Insurance & Financing

Something I HATE, HATE, HATE about having to deal with insurance companies is that you can never get a straight answer out of them and they never give the same answer twice. Take Moonshine. Moonshine is the CS rep who answered UHC's hotline the day I called to find out if WLS was excluded on my company's policy. Moonshine looked it up on her little computer ... or maybe she just pulled her answer out her ass ... and told me that it was. But Moonshine was wrong. So for the past three months that I've been thinking all I had to do was switch to UHC when Open Enrollment came along and I'd be fine for my surgery in the fall. That's three months wasted. Three months I…

Pls post your experiences here. I used to have a link to their Medical Policy...it's gone now. Looking for help...especially what is acceptable for "supervised conservative weight loss program for 6 months which may be provided by the patients's physcian, a PCP, or registered dietitian"

Just got a call from my surgeons office. I am still reeling from the shock!!! They want 24 months medically supervised diet WTH????? It's not like I need to lose 50 pounds. I am over 300 pounds, have high blood pressure, mild sleep apnea, diabetes, high colesterol, arthritis in my knees (almost crippling), chronic pain, a clotting problem and am on my third abdominal hernia. I still can not believe this. I expected a denial because of the 6 month diet thing.... but 24 months???? Are they freaking kidding me???? I am scheduled for surgery next Thursday... I am having my hernia repaired, we are going to self pay for the lapband ($5500.00). What the hel…

I can pay for the procedure, but I can't find an insurance company that will sell me medical insurance IF I have it done. I live in Texas, and I'm not currently insured because I weigh too much. All I have called so far have told me a lap band disqualifies me, no matter how thin or healthy I become. Anyone bought individual health insurance after banding and associated weight loss?

Has anyone had lapband in the Dallas/Fort Worth area and Tricare Prime paid for it? I spoke with my PCM and he said I needed to find a surgeon. But tricare doesn't have bariatric surgeons listed on their site to find a specific doctor. How do you go about finding a surgeon that take tricare prime?

Surgeons office just called, UHC denied me. :smile: My policy states you must have a 5 year history with a BMI of 40 or above. 4 years ago I went on phentermine and lost 65 pds. Because of the I was denied. Never thought I would be punished for trying to get healthy. Any suggestions on what to do? Is it worth appealing?:tongue2:

APPROVED APPROVED APPROVED!!! Do you know how good that sounds to me!! I have waited for this for soooo long and have read so many aproved threads and wondered how great it would feel... well now i know! Goodbye Fat Britnee and hello Smaller happier Britnee!! Thank you UHC!!!!!!! Only 12 days of waiting!!!!! :sad:

Has anyone delt with Rocky Mountain HMO? I had the surgery but was on different insurance and was wanting to see if my husband can get it too. Just wondering if anyine has dealt with them or if they except the lap band.Thanks

I am in the process of waiting for approval from my insurance and have a question. My BMI is 36 right now and my insurance requires a weight history of the past 5 years. I have only beem 40 lbs or so overweight before my kids so my BMI was probably like 32 or 33 in the past couple of years. Is that going to be a problem? Has anyone been in the same boat?? I want so badly to be approved!!!!

Does anyone with Highmark know if adjustments are covered? I tried calling them but no one knows what I am talking about

hey guys new here and looking for info on the lap band. anyone have bcbs of wny? do they cover this/ just went to the seminar at buffalo general. was very informative, but not with insurance issues. any info would be appreciated

:biggrin::Banane42::thumbup::frown: Well I finally got approved by Aetna! I had to do the 3 month comprehensive diet and exercise. Then the doctor's office didn't submit it for over a week, then Aetna needed the sleep study results (which I had done over 2 months ago). Finally found out today that I'm approved and surgery is scheduled for Aug 13th. I would have done it sooner, but I'll be heading to the mountains for 2 weeks at the end of July. Now the nerves set in!! Good luck to all.

:blush:Ok i was truly thinking about being banded until i saw more information on the sleeve and i am thinking that may be more of the one for me. anyways, to the insurance! i dont have insurance right now, but i will on 8/1 BCBS of South Carolina. i am not sure that the insurance is going to cover the procedure so i am needing some advice. should i look into weight loss surgery as soon as the insurance kicks in or wait some months? also, if i cant get approved by the insurance and need to do self pay, what are the options out there. if i go with the lapband i am going to use dr wade barker here in tx but if i get the sleeve i am going to use Dr. Guillermo Alvarez in mexi…

Hello Everyone, I was approved by Aetna POSII this morning. I was so excited and full of emotions I cried I was so happy. This has been a long journey for me. I started it on January 8th. Went on the New Direction Diet and I am still going. I didn't want to quit until Aetna approved me on my three month pre-surgical diet. Last week it seemed like Aetna was dragging their feet so this is what I did. I sent them a list of diets I did along with the months and how much weight I lost. I also sent them a copy of my diet underlineing everything they wanted on their three month presurgical diet. I also took their clincal policy underlined their requirements for a three month d…

I was told by my doctor today that Aetna denied my request for a Lap Band. My BMI is 37...because is it under 40, I am required to have a co-morbidity...I was diagnosed with sleep apnea. I have had all my tests, done my three months with a dietician. I have been working on this for a year and a half. I am so disappointed and upset. I called Aetna and they were not too nice about it. They told me to wait for the letter to explain why they turned me down. Has anyone ever appealled and won? What should I do?

My current policy has an exclusion that my employer won't get rid of... so I am thinking about getting a second, part-time job. Someone recommended a national chain where you can get benefits by only working part-time AND their plans don't have WLS exclusions. I have to work there three to four months before the insurance kicks in, and then what do I do? Can I apply right away for WLS, or will an insurance company not approve someone new to the plan? the coverage is with AETNA.

Has anyone out there gotten Tricare (the military insurance) to pay for Lap Banding? Any info you have is greatly appreciated! Thanks, Pattie

Does anyone have any information on getting surgery approved through Boeing's UHC Choice plan? I'm just starting on this journey, but have been told that the surgery is "excluded" Any other Boeing insurance information would be appreciated! I'm in St. Louis

Hello, I would like insurance for LapBand surgery but if I inquire about it to the insurance agent then I am labeled as having a pre-existing condition & my premium skyrockets to the point where I'd be better off just paying for it out of pocket. I am self employed. Who can I get insurance from? How do I know if they will cover this without asking about it specifically? If I cannot obtain insurance then is there a place to go where I can obtain a loan with a reasonable interest rate? Thank You!

Hi, I have the Blue Cross/Blue Shield Federal Employees Plan. The center I am going with submitted all my paperwork documenting my BMI (38) and health history (high cholesterol) for insurance approval. After 4 weeks, the insurance wrote back and didn't approve or disapprove but asked for a psychological evaluation to be submitted. Why would they do this? Is this a good sign that once I "pass" this, they will approve? Has anyone else had this situation? What are they looking for exactly? Thanks so much ! I'm excited but scared

Hi All!! Just had to drop in to say that I got my approval letter from Cigna today!! I didn't necessarily want to sign in just to say that, but I did want to say to all of you just starting or in the middle or at the point of maybe giving up.... DON'T!!!! Dealing with Cigna was the hardest, most frustrating, pain in the butt I've ever had to experience but I didn't and WOULD NOT, give up. Keep calling these insurance companies, go for what you really want... Don't let them beat you down because I'm telling you it's all a game with them. They figure if they keep saying no, you'll eventually give up and they don't have to pay for a surgery but those of you th…

I have a second slippage and have to have surgery soon. The only problem is that I can't decide what kind of surgery to have. My doctor told me I could either get the newer band (I can't remember what it's called) that is supposed to have fewer slip issues, an RNY or a sleeve. The sleeve would be his (and my) first choice, but my insurance doesn't cover it. He (and the insurance specialist in his office) seem to think that if they go ahead and do the sleeve and request coverage after the fact that it *should* be approved. I am in no position to pay the $20,000+ that this procedure would cost if insurance didn't pay. Do you think it's worth chancing it? Or would you…

My info was sent to them last thursday. when should I call t check up and what do I ask. TIA!!!

I finally got in to have my Psyc. eval. I told him about the weight loss surgery...why I wanted to have it....told him a couple of my fat girl stories(I've been heavy all my life so I have ALOT of them). All said and done he tells me to come back next week. :tea: I thought it just took one visit. Am I going to have to see him for a month or so just to get the ok? Or does he see something else??? Please let me know what the normal timeframe is to get the ok. Thanks!!!

My surgeons office submitted my preapproval request two days ago. I keep getting on the uhc website, myuhc.com, to see if it will show me they are looking at it or have even received it and am not able to find anything. I am not very familiar with that site and want to know what section I should be looking in. Maybe I am missing it?

I finally finish my long 6 month diet jump through those super big hoops in all hopes that my journey will soon be over. After leaving numerous messages with the bariatric coordinator, I call her today and she answers the phone!! Wow!! I say what do we need to do to get this stuff sent to Bc and she said well and was flustered and fumbling and I started to worry. She said we still need documentation from 2004 about your weight, I did not go to the doc in 2004. She said you better start digging or find some 2003 and 2002. Great idea, but considering I was on a power Atkins diet I was not obese in those years to qualify. I am thinking I will just pack on some pounds for th…

I am trying not to stress right now but I have to come up with a 24 month weight history. The only thing I have is only 16 months old. I have tried hopitals and doctor offices but all there records are from 01-02 and my weight was not high enough then. I only got above 40 in about 05. The doctor office said I could write a letter about my past weight, but I don't know where to start. Does anyone hava sample letter or a letter they wrote? Iam just not a writer and don't know what to put or how to start. Any Advice??

So im starting to get close to the end and thinking about every possible thing that could go wrong....yes, bad attitude, i know, but im just trying to be prepared for anything. I have Cigna and was required to do the 6 month pre op appointments. I am in my 5th month right now, but when I look back over my dates of my visits I wonder if this will be a problem. My first appointment was Feb. 1st. Ive been trying to go at the beginning of every month but this month I ended up going on the 2nd (counting as my 5th month appointment) and am going again on the 30th (counting as my 6 month appt). Do any of you know whether my insurance will consider the dates too close togethe…

Just got off the phone with my insurance company and I am feeling down in the dumps now. They told me that under no circumstance would they ever cover wls of any kind. It is considered a medical exclusion and no amount of appealing would get them to change their mind. I called my dr's office to cancel my consultation but the receptionist wouldn't let me, she said that sometimes insurance companies change their tune when they're on the phone with the doctor. I am hoping. I asked her how much the surgery cost in case I decided to finance it and she said 20k. Ekk, thats more than my car and its more than a year at my college. So I don't know what to do if my doc can't…

HELLO EVERYONE I HAVE JUST STARTED MY JOURNEY AND ITS BEEN OK SO FAR:rolleyes2:. I JUST HAVE A QUESTION I AM FROM THE BRONX AND I HAVE 1199 FOR INSURANCE. JUST WANTED TO KNOW IF ANY ONE IS HAVING PROBLEMS WITH THEM. I WAS TOLD BY THE HOSPITAL I MUST KEEP ON TOP OF THEM BECAUSE THEY ARE SO SLOW. ALSO I AM GOING FOR MY PSYCHOLOGICAL EVALUATION AND MY NUTRITION EVALUATION AND I WAS TOLD THERE WOULD BE AN OUT OF POCKET EXPENSE. I DONT MIND BUT DOES ANY ONE KNOW HOW MUCH? IF ALL GOES WELL I COULD BE BANDED BY THANKSGIVING AND I WOULD GIVE THANKS:thumbup:

I found a group that I used called H.B.C. they id all the work for me. They worked with the ins. company they had a diet person and a mental health person. I don't think they have a website but there based in Dallas, TX and they have another office in Houston. I spoke to Andrea @ 972-487-2407 in the H.B.C. program.

My best friend called my doctor’s office today to ask about the authorization and was told that GPA, which I guess is the provider, wants receipts! I don’t have any from twenty years ago, or even fifteen, which is when I went to Gloria Marshall. And they want literature from Cedars, which is where I’m requesting to be sent. And of course, I can’t prove that I went to Overeaters Anonymous. So now what?! I’m so frustrated I don’t know what to do. My friend says it’s just a loophole, and something to discourage me from pushing. My sister said it’s because they don’t want to pay for it. Whatever the reason, I’m not happy, and I feel like I don’t have the right to be on thi…

I called cigna, got all of their new requirements. I have been 260 for 2 years which is slight more that 40% BMI for my 5'7 1/2" ht. I have to show that I have been this weight for 24 months. I ordered all the medical records and the only one I have that is from 18 months ago (I need to finish the 6 month dr supervised weight loss -- I actually did this last year - for 5 months so I *know* it won't count). It says I was 256 AND 5'8" which means I am 39% BMI! The other drs didn't even measure how tall I am. I have slightly elevated bp but not enough (according to cigna). Grrrr. I am in NYC so I would probably go to Fielding. Should I make an apt to discuss this wit…

I'm in the last month of my 6 month supervised thing with my primary care physician (PCP). I've already sent all of the paperwork to my Bariatric people, and I'm awaiting my first consult with them. Here's my question: How does this work from now? :unsure:Do I ask my PCP to give me all of the records from my 6 month visits or does the insurance contact them and get the records from them on their own? He has written me a letter of recomendation, stating that he has supervised me for the 6 months, but do they need the records of that too? If anyone has any experience, please help! BTW, I have HUMANA Insurance.:thumbup:

Hi, I would appreciate hearing from people who had banding surgery in the DC area, who are BCBS Federal Plan Standard Option members. Any and all information you can give me will be useful. Stuff like: what was your BMI before surgery, did you have any comorbidities, what was the approval process like, did they require the 6-month supervised weight loss program, who did you choose for your surgery, was it in-network, how much did you end up paying out of pocket, would you recommend your doctor, etc. I have a BMI of 35-36, have several comorbidities including sleep apnea, high cholesterol, depression, etc, and I'm looking into the surgery. I went to a seminar but it turned…

HI I have BCBS of MN I have done everything they asked. I did the 6 month diet with my last appointment being on the 16th of this month. I have a BMI of 43.. It started at 41 but I gained a few pounds because during this past 6 months my dad died and life has been very very hard. I was told not to loose any weight or I would be denied. Anyways So now its getting close to the day to file and I am sooo stressed. I am worried that I will be denied even though I did all I was supposed to do. So I want to hear from others that may have done all they were supposed to then were denied. Right now I am in the dark because my Doctor I am using is HORRIBLE and the people in his offi…

So... I got my referral, then my approval and then a surgery date. I was going to be the first tricare lapband patient at the hospital. I went for my pre-op today and a bomb was dropped on me. Apparently the hospital checked with tricare and found out how little they would pay and have decided not to take my insurance. Both the hospital and the doctor accept Tricare... but have decided not to take it for the lapband. I feel a bit betrayed, by the hospital... but I do understand since apparently Tricare would only pay about $850 over the cost of the lapband. But, I wish they would have figured this out a few months ago before they led me along. So, I am now shoppi…

I have Aetna POS insurance and it covers 90% for the lap-band surgery. Well, someone mentioned to me that though the surgery is covered, you have to go through 6 months of recorded weight loss attempts with your doctor. Well, I know that I have some record with my doctor and I want to get a jump start on exactly what I will need. No one will tell me. In 2005 I had my twins, so I don't have a record for 2004 and 2005. My first consult isn't until June 25th, but if I need to start seeing my doctor before that I want to get going on it. Please, please, please give me feedback. I'd like to get a jump if I can. I am 36 years old, 243 pounds, 5 feet 7. I also previousl…

I work for Farmers Insurance and had my surgeons office submit the preapproval request yesterday to UHC Choice. The surgery IS covered on the policy and I have previously spoken with the reps and they gave me the specifics about the policy. That you must be over 21, a BMI over 40, you must have it done in a hospital and "you have documentation from a Physician of a diagnosis of morbid obesity for a minimum of five years" I am 25, my BMI is 44.9, I am more than happy to go to a hospital but I have had fluctuations in my weight. Five years ago I was about 218, then went on phenteramine and got to 165 by December. Than slowly began the process of gaining it all b…

Question for the group..... I am changing to Oxford PPO Freedom plan as of July 1st...According to a friend they cover the procedure with no precertification or referrals required....How long should I wait to call the doctor to schedule my first visit....I'm thinking 9am :cursing:

I just found out last week that my hubby work is switching to Oxford from Health net as of Jan 1, I wanted to know from anyone how oxford is regarding approval of the surgery? I am nervous that I might have to do teh 6 mounth diet over!! I just about finished with it and my dh is finished with his just waiting for me so that we can do the surgery together. any help with this will be great. thanks:help:

After reading quite a few of the threads on this board I see that there is a BMI requirement and/or co-morbidities needed to get approval from your insurance. I don't think I'll qualify. I haven't called yet but plan to on Monday. Anyone pay completely out of pocket? How much (if I can be so blunt)?

I have Cigna HMO through Verizon. Just wondering if anyone else did and if they had a hard time getting approved for surgery. I have had my psych eval and am scheduled for my nutrition eval this week. Also, I have been seeing my primary care doctor now for 4 months and have two more months to go for my supervised diet. I have 2 co-morbidities and have a BMI to qualify. I am getting very excited about this surgery and don't want to be let down by my insurance company. :confused2:

My plan will cover the band after several conditions are met, one being that you have to have weight histories for the last 5 years and have 4 of those years obese. I do not have any comorbidies but my curent BMI is greater than 40. I had surgery 4.5 years ago and really packed on the pounds (201 to 231 in less than 4 months). My question is, last June I was 231 ish which is not quite a BMI of 40. Within the next few months was over 40. Will they get that technical down to the month when we are talking four years? Also, I'm a teacher and actually work out in the summer. If I lose weight (which I would like to in preperation for surgery) and fall below 240 before my…

Hi. I'm Dee and I am sort of new here. Today was my very first appointment with True Results in Richardson, Texas. I live in McKinney and work in Plano. The good news is my insurance will pay for the lapband, if I prove I can't diet lol. The bad news was BCBS requires I go to a "certified blue hospital" to have the surgery. Now I'm back to not having the money to pay the hospital. Seems like BCBS will only pay 50% of the hospital bill now because of this. Has anyone had this experience?? The only hospital they seem to have found with this "certification" is near Denton, about 45 mins away from McKinney. And they, BCBS, expect me to try dieting for 6 months before it will…

Who's you're insurance company and what were their approval requirements for the surgery?

I have to self pay.:thumbup: Do to an unforseen windfall, forturnatly I will be able to do so, but I sure would like to save some of that money if I can. I have a small umbilical hernia. Does anyone know if I could get a discount on the lap band if I have another insurance covered procedure done at the same time? When I had my hyatel hernia fixed I asked the surgeon just before surgery if they could take out my remaining ovary with a cyst on it. He said yes...I signed the papers right there, and they did it all at the same time. Come to find out I saved my insurance money, because they were already paying for a laprascopic procedure, so all that was added bill was the cos…

Hello everyone, any assistance I can get will be greatly appreciated. My doctor (I am overseas) has determined that I am a great candidate for the lapband and they are willing to do the necessary paperwork to try to get me approved through my Aetna insurance. What should I begin to do i.e. I have read some being a 3 or 6 month diet, ask my doctor or diet pills, etc....I am also looking for support as I go through this process hope to get a response soon.

So we finally got switched to our new insurance which is Unicare. I was planning on getting the lapband this spring but I got the shock of my life and found out we are pregnant with our 5th baby. So of course, the lapband is on hold till at least the fall. In the meantime I thought I would see if the new insurance would even cover the surgery. There was nothing in the paperwork so I emailed them and just got this response back: GENERAL MEDICAL EXCLUSIONS: Treatment for obesity or services performed primarily for weight loss or control (including gastric bypass and gastric staplings); but this shall not exclude procedures that are necessary due to a specific …

For those of you with a pre-band BMI between 35-40... Did BCBS FEP require a 3 or 6 month weight loss program before authorization was granted? What conditions do they consider to be co-morbidities? How long did it take to obtain approval? I appreciate your input.