Insurance & Financing

I have just finished all the requirements that the surgeon office asked for. Cardic consult, dietitican consult, psychological evaluation, medical records and attendence of seminar classes. The surgeons office will now submit to insurance, how long should I wait before I call to see if I am approved. This doctors office is on the busy side and the are short staffed I was told. Any ideas?? I don't want to be a pain but I want the surgery

Hi everyone, I know this question's been posted but I was wondering if anyone knew the latest turn around time for Cigna to issue an approval? Meaning from the time paper work is faxed to Cigna and call from Surgeon's office> approximate?

Hi folks, I've got a question on Fed BCBS copays. I have the basic option and used a BCBS Center of Excellence. I had no trouble getting approved, and originally thought I would only be responsible for a $100 copay to the surgeon and a $40 copay to the facility. However, it looks like the facility has billed the band itself as in implant, and the way my coverage reads, an implant during an outpatient surgery is only covered at 70%, which leaves me holding the bag for almost 2k. Has anyone had this experience? I've not read anything about this aspect on the forum, and the insurance coordinator from my surgeon says she has never heard of it, but cant do anything b/c s…

The Dr's office submitted my paper work today to UHC. My insurance covers this surgery if I meet their criteria. My BMI is 39.8 weight 197 and am 4"11. I have high blood pressure and sleep ap. Do you think I'm a good candidate for the insurance to pay. I'm really excited.

Hi, all - I had my initial consult December 6. I got a notice from my insurance company, Wells Fargo TPA, saying the visit wasn't covered because of insufficient documentation of medical necessity. I finally, after three tries, got ahold of someone at WF and she told me she needed a letter from the surgeon with my explaining my diagnosis and outling the medical necessity of the visit. OK, fine ... Thanks for telling me in the first place so I could have taken care of it beforehand ... sheeesh!

Re: Approval. Will it get me anywhere? Who would I ask to talk to? Has anyone suceeded in getting any good info on approval or even to the right dept to see if my files have even been touched? Thanks:biggrin2:

I have federal bcbs basic and I was approved over the phone and got the approval by the time I arrived at home. So it was really quick. my date is april 15. Does anyone know how many fills are covered by fed bcbs :cool:basic.

Hi everyone. My name is Amy and I am seriously considering LapBand. I have a few questions about the financial side of the process. I am in Las Vegas and have Tri-care insurance. The surgeon that I am seeing requires a $2000.00 deposit. This baffles me because I know that Tri-Care covers this procedure and if it is approved they pay...they do not come back later and say no they pay. I have never seen this before on any board other than my Drs. message board. Some get the deposit back and others do not. I know that Tri-care has a catastrophic cap of 1000.00 and anything over that is covered at 100%. Also anything over 300.00 to the 1000.00 Cat. Cap is only a 20% deductible…

Hi, my insurance hasn't kicked in (I switched jobs) and I am waiting to get BCBS Colorado to apply for the Lap Band! I am so excited because I heard it is much easier than Kaiser, my last insurer. Can anyone tell me my first steps towards this process so I can begin to prepare for when my policy begins?? Thank you!

Does anyone know what Health Net CA Silver Plan requires for the two years of supervised weight loss? The reason I ask is I have been going to an alternative weight loss nutritionist (she is licensed) for 3 1/2 years. She recommends diets and vitamins and test for food allergies. The first year I lost 60lbs with her help then feeling pretty good I paid for a tummy tuck. After that as we all know the weight came back on with more to spare. So I was wondering if she would qualify as a supervised weight loss professional. Does anybody know what the requirements are and what kind of paperwork she needs to give me, how in-depth and so forth? Thanks in advance, Justine…

I am wondering if anyone has had the procedure done though Kaiser in Oregon? Last year I was told that they did not do this procedure, however from other posts in here with Kaiser in other states it looks like they might offer it now? Does anyone know?

Does anyone have Preferred Care? I know they cover it but I'd love to talk with someone who's had lap-band done with preferred care insurance...

I am being baned on 3/27, I am wondering if the insurance covers the fills??? I called today and the customer service rep. was clueless:huh2:....I have BCBS Blue Options... Thanks

Hi Guys! Well reding on this website, i got the impression that the Dr's in the states were a bit more pricey then the Dr's in Mexico, but i thought most people said their surgery was between 8-12,000. Okay, im freaking out.. I live in Orlando, FL but will travel anywhere in FL or GA for a good Dr. and i have Aetna PPO. I am going for my first appointment with the nutritionist next week to start my 6mo. diet so i still have time to find a good surgeon, but this price thing is killing me. I spoke with a Dr. Beltre's office in Orlando and they said that the total cost is $15000. In general that isnt awful as my insurance will pay 90%. HOWEVER, they are saying that t…

I finally found what my insurance policy says about surgery: "Gastric restrictive procedures, gastric malabsorptive procedures, and combination restrictive and malabsorptive procedures to treat morbid obesity – a condition in which an individual has a Body Mass Index (BMI) of 40 or more, or an individual with a BMI of 35 or more with co-morbidities who has failed conservative treatment; eligible members must be age 18 or over. Benefits are also available for diagnostic studies and a psychological examination performed prior to the procedure to determine if the patient is a candidate for the procedure." It also states this" Preferred: $100 copayme…

My surgeon's office just called and told me she got the insurance approval this morning! I can't believe it! My 15th wedding anniversary is at the end of next month, what a wonderful gift, for us both! I'm so ready to start living. They told me I would be a good candidate, but I never thought it would come so quickly. I've been so afraid to look ahead and didn't want to get my hopes up. I've been a nervous wreck! Now I can just get on with it! What a blessing!!

I have been working toward my insurance approval with bc/bs anthem of michigan since october of this year!!! I have been to family doctors, psychiatrists, sleep centers, the barix surgeon, seminars, and nutritionist. now it has been 2 weeks since all my information was submitted. I have a lower bmi with no real health issues. lucky for me, I had moderate sleep apnea:} ( that was a fun night!) I called the insurance company yesterday, and they haven't even looked at my file yet. I just hope there's not just one skinny person holding my fate in their hands thinking, why dont you just quit eating and exercize!!!!!!! DENIED!!! I just HATE all the waiting.:tea:

I have my initial meeting with the surgeon in a week. I called my insurance company and asked about coverage. According to the website and their on-line policy, there is no specific time frame that you must have been on a medically supervised diet. I thought I would go ahead and ask anyway, and I was told by the insurance rep that she wasn't sure and she guessed that a 6-12 month supervised diet might be required. She said that they would let the physician's office know when they filed for approval. This doesn't make sense to me! Either they do, or they don't. Has anyone else run into this with this specific plan? Thanks! :confused2:

I am wondering if I have to visit my PCP or if I can just go to the seminar and start the insurance hoops through them. What did you do? My PCP for the last 2 years quit and moved away, the facility he was in is still there but I have no relationship with the new doctor I have been hooked up with and wonder if she will agree to do a letter or referral? I have one iffy condition on my insurance policy, proving my morbid obesity for 5 years when it has only been morbid for 2 and sever for 2 before that.... Any input is greatly appreciated. And I just want to give my shout out to this forum - I LOVE IT AND EVERYONE ON IT. It is a shame there isn't support like this ev…

Has anyone had luck with getting insurance approval for the lap-band because of back pain? I have severe back pain, and it is much worse because of my weight. I have a BMI of 36, so I need a co-morbidity to get surgery. Also, I called for a quote on doing the self pay option and was quoted $6500 for surgery and anesthesia. Based on the other threads, this seems way too low. What other questions should I be asking them about the quote. (Portland, OR) Thank you!

Hi everyone.. I currently have tricare prime, but was told there is a 6month waiting list at the MTF which I am assigned. I talked to tricare and they said the only way to get around it is to do Point Of Service just for the surgery..which I'm not clear on what that does... or completely unenroll from prime and switch to tricare standard. I understand I have to pay co-pays and what not, but i'm just wondering, after surgery, how much did you end up paying for hospital bills and everything?? I'm so confused and don't know if it's just best to wait 6mos. or if I should get the ball rolling and just get off my wallet. :thumbdown:

I got my approval today from UHC!!!!!!!! I faxed my Cap One financing contract in yesterday to my Dr & they were faxing it in today but decided to call UHC for one final check on my 3rd appeal & they overturned my denial!! I was so happy I was in tears w/ the billing girl from my Dr's office. 3 months of fighting paid off. My surgery is set for April 11th. No turning back now! I could have set the date sooner but I just paid $2,000 for a 3 night trip to Disney World for spring break & I dont want to be 3 weeks out from surgery & trying to walk around amusement parks for 3 days. I am still in shock! My Dr made UHC fax over the approval in writing sin…

I just found out that my company -- the one with killer benefits that include just about everything including IVF and all sorts of alternative treatments -- excludes WLS from their medical plans. I'm pretty upset about it because, given their generosity on everything else, and their emphasis on people improving their health, I am convinced it's a matter of prejudice and ignorance. Anyway, I'm thinking about writing them a letter. Our Open Enrollment period is in 5+ months so I'm guessing they are working on what the coverage will be right now. If I could convince them to add this coverage, it would help a lot of people. Has anyone been successful in doing this?

I am hoping someone might be able to give me a ball park figure on the charges for the hospital. I have been trying to get an amount from surgeon/hospital/insurance and have been getting the run around. I am just trying to get an idea how much out of pocket I need to plan for. My copay is 10%. My surgery is scheduled for March 25th.

I heard (or read or something) that if you self pay for surgery and there are any medical complications that insurance will not cover you for them (infections or other problems). That is terrifying, what if I had a heart attack or something else very expensive? Does anyone know if this is true???

Hello All, I am a newbie, this would be my first post and I need some advise, please help. I have my consulation this Thurdsay with the surgeon, we'll see what he has to say. I am more worried about my insurance then anything else. I am 35/M, BMI 39, high blood preasure and high triglycerides. Does anyone have any advise? Anyone have any Blue Shield stories? Anything? Thx!

So after calling Aetna and talking to the CS rep and finding out that the lap-band surgery is excluded from my company's policy, I called our HR reps. The one I talked to said that WLS is excluded unless it's medically necessary. This is sort of what the Aetna rep said but the Aetna rep was coy about it and I got the impression that it was only if I went self-play and later had complications that the complications would be covered, not that I could make a case for the surgery to be covered from the start. However, HR person said straight out that if my doctor can make a case for the surgery, they'll cover it. She said to use terms like "medically necessary" when my doct…

Hey guys, I thought this was so freakin funny. I pulled up my online status with my Insurance and it shows that the Hospital/Dr.s claim for . . . Drum Roll . . . $46,521.64 My Insurance paid . . . $6783.74 I just thought that was too funny not to share.

Okay. I've been on the phone all day. Is their anyone on this site that has Tricare Reserve Select that's been through the motions of getting approved or having the lapband surgury. It's a bit different than Prime or Standard and I'm getting SUCH a run around from doctors. They keep telling me that they don't take Tricare... but Tricare Reserve Select pays doctors "out of network" so I don't understand the problem their. They also want me to get a referal... but Tricare says I don't need that either with Reserve Select. Then they're saying all this history I'll need and that I'll have to see a therapist and nutritionalist.... but my Tricare doesn't require that either. Ho…

Hi everyone, Im kinda new here but I have Tricare Prime (South) and I was wondering if everyone who has been approved or disapproved for Lapbad (since they have started approving Lapband) will post here and include their starting weight, height, BMI and any comorbities, if any. Also, if you got denied, can you please include why you were denied. Thanks!!

I have a care card for 6k, 2k cash, and I cant get any more credit cards. Is there any doctors that have in house financing? I would be willing to travel, I reallllly want the lap band!

I was APPROVED!!!!!!!!!!!!!!!!!!! I was approved today! I am so excited. My surgery date is 03-07-08. DH and I are having it the same day!

Won't they? The ONLY proof of my weight for 2004 I can find is the paramed exam BCBS did on me when I went on DH's policy for awhile. It seems logical that they would accept it since it was "official" enough for them to use it for their own puposes, right? Has anyone used this type of information as weight documentation? I think it should be MORE convincing to them to cover the procedure due to the fact that the our premium was the same as it would be if we were smokers because of my weight. Ooo I might could use that against them if I have to appeal!

My sister lives in MO and has UHC Choice Plus and found out today that LB is not covered. This is what the Surgeons office told her. I was wondering if you could share what type of policy you have and see if there are any suggestions you could give us to help her get approved. She works for a small business and could likely get the plan switched if she just knew which one to go with. Any insight or help would be greatly appreciated.

I have to pay $200 out of pocket for my fills. I need to fight UHC. My doctor is not in network but I believe if there is no specialist with 30 or 60 miles of where you live you can fight them to pay. Has anyone else ever been through this. What did you have to do to have them pay for fills?

you to be on a supervised diet for an extended period of time before they will approve the surgery?

OK, after weeks of practically harrassing my PCP to send my records to the SWL coordinator, I find out I have NO documented proof of my weight for 2004! That's the only thing I need to meet the requirements! Have any of you had this problem? What did you do? Were you denied coverage? I have BCBS of NC SEP. Anyone have experience with them?

Hello all, I was originally banded in December 04 and my insurance company at the time, Pacificare covered the surgery. Recently because of a horrid stomach virus, my band slipped :drool: . My new insurance company, Aetna EPO approved the removal and replacement last Friday and surgery is set for this Thursday March 6th. Add me to your prayers guys. I am hoping this surgery is a breeze like my last one :laugh: Good luck to everyone and their insurance companies!!!

HAS ANYONE HAD ANY EXPERIENCE WITH CIGNA INSURANCE. I AM DOING MY 6 MONTHS,BUT DON'T START THIS INSURANCE UNTIL JANUARY. I DON'T WANT TO WAIST MY TIME IF THEY WON'T COVER IT. IT SAYS IN OUR POLICY THAT IT IS COVERED BASED ON MEDICAL NECESSITY. MY BMI IS 42. I HAVE ACID REFLUX, BACK PAIN, STRESS INCONTINENCE, AND DEPRESSION. I WANT TO HAVE THE LAP BAND. MY PCP STARTED ME ON WEIGHT WATCHERS. IS THIS A PHYSICIAN DIRECTED DIET? ANY HELP OR ADVISE WOULD BE GREAT!!!!!!!

Anyone have experience with this insurance? They said the surgery is covered, but I am wondering how long the approval will take. It has been 1 week. I am getting anxious already! Thanks! Sharon

I have several questions if anyone can help. Can a Obgyn be used instead of my primary. Primary care physican said he would support me but didn't seem to thrilled. When I went to my Obgyn he couldn't have been more thrilled. He said it would be up to my primary but he would write a support letter. I think my insurance company stated in their benefit section that a obgyn would count. So I guess my question would be instead, is it wiser to use the primary or obgyn. Also during the six month waiting period what are some good points for the doctor to include in each months "statement". I'm barely in there with the BMI. What about the surgeon? Lastly, anyone know a good…

For anyone with this insurance I would love to hear your experience with approval. Time line, any problems, successes, etc. My BMI is currently 39. I went to orientation with a local bariatric surgeon and my first appointment is scheduled for next week. I have some potential comorbitities that I am worried are "weak" and so I'm trying to gain 5 pounds to push me into the morbidly obese category by next week. I was (shhhhh) told that this would help me by someone at the surgery orientation, won't ever tell who. My real concern at this point is that my weight fluctuates considerably and sometimes I have seen Dr.s with low weights, as low as 160, however that lasts for…

Any Veterans out there? I was in the Air Force and am wondering if the VA would pay for lapband surgery. So far, looking at VA websites, I don't see any exclusions. Just wondering if anyone has had any experience getting this done by the VA. I have United Healthcare where I work but my HR dept has excluded WLS so I doubt that I can get it thru them. I live in Missouri so Kansas City VA or whatever they have at Columbia might be an option for me although I don't mind traveling farther if I need to. Thanks for any input!

It is that dreaded time of the years and I have a question about my taxes. When I found out that a lap-band was very hard to get on my insurance I went to Mexico(07/2007) and got mine as a self pay. Can I claim this medical expense ($7250) on my federal and states taxes? Any advice would be great. Thanks in advance for any and all help.

hi were stationed in schweinfurt germany and im wondering if anyone knows of any doctors who do lapband that take tri-care? and experience with them etc. i dont' wnat to have to stay in hospital for a bunch of days and it seems with german hospitals you always stay forever. thanks.:blushing:

Ok...I am probably going to come across here as very impatient...but I need to voice this. I was approved last Thursday (January 31st) and I haven't received the approval letter from the insurance yet. They claim it was mailed on Friday from Dallas, Tx. I live in Houston. The problem is that my surgery is scheduled for 2-13-08 (one week from today) and I have no idea about my pre-op requirements...clear-liquid diet, blood work, pre-registering with the hospital... The doctor's office is telling me that they cannot proceed without that letter in hand. They won't even talk to me about pre-op. They have already called the insurance company and confirmed that I was …

I have a question if anyone knows, I have UHC, and from what I have read on their site, they will cover this if my BMI is 35-40 or higher (currently 42) and I have comorbs. Well, I have severe, almost bone on bone arthritis in my knee, so yeah, have comorbs. My question is, I see a lot of 'self pays' how does that work? I don't have 17,000 sitting around, but I sure would like to fast track this as much as possible. What's the deal? Thanks! WannaBeMeAgain

All my information was turned in Oct 25th which was Thursday and I called my insurance company on day and they told me that I was APPROVED!!!!!!:whoo:I can not wait. They will sent me an approveal letter and now I just have to wait until the Bariatric center calls me with my date. But when I talked to my insurance company, they told me that the date of service listed on the paperwork was Dec 13th. I think this is the band date. Will post more info sooon. I am so excited:faint: Caramel

I went through the Pre-op process with the surgeon that I would like to do my lap band surgery about 4 months ago. Back when I had United Health, the surgeon's practice was not IN Network so they did not submit to insurance. I have since changed coverage (my husband got a new job). March 1 we will have Blue Cross Blue Shield, who is contracted with my surgeon's practice. The insurance department has seen 100s of surgeries approved with Blue Cross Blue Shield. I am so very anxious to have the surgery done, I would like to submit the claim for the Lap Band March 1, the day coverage starts./ Do you think that is a good idea? I am pretty sure I will be approved, my BMI is …

My insurance is switching to NJ Direct 10 as of April 1, 2008. Does anyone have any info on them and their requirements??:eek: