Insurance & Financing

Instead of a Group Policy?

I was curious if anyone has Aetna insurance and what Aetna requires before approval of surgery. Thanks

In know that the surgery is covered, but I was wondering if they require the 6 month wait period. My consultation is in about 3 weeks. Thanks!!!

So 7 months ago my doctor talked to me about being severly overweight . My BMI was 42 and now 43. Anways at that time he told me to go on a 1800 calorie diet, gave me a diet book, and told me walking 3 miles once a day, 5 days a week, would be fine. Every month I saw him (though not offically to keep tabs on my diet), and every time he would take my blood pressure and my weight. Dec, he recommended the lap band. Jan, i saw the baratrics doctor and started putting my papers together, getting the psyc eval done etc... My doctors gave the baratrics center my records and I get a call about a week later. They said there is nothing from my doctor about 6 months of dieting. To…

My Company uses UHC, AETNA, and some smaller health care providers. They all have weight loss surgery in their packages. Aetna, however has the 3-6 month diet regimen. Luckily for me my provider is UHC. Which poses my next question. My surgery inpatient/outpatient coverage is 90% covered by uhc after deductible ($100) is met. Can anyone share from their experiences what the 10% cost to me will be? Will I have to pay up front or will my insurance company bill me? I am going through Lap-Band Solutions in Dallas so any advice you can offer definitely will help. I'll probably know for sure after my consultation but knowing a rough estimate sooner would be wonderful. …

I have just been denied lap band surgery for what ever reason.I am so depressed at this point and jsut thinking about giving up. :thumbup: Could someone PLEASE help me with information in regards to an appeal????? Any suggestions?

Hopefully someone can answer this for me. I have BCBS PEEHIP ins. Can my medical records be from both my PCP and my GYN?

I went to a center that does Lap Bands and did a free consultation. They said I was one of the best candidates they'd ever seen (given my weight, enthusiam, preparedness, etc.) but then when they called my insurance they denied it. They said there was an exclusion and there was no way they'd cover it. Am I just screwed? I can't afford to hire an attourney (which is why I was depending on insurance so much; I can't afford this!). This was the one light for me in turning my life around. I can't do this alone. I know it isn't a cure; it's a tool. A tool I need. I can't build a house without a hammer, y'know? I have a BMI of 45 so that isn't the issue. It's just that …

Hello! I need help! I am in the process of jumping through all the hoops for my Ins. Co. BUT they are being so difficult! I am looking to see if anyone out there as BCBS IL. that is National Automatic Sprinkler Wellfare Fund. I was told by Sprinkler Welllfare fund to follow their requirements and NOT BCBS IL. Our ins. is through my Husbands Local 550 Boston. Thanks for reading!:tongue:

Does anyone have any stories they can share of creative ways to get around the six month, dr. supervised diet that my insurance company requires? I can not wait six month, I need to get on that table ASAP!

Hello everyone. I am new to all this. Just went to my 1st seminar & have my 1st Dr. Consultation May 9th. Already have an appointment with a dietician set up for May 14th to begin the 6 months for my Insurance which i already know does cover the surgery. when i called the dr.'s office they asked what insurance we had....i told them BC then they asked what company through .i told them and the reaction was Oh yeah they cover WLS ! .....i am now in the process of gathering my medical records for the past 5 years or so so i can take them in with me the 9th when i go see the dr. * SO EXCITED * Angie :biggrin:

Wow was I scared to call my insurance company after reading all your post. So I did it and she said all they needed was the doctor to send in a letter of request stating WHAT AND WHY!!! I said to her I think 10 times are you sure thats it? She said that and your BMI. Wow ok that seems easy enough. Ok so What: Lap Band Surgery :smile: Why: Overweight with high blood pressure, high cholersrol, high triglycerides, skin problems that have required surgery, Grandfather died at the age of 41 of 3rd heart attack. BMI of 39.3 and with some Oreos could be higher!!!! I think I might just have a chance!!

Hi all, I called UHC last week to find out if the surgery was covered by my policy. It is...$200 deductible at 90% - great news! I was also told it is subject to predetermination paperwork? What is that exactly and what all does that involve? Is the process long with UHC? I know I called the doctor I've chosen and was told that after attending the seminar next week, I'd make an appt. with the surgeon and then be referred to a nutritionist and the psych eval. The psych eval, I was told, takes the longest as it can take about 2 weeks to get in and then another 4 weeks after for the eval to come in. Just wondering if this is all the stuff UHC needs to approve?

I'm probably going to be self-pay.. I want to negotiate with my surgeon to pay what insurance companies will pay. Can anyone tell me what their ins. billed vs. what was paid? Thanks!!

My insurance (tricare prime) has approved me for four visits to the bariatric center where I'll have the procedure done, but they haven't approved the actual procedure. I know that the bariactic center will send them the referral for the surgery after some of my appointments, but what are the chances that Tricare will deny it? By the way, I weigh 239 and am 5'7'' (don't meet the weight requirement) but I have one co-morbidity....high blood sugar.

I was pre approved for my surgery that i had in november. All the i's dotted and t's crossed, so i thought. Well it seems now we are here in April and the surgeon has been paid along with his assistant and anesthesiologist(sp). However, my insurance, Benefit Management (branch of bcbs) is denying the payment to the surgical facility i had the surgery at, saying my weight problem is pre-existing>? NO DUH!! What exactly they want I dont know as of yet other then to speak to my other few dr's i've seen through the last year. My cardiologist who told me i needed to lose weight althougth treated me for blood pressure not weight loss, my surgeon who sent everything they say…

If I don't find out today, I won't be showing up on Monday.

I am desperately waiting for my packet in the mail. Will someone tell me what will be in it when I get it and the best things to put on their for easy approval? Thanks Lisa

5 years worth medical records BCBS Have any of you with BCBS (I have Blue Shield Access HMO and am in CA) been approved without 5 years worth of records. Does it have to be the last 5 years? I have not had insurance and maybe have 1-3 doctors visits during this time. However, since I've had 6 kids (starting in 1981 and ending in 2000) I can get them weight/blood pressure records in 9 month increments from the obs office:blink: I really hate to think I'm going to have to wait 5 years to begin this process. I believe I'm a great candidate for surgery and my BMI is 42. Thank You! Cindy T

Hey guys.... I'll make this as short as I can because I'm so ADD, LOL! Do any of you pay for your own insurance plan out of pocket? If so, did being obese cause you any problemswhen you bought your plan or attempted to buy your plan? Did any of you have it easy when buying your own policy being obese or overweight and also have an easy time getting approved for your band surgery? What companies did you attempt to get coverage under and failed/suceeded? What company did you choose? If you're in Texas, your input is even more valuable because I'm sure the differences in coverage varies by state. However, everyone's input is greatly appreciated!

My surgeon's office sent in my paperwork over 5 weeks ago and they have not heard from Cigna either way. I am hoping that this is a good sign? I heard that approvals take longer than denials? Does anyone know what an average waiting time is for approval from Cigna is? Any feedback would be appreciated. This journey is getting old...I've been working on this for over a year now!! Thanks, Marg

Hello all....maybe someone can answer my question. I am planning on being banded toward the end of the summer after i finish my 6 month supervised weight loss plan. My current insurance covers the procedure. If in the future I switch jobs and change insurance will the new insurance cover the upkeep such as fills and emergency removal (god forbid!)? Im sure it varies by insurance, but would the lap band be considered a "pre-existing condition" of sorts?? It would just really suck to have to start paying out of pocket if I ever change jobs. Thanks in advance for any responses!

Hi, Tricare wants at least 1-2 Co-morbities before they will approve. Im wondering what everyone used?? I am really actually pretty healthy besides being fat, no high blood pressure, diabeties, etc. So im wondering what the heck i can use. Because without at least one NO way is tricare going to approve me even though my BMI is 40. thanks

Ok, having talked to my insurance (NEIB-managed by bcbs and medical cost management) I have found out that though BCBS IL is a pain in the butt to deal with, our union has the final say about the go ahead... so far I have leared that my requirements are as follows: 1. height, weight, bmi (easy enough) (done) 2. TSH levels (again easy) (done) 3. physical and history 4. cardio and pulmonary clearance 5. 5 years of diet information 6. pyscologist 7. comorbidity My concerns are what comorbiities are considered... I have GERD, planters fascia, fatigue, menorrhagia, and had my gallbladder removed. I am going for a sleep study to rule in/out sleep apena. …

Do they think we are all stupid and haven't researched this before we contact them? I e-mailed Aetna last night asking which plans do not exclude bariatric surgery and this the EXACT e-mail I just received; Thank you for your interest in the Aetna Individual plans. Unfortunately Aetna does not cover Bariatric Surgery and depending on the circumstances surrounding the medical necessity for the surgery you could be declined for coverage under our individual plans. At this time you can contact the guaranteed issue plans in your state at 1-877-461-3811. Sincerely, Aetna Individual Advantage Plans Direct Sales Team OK...So how are some people on here get…

Tricare question for Trell and others approved I am starting to go through through the process of trying to get the lap band. I noticed in one of your posts you listed that you were approved for the procedure before you saw the bariatric surgeon. Did you PCM take care of it for you? Do you see a base PCM or a civilian PCM? Also, I am looking at a local doctor (who is listed as a Tricare provider) to do my surgery... but his office said that they are still unsure whether they are going to take Tricare patients for Lap Band. Apparently they do not believe they will be paid enough. Who is your surgeon? Have they said anything to you about Tricare undercutting what they…

Forgive me - I know nothing about insurance. I am the idiot in the corner selecting my plan by the "Eeeny-Meeny-Miney-Moe" method. I am not proud, but it is what it is.... I am banded, have been since September, and my friend wants to get the band. She has UHC, and was told her plan doesn't cover it. I have UHC through a different employer and they did cover it. My question is this: Is there any way she can get supplemental insurance that would cover the band? Was anyone here told their insurance did not cover the procedure, but then was able to get around that somehow? Also, if it is employer exclusion (I'm certain it is, since mine covered it, but don't kn…

SUPER MAJOR VENT IN 5.......4.......3......2........1! I'm about to scream! I finally got the approval from my psychologist to proceed with the surgery. He told me he faxed over the papers on monday. I called today just to check and make sure things were in order and see if it's been submitted to UHC. First I was put on hold for 10 mins while she searched for the fax.:Dancing_biggrin: No they don't have it. I told her who it was faxed to...she says oh maybe it's in the pile on her desk and by the way she's not in today.....:Dancing_sad: So she tells me to call back tomorrow. But before she hangs up she tells me oh by the way we still need your 5 yrs medical history. I …

If my insurance says I have to be 100% over what should be my normal weight, PLUS comorbidities, BUT if I'm 200% over what should be my normal weight I don't have to go through the comorbidities workup, how do I know which catagory I fit in? I just don't want to waste a couple of extra months having to go through another sleep apnea test (which I have), diabetes (I have Type II and take medication for it but it's under control and has been for 10 months), more painful fibromyalgia testing (have been on permanent disability for it for 10 years), more CT scans for my degenerative arthritis in my spine, etc. I mean really, I need this. I'm going to die if I don't have th…

Has anyone had any experience with medicare??? I am on the six month diet and wonder how long it takes after that?? I go to a seminar next week and maybe I'll be able to ask questions...any suggestions? Any body in Mississippi?? How do you do the " tickers "???

My Dr's office here in NC submitted my paper work on March 20th to BCBS AL.. I call every couple of days and no word yet... It's so frustrating... I cant wait to get a surgery date. Keep me in your prayers for a quick Approval.. Thanks all...:thumbup:

I am covered by Highmark BCBS of Pennsylvania. They required me to complete 6 monthly visits to my Primary care physician with the attempt to lose some weight in that 6 month period. I have 1 more visit next week. I have gained with only a total loss of about 8 pounds over the last 6 months and am concerned the Insurace Co might expect a greater weight loss success.:confused2: I also have gone through all the testing and psycological requirements. Any input with BCBS of PA?

If I was told by one customer service rep that Lap Band was not covered by our policy, (Anthem BC/BS) Does any one have any good advice on what to do next? Does no always mean no? Can it be challenged by arguing for a "medical nessecity" plea. ( BMI is 40, Have History of very high blood preasure,joint pain. All my siblings have diabetes and heart disease.) I'm so ready to get started, any good advice would be so appreciated!!!!!

I've been surfing the web for a loan to pay the approx $5,000 co-payment I will have. We have excellent credit, and would like to find a zero interest 12+ month loan. I had this kind of financing for my lasik eye surgery a few years ago. My surgeon's office doesn't offer anything. Any ideas?

Does anyone have Scott and White insurance? My emloyer is changing from First Care to Scott and White. I self paid for my band, and was just wondering if Scott and White might pay for fills...probably not, but I can dream big! :thumbup:

Does anyone out here have National Elevator Industry Benifits??? Have you been successful in getting approval for surgery??? I have the "list" of requirements that I have to submit but wanted to see if there was anything else that I needed to do... :thumbup:

The short story is.... I no longer have insurance through my employer and have no way to get it back right now. Which in regards to the lapband surgery, doesn't even matter anymore because my employer has a weight loss surgery exclusion written into the policy. So I can never get the surgery as long as I work for this company (Yes, I already tried to get them to waive that exclusion with no luck) I called United Healthcare the other day and they told me my height to weight ratio disqualifies me from being able to purchase an individual healthcare plan from them. Luckily I was able to get my 7 year old daughter a plan with them or Golden Rule (that's who their individua…

In the experience of most people, have complications been covered by your insurance ? For example, I'm curious if I ever have a band slip or erosion, would surgeries and procedures to fix things like that be covered by insurance ? Or if I have some emergency that I have to go to the ER for directly related to my band, is that covered ? I'm trying not to fall into the trap of only worrying about what I have to do to GET the band. I want to make sure I can afford to live with it !! I'd love to hear about any experiences you all have had in that regard. Thanks in advance ! -Cate

Hi Everyone, I am going to be banded on 9/9/05. (nervous wreck). Anyway I am paying a discounted rate because I am entering a clinical trial for those who have a BMI below 40 and do not have "significant" comorbidities. My husband, however, does have a BMI of 40 and moderate HTN. He however has GHI through the NYC Sanitation Dept which excludes the Lap band but covers the bypass (according to the physicians office he is going to). Has anyone ever appealed and had success with GHI where it excluded lap band surgery. He does not want to do the bypass. I would appreciate any input anyone has. He has the option to chose another insurance during open enrollment in Sept. His…

Hi -- Just thought I would see if anyone has had experience with Empire Blue Cross Blue Shield PPO? I am located in Missouri. According to their requirements, I should qualify, but am just curious about any positive or negative experiences. Thanks. Cynthia

I've been approved! My dorctors office faxed the paperwork Monday. I hadn't heard anything so I gave the office a call. Nothing yet so I called the pre autorozation department directly and they said it was approved. I will be having my band April 15, 2008. I am so excited. No clue how I'm going to sleep tonight. What a relief. I am so thankful!!!!

Hi All, I am trying to figure out every way possible to get this surgery ASAP so here is the deal... I started seeing my physician in October but I had been attending Weight Watchers WEEKLY since April, with september being my last month. Do you think there is a way to get them to use that as my supervised diet if I had my physician verify that I was on a diet plan???? It really just hit me that I had done it for the 6 months prior to starting with my physician. Anyway, if you have any ideas, suggestions, general knowledge about it, I would certainly appreciate it!!!

I have Tufts which requires I wait the 6 months. I originally consulted with my PCP in January about starting the journey for lapband surgery, attended the seminar in January and met with the Surgeon in February. The surgon's office said that they send in the paperwork to Tufts and then Tufts will send me a letter stating that I am enrolled in the 6 month "I can change program". 3 weeks later, I'm still waiting! The surgeons office said that Tufts has approved it that I will be approved after the 6 month completion date of 9/12. I called Tufts to tell them that I never received instructions on what to do for the 6 months and they are saying that they gave the info to…

My doctor is completely unsupportive. She says both my BMI (42) and age (22) is too low for the surgery and that I am just not trying enough and it can be done without surgery. Whatever her reasonings, I want a more supportive doctor, because without the doctor's supprt I'm not getting banded anytime soon. Please tell me who your doctor was in the Kaiser network in Colorado?

anyone have united health care of ohio. our company just changed our coverage nad now the band is not covered. any way around it? i spoke to like 3 different people on the phone and one told me that if it was an out patient procedure it would get covered. any thoughts?:teeth_smile:

Finally today a letter from CIGNA saying ..."We received a resquest from you on 3/25/08 (faxed my paperwork _$30.00 UPS store on February 20th to the Sugeon's office! - trusted the coordinator there- silly me) and they said To process your request, we need the following additional information: - Clinical information for medical necesity is needed fax info to 132438948923 I sent them EVERYTHING they asked for!!? Has anyone ever received this? They are closed today of course ...what is clinical info exactly? :thumbup:

I just wanted to share my experience with Cigna in an effort to help others. I have been reading the many posts regarding Cigna and I have to agree that they are very difficult to work with in regards to customer service and follow up. My BMI is 41 and I have been overweight for more than five years. I completed my 6-month supervised diet in September, 2007. My months were not consecutive. I saw the doctor four consecutive months (June, July , August and September) but at the beginning of the visits, I skipped two alternate months (went in February, skipped March, went April, skipped May). However, it was six months. I had to wait on my psych evaluation and then my p…

I am so excited, I can't believe it happened this fast. My paper work was faxed the first time on 3/17. Called my insurance one week later on 3/24 to check the status. They told me they had never received anything from my surgeon's office. Called the surgeon's office and let them know that the fax had not gone thru. They refaxed it that same day (3/24) and I found out yesterday that my surgery was approved and I'm scheduled for April 14, 2008!!

So I need you all more now than ever UHC denied me yesterday because they want more of a documented wight history. I have been seeing my doctor since 2003 and he wrote I have been overweight for 15 years. The Drs were so sure I was getting approved they were in shock, soooo I had to ask my Dr to write a specific letter or update the old letter that I have had a BMI of 40 plus for 5 years. Thats what they want UHC people.. documented BMI for 5 years. I have 2 co-morbidites, polycystic ovarian disease and diabetes (discovered during bloodwork for surgery) Did the nutritional and psychological consult, EKG and Chest Xray.. guess theywant my firstbiorn now too (when …

I searched the forum and could not find anyone who used Medicare as the Primary insurance and Tricare for Life as the secondary insurance. If you have, how did it go? And, Medicare DOES REQUIRE an overnight stay, correct? Thanks in advance. :smile: