Insurance & Financing

I live in SC and work for the state. I have BCBS BlueChoice Health plan. I have just started researching the lapband. I have an appt with my family dr on the 28th of April. I have my first seminar on May 5th. I have also called my insurance comany and they said they wont cover this. Does anyone else have this insurance comany and going through the same problem, or can you tell me how to get them to cover this.

it has been about 10 days since my paper work was sent to the ins, so I called the dr.office they said they have up to 30 days to get back to me,has anyone heard of this , and why dont they let you know that up front,??????????

I'm a teacher, and we currently have Oxford. As of July 1st we will be going to BCBS. When I go see the surgeon next week I'll have to make sure that my surgery is in June. I hope that's doable. I don't know what plan we will get with BCBS and I don't want to have to wait 6 months doing preop God knows what b/c Oxford is easy!

I got my letter of denial from Tricare yesterday. Very disappointed. I was wondering if anyone on here had ever appealed with Tricare and if so what was the outcome? Also, I have Tricare Prime, is Tricare Standard easier to get approved with? If it is I'll switch!! Thanks in advance for any info!

I have BC/BS of IL. I called my surgeons office to make a initial appt. they took my insurance info, called back and told me I had "excellent benefits" ... bariatric coverage, no copay, no deductible, no prerequisites, the insurance girl at the office told me she wished she had such good coverage. Now comes the rub... I am still waiting on a preauthorization...the doctors office said they faxed in on Wednesday...they claimed they never got it...she has been trying all day to refax it...been unable to get through. Also..the doctor is sure I have sleep apnea (by my symptoms) he will not do the surgery without a sleep study (btw..I also have a incarcerated hernia he will …

This might be a silly question but will my insurance cover the 6 mo. supervised diet w/ my PCP. If yes do I just pay my co-pay? :confused2:

Well, I turned in everything in the policy required for the lap band, and after 4 weeks I was denied (in Feb). My doctor's office was shocked because I met all requirements. My doctor's office called me this week and said they wanted my permission to send my case to Obesity Law at no expense to me. I was wondering if any of you have had any experience with Obesity Law. I'm just wandering what my chances are that the denial will be overturned. I hate BCBS of IL.

hi i have bcs michigan i live louisana,im trying to find out if they approve lap band,i went to a seminor and been waiting to hear bk.i really hope i get approved my bmi is way over 41,and last yr i had double knee surgery replacement.my hubby works general motors,i hope i wont have to be on a diet a yr to finally get approved?lmk if any one has bsbs michigan and live in louisana?thanks:rolleyes2:

My surgen said that because my bmi is so high, the insurance company may not make me do the 6 month supervise weightloss, I have been seeing my doc every month talking about what I have been doing getting weighted and such just in cause but the surgen said that the insurance companys are finding out that they spend all the money for the supervision and then still spend it for the surgery? Has anyone heard of this?? Also after the new year things were suppose to change making it easier?? I have BC/BS of IL

I just lost my insurance (which is fine) and will be picking out an individual plan. The bariatric surgery option is the number 1 in importance to me. Can someone tell me the company I should go for that offers this surgery with the least trouble as possible? Thanks. (I'm in Colorado, national company preferred)

All - I saw the dietician yesterday - she faxed the paperwork to my doctor this morning and I got the call at 4:00 today saying they got approval from the insurance company. I have Horizon Blue Cross Blue Shield of New Jersey. I had heard that they were quick - Now I am just nervous - I am scheduled for surgery on April 29th after I return for Disney with the family. WOW.......:redface:

My Federal Employees Blue Cross Standard pays for 90% of the Usual and Customary fees - i.e, I pay 10% for the surgeon and the facility. Can anybody out there give me an idea of how that translates to my actual out of pocket costs for each of those items? Just trying to get informed! Thanks alot!!:thumbup:

Hi all, I went through the consult, 6 month diet., meeting with dietision, (sp?) only to be rejected in December 07. In Feb. 08 I met with my Primary Care Phys. to begin the appeal process, he checked my heart, liver, blood, etc....Yes, I have high colesterol and he suggested I pay for the surgery my self. I insisted on the Sleep Apenea test. Well guess what, I've got it and pretty severe. Now, my doc. and the sleep clinic both want to "cure" me by making me sleep with a stupid mask on my face every night!! The sleep clinic isn't on my list of providers either so now I also have a bill from them close to $900. for the 2 sleep studies. (the part my ins. won't cover) My que…

Please don't think I'm trying to spam on here, I just want to help. I know first hand how fustrating it can be when you want the procedure, and get declined by the insurance company. (it happened to me twice last year) If you are thinking of self paying, I may be able to help. I'm a Home Mortgage Consultant for the largest mortgage company in the US. So if you own a home, and are thinking of doing a refinance to take cash out to pay for the procedure... give me a shout, I can help. (even if you think you don't have good credit) You can email me on here if your interested, or even if you just need some financing advise.. I'd like to help. :biggrin:

I called my insurance company, Care First Blue Choice, and they said that they don't cover the lap band surgery. Does anyone know if there is any way to have the doctor appeal this? I haven't met with my surgeon yet, so I'm sure they'll have some ideas, but thought I'd check here first. Thanks!

Unified Group Services? The insurance card also has an HFN 10 logo on it. I am waiting to hear back from them, but also looking for someone else who has used them.

I just called Cigna and was told that my claim was pending. The rep said she was surprised because it usually took longer. My information was faxed on the 10th of April and received on the 12th by them. She said it was very quick that the case was pending. The insurance clerk at the doctor's office faxed over 100 pages. It is looking good! :thumbup:

Anyone have Fallon Community Health Plan in Massachusetts? I am just starting on this path and I just found out my work is changing from Tufts to Fallon on May 1st. I haven't told anyone at my work that I am considering the band and am not ready yet to tell them. I don't have a member number yet so can't call member services (and don't want to raise any unnessessary red flags) Just wondering what they cover (or no). Thanks everyone!!:crying: Meg in Amherst Mass.

My surgeon submitted my paperwork on Tuesday and I was approved yesterday. I was informed by my surgeons office that I would have to them pay $336 in advance, but that the hospital that I will be banded will require that I pay the amount of my insurance's out of pocket expenses up front...$2500. What the *#&$^!!! I am at a loss. I've never heard of this before. A deposit, yes, but my entire yearly out of pocket? Is this common? I've not had an opportunity to speak with anyone in the hospital's billing dept. I will be calling first thing in the morning. Does anyone else have any experience with this? My insurance is with Anthem Blue Cross Blue Shield VA (PPO). Any help…

I just wanted to share my story to give hope to all still waiting... i started my 6 months doctor's visits in october.. I have everything finished and submitted to the insurance company on 3/13... i received a letter of denial on 3/18 stating that the facility wasn't "in network" ... the doctors corrected the paperwork (they accidentally put in the wrong facility) and the paperwork was re-submitted on 3/20. I was then expecting the worst and i HATED the waiting game.. but much to my surprise just a few weeks later on 4/8 i received my letter of approval rom Cigna!! it was so much easier than i anticipated!! So to all who are waiting keep your head up and keep positive.…

have my 1st consultation appt with Dr. Michael Hodge in Johnson City, TN on Feb. 18, 2008...just wondering if anyone has dealt with cariten insurance that could give me a time line or what to expect....? thanks, nay ht:5'4" current wt: 262 current size: 20w-pants 22/2XX-shirts

A while back someone posted the official clinical policy on bariatric surgery for Aetna. It looks like I won't be able to get this surgery with Aetna because my employer excludes it and I will have to switch to one of our United Heathcare policies. So I'd like to find the official policy for UHC. I haven't been able to find it on their web site though. I'm interested in what their policy is for approval and also what their requirements are. I meet the NIH guidelines... BMI over 40 plus 1 co-morbidity. But when I called our UHC hotline, they said they only approve if you are doing it to treat another disease and it wasn't clear if hypertension was one of the ones they …

:confused:i have bcbs of MA. i know it covers the lap band surgery. i have my dr appt set up (may 9th initial consultation ) here is where i am confused. i am hearing a lot of people say you have to wait 6 months.......... i just received my BCBS coverage papers in the mail today ( i requested them ) it says nothing about a 6 month wait. it does say (and i am writing word from word here ) *" ALL ELIGLE PATIENTS WILL BE GIVEN AN AUTHORIZATON LASTING 3 MONTHS . ADDITIONAL 3 MONTH EXTENSIONS REQUIRE DOCUMENTAION OF WEIGHT LOSS OF AT LEAST 4 LBS PER MONTH DURING THE PRECEDING 3 MONTHS . COVERAGE WILL BE DENIED PERM. AFTER 2 FAILURES TO LOSE 12 LBS PER 3 MONTHS OF…

I have Anthem insurance now.:eek: I did have UHC, but my husbands work switched. UHC said it was not coverd.:thumbup: Has anyone had any luck with Anthem Blue Cross and Blue Shield Alliance PPO insurance?

I think I have a good case because I have so many other health issues caused by obesity. They rejected the request pretty quickly however. Should I bother appealing? Has anyone successfully appealed and won?

Hey all, does anyone have any luck with getting approval for a tummy tuck, and breast lift/reduction from Aetna. If so, what hoops did you jump through to get the approval, and what was the time frame from start to surgery date? Thanks so much for your advice, and input.......:biggrin: Debbie:tt2:

Hello I was wondering if anyone had any advice where I could look to find help writing an appeal letter for my insurance to cover the surgery. Thank you for any suggestions you may have for me. I appreciate it!

My Doctor told me I should seek out getting the band done in Dec. Had a consultation with the surgeon on Jan 2. He told me what I needed, had a sheet on what package of records and tests I needed done. Finished everything including my Psych eval by the Feb 5. The surgeon's office called back and said they needed more documentation from my PCP and so they called his office and they sent more. Well that apparently wasn't enough so now they are bouncing back and forth. Now its April 13th and my head is about to explode because the surgeon is waiting on just one letter from my doctor before they send into the insurance company. Now I hear 3 people who had to wait 5 …

I have unicare Illinois and was wondering if the company was likely to approve the lap band. Please help!

I completed all of Cigna's requirements and my surgeon sent the paperwork in on 3/3. He told me that I would get a letter from Cigna telling me they needed more information but just to ignore it. He also told me that if I call Cigna, they will tell me they didn't have any of my paperwork. All of those things happened. Then about 2 weeks later, I found out I was denied due to not showing "co-morbidity - such as a serious cardiopulmonary problem, type 2 diabetes, hypertension, coronary artery disease or pulmonary hypertension -that have failed to respond adequately to appropriate medical management". I didn't know what to do next. The letter said my doctor would need to …

I have blue shield ca- sante physicians group, and was told a 6 month supervised diet is necessary. The insurance company itself did not know what I was talking about. I have a 15 year history of weight loss attempts, have been on weight watchers for 1 year with weight fluctuations, and will submit my 10 year weight history, do I really need to wait another 6 months, my bmi is 47 with no co-morbidities? If i go ahead and submit before my six months is up, can I resubmit after my 6 months medically supervised diet is over? Can anyone guide me please!!!!!

I have not been to My Primary Care Physician in 3 years (putting my career b4 my health). My insurance (UHC) requires 5yr medical history. I want the approval for Lap surgery to go as smooth as possible. Is the fact that I have medical records from 2003 - 2004 going to make me have to wait longer. I read so many blogs about the fast approvals for UHC but I have not seen any that have not been to the Dr in 3 years. I have 47 BMI and 2 obesity issues. :confused2:Help!!!

I went to the free seminar and setup an appointment. I already knew my insurance company covered it but I didn't know all of the requirements. I called this morning to find out the only requirements are "medical necessity". I asked if there was anything else then they said no. She told me to be completely sure I should talk to their "care now coordination" (uhc) and so I did. The lady said she didn't know for my plan specifically but for all of uhc there is a 5 year medical history needed. That of course got me discouraged. Since I havent been to the doctor in years with the exception of for the dermatologist and my weight has never been recorded. What should I do? Y…

Just got off the phone with UHC....the guy on the end of the phone sounded like he had no clue. He said that it was not covered. I gave him the CPT code, he said it was not covered. So many of you have UHC...I was really suprised. He said to call my HR manager...but it is my DH job, and I don't want to talk to anyone up there if I can avoid it. Any suggestions? Should I just keep calling, or is NO a NO?:lost1.5lbs:

I just got approved by Tricare for my surgery==WooHoo!!== However, I will not have Tricare Standard as my primary insurance for long, as I have to go on Medicare on June 6 :sad_smile: as I'm on disability now. I know Medicare requires the surgery be performed at a "Center of Excellence", but does anyone know if they require the fills be done at one too? I hope not, because the nearest one is about 100 miles away.:scared2:

I just spoke with my bariatric coordinator. She has my PCP records and was concerned about my "6 months" of medically approved diet. Although I went to the doctor monthly (with minor exception) for the required 6 months, there was one month that I didn't make it within the 30 days since last appointmen. That was due to scheduling conflicts, etc. and I got in as soon as scheduling allowed. I guess we'll see what happens. I can go back 15 years documenting my weight and comorbidities, but I'm half way expecting them to deny and make me do it all over again. But that would have been my fault. I find it interesting that my insurance will pay 80% for 3 seperate treatme…

I am thinking about taking a loan from my 401k instead of waiting so long and possibly not getting approved by my insurance company. It is like I have the devil on one side saying do it and the angel on the other side saying wait; good things come to those that wait. I just don't know. Should I also talk to my surgeon about this and find out what the total cost will be.

Okay.... I started my 6 months of supervised diets at the end of October (1st WL visit) . I went the end of November (2nd WL visit), end of December(3), beginning of February(4), beginning of March (5) and will go in a few days April (6). Each time I go the next appointment gets put back a little more than a month, more like a month and 5 or so days. At my last appointment my PA said I only had one more visit. I though I had 2 left, one at the beginning of my 6th month (April) and then another at the END of the 6th month. So, my question is... on the six month supervised diet do peole usually just go at the beginning of the six months or do they have to go at the end of t…

My surgeons office said they can supervise my 6 month diet. I was under the impression that my pcp had to do the superviving. Should I go ahead and schedule an appt. w/ my pcp anyways ea month? I'm in my second mo now. I'm not even being weighed ea mo. One mo I see dietician, one mo psych eval, then weight counselor, finally surgeon. I was weighed at first appt. then again will be the last month. What role should my pcp play. I have BCBS of Ala. Thanks

We are geting read to submit to insurance anyone have any luck with Lumenous BC/BS PPO. I am in ohio surgery is in Michigan.

i have ameragroup were in TN can i find a docter for lapband im near clarksville TN thanks sunshine169p

Newbie, just signed up for seminar at Barix Clinic in Langhorne Pa. (04/23/08). Just wondering how hard is Keystone East to deal with to get approved? Any do's and don't's with this insurance? Age 57 BWI 43.1

I thought I would take a shot in the dark to see if anyone has this insurance and if they got approved....I'm still waiting for the final ok.

I received a letter from my surgeon telling me that the next step is to get a psyciatric evaluation along with names of five doctors. I called to set up an appointment with one which will include an hour appointment and then she will submit a written report to my doctor. The charge will be $400 out-of-pocket. I called my insurance and they said they will most likely not cover it because the psycs that don't accept insurance billing normally haven't gone through the steps to be accepted by insurances. I call the surgeon's office and ask if I could chose someone closer to home and was told I could but they had to be board certified and have a PhD. I was unable to fin…

Cigna has denied me for the second time. They denied me the first time because they said they didn't receive the nutrition eval consult. Now they have the eval and they have denied me again because they want another letter from the dietician. (The RD is working on the letter). I think they are just knit picking to try and get out of paying. Has anyone else had this happen? I am not sure what to do now.

My insurance does cover the surgery. But, they require documentation that more conventional methods haven't worked. First, if more conventional methods did work, then I wouldn't be in this situation. Second, I haven't been on a doctor guided plan per say because all my doctor has said is that I need to lose the weight and has given me copies of diets. But, he hasn't followed me through them. They will also accept something structured like Weight Watchers or something. The only things I've been through is Men's Health Personal Trainer / Ab Diet and The Biggest Loser Club. And, I don't know if they would count them or if I can even get documentation from them stating…

Hi- I have been one of the many Americans without medical insurance (and I work in the medical field!) for over 5 years. Anywho- I just recently found out that we are getting Medical Insurance through Anthem BCBS PPO Virginia (I live in Texas). I am still in the process of filling out initial paperwork ect. I don't officially have the insurance quite yet but will in the next few weeks. I have not gotten my official disclosures and medical coverage explanation packet yet but I am hoping that one of you out there have had a good experience through them and gotten accepted?!?! The one thing besides total non coverage for the band that I am worried about is that they are g…

Hello all, I contacted my insurance co (Anthem BCBS VA) a few weeks ago to find out if I had coverage for WLS. I was told that I did and that the surgical clinic would need to contact them to determine what was necessary for approval. I attended my WLS seminar last Tuesday. We were all told that we would receive a call from the surgical center on Friday after our insurance was verified so that we could start the next steps. Well, Friday I received my call. I was informed that Anthem would cover my surgery and that they only asked for a letter of medical necessity from the surgical clinic. Well, I am meeting with the surgeon tomorrow and they will be taking my vitals and…

Does anyone out there have Health Alliance Plan HMO of Michigan. What has your experience been with their approval process? I'm getting nervous and need some reassurance!!! Thanks!

I have been getting everything ready to apply, and I just overheard on the boards somewhere that a Kaiser INDIVIDUAL policy would NO WAY include even the option for bariatric surgery and my heart nearly stopped. The site, the phone...no one will tell me. How will I ever know? When I submit my application and get my heartbroken six months later? If anyone knows a away to check, please...by all means. I am anxiously waiting to find out if it is even worth my time since I am not under a group policy, thank you.