Insurance & Financing

Hi all I'm new to this group and have a few questions! SORRY THIS KS LONG, I had the Lap band done back in 2011, I did ok with it I lost about 30lbs, I had bcbs with a bmi of 36 but also hypertension, PCOS, insulin resistance, Psoriatic arthritis, degenerative disc in my back...my Dr used these as comorbities and I was approved. In oct of 2015 I had a csection and my daughter passed meconium which they never told me, about 2months later after waiting in pain I went to see my WLD who thought I had a hernia by my port, he put me in for surgery the next day to repair it but it turns out I had a softball size infection of MRSA because I wasn't properly cleaned out, my port h…

Hello, I have BCBS of MA and I am trying to figure out if there is a 6 month requirement to meet with a dietician. When I call my insurance company, they do not mention any such requirements, I obtained policy 379 and it doesn't mention any minimum or maximum requirements for meeting with a dietician/ supervised diet. When I went to my consult, the nurses mentioned I would have to do 6 months of dietician visits. Which shocked me because even though I know it would be helpful I don't want to wait half a year to get my surgery and when I called my insurance company they never mentioned this. I am going to call my doctors office and have them re-look in…

Hi Everyone...I am new here and have been reading through many of the boards. I know that Tricare has just recently added the gastric sleeve to their approved procedures and wanted to see if there was any new information from people who have used them. I have my first consultation next week and I am curious at how long they require documentation of weight loss. Is it 6 months or 3 months? I see so many conflicting answers and the website does not specify. I have Tricare Standard North (Tricare Reserve Select to be exact). The surgeons office told me today that their average wait from first consultation to surgery is about 12 weeks. That leads me to believe that it is…

Wondering if anyone has dealt with masshealth thru this process, wondering what it was like for you?

My Dr sent all my paperwork to Aetna on Wednesday. Now I've got a whole new set of worries! Anyone else use Aetna? I did 6 months of appts, nutritionist and psychologist visit. I couldn't weigh more on my last visit I comparison to my first, and I'm down 5lbs, so it's less.

I'm just starting this process have my first appointment with the Surgeon on June 26th. I am trying to find out what the requirements that my insurance company has before surgery. I tried calling them and they said I will just have to ask my surgeon. I have Welmark BCBS of Iowa. Does anyone else have any experience with them? I just want to be able to prepare myself. I've seen anywhere from 8 weeks to 6 months of having to meet requirement and would like to have an idea of how long my process could take.

So I have Highmark BCBS and I have completed everything and had my pre-op appt with my surgeon this pat Monday 5/08/17. She said they would be submitting everything to my insurance for approval. Today is Friday and I found out surgical coordinator has been out sick all week (God bless her soul) but the wait is killing me. I'm so anxious and worried I may not get approved. Patient Selection Criteria for Adults The patient is morbidly obese and is at least 18 years of age. Morbid obesity is defined as a condition of consistent and uncontrollable weight gain that is characterized by a weight which is at least 100 lbs. or 100% over i…

Hello do anyone know anything about GHI Medical coverage? Sent from my SM-G935P using BariatricPal mobile app

I finished all of the Medicaid requirements for surgery, and then the surgeon I was going to see stopped taking Medicaid. The only other doctors who accept medicaid won't see anyone outside Covington/NOLA or Thibodeaux. All Medicaid suggests is calling general surgeons and asking if they do bariatrics as well. I'm devastated and desperate. What can I do? I have no money or credit for self pay. Has anyone seen Dr. Dominguez recently who can plead my case? Should I move to NOLA temporarily? Should I call every day? What can I do? It's just not fair that I'm this close. Does anyone know if other states accept Louisiana Medicaid? They said it doesn't travel but I believe near…

Question, my nutritionist said I would have to have 75% total usage on my CPAP machine but I have 69%. My BMI is 53.5 and the only comorbidity I have is sleep apnea. I have met all the requirements of the program, and as of I have met the weight loss requirements. My last appointment is June 14th, then they are submitting me for approval. Will I get denied? I'm so worried? Do you think they will make me use the CPAP Machine for a longer time, then check it again? I'm so nervous!

I'm sitting here full of nerves I've finally submitted all of my paper work for surgery so now I'm just waiting on approval paperwork was submitted last week but I can't stop thinking about all the bumps in the road along the way this is crazy I feel as if I'm going out of my mind I no I need to let go and let God but my nerves are out of control R4C?

Hi I saw my doctor a year ago about bariatric surgery. I have seen him two times after that about the weight. I currently Have GEHA and their requirement is 6 months of supervised diet. I brought the paperwork to my doctor thinking it would be all set since we had already attempted the weight loss. Now I'm thinking I probably won't be able to get approved by them anytime soon...I'm assuming the six months would have to start now and I would have to go every month for 6 months? The visits I've had won't go toward the six months? Is bcbs federal a better option for me since they only require 3 month supervised diet? Open season is November and I'm wondering if I shou…

Today it's been one week that they received my file and is still being reviewed, all I can say is I am anxious and excited ?

Hey guys! I'm so excited. Just got a call from my insurance coordinator and my gastric bypass has been approved! Just wanted to give you guys a timeline if anyone's curious. (BCBS Michigan) February 14th: Weight loss surgery orientation February 28th: began classes that are required by insurance. (8 weeks) March 6th: first appointment with surgeon. March 16th: Psychologist appointment. (3 of them, a week apart each time) April 19th: Last class. April 20th: Nutrition evaluation (required) May 3rd: Everything was submitted to insurance for approval. May 8th: Received the approval. I have BCBS of Michigan, overall the process was about 3 months total. I'm so excited for …

Unfortunately I just got word that Aetna has denied my request. My BMI is too low and I don't have a qualifying co-morbidity. I'll be moving forward with self-pay. My question for others is, where have you applied for/received financing (if you have needed to)? My surgeons office recommends Prosper Healthcare Lending, but depending on the interest rate I might look at my credit union. Any feedback is appreciated!

Hello, I've been looking at getting a loan for the sleeve. I was wondering if anyone had a similar experience with bad credit/revolving credit. My credit is about 600 right now, but I am expecting it to go up as a credit card my name is associated with is finally being paid off this month (it's carried a balance for over a year). I made about $28,000.00 last year. So basically I say all of this to ask if anyone had similar stories of low credit/low income and were able to get approved for the loan? I'm also considering applying for a smaller loan, and using a credit card for the rest?. The surgery cost $11000.00, Should I apply with a credit union or prosper? Sorry for so…

Just wanted to share an exchange I had with my insurance company today (fepblue basic). Right now I'm going through the process with a local bariatric clinic, but am keeping Mexico, Vegas, Florida Medical tourism surgeons in case I receive an insurance denial (BMI is 35.1) . If insurance approves, it's a great deal, but if they deny, I'm not paying the $18500 cost. I am also not sure if I want to wait till October. I asked (via secure portal) if I had surgery in Mexico, away from my home state, was cash pay, or anything other than approved and paid for by fepblue, Would complications be covered? Such as a stricture or a leak. I also asked if…

My surgeons office submitted my file to BCBS this week to my insurance. I called the insurance this morning and nothing is showing in the system yet. Does anyone happen to know how long until it pops up in their system? Thank you

At the moment I'm in a battle with my insurance (Cigna) because apparently my employer has not allowed any form of diagnosis related to weight loss and obesity from the plan. I've received a referral from my primary to simply start the process with a weight loss management group for nutrition therapy as well as psych evaluations before finally meeting a surgeon. The problem is that even THOSE aren't covered so I haven't even met with a surgeon to get the final go okay for the surgery. I'm basically stuck at step one and I honestly don't know what to do. I've met a brick wall and haven't found any luck finding information or feedback about anyone else that hasn't been…

I'm at step one of this process & have my appt with the surgeon next month.... so I'm brimming with questions, concerns, etc... with regards to what insurance requires and what may or may not count. I have BCBS AL..... My question about the diet thing is this: My Endocrinologist (not my PCP) told me to lose weight (because I'm pre-diabetic) and to follow the plan on a paper she gave me. I went back later, and it wasn't every month because she didn't ask me to do that, and I'd gone from 328 to 280 (was a very restricted diet), and it was literally over 6 mos time from when she told me to follow the plan and when I saw her last (about a month ago) and I'd lost t…

Has anyone been approved or denied by Aetna POS in the 90 day plan and what did you do for the exercise requirement? I am pre-surgical and interested in doing the 90 day vs 180 with Aetna. My dr office (Magee) seems to favor the 180 and neither they nor Aetna can give me a good explanation of the exercise requirement "Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional;" which seems to be the only difference b/w the 90 and 180 day prep plans. Thanks!

Hi everyone, I am considering asking my PCM for a referral to see a bariatric surgeon in order to get the gastric sleeve. Are there any other military spouses in the MacDill area that has had success getting a referral? I go to the Brandon Clinic and have an appointment today to talk with my PCM. thanks

So with my BMI of 35 I need one comorbidity for my insurance to cover surgery. My question is... if I get diagnosed with sleep apnea... do I then need to use a breathing machine for some time before getting approval? I have BCBS of TX if that helps. I have an appt with my PCP tomorrow to get a sleep study script... I'm assuming that's what I need to get the ball rolling. ☺️

I am going to get the sleeve but I have anthem Medicaid in Kentucky and the closest doctor is in Lexington a couple years ago I was going to get lap band and failed my psych eval, now I am trying a different procedure and wondering who is from ky and what is you experience with Medicaid and the psych eval I am completely new at this and really need this done I am 29 have pcos and 300 lbs 5'2"

Hello everyone! I was just approved for Medicaid in KY and I know that it does cover WLS but was wondering of anyone has been through the process in KY with Medicaid and how it went. I have Anthem Blue Cross Blue Shield Medicaid and am planning on getting the process started as soon as they mail me my card! Thanks to anyone who can give me any input

Has anyone experienced this? I weaned my son but still lactating a little.should i not say anything ? Someone mentioned if your lactatint bcbs wont pay for surgery

I have peachstate health insurance and i have made up my mind that i really want to get lap band. I am 25 and have a BMI of 41. I do not really know the process that i am to go through.. i need some advice. I went to a primary doctor to see if i could get a refferal for a surgeon. My doctor told me that he wanted to give me a blood test for metobolic syndrome. So that is where i am now. I have another appointment with him in a few days to get my results. Do i just wait on him to refer me? Do i call a surgeon ahead of time. I am so confused! Any Suggestions?!?!

http://money.cnn.com/2017/05/10/news/economy/aetna-obamacare/ This is not a political debate. Even prior to the current presidency the ACA wasn't working for insurance companies and they dropped out. I used to have many choices of companies in the first two years of the ACA. This year I had 2. And next year it sounds like only ONE and not my current one. This is information. This year may be the year you HAVE to get surgery if you use either Aetna or Humana insurance to do so, as they will drop being part of the ACA.

I have a 35 BMI and possibly co-morbidities (still waiting for results but it is looking like sleep apnea as well as gallbladder issues and reflux). Does anyone else have experience with Blue Shield Gemcare insurance (Bakersfield, CA)? Please let me know if anyone else is going through the same hurdles as I am so we can talk about the best practices to get this insurance to cover the sleeve surgery. Any information will help...

My insurance requires weight history two years back. However, in 2016 i did not go to the doctor due to insurance problems. Do you think this would present a problem in the approval process for VSG? Sent from my SM-G935P using BariatricPal mobile app

For those of you who have been (unfortunately) denied by insurance, do they give you a reason why? I just submitted and am waiting to hear. If I'm denied I will likely self-pay, but just curious as so what insurance says in their responses.

How long did it take for you to get approved from bcbs federal? Sent from my iPhone using the BariatricPal App

I'm looking for surgeons in NC that accept Medicaid as a primary. I was referred last week by my new PCP, that I have a LIST of pre existing conditions caused by my weight . Three of the programs I've looked into only accepted Medicaid as a secondary insurance. Recently I started a new job the pay isnt all that great and insurance takes effective, once I'm employed 90 days. The premiums alone are over half of my pay check. So now I have to look for a program that accepts my primary insurance (Medicaid) , to start the process all INFO is greatly appreciated. I am willng to travel as well as long as its in the state of NC. Medicaid does cover bariatrics in NC my PCP is…

Wondering what experiences have been working with BCBS of Illinois.

I was wondering about this and I am keeping all my receipts just in case.

I have UHC and have the first call scheduled with the nurse on Tuesday. I know that if I go through the whole process and end up getting approved, with the way my insurance is set up, I'll still have to come out of pocket a lot. One of the questions on my list is to ask what my out of pocket expense will be... My question is this: If my insurance turns out to cost the same, or be more expensive than going to Mexico to get it done at a reputable bariatric surgery center, is there any benefit to still going through insurance? Part of me thinks it would be better to just go to Mexico so I don't have to go through the 6 month process and jump through all the hoops that the in…

I have BCBS (Ohio) but I live in Florida, my company is HQ'd in Ohio. -Monday, doctor office confirmed they faxed paperwork. -Tuesday, I called insurance company to see what the case # is. Insurance said that they closed my case because paperwork didn't come through on fax so they closed. Then the woman said, actually your doctor office sent it to the wrong number. She then transferred me to the Bariatric line and to a woman that said my precertification is handled by a specific group because of my employer (I work for a fortune 20 company, I assume they have a special line because a lot of employees). She gave me to correct fax number, I call doctor, gave to them, the…

Is it hard to get approved with GHI health coverage? Sent from my SM-G935P using BariatricPal mobile app

Hello everyone April 15 will be my 4th weighing with my pcp. My questions are the following, my insurance is 1199 SEIU in NY. Any body with this insurance... how is the process with them? How long do they take to approve the surgery?

I researched a head of time. I know the requirements. Double checked with insurance and with surgeon. Finally completed the 6 month weigh ins as a monitored weight loss program with the primary care. Completed numerous tests and had a tentative surgery date scheduled then I got the call from my surgeons office saying they received a denial. Luckily the team is on top of things and called the insurance to ask why. They were told it was not deemed medically necessary. Even though they provided a letter stating it was. So I called my insurance and was told I was denied because I had no proof of excersize. I submitted the forms signed monthly by my dr with notes that included…

Hi Everyone! I have a question about insurance. My Insurance covers weight loss surgery. I just had twins in June and I've hit all my out of pockets, so I figured this would be the best time to have surgery. My insurance requires 3 diet consults with a dietician. Well I didn't lose any weight during this time. I met wth the psychologist for the evaluation and she said that I would be a great candidate. So I'm worried I won't be able to have surgery bc I didn't lose the weight.... anyone else's gone through anything similar? Sent from my iPhone using the BariatricPal App

My info was submitted to the insurance company on March 28th. Yesterday, my surgeons office called to let me know that Cigna sent them over a questionnaire to fill out?? Has anyone else had this happen?

Hi everyone, My information was submitted to Aetna on April 24th and I have yet to hear from them. I'm sooo nervous I can barely focus. The only thing keeping me sane is seeing posts from other people that had Aetna. So for my Aetna peeps, how long did it take you to get approved or denied? If you were denied, why? Thank you!

I'm looking for a second set of eyes to help me decipher my insurance policy/share if they've had similar experiences with their insurance hurdles. Before anyone asks, yes I have called my insurance company to clarify but the woman on the phone seemed a little unsure about the details of timing and that's where I think I might get denied! I'll link my insurance co's policy here: POLICY My history: In the past 2 years I've had a BMI between 35 and 40 (however I have been pregnant in that time period). I've had sleep apnea symptoms for probably 10 years but didn't think they were a big deal but now that I'm trying to get approved for VSG I'm going to be tested for…

If I have a bill that was denied by my primary insurance because it was out of network, but my secondary pays out of network benefits can I send it to the secondary ?

After a long three months of hard work, my doctor's office submitted my request for surgery on the 24th of April and I was APPROVED the very next day! Amazing! My question is- How much will I pay out of pocket? I know I have co-pays, and I have been paying those at each appointment I've had (dietician, medical weight loss, surgeon check up, etc) But will there be any surprise bills? I've never had surgery befoe. I plan to call my insurance on Monday of course, but any advice/feedback from the community would be nice too!

just wanted to let you all know of my experience. my BMI is between 35 and 40, and my program was concerned that I may not be approved by Blue Cross Blue Shield with just hypertension. Therefore part of my program included being evaluated for other conditions. It turned out that I have both fatty liver and severe sleep apnea. while I am not thrilled to know that my obesity has led to all of these conditions, it does help my cause for getting surgery approved. I completed my program last week and my packet was submitted to Blue Cross Blue Shield late last week. I called customer service at Blue Cross Blue Shield a couple of times just to check and I found out early this we…

Hi guys, I need some help. I am currently going through the 3 months supervised diet program with my nutritionist and went on a two week vacation a week after starting seeing her. I am now back from vacation and on my second visit turns out I have gained a few pounds which I know she was not happy to see. I now have a month until I finish the 3 months with her and she basically told me to do the best I can but I am afraid the insurance denies me. I have Federal Blue in Florida and in my initial weight in was above the 40 BMI required. Do you think I can be denied if I don't lose any weight during the 3 months?

Okay. So first thing is I have Aetna better health premier insurance out of Michigan. It is a Medicaid/Medicare dual enrollment plan that I've never had issues with before. Prior to receiving my referral to Bronson Methodist hospital two years ago I haf called my insurance and asked about covered services. I was told they'd cover everything as my BMI was over 40. After working for 7 months to complete paperwork and go to the required before initial appointment but always full seminar, the surgeon left and I had to start over at Borgess Surgical in Kalamazoo. Now I'm finally on to month 1 of my 6 medical weight loss appointments, and the surgeon requires a checklist to be …

Has anyone had any experience with Highmark Blue Cross Blue Shield Delaware in the approval/denial stage? I'm not at the submission stage yet -- I will be in October 2016 -- but I would like to know if anyone else has any experience. Thanks in advance!