Insurance & Financing

I called UHC last year and the surgery was covered with a BMI between 35-40 with 1 comorbidity - no diet required, no nutritionist required, no psych eval - just five years of being severely obese. So I waited until the start of the new year and went to the doc who says I'm the perfect candidate. I call my insurance today to ask them my list of questions and BAM!! I'm told that you have to have a BMI of 40 or above with 5 year history of being morbidly obese (not just severely) and there is no comorbidity exception for lower BMI's. So am I screwed? Is there no way to get it covered? And if not - does anyone know of a place where a person with horrible credit can get…

HI GREAT NEWS TODAY WAS APPROVED ,I HAVE HEALTHNET HMO AND WAS NOT SO SURE IF THEY WOULD APPROVE IT,IT TOOK THEM 15 DAYS ,iAM GOING TO SEE DR.OLIAK IN ORANGE CA. i NEVER THOUGHT I WOULD HAVE SO MUCH TO LOOK FORWARD TO, I FEAL HOPE FOR MY LIFE ,

OK, my paperwork was submitted on Jan. 29th and I've been not-so-patiently waiting for approval. I've been calling every day. Well, I called this morning and was told my claim was denied because the Dr.'s office submitted it with an out of network Dr. and facility. WTF?!?! They knew what my insurance was on my first visit. They made me choose which of their surgeons I wanted to use on my first visit. I figured they would know which of their Dr.'s were in my network and let me choose one of them and be smart enough to submit it with an in network Dr. Apparently not. So I called the Dr.'s office and they're going to resubmit it today with an in network surgeon, Dr.…

I have UHC and they are telling me the bariatric surgery is excluded from my policy. Is there any hope in trying to submit it and appeal it or am I out of luck. My PCP tells me there is no reason for me to be denied because of my weight and health history. Just wondering if anyone else has been down this road..

O.K. my deductible (in network) is $1,000. Then 80/20 up to $2,000. What does this mean? Am I going to pay $3,000 or $2,000 or just the deductible. Can someone explain this to me in kindergarten terms. I just don't get it.. Thanks

I'm so happy, Cigna approved my lapband surgery!!! Once the paperwork was actually recieved it only took a day (had a few problems with the doctors office). Just to cover it for anyone who might have questions like I did. I have Cigna PPO in Virginia. I submitted the psych letter, PCP and a nutrionist 6 mos of records from seeing them both each month, letters from my PCP and GYN. The only problem now is that my surgeon is booked solid through April, luckily I do have a cruise to enjoy at the beginning of May. I will wine and dine myself like crazy before hand.

does anyone here have Preferred Care who can give me any information on your process with them and Lap Band?

hi all!! I have aetna medicare (advantage) I was wondering if anyone in this area has had it done and did aetna medicare pay for it? I am 40yo and disabled due to heart problems 6'2" 280. I am seeing my primary care doctor on Feb 19th to discuss getting the lap band. SO if anyone is local, has aetna medicare and knows of a good doctor that handles this stuff I would greatly appreciate some information! :biggrin:

My documentation was submitted by True Results last week. Today, Sat., I got a letter from Aetna telling me they need documentation of my three month supervised diet. How could that have not been sent? That was the whole purpose of my going to the center for three months, so that the three month documentation would exist. Why would it have not been sent? So, because it is Sat., I get to live with this until 8am on Monday. Who should I call first, Aetna or True Results??

Since nobody replied I am deleting, no hard feelings. Must have not been in the right place.

I recieved a approval letter from Blue Cross of CA for surgery, so I had it on Dec 3rd, 2007. Today I recieved a letter from Anthem Blue Cross (say at bottom of letter it a trade name of Blue Cross of CA). They said they have previously requested additional information of surgery and have determined with the information provided that no benefit is payable. I'm going to call the doctor office tommorrow and also the insurance company but I dont understand what is going on. How the hell they approve someone and have them go ahead with surgery then wait 2 months and deny them? Only thing I can think of is cause my company moved to new insurance in JAN and maybe the…

Has anyone been approved with TRS Active Care?

Use this in your appeals and also request for surgery JAMA -- Abstract: Adjustable Gastric Banding and Conventional Therapy for Type 2 Diabetes: A Randomized Controlled Trial, January 23, 2008, Dixon et al. 299 (3): 316 Adjustable Gastric Banding and Conventional Therapy for Type 2 DiabetesA Randomized Controlled Trial John B. Dixon, MBBS, PhD; Paul E. O’Brien, MD; Julie Playfair, RN; Leon Chapman, MBBS; Linda M. Schachter, MBBS, PhD; Stewart Skinner, MBBS, PhD; Joseph Proietto, MBBS, PhD; Michael Bailey, PhD, MSc(stats); Margaret Anderson, BHealthMan JAMA. 2008;299(3):316-323. Context Observational studies suggest that surgically induced l…

i am now... finally.... able to sign up for health insurance through my work........ keeping it basic, Kaiser, or Aetna?

A little summary of how I got here: March 07 I went to an information seminar. I filled out forms, had required testing done, saw lap band doctor in August 07, and after much frustration with the office staff (took them forever to get my paperwork to insurance), I finally got my denial yesterday, 2/1/08! I have Humana insurance. On the phone, I was told by the dr. office that I was under 40 BMI, and my only problem was hypertension, which is controlled by meds. I also do not have a doctor-supervised weight loss (which I was told early on this was not necessary). I have tried many different programs over the years, but nothing that my doctor has notes on. My hyper…

I went to a well known doctor in West LA. His office told me he accepts Cigna as full payment. After going for my initial visit I received a bill for $350 - Cigna paid $95. They are not a Cigna provider in the true sense - they only accept it as 70% pay...they did not tell me this. Don't you think they should have told me this when I asked them if they accepted Cigna? I had talked to another doctor closet to me who said they would take Cigna but I would have to pay an additional $6000 as Cigna doesn't pay the doctor "enough".....I even told the LA doctor this story and they laughed and said they'd take all his business...what crooks..I was so pissed With that said...…

I'm sure this is on here somewhere but couldn't find it. I plan on calling my insurance company on Monday to ask if LapBand is covered, what is the best way to do this?

Has anyone gained weight to push yourself into the 40 "morbidly obese" BMI bracket? I am relatively close to 40% at 38%. If so how does that work don't most insurance companies want a 3-5 year weight history? Do you have to be morbidly obese the entire 3-5 year period? Currently this is my all time highest weight since giving birth to my 7 year old. All I have done since that time is yo-yo'd w/ this being my highest in the past 7 years. Also I don't have any life threatening co-morbitities that I am aware of. I suspect I am borderline type 2 diabetic but as I don't really want to be diabetic (family history/know what it can do to a body) I really have no desire to create…

Hi all, I wrote to Tricare 6 months ago to see if they covered lap band surgery. I was told that they didn't so I self paid in Mexico. I have since learned that Tricare to do cover it and have put a claim in to see if they will reimburse part/all of it. Has anyone else been sucessful at getting reimbursement?

Anyone have any success with getting approval for Lap Band surgery through Uniform Medical? Is so, how did you do it?

Yes, I'm joining the ranks of people who're frustrated with an ins. company. Bariatric coordinator faxed in paperwork - BCBS said they didn't receive it. Faxed again 1-18 BCBS said oh, we got it but it's not scanned into the system. Called 1-24 BCBS said it's in syst. you should know in 5-10 bus. days. Called on 2-1 BCBS said it just made it to the pre-determination dept. and I should hear something in 7 to 14 business days. Yep, they are giving me the run around. Kinda expected them to since I've heard they can be difficult. Matter of fact, I don't think I've read anything positive about BCBS IL period!

NEW NEWS I DID TALK WITH A REP. FROM BCBS MI AND THEY HAVE MADE REVISIONS TO BARIATRIC CRITERIA NO LONGER 12 MOS. PCP SUPEVSD. DIET. IT IS NOW 6 MOS. YEA!! wtg BCBS MI!!!:tt1:

Hello everyone it has been awhile (since April 2007) since I was turned down with my United Healthcare.....my company since then has been bought out and we have the United Healthcare PPO.....does this mean better news for me???? Does anyone have this and have any suggestions to help me???? My new insurance comes into affect Feb 1, 2008...so I am patiently waiting,,,,,Thank you

:confused:I was told I have to do the 6 mo Dr supervised weight loss plan. I am just @ 40 BMI. (40.01) I actually had to gain 10 lbs to get there. Now I am worried I will put out all this money on Dr bills and just be denied because if I lose even 10 lbs I will not qualify . The surgeon I went to see said they do not submit anything to insurance until after I do the 6 mo diet because they said I would just be denied and have to appeal, but they will have to go w/ the weight I am after the 6 mo is up. I have HUMANA Insurance. I did not have any idea they covered weight loss surgery when I took out the plan . My past insurance company did not for any reason. So I had pretty…

Does anyone know anything about United Health Care?

Change 66 issued today. Manual Finally, Don

I have United Health Care and there is an exclusion in our policy for any treatment for obesity. I am waiting for the rejection letter so that I can file an appeal. The appeal is not likely to be successful, so I am trying to figure out some self pay options. My doctor charges about $15,000 and that includes all visits for one year after surgery. My question is for you accountants and tax people. I make under $30k per year and am single with no dependents. Can I claim the cost of this surgery on my taxes? And how will that affect my refund? What if I opt for the Mexico surgery that will cost less but have some travel expenses....are those deductible? Thanks for any …

What are the chances that Cigna will not make me do the 6 months doctor visit?

This is my first post so please forgive any ignorance. My insurance clearly states they do not obesity surgery even for the morbidly obese. Is is still possible to get them to cover it?:tongue:

:rolleyes2: I was told by my sergeon's office today that my insurance, carefirst blue perferred, required a 6 month weight loss program. But Carefirst told me that this was a national standard just like the 40 BMI and 100 lbs overweight, and that they are not the ones that require it, but the doctors do. Doctor says it is Carefirst, in VA. Can anyone shed some light on this for me so I know what to do. I would rather not wait 6 more months but can't seem to get an answer. I'm so confused.

I have high BP, have for over a year now and have higher than 40 BMI... I live in Texas and have Aetna HMO... will I still need to do the 6 months supervised diet? What exactly is that all about anyway? What kind of "diet" do they want you to do?

OK, I have BCBS of Alabama PPO. According to the rep that I just spoke to these are the following requirements: 1. Medical records from the last 3 years stating ht and wt from Primary care MD 2. participation in a 6 mo weight loss program 3. Hystory and physical from your surgeon 4. and documentation stating that you do not or will not smoke 8 weeks prior to surgery. My question is this: my current BMI is 43 HOWEVER in 2005 I actually got down to a BMI of 35 will BCBS deny my claim due to this or does anyone know......I have all my records sitting here at my desk and am really discouraged bc I feel like due to this they will deny my claim!!!! Also, I dont have a p…

My BMI is now 35.7. I have been recently diagnosed with Hypertension. Every three to 6 months for years I have to go to a Pulmory Dr for a sleep disorder(not apena). I'm weighed and blood pressure is taken. Heres the problem and question: BCBS of Ala requires a three year recorded history of weight and pressure but I don't have three years of a BMI of 35, close maybe 33 or 34 sometimes. Does anyone know if I have a chance in heck of still qualifying? Any BCBS of Ala advice would also be appreciated. Thanks

Does anyone have any recent info on whether or not BC/BS of Alabama is now covering Lap Band? They recently stopped covering gastric bypass and I was told that Lap Band was experimental. I am interested in learning more about the surgery but don't want to waste my time if there is no way AL will cover this. Thanks

Hello All: This site has been fantastic. I have been getting all my ducks in order since September. I switched insurance companies as of 01/08. I looked at their criteria. They require 6 months "clinically" supervised weight loss. They will take Weight Watchers and/or Jenny Craig, etc. as "clinically supervised". I asked a rep about how I can prove this, she said that the doctor just needed to write that in my report. Has anyone heard of this? I have BCBS of Texas. Any input would be great! Thanks, Dee

Hi, I have Humana and I am wanting to know long it took to get your approval. Or if you did not get yours approved, why not? I will be submitting for approval in about 2 weeks after my phys eval is completed. I go on Monday the 28th, but then they have go over it so it will be a few days after. So I am hoping I can kinda know what to expect from them. Thank you in advance for any help!

I had my last appt. of my supervised diet last Monday. I got a call this morning saying that my file was now complete and they would be submitting to Aetna this week. I have Aetna Pos II. I will keep all you Aetna people posted as to what happens next.

hi ya'll.. first of all i am 21 and definatly overweight.. i have tried countless diets and seem to be heavier (sigh) so i want.. no, NEED the lap band surgery but.. i dont have health insurance.. at all.. so i am looking for an insurance company in iowa, that is reasonably priced so i can get this surgery i am desperate for.. do ya'll have any ideas? thanks so much!

I am currently going through the 3-mo. requirements (doctor and dietician) for AETNA. I also have five years (even longer) documented obesity weights. However, I don't have a lot "wrong" with me--I've been on high cholesterol meds for the last ten years and Nexium for probably the last 5 for GERD. Has anyone out there been accepted for surgergy by AETNA with a POS II. I have also been on thyroids meds for over ten years. I'm afraid to get my hopes up about the surgery b/c I'm afraid they will reject me. Also, what does surgergy cost when out of pocket? I live in West Houston and working with Dr. Ferrari. Has anyone out there had a similar situation or have been ap…

I am still trying to find a way to get the LapBand. I have a high BPM shouldn't be a problem but what about HealthNet? What Steps do I have to take? 1. Talk to Primary doc 2. Make a claim with my insurance? How does this work??? Thanks sooo much for the tips! Kitty:clap2:

TRICARE Now Covers “Lap-Band” Surgery January 16, 2008 No. 08-04 FALLS CHURCH, VA. – TRICARE beneficiaries whose weight poses a serious health risk now have a new surgical alternative available. For those who medically qualify, TRICARE now covers laparoscopic adjustable gastric banding, also commonly called Lap-Band surgery. Although the TRICARE policy change has only recently been made, coverage is retroactive to February 1st, 2007. “We at TRICARE are careful to only cover procedures that have been proven safe and effective, and are accepted by the medical community,” said Maj. Gen. Elder Granger, deputy director of the TRICARE Management Activity. “We’ve added this…

My husband and I both have Aetna. I've been approved and my husband hasn't. The reason is because he doesnt have 5 year weight history. He only has 4 years. We've spoken to the insurance company and they say the surgeons office has to resend the info. The surgeons office says we have to resubmit it ourselves. Because we only have 4 years, I dont know what else we can do. If there is anyone out there that can give us some feedback on appeals that would be great. Any advice would help.:smile:

:rolleyes2:I FINALLY GOT APPROVED!!! I've been working on this since May 2007 and I just got approved! Yay!!!! I am so freakin' excited! I love this forum! I have learned so much here! My insurance company (Aetna) and my insurance coordinator didn't seem to speak the same language and there was nothing but total miscommunication for so long! I took matters into my own hands and obtained copies of my info yesterday and faxed it this morning and got a call back TODAY! I don't really know why the insurance coordinator is on the payroll at my doctor's office, but who cares-I'VE BEEN APPROVED. I'm hungry already:wink2: I have so much support from my fiance' and this forum is …

Has anyone argued or apealed to reduce 6 mo. required diet and won? My psyc. doc and pcp both said I was an excellant candidate and should call my insurance company and talk them out of a 6 mo. required diet (I've already finished 2 mo.) I've done every other requirement so my psyc. doc says I should just start calling my insurance company and bugging them about it. Anyone ever do this and be successful? Any suggestions?

Anyone have Medica insurance? I know that the surgery is covered, I am just wondering on how long the approval process is. Also, they require a 3 month diet. Can everything be submitted before that is complete? TIA!

This is my first time writing in i went for my consult last week and i have BCBS of Oregon i do have an exclusion how do i get the insurance to pay for this, i do have hypertension and i am prediabetic, the surgery is not that much money but if there is any complications wow it will be a very costly surgery.

Hey all We all know by now that tricare does not pay for lap band. ALthough some people have luck getting them to do so. It seems like the only option for us in going through a military hospital. Can someone give me the names of all the military hospitals that perform lap band? I have been trying to locate the info online for months with no results. Also, does anyone know if it's possible to travel outside your region to goto one of those mtf that do it? It is my understanding (from talking to people) that walter reed does ( I heard a rumor that they are closing that hospital), fort bliss is starting in January, and wilford hall on lackland afb may or may not be doin…

I started a new job yesterday and the 2 insurances I have to choose from are Cigna Premier (w/HSA) and Aetna HMO. I have contacted both of them today and both say they will approve Lapband for medical necessity and after I have been under a doctor's care (diet) for 6 months. What is the opinion on either company?

Has anyone been required to do the 6 month supervised and lost enough weight that disqualifies them for surgery? Has anyone "thrown" their supervised diet to still maintain qualification for surgery? I understand the idea of the diet is to prove that you can follow a restricted diet, but what if you lose too much to still qualify to have surgery?? Personally, I am just over the qualifying mark - so to lose 20 or 30 lbs may put me under all the requirements....how scary is that???

Does anyone here have humana? I live in Tampa, fl and I have humana and I am told I have only 1 dr that I can go to for the band. The dr is Dr. Murr and he has a certain company Spectra that will do the work up ekg,bloodwork, etc... Please help I am in the beginning stages I go to the orientation on Jan. 28 with Murr. I have been to a couple of support meetings. Vickie