Insurance & Financing

Hello all! I have Oxford insurance and WOW! I just got my surgery date Friday and the surgery coordinator just called me (10:30 AM) to tell me I was approved! :wink2: No supervised diet, and all I have to pay is $250 for the entire surgery and one night in the hospital!

I am new to this forum and am thrilled that I found it. I just found out a couple of days ago that Tricare will cover lap band and am thrilled but don't think I will qualify. I am hoping maybe you guys can give me some guidance based on your experiences. I am 5'5 and 100 pounds overweight. My concern is the co-morbidities that Tricare requires. I already had asthma but now it is worse. I can actually be doing something and catch myself gasping for air. I can't speak more than 10 words without losing my breath. My husband tells me I snore (loudly) which I never did before. I have woken up catching myself trying to catch my breath. I have knee pain and it kills my feet to w…

I have UHC which covers Lap Band and I have decided without a doubt I want this and I went to the seminar and I went to the doctors consultation and he said I would be a good canidate as I have a BMI of about 38 and I have high blood pressure and he listed other things like back pain, ankle swelling, etc. I also have a sleep study coming up tomorrow and I am confident I have sleep apnea and I will use that in case the insurance company denies me. The require two comorbilities. But my problem is that the insurance lady at the doctors office said she had everything and would submit it 3 weeks ago and I have called my insurance company a few times and they say they dont s…

I wanted to say thank you to everyone on this forum. :confused::laugh::tt1::laugh:I have UHC Choice Plus, my paperwork was submitted on Apr. 8 and was approved on the 17th. I just received my official approval letter in the mail today. :rolleyes2: So we'll see how long it takes the surgeons office to call me to setup my surgery date. This forum was very helpful to me!!! I just lucked up on it one late night doing a search on the LB. Those who are still trying to get approved....KEEP AT IT, DON'T GIVE UP!!!! :cry_smile:

I'm going to be self-pay, and am wondering what kind of "extras" to expect. I've been quoted $15k by True Results, which includes after-care of 10 fills or 2 years (whichever happens first). I know I have to pay fo rmy pre-op tests and stuff, but I'm concerned that there may be other expenses. Also, how likely is it that I will need more than 10 fills? Thanks, Marianne

WooHoo, Cigna has approved me on my first try. My paperwork was submitted on a monday and it was approved 10 days later. I was very careful about making sure I had exactly what they needed and I think that's what sped things along. I really was expecting a hassle but was pleasantly suprised.:redface:

Has anyone had any experience with health plus hmo of michigan....any feed back would be helpful thank you

i am new here and wanting to know if i get individual insurance will it cover the surgery? i am looking at either aetna or uhc, i'm not sure what plan to get but my job doesn't offer any group insurance. has anyone been thru this type of situation? please help as i am desperate to find a way to get this surgery. i am only 24 and not that familar with insurance so this question may be a little silly but, do you pay for your deductable ahead of time or is it billed to you? thanx please write back

For more information about BLIS, Inc., and the BLISCare program, please visit BLIS - Improving Access to Weight Loss Surgery. The cash price patients pay when their surgeons participate in BLISCare includes something virtually unprecedented: additional medical care. Increasing Surgical Access Novel Solutions to Old Cash-Pay Problems by Nikki Johnson Obesity Help http://www.bliscompany.com/patientfinance/BLIS%20in%20Bariatrics%20Today%20Nov%2007.pdf

After being denied twice, I received the letter today from Cigna saying that they have approved my surgery! I can't believe it! I should have my surgery date on Monday!

that I have a $2,500 deductible. The lady at BCBS said that that would be the most I'd have to pay out of pocket, but now I'm worried that I'll have to pay that all at once and that would be tough right now. I've got a voicemail into the surgery center to see how that deductible can be paid....monthly...or what?

I have BCBS of NC and haven't started that process as of yet, but wondered how much, on average, you had to pay out of pocket to cover co-pays and what not?

I was denied yesterday by Tri-Care. I'm so disappointed. Has anyone else out there been denied by Tri-Care and then approved on appeal? The doctor is of course appealing it, but I just don't think it's going to happen now. So I'm not getting my hopes up. :huh2:

I just HATE BC/BS of IL!!! :smile: I just spoke to my doctor and found out my sleep study results came back as mild apnea. I guess this is good news, even though I am probably going to have to pay for the test. I told him I got a letter from them stating one of the prerequisites is a 6 month diet. He told me even after the diet, they may deny me..jumping through all theri hoops is not a guarantee. I talked to him about my need for hernia surgery (he was planning on fixing my incarcerated hernia at the same time) I asked him if we can put the lapband into insurance as a procedure secondary to the hernia repair (assuming, of course, they:scared2: consider a hernia r…

Hello, I went to my suregon's office on Firday and he said it is hard to get approved in Illinois? Is this true? I have Aetan POS II and wanted to find out if anyone had a hard time getting approved.

Banded 4/8. Self pay. Paid $400 up front fee, then $12.5K for rest which includes 2 yrs. fills. Was reassured this was total cost by several staff of Dr. office. Yesterday, rec. bill for $4,000. for surgical services due..in 7 days. Sure, I have bags of $ sitting around. WTF?:w00t::huh2:... Am boiling inside. Will be calling office first thing tomorrow am....and asking is this some kind of a joke... if so, not really very funny. Has this happened to anyone else? I have previously given my Dr. and his staff high praise.

I'm pessimistic, but I'm going thru the process...... anybody have any luck out there?

I was told by Health Alliance I had to do a 6 month pre-op diet but then found out I would need to have co-mobitities since I am only at a 38.4 BMI. I then read the policy and said that I had to have done a six month Dr supervised diet within the last 3 years so I asked the Dr for my records and it does show that I was at 255 lbs back in oct 95 and I did do a diet with him for longer than 6 months , so my question is..........do you think they will use my BMI at that starting point? They do not require co-morbids with BMI over 40 and am hoping they will use those numbers. What does anybody out there think?:drool:

Ok, so I thought that I was in for a fight to get this thing approved. However, as I was leisurely checking my cell phone messages this morning from yesterday, I found a message from the weight loss surgical center saying that my surgery has been approved! I couldn't believe it...my first appointment was just on Monday, the 22nd. I think that when you are waiting for something that you want so bad, you can't really believe that it will happen. Anyway, my heart goes out to those that are still waiting...keep strong and don't give up. FYI...I have a BMI of 39.7, REALLY high blood pressure, and my insurance company is BCBS-Blue Care in KCMO. :thumbup: Nuali

I have tricare and I do meet the requirements for the procedure my only problem is I can't get my doctor to refer me, he is in the mindset that surgery isn't an option and that diet and exercise will fix everything, even after being on several diet and nutrition programs and countless gyms. I don't know if I should ask for a new PCM who understands where I am coming from or what. I am so lost as to what to do now.

<p>my insurance company ( aetna choice ppo II) requires you to have proof that you have been 40+ bmi for at least five years. i have been for over five years but being that i was never really sick and didn't have insurance till three years ago i never went to the doctor. so i dont have the documentation to prove this. i just now got a pcp. what should i do?? will they not cover me because if this?</p>

I have Health Alliance and last year I asked my doctor about the Lap Band and the first words out of her mouth was they don't cover that and you don't weight enough for the other one. Then sent me to an over weight dietician. I have been on Weight Watchers for 2 years and have lost and gain the same weight. I live in Bloomington Illinois, does any one know a doctor here that supports the Lap band? Help. cyndi

Has anyone had this problem and been successful in getting the insurance company to overturn their decision? I had my lap-band surgery pre-approved and had the procedure done on March 3rd of this year. I will be ready for my first fill on April 22 and have an appointment all set. When my doctor's office called the insurance company (Unicare), their pre-certification people said adjustments/fills are not covered!!! Say what????? I don't get it.... you can approve the surgery, but then leave me hanging there? I sort of feel like what if I were a patient having breast reconstruction following a mastectomy.... have you seen some of those surgeries? Sometimes they pu…

This is my first real post on this forum, although I have been lurking for some time now. I cannot believe how fast the process has gone. On 4/18 I met with my surgeon and attended his seminar. Last week on Monday, my primary completed my letter to Highmark BCBS stating my need for Lap Band and the 6 month nutrition program I completed under his care. On Thursday, I met with the nutritionist. On Friday, I met with the psychiatrist. Today at 10a, I received a call from my surgeon's office letting me know they were faxing all the info to Highmark and that they would let me know if I was approved within 72 hours. I heard back that I was approved THREE (3) HOURS LATER!! My su…

Has anyone every got approval from this insurance company(BCBS-Il)???? If so, what was on your claim???Because, I have yet to see anyone approved...I have BCBS-IL and I am a little afraid they will not approve me:mad:

Hi Margo, I tried to post this to the group, but since I'm new, I'm not sure if I did it right, or if you'll see it, so I decided to email you. This is such important info for you (I feel:). I also have Cigna and was under a 40 BMI with some co-morbidities that I thought would qualify me. However, Cigna decided that since I was responding to my meds, I shouldn't qualify. However, thanks to a free-to-us advocacy service, that the manufacturer of the Lap Bands pays for, the attorneys there dealt directly with Cigna after I was denied and after another denial (expected), I was approved!! Cigna is a stinker, but these people are my new heroes! They've worked with…

I've been approved under Blue Shield and my surgery is end of April. My company is considering switching to Pacific Care (in July). I will have had my surgery, but does anyone think I would have to worry about fills, etc. I think I'll phone my care coordinator. I'm very active in our union and I want a lot of info before the staff meets to discuss. Thanks. Any info is helpful. Gwenn

Hi All, My name is Rose and I live in NC.. I had a bad week and need to vent... I have been doing this journey for over a year and a half now and got everything done and my file summited to the insurance Medical review board on March 20th.. They are still working on it and the time is killing me. They wanted a paper from my Dr stating I quit smoking , that took my Doctors office 3 weeks to write and fax... Geez... Now the insurance company says I did not complete my 6 month diet.. I DID.. They want another month so thank God we are not out of April yet.. They will get their paper Tuesday and then I hope I will be done and approved.. It's been over 30 days... Then las…

So I've been reading and posting for quite awhile now. I even went to the seminar back in march. But I never thought I would get approved for the surgery because of those 3 words..... "Documented Weight History" I haven't been to the doctor in years (I know, very bad) and every forum post I read talks about that in one way or another. To make a long story less long someone from my work told me she was approved without a weight history and so did a few other co-workers. I got the name of their doctor and gave him a call. The office clerk told me to fill out the application online and so I did. A few days passed and I called them because I didn't know what was next, it…

I am looking for what other Dr.'s have wrote to the insurance company to get you approved. My Dr. is unclear as what to write. Can anyone help me? If so please send it to Tazz7722@aol.com

I got the beautiful call today that I am approved for lap band surgery... now i just have to wait for them to call me and give me a pre-op screening date, and a surgery date. I am so impatient I WANT IT NOW

Hi all, I am in my 4th month of the 6 month supervised monitoring. I am at 35.2 BMI. After years (I am 63) of fighting up and down, I know I need to do something that is more likely to work. My doctors office wants everyone to lose up to 20 lbs in this 6 month period. If I lose that, my BMI will fall below the required 35. I know I may not be in the same situation as many but it is still a big problem. I have not been able to maintain weight lose for any period of time on my own. I need this surgery. Has anyone been in my situation and been able to qualify with BCBS? Any tips will be greatly appreciated.

:confused2: I was denied Lap Band surgery and have filed a grievance letter, They wrote back and stated that they had received the grievance letter and would be turned over for review, letter states that case will be reviewed with 30 calender days and with in five working days of review I would revieve a letter upon the determination. BCBS of TN received grievance letter on March 20, 2008, I have called back constantly everyday, today when I called BCBS of TN the lady stated that the Grievance Department had not made a decision. What????????? What should I do? They have already had 30days, and nothing has been decided, when I call the department I just get the answe…

If you have BCBS of Al PEEHIP, how hard was it to get approved and how long did it take? How many hoops did you have to jump through?

I have a BMI of 40 right now, but BCBS put me on a 6 month diet and I am losing very slowly, will they still cover me if I go lower on my BMI? Thanks! :rolleyes2:

Is anyone familiar with medi-cal? Do they pay for the surgery under special circumstances.

I am in the final pre approval stage. I just compleated a month of presurgical diet and excersise instruction and now I'm just waiting on my dotor to write a letter and then everything goes to insurance. (core source (medcost)) I have no idea how hard or easy getting approved will be. I have a hard time even loggin on this site because I don't want to get my hopes up. Does everyone feel this discouraged?:thumbup:

I am in the very beginning stages of this whole process, and want to make sure that I will qualify for the lapband thru my insurance, as with copays and time off this can become costly. I contacted my insurance Amerihealth/Multiplan and it appears that I have met all of the required criteria, but there's one I am still unsure of. This is what is says in my policy: Has documentation of a failed history of medical weight loss. What exactly does this mean? Like some other posts I've seen, I rarely went to my doctor unless I was dog-sick, and any diet and/or excercise plan I have been on I did on my own. Does Medical Weight Loss mean a supervised program? For the times…

I have Aetna PPO and have jumped through all the hoops. My surgeon's office submitted paperwork on 4/15 and I called today to Aetna and I'm approved! Whew! Surgeon had already scheduled me for May 5th with pre-op on May 1st. I have to say this forum has been the best thing for me. I am on several times every day reading the questions, successes, failures, etc. of so many people. It has given me more information than I could have wished for. Thanks and good luck to everyone on this journey!!!

Does anyone know of a good company to finance the coinsurance through? I don't have very good credit, so I am having trouble finding financing. Any help would be appreciated!

I have just hit a snag I didn't see coming. I have completed my 90 day plan and my doctor sent in all my records over a week ago to Aetna. I call Aetna for my statis and I was told it never came. They said it probably was sent to the regular Aetna office and that it would eventually get to them, however, it would dramatically slow down the process. They also suggested asking my doctor to resend my information to a new number. I sure in the long run this is going to work out, however, I want the short run!!! Has anyone ever hit this snag before? Are there any other Lockheed Total Health people out there and what is your experience?

I just got the letter that my PCP sent to the surgeon's office (which was part of the fax to insurance). It said I had been on Jenny Craig (I've been on LA Weightloss for a year) it said I had knee problems I don't have, and said nothing of the pre-diabetic condition. It did include my sleep apnea and my weight loss and the weight gain. I've been with him since 2001 which he included, and he recommended the surgery. I"ve got CIGNA insurance. Should I just sit tight and see what the insurance comes back with, or should I call to correct the problems??? I need help with this one. Anyone out there had an experience like this?:confused2: molly

Hello: Wanted to comment on Aetna. Suprisingly, they have been SUPER responsive and approved me in less than a week. Obviously, one has to have the proper documentation or they will find a way to deny. However, once submitted, they have been agreeable and responsive. It literally only took them 3 days from receipt of all information. PS-I called every day to check status. Perhaps this is part of the trick. Best of luck to all

Hello all. When I went to my GP about a year ago, she presented me with the idea of getting the lap band. At that particular point in time, it was not an option for me. I still felt that getting it was like admitting that I had failed somehow. (So silly!) Obviously, I now see the error of my ways and am researching getting it done. Anyway, my husband seems to remember her saying that if the GP prescribes the procedure, it will be covered (or partially covered) under the Australian Medicare (free healthcare) system. Is this true? I'd love to get some advice from any Aussie members. Thanks!

Just wanted to tell people who have this insurance what I had in my "packet" of stuff. I had my sleep studies in there with notes about sleep apnea. My test results for GERD. My doctor noted 8 months ago that I was overweight and wanted me to go on a 1800 calorie diet. He went on to weigh me every month and did my vitals. He didn't make any other notes. Then last week he dictated two letters for my packet. One saying I am fit enough and I am a good canidate for sugrery. The second letter stated I tried dieting and I had ups and downs and that WLS would help me. Also, included was my results from the psychiatrits visit. Hope this helps anyone with BCBS of Mich…

My mom works for Intel and has united Health care. My dad is looking into having WLS . He is undecided between LB and RNY . I obviously would rather him have the band. But they are unsure if their united health care pays for the band or RNY ? Im too impatient to wait . Does anyone know ? All i know is they have PPO but I know someone else that has UHC PPO and it did NOT pay for the band . Thanks Mindy

Hello all. I have bcbs of michigan & i called & asked them if i could use my Curves & weightwatchers information for my 6 month supervised diet and they said yes!:cool:But the only thing is my first weigh-in was with Curves in May of 2004. Then i got September through December of 04 weigh-ins with them & January through April of 2005 weigh-ins with Weightwatchers. SOOO do that really matters?? I mean as long as it is 6 consecutive months like they require. I might call tommorrow & ask but i have called with so many questions, they probally know me by now:rolleyes2: I just want to get everything together so when i finish my last 2 appointments, all i wa…

My question is have you had surgery at Condell Hospital in Vernon Hills Il? If you have did you have to pay your deductiable upfront?

I am so ready to do this lapband, but the insurance part has me worried -- they said YES, now I have to get "precertified" - Fiser is the company. After which I can have it? Do you know, since I will owe 20% of the costs, if I have to pay that ahead of time? I'm doing Dr. Spiegel in Houston. Thanks so much!

After getting the run-around for several days now from both my surgeon's office AND Tricare, I finally got ahold of someone who knew what was going on. It's not online and I don't have a letter, but I have a case manager who said "I just faxed the APPROVAL to your surgeon's office today". :tongue::w00t::w00t: :redface: It's too late today and I also have to work tonight, but you can bet I'll be on that phone tomorrow asking for a surgery date!!!! (a little background: I am 100lbs+ overweight with arthritis, depression, asthma, and pre-hypertension. We are PCSing in less than 20 days, so that's why there's a huge rush on it!)