Insurance & Financing

Has anyone received Short Term Disability Payment for time off work for this surgery? I'm not sure if they will count it as Elective. My company automatically puts you on FMLA after 3 days and then STD will pay after 7 days if approved. If not approved or I miss 6 days or less of work, I have to take it without pay or as vacation time. One more week until I'm banded!!!

Hi is anyone here an employee of Wells Fargo? They are changing our plans in 2008 to Wells Fargo health plans Silver and Gold, High Deductable and I believe a Healthnet one. I am not sure which plan covers the Lap Band Surgery and was wondering if anyone does. I am on Pacificare but it will be up in Dec. I am just waiting for my CPAP machine as I had sleep study done. But Pacificare does not pay for a Nutricianist. Since I have to pick a new plan by Nov I was hoping someone else might be employed by WFB and know. Thanks all and good to be here. I am sure each and everyone here has some great advice and support. LuAnn

I was banded on 2-18-8 thru Blue Cross on my group insurance. I need to get my own insurance so I applied for individual insurance with Blue Cross since they already know my history. I was denied because I had Lap Band surgery!! They OK'd and paid for the surgery! He told me I have to wait 3 years until I can get individual insurance. I wish I would have known that!! Has anyone had this problem?

Finally after a long weekend, i called them and they said the best two words ive heard in my life, "your approved!" YES! So excited, hopefully i can get in for the surgery soon!

I have Blue Cross Blue Shield PPO insurence through my employer, I pay the most amount for the most coverage. It just kicked in may 18th, I called them to ask if they would cover for this surgery and they said no, but I can file for a appeal process... Has any one been told this and so on? What can I do, or whats happend to you? I have been on a monitored weight loss programe with my family doctor useing Adipex and I lost like a total of 15 pounds since Februrary.. Ive been approved for gastric by the military before but chickend out of the drastic process... I need all the info and help I can get. Also June 6th I attend a King Daughters Med Center in Ashland Ky Lap Band …

My surgery was approved and I was banded on March 31, 2008. So far the insurance company has paid for the anesthesiologist, but not for the surgeon or the hospital. The bill was sent to them quite some time ago. I contacted BCBS and they said the claim was being “processed.” Has anyone had an insurance company approve lap band surgery and then later decide not to cover it? :confused2: I am getting concerned because the hospital said that it usually does not take this long for an insurance company to pay once they send the claim in. Since the surgery, they have only paid for the upper GI and not the fills yet. Thanks.

Have any of you CA Kaiser members out there had your bands done in Mexico/by other US doctors and had Kaiser do your fills or revisions? I have Kaiser (NorCal). I might have to get a port revision but since I'm self-pay with the band I may not be able to afford more money for this second surgery with my private doctor. I'm so worried I won't be able to get this fixed. I've only had the band for 6 mo. and 2 fills.

Hey guys, I am a newbie and I am currently researching the band option to see if it's the right onw for me.... I am currently living in Canada and wanted to know if anyone else is/ I noticed two people from canada and one form Ottawa (me 2!! :-)) and I was simply wondering where you got the surgery done and how much it cost and all that good stuff .... Thanks so much. I am in desperate need of help here EH! ha ha ha Mandy

Hello everyone. I had written in about a month ago and was just so depressed because I found out that my employer opted NOT to cover weight loss surgery in their plan. After taking the advice of the PA at my doctors office, I went to my HR at work. I told her my story and she put me in touch with the broker who signed my work up for the benefits. To make a long story short, they removed the exclusion and now all employees that want this surgery can get it if deemed medically necessary! My paperwork was submitted one week ago and here I am with an approval code and waiting for a surgery date. I just wanted to let you all know that even if you hit a bump in the road, …

I went last night for my "cosmetic" sleep study. I still can't get over the fact the insurance co may not pay for it because they consider it cosmetic (since it's being ordered pre lap band) Darn BC/BS IL. Anyway, I barely slept. I had about a half hour of REM sleep at the end of the night, the rest of the night I just layed there like a log...an awake log :thumbup: The girl who did it would not tell me what the conclusion was (I fully understand, it's against policy, and she is not a doctor) but, the impression she gave me was that it was OK :sad: I was really hoping it would show I had sleep apnea. Furst and foremost..it would really help my chances of getting t…

Well, after searching high and low I have finally found out that Kaiser does cover the lap band surgery. :clap2: My PCP referred me to the bariactric surgery center and I am now waiting for my appointments to start. They set you up for all the necessary stuff like physc evaluations, nutritionalists, etc. According to what I was told by the referral coordinator it will take 4 - 6 weeks for me to get into my first appointment and surgery will be approximately 3 - 6 months out. Now most people would be upset about the time table for surgery but considering I was going to have to change my insurance to CalPERS BC PPO and wait to even get started until after Jan. 2008, I'm…

My file was just sent to insurance for approval!! I am so excited:teeth_smile:

Just wanted to shout hooray! I got a call from Tricare yesterday about my surgery! I was a bit confused because I hadn't gotten a call from my surgeon yet, and the lady from Tricare didn't tell me I had gotten approved. She was saying things like "are you getting excited" "are you ready" things like that and I was totally lost. Then my surgeon called and said that I should come in on the 5th for all my pre-op stuff and he'll give me my surgery date that day, which is usually not more than 2 weeks after pre-op! I'm so excited! So bouncing off the walls!!! The whole process has been less than 2 months! So happy!!! :wink2:

Ok so title says it all. I have a referal and my surgeon's office called and said it looked like I met all requirements for my insurance and everythings going well. I have Tri-Care For Life. How much am I going to have to pay after their coverage? I'm hoping all or 99% or I can't get it. Poor college student, yay!

Hello all- I will be banded at NYU hopefully sometime in September and plan on completing the psych eval. and the nutritionist appointments soon. NYU requires that these are paid out of pocket, but I have read that some of you submitted the receipts afterward to your insurance company and were reimbursed for at least a portion of the cost. I definitely want to do this as these 2 appointments alone is going to set me back about $600 if I don't. Can any of you who have done this tell me how you submitted the paperwork. Also, about how much were you reimbursed....the entire cost? all but the copay?? BTW, I have Cigna. I would really appreciate any help as I am poor …

I am totally kicking myself right now. Next month I will be on BC/BS of Mass. PPO with a $15 co-pay and no co-pay for surgery or hospitalization. Also, no exclusion for WLS. I am like a lot of people who have always struggled with weight. I had no co morbidities so I rarely went to the doctor. I despised going to the doctor because I was too embarrassed to get weighed. That was the real reason. I do have a few trips to the doctor for pap smears (not as much as I should) and for the rare occasion I was actually ill. I dont however have 5 years of being weighed in at least once per year. The last time I went to the doctor was Jan 07 so right there it's been 17 months. I ca…

Hello everyone. This question is not for me, but for a friend. I have already been banded, but my friend has a different insurance company and has been told in the past that they only cover gastric bypass. Has anyone had any success with getting approval in Maryland from Kaiser for lap band? If so, please share your expience with me so I can pass it along to my friend. Thanks, everyone!!!

I made it!! I am done with testing, the insurance has done the "official" approval and I have a date set!! I am sooooo very excited!!! My date is June 27th!!! And i am looking forward to starting a new chapter in my life!!

I will have my band done in Mexico next month. Anyone have info on financing options. I will need to get a loan and was wondering if anyone had ideas on which companies are worth contacting.

:clap2: I am so excited and nervous. My dr's office filed the paperwork with Cigna yesterday, Nov. 16th. I hope to hear from them soon!! It's been a long and hard road. I thought I'd never get to this stage. Now if I can only get my ticker to show up on here. I really like this board and all the people I have chatted with. I only know of one more person in my town I can talk to. Good thing Lynchburg is small, easy to find her. Thanks for the support. Felicia

I have insurance that only covers $7,500 of surgery....so I have to find the cheapest place, but is that the same as self-pay if it's the rate they charge my insurance?

Hi Everyone. I am going thru all of the insurance/surgeon's requirements, and would like to include a letter to the insurance company telling them why I *NEED* this surgery. My BMI is 47 and I have no co-morbities, but I would like to write a letter to illustrate other problems I've had that they do not consider co-morbidities (Amerihealth Insurance). The letter is not necessary, but I would like to think that maybe a personal touch would get me the approval I am hoping for. So have you written a letter? Do you have a copy or website that I could reference? Any and all help would be greatly appreciated. Thanks in Advance. ~Jessenia

does any1 have priority health insurance ? and if so hw long do they usually take to approve for surgery?

This story may prove to be instructive for anyone who manages to have their carrier's denial overturned on external review. I did just that, and was thrilled that Aetna was going to be forced to pay for my band surgery. Everything is scheduled and set--I thought. Last night I get a call from my surgeon's office telling me they'd like to postpone, since they can't seem to reach an agreement with Aetna on the rate for the operation. Aetna's offering a really lowball amount, claiming this is their "contracted amount" for the CPT code assigned. Well, duh, I KNOW they don't even HAVE a "contracted amount" for this procedure, because they don't PAY for this procedure!! So now…

For an exclusion... Does anyone know the first steps? I hope I can find those who have been through this.

Hello! I am new here and I have a PCP appt. tomorrow to talk about the lap band. I have read Cigna's most recently revised requirements for WLS and I am wondering about the BMI of 40 for 24 months "proof." I haven't been great about going to the doctor for check ups since I moved out on my own many years ago. I did go to a weight loss center (Slim4Life) starting in April 2005 and weighed 255 at the time, which would definitely put me past a 40 BMI. But then my weight has gone down and up a lot during that time and I also was pregnant and had a baby. I did go to the doctor, I think, around Nov. 2005 because I felt like crap all of the time. He tried to tell me he…

There seems like there are so many different types of insurances! I was trying to find some people who have Anthem BCBS of Colorado (HMO) to give me some advice and let me know things like their requirements, and surgeons.

I just called Aetna to check on my clain for surgery. They said they called my Dr.'s office yesterday asking for my six month supervised diet. I never did a six month. I only did the three month multi-discplinary surgery one! I paid $1200.00 just to do it. I hate them. I don't know how everyone else has gotten away with only doing three months and they get approved. I don't think this is fair. We all have the same Insurance why do they approve some and not others? Can someone please tell me how they got around the six months? I had my Dr. put down a list of diet's that I did in the past. I never went to my Dr. before to have them supervise my weight loss. I never thought …

My previous insurance, Kaiser, had a secret 'exclusion' that the sales person LIED about when I bought my individual insurance a few months back and specifically ASKED about bariatric surgery, so naturally, when my paperwork came back that was my reason for denial. Some people have told me not to waste my time, how could I fight it when something as simple as "We told her, her insurance doesn't carry that surgery!" OR SHOULD I? HAVE ANY OF YOU ever fought this and won? It's so silly, I can't believe they can treat it like it's something cosmetic...

I know I've posted a million times about Kaiser...but the person I'm technically a 'dependent' under wants to shop around more.... I know Aetna excludes Bariatric Surgery on their Individual plans, does BCBS, United, Cigna or Humana?

I don't know the lingo here so bear with me...My husband's company has PHCS, but on their company profile for what they approve and what they don't, they do not pay to cover WLS, I guess the less the company pays for the less each person pays for insurance?. How do we go about getting a waiver? Does anyone else have experince with this? Joy

My BMI has been 40 for 1 year and my insurance (cigna) requires that it be 40 for 24 months or 35-39 and other complications. I have (documented) "high" blood pressure. I put it in quotes as it was actually in normal range (Diastolic of 90) but then the cut off was revised several years ago and 90 is now high. It has been on and off 90-100. Do you think this counts? I will be working with Fielding and Ren in NYC so I would imagine they are pretty good at working with insurance. TIA!

If an insurance has a $1,500 out of pocket max for you but only covers part of the surgery, how does that work? I'm confused.

Hi...I've posted this before in a different section but was hoping I would have more luck here. I was told to call or go to the website for this information but when I search for it it brings up hospitals, not bariatric facilities, so I am still confused..and the lady on the phone was rude and not helpful.. I am just trying to find my insurance, Anthem Blue Cross Blue Sheilds Colorado HMO so called list of "approved facilities" for bariatric surgery. Any help would be appreciated in helping me find a surgeon they will partially cover as stated in my manual. There are simply too many for me to call personally, and I am willing to travel as well since they only cover $7,…

My insurance will cover the procedure at 50% with a maxium coverage amount of $15000. I am curious if anyone has had a similar type of coverage and what your out of pocket actually turned out to be. My out of pocket maximum for the plan year is $2500, but curious to know what happens when the $15000 maximum coverage for WLS is filled. Also, I am curious to know what the difference has been in costs with those with insurance and those without and why. Thank you in advance! Amy

I live in Pennsylvania, I have Highmark PPO Blue. Over a year ago, I was approved for gastric bypass surgery with a BMI at 41%. I went to the first consultation but decided I didn't want to have that radical of surgery. I am, however, very very interested in the lapband since it is not nearly as invasive. I think I was told at my initial consultation that lapbanding was not currently paid for by insurance companies in PA. Does anyone know if Highmark PPO Blue has changed their tune? I would ask my doctor, but he passed away and I haven't discussed gastric banding with my new doctor.

What if you are a self-pay in the U.S. for the surgery and then you have a complication, like infection or stroke or whatever. Does anyone know if the insurance will cover? I need to call my insurance to clarify this.

yesterday my insurance denied me stated I did not meet the 6 month supervised diet reqiments. Did this happen to any of you and what did you do to fix it?

So...today I found out I get kicked off my insurance on December 31st, 2008. What if something goes wrong or something and my 6 month diet goes a little past 6 months or my pre-op testing does or I can't quite get the surgery in before December. We were told before by the insurance as long as I am living with my mom and she can file for me on taxes then I could be on her insurance. And now they tell me this. WTF. I just have this odd feeling not everything is going to get done before then. I should be having surgery maybe in Oct possibly Nov. But if something extends out and takes a little longer I am afraid I am going to be screwed and went through all of thi…

If any of you have insurance that provides Health Care Advovate services, I advise that you get set up with one. Most BCBS insurances provide this service and is free. You will get assigned to an Advocate that will see your case through to approval. They will also provide advice, answer surgery questions, etc. They will also be able to help you build your case in the best way so thay you get approved and not denied. Many insurances not only want the 6-12 months supervised diet with a doctor, they also want to see that you meet with a nutritionist montly, have a psych evaluation, and meet with an excercise trainer quarterly, plus there may requests for blood work, stre…

Starting June 1st i am going to have BCBS of TX and i am wondering if Lap-Band is covered by the above insurance? i have United Health Care for the mean time and i know that UNC does cover the procedure. I have done some research to see if it covers., i have seen some comments that it does and it doesn't covers i am lost really need to find out. Please help :cursing:

I just found out today that Tricare approved my surgery!!!! I should find out my surgery date in a few days. I'm so excited!!!!!!

I go Monday for my consults, then the insurance papers are filed! I have spent the last few weeks trying to prepare myself, but I am confused as to what to prepare myself for, let down because of insurance denial, or the joy of being accepted. My insurance is Tricare Prime, one of the easiest to be accepted for, but still have my doubts. I spent all day yesterday in my PCM's office getting seen for swelling in my ankles and knees. He is very supportive of me trying to get this surgery and an all around great man, he gave me some pain meds and steriods for the swelling (which I can't take until NEXT Thursday due to allergy testing), BUT anyway, back to my doctor, he sa…

Hello all! I was wondering if anyone has had any experience with Medicare and this surgery. When my doctor suggested the surgery as I boo hoo-ed in her office a few months ago, I said to her through my frustrated tears, "yeah like Medicare would pay for that" and she said well actually they do. I was shocked. Also I called the medical facility where I go to the seminar today, and I asked her - she said over half of the patients that get the surgery there are Medicare... I have seen different things online and heard different things elsewhere about the 6 month supervised diet. I've heard that they do require it, but I've heard more that they don't. C…

Hello Everyone, I need to know if anyone else is having this problem with Aetna. I call the customer service they say my file is assigned to a nurse I call the pre-cert dept and they say it's on hold due to not information. My question is to everyone have you had this happen conflicting stories? Plus the nurse at my Dr.'s office said she doesn't need to submit the three month diet I did with all the notes she said all they need is a summary? Is this true? What did everyone submit? I am so fustrated I could scream. I waited three weeks for the Dr.'s office to submit now you are telling me they didn't get it right? Please someone help! I don't want to get denied because o…

:wink2: I'm so freakin excited I can't stand it!! I just got approved today after 3 long months!! Now I just have to schedule the surgery. So excited I can't stand it!!

I went to my 1st appt with Dr. Enochs office in Cary and found out the lap band cost is about $18,000 - $20,000 plus $1,000 for a years worth of fills. I sure do hope my insurance covers this.

Can someone give me some advice? The doctor's office submitted my medical pre-assessment last fall to the insurance company (Blue Cross Blue Shield Federal Employees Plan). The doctor's office called me around Christmas saying: "Congratulations, you're pre-approved !!" At the time, I didn't get a copy of the letter the insurance sent but I have since gotten a copy after the surgery and it basically just reiterates the medical requirements. It never says I was "approved." So I had the surgery and now afterwards, the procedure has been disapproved twice. Based on the same exact medical information which was sent to the insurance prior to the surgery. I called them a…

Does BCBS of TX PPO (Blue Choice) Covers Lap-Band??? Anyone!! Please help :wink2:

I'm curious to know how many bandsters have Univera and received approval for the LapBand? Thanks!:thumbup: