Insurance & Financing

:thumbup:I had my appointment today to set a surgery date. March 20th!!!! My doctor said I had already lost 12 lbs. since my last visit so I just needed to maintain. I am tickled BRIGHT PINK!!!! I am excited and scared, guess I am doubting my decision but I believe this is what I need to do. March 20th!! PA

I recently accepted a new job, my current insurance covers the surgery and the papers were just sent in for approval. I'm covered through the end of March, however if the surgery is not done in March I'd have to sign up for Cobra. I'm wondering if anyone else has done this or if I should really push to have the surgery in March. My new company does not have insurance the covers the lap band

I could just cry! I rec'd word today that our insurance does not cover ANY bariatric surgeries. I talked to the head of our personel dept and she stated that we are a fully funded group (union and negotiated terms of insurance) If we were an idividually funded group, there would be a possibility of exceptions to the denial. Has anyone ever dealt with a full funded insurance plan before and how did you get them to approve your banding? I have BC/BS -Anthem (Wisconsin) We have new insurace since AUgust and our old insurance covered the surgery 100% but now they won't cover a dime!! Any suggestions??:glare:

My first question is Fibromialgia even a comorbidity? Drrr... sort of frustrated because I've put on a lot of weight this past few years and now I'm older my joints are hurting. Doesn't seem hard for me to put two and two together. Fat=achy joints. Okay, so I told my primary (this is the 3rd time I've seen her within a year and told her this) joints were hurting. They are, ankles, knees, and some pain in my lower back specifically when I try to exercise or am overly active. I got a call about my bloodwork and while I do have some indicators that I have inflammation BUT she feels I may have Fibromialgia. I researched it and from what I read I don't feel I have even clos…

Ok, so I just found out United Healthcare denied me because overall I had no co-morbidities. No sleep apnea, hypertension, diabetes, cardio-pulmonary problems, etc.. I've been 5'4 and 225 or higher sice 2001. Right now I'm at 280 with a BMI of 48.1. The girl I talked to at United Healthcare thinks I should appeal with my case and it'll go to a medical director to re-review it. Has anyone had that done and get approved? Thanks in advance, guys :smile2:

I was so excited to be going to a lap band seminar tonight. I have been looking forward to it for weeks. After talking to one of the girls at the SEB office, she wasn't too confident medcost would cover the surgery. Of course I am putting the cart before the horse hear but I was really hoping for an easy approval. Im really discouraged now. ETA: I just got off the phone with insurance. They require 6 mo of prior physician assisted weight loss. I was seeing a doctor from 6-26-07 until 11-06-07...not exactly 6 mo. Anyone know how closely they look at the actual dates? I stopped seeing that doctor cause she was terrible.

Woo!hHoo! I am finally aproved for my surgery! Took damn long enough! And I know there weren't as many hoops for me to jump through as a lot of you guys out there but I am SO relieved! Next step set a date! I'm getting banded! OMG I'm literally bouncing up and down at my desk! Better stop before my boss starts giving me the evil eye!

Can those of you who have been covered by BCBS of Ca tell me about your expierence. How much your copay was(if any) time it took to get your approval. I have also read where some people said they found a list of qualifactions on the bcbs website that I haven't been able to locate at all. Thanks for any and all help

I got my statement from my insurance company the other day and I thought that I would share the cost info that I got! This is a lot more expensive than what I thought it would be! According to my statement the total amount charged for my surgery..drugs and all $32,000.00!!!!!!! Isn't that alot??!!! I couldnt believe it!!! My portion :thumbup: $1100.00!!! Now that number is WAY less than what I was told so that part I am totally happy about

Does anyone know if you using a surgeon/center of Excellence (designated this by BCBS) if you have BCBS insurance make the approval process go any smoother or quicker? (provided you meet all their guidelines for surgery - which I do). Thanks in advance!

:smile2: According to medical records five years ago my BMI was at 34.4 as of today it is 40, I am awaiting to hear back from insurance to see if I will be approved. Any suggestions or has anyone dealt with BCBS of TN in reference to getting covered for LapBand Surgery?

My primary care doctor submitted my referral to Tricare South for a consult with a surgeon for lap band. I just got a phone call from a Tricare rep and she said that they wanted to refer me to a surgeon who is affiliated with a "Center of Excellence". Has anyone else had Tricare request this? Luckily the surgeon my doctor requested a referral with is in the same practice as the surgeon that Tricare wants me to see and I had not really had a preference of one over the other. So hopefully all is going well and I am on track to getting the Lap band. I am very happy with how quickly Tricare responded to my doctors referral request. It has only been a couple of days. L…

Hi everyone. I have been lurking around on this website for a while but have never posted. I was too afraid to post before getting approved and jinx myself into being denyed. I spent a lot of time reading other people's insurance stories, looking to see where I might stand with mine. There are so many variations with each company as to what is required to get this surgery: Six-month supervised weight loss programs, psych evals, BMI over 40 and co-morbidies...I fully expected for my approval (or denial) to take a few months. All I can say now is "WOW!" I went to the seminar with the surgeon on January 24th and my paperwork was submitted to the insurance on January 28th…

CIGNA may face murder charges over this one Family sues insurer who denied teen transplant - Health care - MSNBC.com MAybe it will hep us all out along the way if they finally look at how these companies look at patients, and make medical decisions. Gary

Hello All- I have another post about my obsession with getting Lap Band surgery - I guess as this is my third thread on different topics - my obsession is obvious. I am one week from my first appointment with the surgeon and nutritionist (the adminstrative assistant in the office is a gem- she set up both for the same day) and am fairly freaking out already - I cannot imagine what I will be like when I am actually waiting to get approval from the insurance company. I have Harvard Pilgrim HMO and the administrator mentioned that it was not one of the harder companies to get approvals from - is there anyone on here who has had a recent approval or denial from Harvard P…

My insurance is with UHC under Office of Group Benefits (Louisiana). There is an exclusion on my policy that will not allow me to have the surgery. Aside from becoming a self-pay, is there an insurance company I can purchase a policy from (rather than using employer carrier) that will cover this procedure? I am so disappointed that my insurance won't cover it.

Dumb question I know, but....is they a shortcut around the 6 month doctor supervised weight plan that is required? How about a doctor that sees me once every 3 or 4 months and helps with the weight?

I was determined to self-pay, but I called my insurance company today and they will pay 100% if my BMI is over 40 and I do 6 months with a Dr. under a diet program first. I am 7 lbs away from my BMI being 40. 7 lbs is nothing right? I could gain that in no time. I know it seems silly to gain weight first, but it's only 7 lbs and I could keep my $15K I was gonna pay. Any thoughts?

Has anyone been approved by medcost/perferred. I have a BMI of 45, I have sleep apnea, type II diabetes,high cholsetrol, several back pain. Do any of these factors help in getting approved. I have heard it will help?

I'm on Ohio Medicaid and they turned me down basically saying that although I had a bunch of obesity related medical conditions, they can be controlled with medication so surgery is not covered. Even though the surgeons office told me that they had got an approval for a man through Ohio medicaid after they sent my case in... although as she said he was quite larger. All I can say is I'm mad and I'm tired of taking these damn pills in the first place... what do they want me to be half dead before they approve me? They've only given me a week to prepare for this so I hope I can get a positive outcome.

So, I have UHC with LapBand being covered. Only thing, I have to have 2 co-mobidities (which I do). I submitted my medical records yesterday to LBS that show the High Cholesterol and shows where they decided to put me on BP meds due to high BP. How long should I expect to wait for UHC to approve the surgery? I am going thru Lapband solutions, so they should work pretty fast (from what I am understanding). The lady at LBS told me 7 to 10 days, but I'm so hoping it's sooner then that. What has been your experience with UHC and LapBand Solutions?

My BMI is somewhere around 37 or 38. I'm 5'10 and weigh about 246. I have treated high blood pressure. I've just about given up on the hope of having this surgery because I don't have a 3 year history of a BMI over 35. Very close though, like 220 one year, 232 another. BCBS of ALA requires a 3 year history of weight and height showing a BMI of 35 or more with pre-existing illness. Here's the question: Eventhough my BMI history is not above 35(except for now), currently I'm technically right at 100 pounds over weight if you go by height and weight charts. Does anyone know if I have a better chance now with that being the case or do I need to show a 3 year history of that w…

Hi Guys! Okay so i am in the process of jumping through hoops and i am still early in the process. I just got more blood work done then i would like, but i just had a couple quick questions.... 1. I am 5'4 and 250lb, i have been overweight by entire life, but i was 200lb from about 17-19, then have varied between 215-245 until now (i am 22) does this seem to be enough of documented obesity? Obviously my BMI has fluctuated, but its not like i was ever thin..???? I have high cholesterol and, i have high levels of cortisol we are re-testing right now. I am also getting my thyroid tested but i doubt that will come back bad. I have to set the appointment for the sleep…

Obesity Surgery GO AETNA.

Greetings everyone! I'm new here and thought I would seek the advice from those that have been successful in the appeals process. My health insurance is BCBS CA PPO which covers the various types of weight loss surgery and I live in Nebraska. Today, I spoke with the Utilization Review nurse assigned to me. She advised that since my BMI is 37.5, and we discussed my co morbidities (hypertension, depression, asthma, migraines & joint pain). She advised that I will be denied as my BMI is below 40 and that I do not have the necessary co morbidities. Despite taking 11 different medications. In fact she advised that I need to be on two medications (I currently take…

Hello Does anyone have BCBSAZ PPO insurance? If so, do they cover weight loss surgery? Thank you

already had surgery. I went to my PCM and she referred me to a doctor in Mobile, AL. I call them and they said I had to have a orientation before I can even see the doctor. So I made that for this Wednesay. My question is, the referral I got is that for the surgery too or just to see the doctor doing the Lapband? The reason I am asking is according to his website, I will need to have a evalution by the nutritionist, psycoligist (sp) and may even need a 5 yr evaluation on showing that I have been trying to loose weight. I thought me going to the PCM and getting a referral for the Lapband was all I was going to need. Can someone answer these questions that have alrea…

Considering that Tricare just began covering the lap band procedure I was just curious if anyone has been approved yet? Amy

Got a call today from the surgeons office stating that they need to get a denial from my primary insurance which is UHC before they can give me a surgery date. UGHHH!!! I am so pissed. First off, I've mentioned to the nurse who is handeling my file not once but numerous times with regards to my primary insurance. Never once did she say we had to submit it to them first because we both new that it was an exclusion on my policy. So we just submitted it to Aetna, who is my secondary and it was approved. So because she is on vacation this week, we have to wait until Monday before she submits it to UHC for the denial. At first the other nurse said to me that I would have to…

What's up with the psychiatric evaluation needed for insurance. What kinds of questions to they ask while they are shrinking your brain??? :lol:I've never seen a therapist before and am kinda nervous about it!

:thumbdown: As of January 24, 2008 Humana has changed their policy. Before you just had to have something documented in your medical records for the past 12 months stating you have tried dieting. No effective January 24, 2008 you will have to do the 6month supervised diet plan. I just went to my seminar today and made my first appt for March 23. Hope to be banded during the summer. Vickie :biggrin2:

I have been obese for many years and have tried everything out there. My work insurance policy through western benefits doesn't cover surgery for weight issues. Is there a secondary insurance I can pick up that will? Insurance stuff is like Greek to me if someone can point me in the right direction I would be very grateful. It seems to perfect to be able to pick up an insurance coverage just to get an expensive surgery done, is it? Thanks. :cursing::sad::sad::tt2:

:mad::angry:After everything I have been thru, all my Dr did to make sure UHC was going to cover this, my surgery was supposed to be this past Friday the 8th. Well on the 7th ins calls my Dr & tells him they are NOT PAYING!!!!!!! They claim its an exclusion in my contract. DUH YOU FREAKING MORONS!!!!! The exact wording in my contract is "Surgical or non surgical treatment for obesity, including morbid obesity, is an excluded service UNLESS authorized by a physician for medical reasons." 5 yrs of weights, and 4 co-morbidities, 3 different physicans writing in letters of medical necessity and over 100 pages of medical records dont just scream "authorization by (3, not j…

Just got off the phone with my hubby's employer (who health insurance is through). They have specifically excluded weight loss surgery from coverage. What do I do now? Anyone else been in this boat? The Insurance is through UHC. :confused2:

Hi all, I'm a newbie here....been interested in lapband for a couple of years, but no luck. Doctors say I qualify but it's listed as an exclusion on our insurance policy. We have BCBS and we live in Ohio. Is there anything I can do now? I want to fight it...but I need to know where to start. Thanks!

I just found out that after all the hoops that you have to jump through for Cigna...my PCP did not properly document my weight loss efforts. Now I have to start all over again. ARGH!!!! :cursing:

HI; I am wondering if this has happened to anyone else, and if so, what was the out come. I have BCBS of Illinois. I work so diligently, to provide the insurance company with all requested information. I finally got the approval letter from the which specifically named, using the CPT codes for the Lap band procedure..approving it. I do not know if someone up there messed up or what..but that is really not my problem. I was so happy to get approved I cried. I had waited 2yrs. So, I had my surgery 7/5/2007. BCBS has not yet paid. My doctors office received a call last week saying that they were not going to pay for it!! I could have NEVER afforded this by myself.…

I have Aetna and have been denied because I only have four of the five years needed to get approved. I just filled out the form on obesitylaw.com. Has anyone here used them?

Aetna Revises Policy downward from 5 years to 2 Years! Check out the attached pages that compare the old Aetna clinical policy bulletin to the new one they just posted on their website with a revision date of Feb 8, 2008 -- reduced the time for severe obesity wording from "at least 5 years" to "at least the last 2 years" . This was the ONLY change I could find in comparing the whole document with regard to anything to do with Lapband surgery qualifications. The whole policy is on their website with details for other weight loss surgery requirements for RNY, etc. but this is all the stuff that compares what was in effect Feb 1 to what is in effect now! Hope this help…

After being sooooo excited that Tricare would pay for the LB, I am having a tremendous problem getting the woman who does referrals in my PCM's office to send the doggone referral to Tricare. I call Tricare every day, and then call her. I asked for the referral on January 25. and the PCM totally approves. I talked to her today and she said that Tricare had sent her something, but she had not had time to look at it. Funny thing: two days ago, I asked for a routine referral to my Cardiologist and Endocrinologist. They are already approved! Tricare absolutely swears nothing had been sent on the LB. Today I called the Bariatric surgeon's office and asked their patient advocat…

has anyone gotten approved by cigna while having no co-morbidities? i don't have any (probably will in a few years though if i don't have the surgery) and was wondering if this will affect my chances of approval. i meet all the other criteria and stuff. thanks!

I'm saddened by all the stories and posts I read about the difficulty you all have. In Australia its so much easier. All insurance companies cover the surgery, you just need to make sure the level you are paying for includes it. We also have medicare, which is a part government payment. To get the part government payment all you need is for your GP to write a referral letter to the surgeon of your choice. To get the insurance payment you simply need to wait their waiting period - 12 months. And that's it. As long as your GP says you need it and the surgeon agrees, you can go ahead. After 12 months paying health insurance, I am looking at paying between $2,000…

Last year I got my band with United Health Care PPO. They covered the band without any problems. This year I'm still with United Health Care, but have the EPO and this plan does not cover WLS. I'd like to know if the EPO will cover a follow up surgery for complications such as repositioning for a slip or removal for erosion. My instinct tells me that they will cover it if it's considered life threatening. If you have been in a similar situation or have an opinion, I would love to hear it. Thank you

Hello Everyone! I am considering have the Lap Band surgery done. I go to the informational meeting on the 23. From what I have read so far, it seems that Blue Cross Blue Shield covers the surgery. Does anyone know if Blue Choice HMO (a branch of Blue Cross Blue Shield) covers the surgery as well?

I have a question.... I have UCH insurance and need to have 2 co-mobidities..... In order to be diagnosed with something, you have to have it, right? What about High Cholesterol? If you have the high numbers, doesn't that mean you have it? Or, does the doctor have to actually make note in your charts that you have it? My numbers have been high the last few times I have had blood work done, but never been "officially" diagnosed I don't think. Would I have to actually be on medication to be seen as having it? My BMI is under 40 so I need 2 co-mobidities. I am on BP meds due to high blood pressure, so I need one more. My labs show me to have high cholestero…

I have a BMI of 42. I was told and recieved a copy of their benfits as followed please tell me if I am wrong but I should be fine for insurance approval based on my BMI and I have tried several different weight loss programs. Thanks, Kelly ( ST. LOUIS) Coverage: The following criteria and guidelines have been developed to judge eligibility for coverage of bariatric surgery for the treatment of morbid obesity. To be considered eligible for benefit coverage of bariatric surgery for treatment of morbid obesity, the following three criteria must be met: A diagnosis of Morbid Obesity, defined as: Body Mass Index (BMI) of greater than or equal to 40 kg/meter squared…

Hi, I am new here, well not so new I have been reading this board for awhile. My first post. I want this, it sounds exactly right for me. The gastric-bypass is just too scary and invasive for me. This just seemed so perfect--to good to be true if you will. I am a mother of four, my youngest is 11. I was always thin growing up, and it seems after each pregnancy like food more n more. I have been on all kinds of diets, and spent a small fortune on excercise equipment and diet pills. I have a disability, when i was younger (13) I was a passenger on a 3-wheeler and got hit by a truck. I crushed my right ankle, and broke both bones. It has been a struggle to try to get wei…

I have several questions that I'm hoping someone can help me with. I have Tri Care standard and I am in the North region. I am 110 pounds over what I should ideally weigh and have a BMI of 47.5. I am prediabetic. I have urine incontinence problems. Pain in my back, feet, legs and ankles. 1) Do you think I will be able get approval for lap band? 2) How long does it normally take? 3) Is there a 6 month supervised diet required? 4) About how much of a percentage of the total cost of the surgery did you have to pay? Thanks for any and all responses. BTW I went WLS seminar yesterday. Melody

Hi!! I am sooooo excited!! Last month I posted about how upset I was with my insurance co., PacifiCare. I was motivated and had preliminary approval for surgery, when they suddenly demanded I do a 6-month online "diet" program before they would give final approval. I tried every which-way to get them to reconsider, but was told "no exceptions". But suddenly yesterday, out-of-the-blue, I got the final authorization in the mail, and today I got my surgery date----YES!! :clap2: I will become an official Member of the Band on Nov. 8. I can't wait! LBT has been so inspirational to me and I have loved hearing all the success stories. Thank you all for the wonderful job you do o…

If you have this insurance, how long did it take you to get approved?