Insurance & Financing

Thanks to BCBS-IL being completely backwards, I will have to drop out of the program. I started the program with a local hospital, and have been going to my six month supervised diet appointments. Well, I got a bill for over $200 yesterday for ONE appointment. When I called the insurance company to ask why I was billed for an office visit, they claimed that they do NOT cover nutritional education unless I have diabetes. So... let me get this straight... THEY require a six month supervised diet, but THEY won't cover it? What the hell? They will cover diabetes, but NOT morbid obesity... which is ironic, really. I suppose in six months when I DO have diabetes, they'll help…

Ok so i got married this weekend and I faxed everything into My husbands heath insurance monday and by some miracle i am already on there today!! Well i have wanted this surgery since i first heard about it and i hear my husbands insurance is one of the best to approve it! (Union Pacific Railroad United Healthcare PPO) My question is... Can i start calling tomorrow to make appointments or should i wait a while since i just got put on?? I want it NOW!!! haha Thanks in advance for all your responses i am totally obsessed with this webcite! :cursing:

has anyone from georgia used medicaid to get the surgery? which one is best peachstate or wellcare insurance? how long did it take? what were the requirements? and where did you get it done? any advice about medicaid users is fine but i am really interested in georgia medicaid advice because it may differ state to state

Well over two weeks (04/2/08) ago I went to my PCP and got the referrel to the Dr. Givens. I went to the Seminar on Monday (05/05/08) and also got lucky and had my first consult with them also that afternoon. While I was sitting in the office I got the bad new, my insurance wont cover anything dealing with weight loss surgery and I don't have $14,000.00 to pay for this surgery. So now I have to appeal to the insurance to prove this is a medical need and not to just look good but for my health. I'm also needing to send a letter to our senator of SC and to the governor of SC. The state of SC has it where the insurance wont pay for this wonderful surgery. I have BlueChoice o…

Anyone ever hear of this? I just followed up with my HR person to find out why UHC has not contacted my surgeon with what documentation is required. She replied back that it has already been approved and a date was selected! WTF??? How can they approve and scheudle without notifying the surgeon or me? I am so confused! They schedueld it for 5/30/08, so now even if I got my psych evaluation and everything else done, I still don't have time to do the 2 week liquids!!! AGGGH!!!!

Here I am again, asking the same questions after denial from Kaiser. I only had Kaiser because they covered the surgery, but their offices are hours from my home. Now I need to shop for insurance again...any ideas?

I started the process year before last. But UHC denied me. And then denied my appeal. So I gave up... :smile2: I am thinking very seriously about findind new insurance. So, I am asking for any help on who to chose and what plan. (I am health insurance illiterate) I would like to find someone to cover this and the premiums not be thru the roof. Any suggestions you can give will be greatly appreciated !!! TIA, Rosanna

My BMI is almost 39 and I was denied with UHC for no co-morbitites. What are my chances of getting approved if I gain the 10 lbs needed to be a BMI of 40. I do not want to gain and then get denied again and be even fatter!!:thumbdown: Anyone who has gained weight after denial please let me know if you were approved. thank you soooooo much:lol:

My surgery is scheduled for May 27th. I am thrilled & would be more excited if I had my final approval from United Health Care. The doctor's office sent in the packet on 5/8 & we haven't heard back yet. They said they would start calling the ins. co. every day, starting this Thurs. I'm very nervous about not hearing in time.:leaving:

TOOK A SNEAK AT 11:31PM 05/17/08 AND I'M APPROVED......I GUESS THE SURGEON'S OFFICE WILL CALL ON MONDAY WITH A SURGERY DATE..........YIPPEE :thumbdown:

Okay, so I've called BC/BS of Western New York a few times this week trying to find out specifically what I needed to do to make sure I start the process correctly so they can't deny me down the road when it's surgery time. The first girl I spoke with told me "oh, you don't have to do anything special, just find the doctor you want to use and then there's some paperwork you have to do". I thought to myself "yea right" So I call again, the second girl tells me that they can't tell me what the requirements are or if my policy covers it. I tell her that according to the policy, it's covered if it's medical necessary. She says "oh, well I don't know how you prove that." V…

I called my insurance this morning to check the status on my file, and they told me a denial letter was sent out this morning. They said it was denied because my 6 month supervised diet was not consecutive. WTH?!?! I KNOW it was. I had doctor office visits along with 1 year of Weight Watchers, which I was told would work as my six months alone. They said I only submitted May 07, June 07, August 07 and December 07. Now I can't get the insurance person to call me back so I can argue, and the lady at the surgeons office(who submitted everything) won't call me back either. I have everything, I kept copies - and I;'m not missing anything!:wink2:

Hellooo Family. I was just wondering who has had an experience with BCBS of Michigian PPO. Are they hard to deal with when it comes to approval??? My bariatric coordinator called me & said she called them for insurance approval for the Lapband for me & they told her they don't do pre-approval, which that is what they told me also. So the coordinator said that they want her to mail in all of my information ( 6 month weigh-ins, physic evaluation, & PCP office notes supporting my failed weight attempts) to them. So what happens when they receive my information?? I am totally confused:confused:!!!

I have been waiting for this day since last November, when I went to my first Lap band appt. I got the letter today from UHC, figured it was just a bill or statement or something. I opened it.....and it said " we are happy to inform you that you are APPROVED for surgery"!!!! I almost came out of my chair!!! I swear, I couldn't wait to tell someone, and my 6 year old son was looking at me like he was frightened, lol. Not only was my surgery approved, but I also found out that it will be covered 100% except for the Nutritionist appts. I prayed about this for so long, knowing I wanted it, just not knowing if it was meant to be. So I just prayed, asking God to take care …

Hello Everyone, I have a question for you. Did anyone have to show proof of previous diet's tried? I told my Dr. which diet's I did in the past and she wrote them in the letter to Aetna but the surgeons office called and asked what diet's I have tried in the past. They didn't see the letter from my Dr. I asked her do I need to provied documentation she said she didn't know she is just the office manager and if I do she will have the nurse call me. Well if I do I don't have any! La Weight Loss went out of business and Jenny Craig was when I was 16. Teen Weight no more was when I was around 14. I did the Zone Diet on EDiets along with Eating for Life on there to. I did We…

I have a referra lfor Dr Reddman in Covington LA but I do not find that the Surgical Center in Slidell onTRICARE list. Has anyone using Tricare used that center? I am so confused. It seems the more I learn the more quetions I have.

I've been trying to find this on the UCH web site for over a month and I finally put the right keywords into the search!! (or maybe they just finally got it on the web site) This will tell you what WLS they cover or don't cover and why, what some of the criteria is for being approved, and lots of other info that might be helpful. I haven't found a direct link, but if you go to https://www.unitedhealthcareonline.com/ and type "bariatric" into the Search box, you'll get a link called "Bariatric Surgery" and clicking on it will bring you to the page. The text is too big to paste here so if you can't find the link the way I describe, PM me and I'll email you the te…

I have a date now fighting to make sure they are going to cover Any advise would help - I have 6+ supervised diet- office visits with my primary bmo over 40 plus high bloodpreasure that is not totaly controled- and pre diabiatic and non smoking- any encourgement or sugestions would help Thanks so much :thumbup:

I am getting different information from different sources. I have UHC Select Choice insurance. I know the lap band is a covered benefit. I'm trying to determine if a 6 month diet and exercise plan is required. When I call, member services tells me the only thing required is a documented diagnosis of morbid obesity. When my surgeon's office calls, they are told a diagnosis, plus a 5 year weight history and a diet and exercise plan are needed, but did not tell them how long of a supervised diet is required. When I talk to my HR person at work, she says a 12 MONTH supervised diet is required! AHHH, I'm about to tear my hair out! What should I do now? I've asked b…

I just got approved and I am supper excited and really scared!!! My surgery is Monday and I really hope I am making the right decission. Thank you everyone for your support thoughout this process!

I am halfway through my 6 month supervised diet with my PCP, required by my insurance, my question is what exactly is the insurance looking for during this period. My belief is that they want me to prove I cannot do it on my own before they will pay for the surgery, so I haven't really been putting much effort into it. Or do they want to see some weight loss to prove I will be successful WITH the lap band. So far I have lost about 15-20lbs. basically because I have given up soda...yeah me!

To receive approved or denied from Cigna??? I've only been waiting almost 10 days but it seems like a lifetime. I was just wondering how long it took others..:biggrin:

Hello to all the fabulous people out there. This is my first post here on this forum. I have been thinking of getting lap band for past 3 months and was even preparing for all the documentations that insurance companies might need to approve me, but today I came to know that my insurance company does not cover this (I should have find out about this first). :thumbup: Anyways, my husband and I have decided to self pay. I have read posts at various places in the forum and trying to compile following 1. List all the doctors in Dallas Area 2. Find out the prices 3. Find out the various packages (hmm I notice comparing by price is not enough as there might be differe…

I started checking into Lap Band surgery in March as I have been overweight since I was about 12 and and now 38. It had been smooth sailing with the referral getting made promptly and getting my nutrition and psych evals and then getting in for the consult with the surgeon! Roadblock came last week when I called my insurance company after them having put me off for two weeks and found out that they denied me, they said is was because my BMI wass over 50 and it was considered investigational. Has anyone else had this happen to them? I have been reading the posts and finally am taking the time to post myself. Please let me know if anyone has any advice. Thanks!:wink2:

Can anyone tell me if Anthem BC/BS has a BMI requirement? Does anyone get approved with a BMI of 32.5 with complicating conditions? I have diabetes, sleep apnea, hypertension, high cholesteral, high triglycerides and leaking heart valves

Clinical Policy Bulletin: Obesity Surgery <DIV class=body id=AdjustableContentLayer>

Does anyone know what aetna's policy on lap band is? I went on their website and got some information but then when I ran a search it said that Aetna is now requiring a complete medical history, you must have had a BMI of over 35 for at least 2 years (2 years ago mine was 33.3) must have a medically supervised diet for 2 years. Anyway, does anyone know what the current requirements are? My hubby just passed 90 days at a new job and our insurace will be effective Jun 1st so i can't call and find out yet. I am currently on Kaiser Cobra and wondering if I shoud just stick with that and try to get them to cover it. Any info/suggestions would be greatly appreciated.

so confused i am in augusta georgia. i am waiting for my medicaid application to be done i just applied for medicaid. how long does the evaluations take? does any state take your medicaid or does it have to be in georgia? does any one know a doc that will accept it in georgia? where do i start after i get my medicaid card? sorry so many questions, but i really need to know!! thanx for all of your replies

BCBS recieved all of my paperwork on April 28. I have called them several times to check my approval status and they say no decision yet. They also tell me that it can take 2 - 6 weeks for approval. Is this normal? I don't know it I can wait 6 weeks, especially after having to do the 6 month supervised diet. Thanks!

:angry_smile:Need any help I can get regarding an appeal, I was denied because my BMI is >38 with no serious co mobities that I am taking meds for. Need some help with all you with lots of experience regarding the appeal process and what needs to be done to get it approved. thank you all!!!!:eek::biggrin::mad::thumbup::biggrin::biggrin::confused2::biggrin:

Hi, does anyone have a good example of a predetermination letter that I can use that would cover either the LapBand or the RNY bypass? I go to the Dr on Wed as part of my 6 mo Dr supervised program and I would like to go ahead and have her fill out one so I can submit it to my ins. I have to find out what is covered if anything before I go any further. I am an emotional wreck over this. The more I read about these surgeries the more I want to just throw my hands up in the air and say "FORGET IT"!!!!!! So if you have one and could email it to me I would be most appreciative. gina0922@cfl.rr.com

my consult to see dr. weiner in Frankfurt Germany as approved Monday. I go see him on memorial day since Germans do not celebrate memorial day. Works well for me since my office does close and i won't have to take any time from work to make the 2 hr. drive up to frankfurt. Now they still can deny my surgery, but im feeling pretty positive they won't. Im really really excited.:frown:

Self pay HOW MUCH is it all together??? For the surgery, the person you knocks you out, etc. I live in Ft Myers FL if that helps Amy

I am just starting to look at having the lapband surgery and have Kaiser insurance. Can someone tell me what the process is to have it approved by Kaiser? I'll just pay for it myself if it's too lengthy but thought maybe there are some shortcuts you might be able to tell me about.

Does anyone else have UHC Select EPO coverage? I know that it is a covered benefit, and at 100% which is awesome. But I'm getting conflicting info about the pre-requirements. When I call, they say the only thing needed is a documented weight history. When the surgeons office got the pre-approval, it vaguley mentioned supervised diet, but did not give specifics of how long and how to document it. I'm totally confused now.... The surgeon's office is going to call again next week to reverify and I have contacted by HR person and am waiting to hear back. Just wondering if anyone else has had a similar experience. I really wish the insurance companies would make this …

:cursing: I was scheduled to have my first consultation w/ my surgeon on Tuesday, but on Saturday I got a denial letter from my BC/BS of Iowa. I called the Bariatric Center and spoke w/ the nurse. She suggested I fill out the appeal (which was included w/ the denial letter), and maybe talk to my doctor to see if she would have any suggestions. Does any one have an appeal letter that worked? I really need this surgery....I feel like I don't have any other options. I have struggled for many years......but up and down. I am again working on my weight loss on my own. I will give it all I have. Please help me if you can. Thanks. :redface:

Hello everyone... Well I am FINALLY finished with all the steps needed to get my referral for surgery in. My surgeon's office submitted everything on the 2nd. When I look it up online, it says "IN-PROCESS" where I assume the approval/denial would go. I got a letter the other day saying that Tricare is requesting an H. Pylori test to be done before they make their decision. Has anyone else run into this? Seems like the first time I've heard of that (and of course it would be me) :tongue:

Hello, I was told it is harder to get approved in Illinois for LapBand surgery than any other state. Has anyone run into this problem that lives in Illinois? Also what insurance did you have? I have Aetna Open Access II I know they are hard to begin with but are they even harder in Illinois?

I know this can be a difficult question to answer but I also know a lot of ya'll have gone through the process. But I have UHC insurance and they do cover lap band and I know because I have called and I have to have 2 conditions with a bmi between 35-35.9 and 40 and over no conditions. But my BMI was about 37.82 and I have BP and I went for a test for sleep apnea but do not have it. But the doc at the consult put down I have swelling of the ankles, swelling of the legs, hip pain, back pain, shortness of breath and he also put down I have a family history of heart problems which are all true. But I am worried since this is documented from my pcp that I will have issues. …

:confused2:Hi! I got a call yesterday afternoon from the medical management lady who is on my case and she said she would be calling me by 5pmest to let me know if i have eben approved. If you could please say a little prayer for me for an approval that would me a lot to me. I don't think I have ever wanted something more than this!!! PLEASE APPROVE ME!!!! XOX Barbie

I have posted this on my blogs but I am so curious about being approved for WLS. My current insurance is some sort of cheap Cigna plan which there are very expensive co-pays, deductibles for labs PLUS 10% on top of the co-pay and a few exclusions (WLS of course is one of them) I never heard of any Cigna plan having a co-pay AND a deductible for an office visit but that's what there is because my husband has been working for this tight wad employer for 19 years now. FINALLY (yippeee) my husband has accepted a job for a great employer who really pulls no stops at making sure their employees are happy. My husband accepted the job and he starts on June 1. The insurance we …

:thumbup: I SWEAR I AM ABOUT TO PULL MY HAIR OUT....FIRST MY DOCTORS OFFICE MESSED UP ON MY FIRST REQUEST....THEY TRIED TO SEND IT AGAIN....BUT FOR TWO WEEKS MY UHC INSURANCE KEPT TELLING MY THE SECOND REQUEST WAS STILL PENDING STILL PENDING AND STILL PENDING....WELL TODAY THEY THAT CAUSE THE FIRST ONE WAS DENIED THAT THIS SECOND REQUEST WAS CANCELLED AND I HAVE TO START AND APPEAL....:blink:AND I WAS LIKE WHAT:scared2::cursing:FOR TWO WEEKS I BEEN CALLING AND YOU COULD HAVE TOLD ME TO START AN APPEAL BUT YOU NOW TELL ME TO START IT WHEN IT COULD HAVE BEEN DONE ALREADY!!!! SO THIS IS WHERE I NEED SOME HELP....IF ANYONE HAS HAD THE RUN-AROUND WITH UHC AND HAD TO DO AN APPE…

Hi All.... I'm new to the board. I was wondering if anyone had a 800 number for Cigna that isn't the recording? There's a number out there somewhere that goes directly to the authorization department but I can't find it.

Does anyone know how much the band itsef costs?(ballpark figure) My hospital has overcharged before, but since its a preferred provider, I have to go there. They charged me approx $9,000 for the band itself, the insurance co said only about $3700 would they pay, and I have to pay 30% of that amount....whereas I think the hospital just charges so much so they can get my $1200 AND the ins co $$ $3770. Does anyone have any answers or have they had the same problems?

Does any one know if there is an independent insurance that covers lapband. I have insurance with my company but it does not cover lapband or any other stomach surgery. Is there any place that does financing? Ginger

Hi everyone.....I am writing this entry with tears in my eyes because after almost 7 months of doing EVERYTHING I was told to do, I found out today that I was denied for surgery due to an exclusion my employer has on my policy regarding weight loss surgery! Now, I am a little confused because I have never received anything from my employer with a list of excluded services. I wonder what else is hidden that they are not telling me about? When I first started this journey, I called BC/BS of NJ and asked not one, but three representatives if bariatric surgery would be a covered item under my plan and ALL 3 of this num-nuts told me "Yes, as long as it can be deemed medical…

Anyone know of an insurance in Florida I can buy to get Lapband coverage. My husband and I currently are covered by 2 insurance that do not cover this. We have Cigna and BCBS of Florida. What luck huh! I am thinking of canceling both of these policies to get one that will cover what we need. We both are canidates for the band. Buying insurance has to be less then paying for 2 surgeries! Any ideas???? Kyrasma

So, I have done everything I can and it has been up to my doctor's staff to get the authorization. Unfortunately the day after my appointment, the lady that takes care of submitting items to the insurance company went on vacation for a week. She said she was going to try to have everything ready for her assistant to send to the insurance company while she was gone, but she didn't finish the cover letter. So, my file set on he desk for the week she was gone. She got back on Friday, but when I called her she told me that I was number 5 on her list of people to finish and she probably wouldn't get to me until Monday. Since I am tricare, she told me that we would probably …

ok so i did my first consult today, and they said that I would be a good candidate for the Lap band. Just gotta get an EKG, blood work, and then wait for the insurance results. i had been so nervous about my first visit that i was actually loosing sleep. I have no idea why! It was awesome. love the place, great people. I can't wait to get this show on the road!!

I have an appointment for the psych consult next week for the Lap Band. I'm currently on a 6 month plan with my insurance company where I meet with a health coach by phone (I'm actually enjoying those meetings). The psychiatrist told me that he will be giving me a weight loss plan to follow also. Can they do that? I thought they just needed to qualify us for surgery.