreciate hearing about anyone elses experiences with UHC or similar insurance plans. Thanks in advance.

Hi guys, I was wondering if anyone out there has dealt with General Motors BCBS? I have had 12 months of weightloss (and regain) but nothing I would classify as clinically evaluated- what in the heck does that mean anyway:confused2:? I have PCOS and my(gyno) doctor tried Glucophage to get my insulin resistence under control and that didn't work- I wonder if they would consider that as 12 month documented weightloss attempt? Anyone that has any good advice- please please share. I am re-starting this journey - I tried back in summer of '07 and got discouraged by the requirements.:wink_smile: THANKS GUYS!

I have been trying to get banded since 4/15. I had a BMI of 38.4, polycystic ovaries, and high cholesterol of 210 without meds. I was denied because I had no co-mobities, UHC said I needed to be on meds for high cholesterol to consider it a comorbitiy. My PCP wrote a prescription for cholesterol meds and my BMI is now 39. I just found out today that I have been denied again. They said they could not give me a reason, a letter was forth coming. I have been waiting for the answer to my appeal since 5/27. Me and my doctors office have spent many hours on the phone. I am completely CRUSHED!!!!!!!!!!!!!I do not know where to turn now. Any suggestions would be helpful.…

Alllrighty well i know its covered, but how fast is the approval process, and whats the rate of approvals from those who have worked with them....juuust curious, i'm feeling very ansy, patience is a virtue, but i seem to lack that virtue quite often. I plan to put my paper work in within a week, if i can get into the psych. evaulation and the seminar... eeep

Can anyone give me a list of their requirements for the lapband surgery? I already have started the weight management program with LVH but I need the requirement list fom Capital BC and can't seem to be able to get it even after contacting them.

i have been on this site many times and have posted a few times but never told my story. I felt like i might jinx myself if i did this too soon. I live in san antonio tx and am 25 years old. i first started this process in feb and just found out today when i called humana ppo that i was approved. :thumbup:I had to do a 3 month diet and 3 month exercise course:sleep:. I had all the paper work turned in on tues and they actually sent the letter of approval out yesterday so it only really took 2 days for the approval :thumbup:. i am so excited about this. i hope to get the surgery done in aug in between my summer and fall classes. i wish everyone out there luck in their proc…

CIGNA seems to require documentation of 5 year weight history with a BMI of 40 or higher. Well, my 5 year history shows a BMI of about 38 over the 5 years. Weight seems to be within a 10 to 15 pound range. My BMI is 40 now, but was less last year as I was on a medically supervised diet for about a year. In part it was to qualify for the band, but I stayed with the diet as it worked for a while. I hit a wall last fall (and was sidelined with an injury so I couldn't exercise anymore). Well, the weight came back --of course. Anyone with a similar BMI history? What was your expereince with CIGNA.

Hi! I am signing up with bs/bc thru healthy ny. Does anyone have this and/or has anyone had any issues with this insurance for getting approved? Thanks!

Hi all, I'm new and recently got a new job, which means, new insurance. Two of the plans offered to me are in my price range, seem to have similar co-pays on almost everything and I was wondering if one was more helpful with the lapband process as far as approvals and any other things that may come up. I don't know if it makes a difference but they are both PPO's not HMO's. one is Tufts Navigator www.tuftshealthplan.com/gic and the other is harvard Pilgrim Independence Plan www.harvardpilgrim.org/gic anyone have any suggestions between these two plans or providers? Any info you could give me would be greatly appreciated! Thanks!

I'm just wandering if any of you used Obesity Law to handle your denial, and if so, how was your experience?

The letter finally came today from Aetna saying I am approved. I am 12days away from surgery. The nurse called me last Thursday and said without the letter they can't do surgery. So I was on the phone the next morning with Aetna trying to get a copy of the letter. Sooo today it finally came. I was so worried it wouldn't make it in time that I gave my neighbor my mail box key and asked her to go check my mail and she did and it was there!!! WOOOOHOOO!!!! I am so excited everything can now go as planned and the man I love will be there!

I was banded March 2006. At the time I had BCBS AL and Aetna - and neither covered lap band. So I self payed. My surgery was March 6 and Aetna started covering the procedure in April 2006. BCBS Al also now covers as of last year. My question - if I have any problems down the road will my insurance cover - since the procedure was not approved at the time of the surgery? Do you think they will now cover fills? Let me also say that if I had waited for BCBS AL to finally decide that it was not experimental - I probably would not have been alive.

Hello everyone... well, I went ahead and called my insurance to see if this would be covered. They said no. So does that mean there is absolutely no chance that they will pay for it? It sounds like a silly question but I am 23 years old and have only had insurance twice before, when I was 16 and then 21, for about 5 months each time. I have no idea how this works. I read about people appealing and getting approved, does that mean they were told that it wasn't covered? Or was it always covered by their plan, but they needed to qualify first?? I am sooooo confused. :biggrin:

I'm just at the stage of exploring this surgery. I'm going to a meeting tonight for a local doc who does the surgery and they want you to bring your insurance card. This is my question. Has anyone LOST their insurance because an approval for the lapband was submitted? I would "assume" that if they (the insurance co) is asked for approval they now know your BMI is high, etc. Is it like car insurance, where an insurance company can choose to drop you after an accident? Hubby and I own a small business and there are just three of us on the policy. It was hard to GET insurance in the first place that we could afford...and I did lie about how much I weighed because…

Gosh, I just do not know what to do.....I found out who my nurse was, and have called her like six times. She has not bothered to call me back. I wanted to make sure they have all the info....the staff there are all really nice, and the one today gave me alot of info (like it was pending, and estimated surgery date). But this is getting really frustrating. I just do not know what else to do...........:smile: My paperwork was submitted on 6/25, so it has been several weeks. It gets me kinda nervous that she will not call me back.

So it wasn't that bad! WLS submitted paperwork last Thursday, I called Cigna on Tuesday morning to see if they had received the paperwork. The person I spoke to said it was received and he submitted it to have a nurse review it and he said I should have the results by early next week. We'll today I got a call from the WLS saying I was approved! My BMI is 46% and I have no co-morbids. Also I nor my pcp didn't have to submit an actual letter for this being medically required. I had a physical back in January and in it my PCP stated that I was going to have Lapband surgery to help with being obese. So I believe it's all in who looks at your paperwork and what kinda mood thei…

Hello All- I am new to the forum, and I am in the early stages of seeking WLS. I was curious at to what insurance companies look for in the five year record. Are they looking for a long history of weight issues in general, or are they looking for a history of having the 40 BMI? Thanks.

I found out yesterday that my surgery was approved but my follow-up (fills, et...) was not listed in the approval. Is this done as a separate approval?

:confused:What is the procedure? Do you have to have the authorization from your insurance company when you go to see the surgeon, or just a referral from your primary care physician? Do you start the six months’ nutrition and weight loss after your first consult? Does your insurance pay for the presurgery testing, or does that always come out of pocket? Help!!!

Hi everyone this is my first post but I have been reading everyone's information and feel like I know some of you:biggrin2:. Anyway, I started this process a month ago (May 21 I think) and had my papers submitted to insurance on Thursday (June 26) and OMG I just received my call from the insurance (Anthem BC/BS) and the doctors back to back. I am soooo stoked, I can't believe how fast it was. I was thinking at least six months or so. Just wanted to let everyone know the good news..............Appt. with Doc on the 17th to set a surgery date.......

I have Cigna Open Access as primary insurance and Tricare Prime as secondary. Does anyone know if Tricare will automatically approve me if Cigna denies me. My surgeon has submitted everything to Cigna (6 month diet, psych eval, nutrition consult, etc.). Tricare only requires 200% over ideal body weight - which I am. It would have been so easy if I didn't have Cigna. I'm wondering if I'll have to start all over again if Cigna denies me (e.g. referral from PCM). Any help or advice would truly be appreciated. Thanks, ML

As some know, I am only 19 and I am undergoing the lap-band. I thought that due to my age, my insurance, Medica would not cover the surgery, but they pulled through for me and decided to cover it! I am in my final steps and am only weeks from surgery!!! Josh:thumbup:

Ok, I finally called my insurance comp, BCBSNJ and was told it was "excluded unless it was medically necessary". She told me I needed a predetermination letter by my PCP. I have a 48.1 BMI with several comorbidities including Type 2 Diabetes. The medically necessary part is definitely there. What worries me is the "excluded unless it was medically necessary" part. I have read all around my insurance book. I didn't see anything about WLS. Even in the exclusions section. Has anyone come across this situation or verbiage in your insurance book? If so, were you approved? Thanks, Gina

Has anyone had or is anyone been approved for Lap Band surgery by Blue Cross Blue Shield Federal of Maine? My husband works on the Portsmouth Naval Shipyard in Kittery, ME and I wondered if anyone has already gone through the process with them as far as what they cover for the surgery? Also, if they do cover it, what did you have to do to qualify? Thanks, Laurie:confused_smile: