Insurance & Financing

I'm trying to get approved thru Carefirst BC/BS Maryland. Does anyone have experience with them? My BMI is just 35 but I have sleep apnea, elevated cholesterol & arthritis. Just had my consult. The doctor didn't seem very optimistic, said they are getting stricter with the requirements. When I told my PCP this, he confirmed that guidelines are getting stricter--he said it's because they are seeing the long term results of WLS are not all they should be. Any feedback would be appreciated. Thanks.

I am officially approved!!!! My surgeon's office faxed paperwork to Blue Cross of California on Thursday, and they processed the approval the next day! I am on CLOUD NINE. Even though I had read the policy over and over I was so worried that it wouldn't go through. I've read so many cases where some of you have had struggles with the insurance companies.:clap2:

I found out today that Cigna denied my surgery. I called them and they said they denied it because they didn't have anything showing that I had a nutrition evaluation. I had the eval a few weeks ago. The doctor's office forgot to fax it in!! I am very frustrated! They are going to refax everything tomorrow, so hopefully they will approve it this time. The Cigna lady said that I was just barely denied, whatever that means! They only took a week to deny it, so hopefully they will only take a week to approve it!!

OK, my surgeon wants to plead a case to my insurance company so I won't have to do the six months diet history with my PCP. I have over a year ove detail weight loss/gain history already. ANYWAY, my doctor wants me to write the letter, and she'll sign it. I have no idea what all to write in the letter. Does anyone have any suggestion on how to word this??:confused2: Thank SO much!

Ok so im hella juiced:thumbup: i just got submitted to my insurance for approval....:tongue_smilie: i know BC of CA usually approves but how long does it take. the default date if 9-9-08:huh2: thats just too far away so i'm going to go on the wait list after i get approved. so tell me if you had blue cross how long did your approval take?

Harvard Pilgrim insurance is amazing!! I recieved approval within 24 hours. I have been so very concerned about this that I had not really thought about this as something that would really happen to me so soon. I am going tomorrow to meet with the surgeon and set my surgery date!!! Wow - although I started this process initially in early January - this went by so fast! If you have an option - chose Harvard Pilgrim!! :eek::thumbup:

My policy changed the 1st of Jan. 2008, and I just finished my 6 mo. diet. They are saying that my ins. will only pay 75% of the allowed amount. Anyone else have this problem? How much did the surgerey end up costing even with insurance??

is there anyone here with sentara employee optima hmo insurance??? anyone who has already gotten an approval?

I have many friends who've had RNY done, but I knew that was not the procedure for me. I did not really look into lap-banding until a few weeks ago, and what I learned got me excited. I didn't have the misgivings about banding that I did about RNY, and I soon realized I'd made an unconscious decision to be banded. However, my employer was in the process of switching our insurance coverage. We were with HealthAssurance and were switching to Keystone Health Plan. The change took effect on March 1. I just got my benefits information yesterday, and I was very disappointed to learn that any kind of bariatric surgery is excluded from my coverage. The worst part is that …

To get the Lap Band procedure done, do I have to have a refferal from a doctor first? I went to a seminar first before I talked to my doctor. :confused2:

UHC has yet again denied me for surgery. Apparently my 5 year weight history is not documentented enough.. Any advice? Considering surgery in Mexico at this point. I am so ready. WHat do I do?

I am considering getting the lap band and called my insurance and they said the surgery will be covered. They said I have to meet the following conditions. 2 years of employment- I will have 2 years on April 14th. BMI of 35 to 40 with two conditions or BMI over 40 with no conditions- I have a BMI of about 36. 2 weight related conditions- I have high BP, depression, back aches and pains, and I may have sleep apnea. I mean I am so tired everyday no matter how much I sleep at night. But my insruance will cover it 100% with a 150.00 copay and each fill will cost 15.00 copay.

I just found out that my employer has extra requirements that require hypertention and or diabetes to get approved for lapband. The 2 HAVE to be uncontrolled meaning you have to be taking meds for the diseases AND they have to be NOT working!!! Those are my employers rules! My case handler I talked to at the doctor’s office talked to united healthcare and she said if my job didnt have those extra requirements I would've already been approved because my BMI is so high She told me to call HR and benefits and see if they can exclude me from the extra criteria because my BMI is so high. I can’t believe this crap! Also she said whatever we do, don't cancel the UHC insurance. I…

The title of this thread pretty much tells the story. When my husband was offered early retirement in Feb. he accepted. Got a nice package including the company paying for most of the next 3 months of our BCBS policy. Which was March, April and May, after May, we would then send the full Cobra payment to them and they would pay for 18 more months. Well some IDIOT canceled our insurance as of March 1st. I have my sleep study done, and hubby had appointments. the hospital didn't mention this till the day before my lap band "big day" and I went in and they refused to see me. I went ballistic....pulled a real nutty with financial. They wouldn't accept the paper work…

They said that when I am approved (Hopefuly soon) and resubmit it will be covered Has anyone had this problem with them? What problems have you had getting approved? I think I have meet all their requirements? Thanks in advance your your help:confused: I was hopping this would go smoothly but getting discourged!

I have been married for a year but i was never added to my husbands insurance due to still being on medicaid from having a baby. I just sent my marriage certificate to UHC and they said it will tke 15 days to get me added and that my coverage will back date to when i got married. My husband works for union pacific rail road so i think our plan is pretty good. I called yesterday and they said lapband was covered 85%. Soooo here are my questions!! haha! 1. Is the 6 month weigh in a MUST? I havent went to the doc yeat but i just wonder if there are any ppl that did not have to go through it? I have tried nutrisysstem and curves but that is all i can really p…

I just got a letter from my insurance company (Anthem Blue Cross/Blue Shield) saying they don't cover anesthesia. What the ???? How can they do that. The explanation is that this isn't a covered charge. Anyone experience anything similar?

Hey guys, I just had my first fill and had to pay a $12.00 copay. They didn't seem to think it was a big deal - I guess I will see what it comes through the online Claim Status. I will also try to find out what code they used. So hopefully this is good news to those trying to find out if Tricare pays for fills.

If so, how do they calculate the time? My doctor has been telling me to lose weight for at least that long for which I've done Jenny Craig and Weight Watchers. He's trying to get me to do Opifast but I think it's because he wants the $500/mo it costs to do it through his office. If I could afford that, I'd still be on JC.

Has anyone had success with getting approved through Care First BCBS of Maryland? If so, about how long did it take for your approval to come back?

I am a bit confused about what Cigna requires to cover the surgery. I spoke with a woman from my insurance company about a month ago and she told me that all Cigna required was that you have a BMI of 40 or more for at least a year. However, I heard that they also require 6 months diet with a nutritionist from someone recently. Can anyone help me out and let me know what all Cigna requires? I am a little bummed because I was hoping I could have my surgery by the end of the summer but if I have to do the diet it will be at least next October or later. I am just being impatient I guess? Thanks. Roxy:sad_smile:

I don't know if ya'll remember me stating that MY company was the one that would deny me for lapband. I went ahead and had the doctor send my information into the insurance company, ready for a fight on my hands, several appeals and to get my lapband by June. Well things have changed! I got my denial, but the good news is they denied be because of the 6 month supervised weight loss plan! First off everything probably wasn't sent in til March 10th and the doctor got a faxed denial back by today that's only ten days give or take a day. But it means that if I do the 6 months weightloss they will approve me so I hope! I had wanted to do this over the summer, but if I can get …

I just had to create my own thread for this because I'm so damn happy! I called member services w Aetna an hour ago to check on the status.. and the girl goes "Oh, for your gastric bandign on 3-31?" Im like what!!!! Apparantly I had JUST gotten approved and they sent notice to my Dr klike 30 minutes before. So, call the surgery center and my coordinator was like, Uh, yeah youre approved but how did you know who called you? There system is down so they set a tentative date of 3-31 but shes calling back later today with my surgery date. :biggrin::smile:

Hi everyone, this is my first post and hoping you can shed some light on what I can expect from Cigna. My paperwork was submitted approximately ten days ago and I am nervously awaiting the results. I wanted to know if anyone knows what "significant gaps" means as it relates to the six-month PCP diet requirement. I saw my PCP in 2/07, 4/07, 6/07, 7/07, 8/07 and 9/07. I have a BMI of 41 and I got clearance from all the necessary specialists (psych eval, nutritionist, etc.). If this is not enough, I have documentation from Jenny Craig, gym memberships, Weight Watchers, etc. but did not submit this with my original paperwork. I have called to check the status every ot…

Hi everyone, I just found out my ins will cover my LapBand surgery! :shades_smile: I have Horizon BCBSNJ and I live in Florida. I am so excited! I guess you could say I am a month ahead of the game since my doctor and I spoke about weight loss last month. She said I was a prime candidate for the surgery. As I have so many of the co-morbidities that go along with being morbidly obese. Bad knees (already had 2 surgeries), hypertension, type 2 diabetes, on Thyroid medicine, weight related Sciatica....you name it. 47.3 BMI on top of it all. I am so happy to find out that I finally have insurance that will help me. I am so tired of hearing "No weight loss surgery of any kin…

On March 12th I went to my first appt. with the WLS. I took with me the print out from bcbs website. I interpreted it as saying the surgeon could not supervise the 6 mo weight loss. Only your primary or another attending physican. When I showed them this they said they could supervise it. It also says on bcbs page that a dietician employed by them or acting as a consultant to the surgeron could not be used. They said their dietician was not employed by them but was the one they used. Hello, isn't that the same as a consultant? So here's how they have laid out my 6 mo plan. Ist visit was on march 12th. I was weighed and the process began. 2nd month is on April 2 with the d…

My employer is a small private company and they don't have the rider for WLS. DH works for a large company and has different options for Insurance. If I switch to his insurance, how would I know how long I'd need to wait to get approval for surgery? Is that even possible, ya know, to subscribe for coverage to a new insurance and then immediately apply approval for surgery? :embaressed_smile: DH's current insurance is BCBS of VA. Any thoughts?

Has anyone recieved info in the mail from BCBS regarding LifeMasters? It is a free service thru BCBS .The program is administered thru LifeMasters, " a condition management program". The program is completely voluntary. Your benefits are will not be affected if you decide not to participate or if you withdraw from the program. You will learn how to monitor your health, including measuring and recording your vital signs and symptoms. Be able to share your info with your doctor to receive improved care. Receive valuable educational materials and videos. Does anyone know if they send this to insurance members for participation when they know that the insured is hoping to ha…

Has anyone had them? I am floundering around here. Getting my hopes up and not sure what to expect. I got the refferal from my doctor and have the first informational meeting on april 8th. What happens after that? I have a bmi of 44 and sleep apnea. I am 42 years old. do you think bcbs will approve me? any info will be appreciated, Thank you

Why did you choose lap band over bypass? I went to the doctor and he suggested bypass instead of lab band because I had diabetes and sleep apnea. My BMI is 36.5 I am worried about possible complications with bypass, but if there is a medical reason, I would do it. I think rapid weight loss was his reason to do the bypass. I think I have the option of chosing either. I need your input , those of you who had the choice and why you chose one over the other. Thanks:confused_smile:

I have been stressing over the 6 month weight loss program requirement from my insurance and found this explination on the Cigna website. It does make it a little easier to consider why they require it. :biggrin: But I still hope I have already met the requirement! Here is the reference: http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf The benefits of a preoperative weight-loss program include all of the following: • identification of those individuals who will be committed to and compliant with the short-term, long-term and lifelong medical management follow-up, behavi…

I am a 27 yr old RN. I have been fighting my weight since I was 20. I have a brother who had a lapband in Febuary of 2007 and has had amazing results. 130 lbs in one year!!! I have decided to take this step because I don't want my weight to comprimise my life or my health anymore. My insurance doesn't cover any type of bariatric procedures so I will be self pay. I need a company that will finance this surgery. I was hoping someone would have a few suggestions.

Self pay… Since my insurance doesn’t cover weight loss assistance I am on my own to find a way to get this taken care of. Any recommendations from those who also had to finance this procedure? I have been thinking about getting a personal loan from my bank in the hopes of getting a low interest rate, I really don’t think I can stomach more than having 8.25% interest. So far I’ve checked intro Health One Financial and they gave me a ball park of what they offered which was 11-22% inertest rate. I about fainted. Any advice? I’m all ears.

I called and emailed HAP and they said they do not cover Lap-Band, but they do cover gastic bypass surgery. They mailed me some info and it contains covered CPT codes. I don't know if I'm missing something or what, but a covered code is #43770- Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device(e.g.,gastric band and subcutaneous port components).Now I know I've seen on here that the CPT code is 43770. Am I mistaken in thinking this IS actually covered according to their info they sent me? I'm new to this and so confused!:confused2:

Hi, are their any military spouses stationed overseas who want to get the lapband? I do, Im stationed in Schweinfurt Germany right now and am looking for others who also are starting the journey. My tricare Rep for the longest time has been telling me that Tri care does not cover lapband overseas, finally after reading another post, i held my ground with her and had her call her main office. Low and behold they do. I know that their are several ladies on this post who have been waiting, and now hopefully they will get the call that they can start their journey also. I was upset that the Tricare Rep did not willing look into this herself, that i had to seriously make …

I am 36 years old. BMI of 36 for 1 year now, prevous ranged from 30 to 33 for many years. I now have high blood pressure & pre-diabetic. Been thinking about Lap-Band for a long time. I have BCBS of MN. Has anyone else been in the same situation I am in? Any good advice regarding my insurance?:thumbup:

Anyone Have This Issue, Im Totally Confused But My Benefits Hotline Said Bc My Companys Main Headquaters Is Out Of Nebraska Thats Where My Insurance Is Designated For... But They Dont Discriminate For Where U Live, Im Confused!

In January, I was approved for the surgery but my husband wasnt because he only had two year weight history. Since then We found 2004, 2006, 2007, 2008, no 2005. Also since then Aetna changed their requirements. We apealed and got a letter yesterday denying him again!!! WTF!!! It says he is missing 2005, what difference does it make if they only require 2 years. It also says they require two years of weight history. When we resubmitted, we turned in a letter from him, a letter from our PCP with the four years on it and a letter from his knee doctor. I dont understand what's going on and what to do now. He is very upset about this and it's hard for me knowing i'm getting…

Does anyone know if Unity Health Insurance in southern Wisconsin covers lap band proceedures?

I have Champva. Does anyone have experiance with them. I know that my surgery would be covered, but I would like to go to Mexico to have it done. It sounds like it may be a less time comsuming experiance. Any thoughts from anyone would be helpful. Thank you

:lol:I'm so excited. I was worried they would not approve me because of my lower BMI (36) and my co-morbidities weren't really serious (yet). I expect to have my surgery in April. Maybe I can wear a nice swim suit by the end of summer!!! My goal is to see the sky between my thighs.....you know, when you stand and your feet actually go together, and there is space between your thighs???!! Its been a long time since I've been able to do that. Would make for an interesting ticker!!

Hi ALl! I have gotten some wonderful emails from some of you San Diego Gals! My Dr wants to put in a request for me on the lapband.. But the gastro Dr.s he uses dont do that procedure. So, I am trying to find a Dr that does lap band under Mercy Physicians medical group in San Diego. Through Pacificare HMO. Anyone know how I can find this info WITHOUT having to call insurance?

I contacted BCBS of AL to ask about fills as I am not yet banded. They will cover my surgery but will NOT cover the fills. WTH!??!!! It just makes no sense to me that they will cover the cost of surgery but NOT the fills...FILLS are part of the lapband process!!!

I think I ve read so much lately that it's all running together. On the BMI history, does it have to be over 35, or just obese? What about a BMI of 31-32 5 years ago and 35+ since then?

Do any of you have BCBS of NC for State Employees? Could you please tell me the good, the bad, and the ugly stories of getting approval or denial.

At the end of 2007, to save money, I chose to not re-enroll in my employers insurance (UHC) but to use my last year on my parents insurance, before turning 26 next year and getting booted off, to save some money by not double insuring myself. Then I decided I wanted to get banded and found out that my parents insurance, Altius, does not cover banding but my employers insurance, UHC, does. So I spoke with my HR department today and they said that if my coverage was terminated with my parents plan I could enroll with them and not have to wait for the end of the year annual enrollment. So here is the question - they work on the honor system. If I tell them that the cov…

Can anybody here recommend or know of a Surgeon that accepts Tricare Prime in North Florida. My PCM will give me a referral but I have to find one for him to refer me to, preferably in the Gainesville or Jacksonville area. I've tried teh search function to find one on this site or at least a lead on one. Tricare website breaks it down by general surgeons not bariatric. Plus, I would love to hear about the experience with the doc if anyone has any.

Hi Everyone! I am excited about seeing Dr. Teel next week in hopes to get the lap band. I am right at 35 BMI and take High Blood Presure meds also with High cholesterol and Rheumatoid arthritis. I have United Health Care insurance and they said it on case to case basis if they will pay for it. Just wondering if anyone has been right at 35 BMI with health issues that has got their insurance to pay for it????? Thanks! Marlanea

Anyone know if Aetna pays for fills?

Hello, I was wondering if anyone has come across something like my situation. My insurance is bcbsnj and I did some searching on the website for bariatric services. The have 2 hospitals that are approved for the Bariatric surgery. But they are in NJ and Delaware. So what does that mean to someone who lives in Florida? I have not contacted the ins yet but I will very soon. I am anxious to learn what the reason would be if they were to tell me that it is not covered in FL. Anyone with any ideas? TIA, Gina:confused: