Insurance & Financing

I had my first appointment yesterday. The dietician and the surgeon feel that I should not have any problems, however another dietician was quiet pessimistic. :cry She doesn't think I'll be approved....maybe she's just being careful. I don't know!?!?! My BMI is 39.7, with 99 pounds to lose. I do not have hypertension or diabetes, but my cholesterol is a little high, but not considered dangerous. I have joint problems though (2 knee surgeries on left knee), a herniated/a protruding/a bulging disk(s) in my upper back and incontinence. I was psyched until the last lady saw me. I work at the hospital that does the surgery, so maybe that will help. I'm in Virginia & I…

Just wondering if anyone has Lumenos insurance and how fast/slow they were with the process of approving you. The bariatric coordinator says that they usually gove approval but wasn't really sure on the time frame...I'm just so ready and waiting is very hard(you all know this though:rolleyes:!!).

I have BCBS of Michigan and all of my things were submitted to them today. Does anyone know how long it will take for approval. I understand that it can sit on the desk at bcbs for up to 45 days if they are backed up with paperwork. But I am curious and anxious. Any input of past experience would be great. Thanks, Patti

Hey everyone. I went to see my doctor yesterday and he is sending my insurance (blue cross hmo) paperwork to see if I can get the lapband now i am 5'4 and 231 LBS he says i am 109 LBS overweight.BUT he said it is probably goin to be hard to get my insurance to cover it since I dont have any health problems (yet) Isnt being 109 LBS overweight a health problem in itsself?! I guess im tryin to get some opinions & advise as far as should i prepare for a battle with my insurance ? anything I can do if they deny me? how can I persuade them? thanks for your input!

The Nurse Coordinator has told me she now has all the required paper work needed to send in my information to request my Lapband Surgery next week to Aetna. I am now at the stage of waiting patiently for Aetna to approve my claim for Lapband surgery. I have completed or met all of the requiremenths set forth by Aetna. I have sleep apnea, type II diabetes, High Blood pressure, Congestive heart failure, AFibb and have proof of a BMI of greater than 40 for the last 5 years. The only requirment I am worried about is the 3 months of supervised exercise (3 times a week). Because of my AFibb my Cardiologist would not allow me to do any cardio work that would elevate my heart ra…

Ok so I just got new insurance with Blue Cross and I want to make sure I go to a primary care physician that supports Lap-Band. Anyone from Californa know of doctors in the network that are all about it?

Hello everyone, I work for a local hospital and have MedCost Preferred. Has anyone has any experience with them regarding the approval process? If so, I would love to hear about your experience. Thank you very much.

Just before leaving for holiday vacation, I got the letter from my insurance. They rejected me for not having 2 things wrong along with weight. I called the lady at my doctors office and she said I needed to get sicker. She said I could appeal it or be a self pay at almost $16,000. I have a herina at the same place where the band goes, but she said that didn't count. Couldn't they have told me 6 months ago before paying the $300 for the classes, etc.? I am supposed to see the Phys. next week, don't know if I should go. Any suggestions?

I just went for my initial consultation last Tuesday, and the letter of medical neccesity was faxed the same day. I am just wondering if anyone has had experience with AAG/Healthsmart? I am a male who has a BMI of 47 and have sleep Apnea. I hope they don't make me wait for the six months of supervised diets. For the last fifteen years I have been asking my doctor to put me on a supervised diet and he just says, here is a paper follow this, you can do it. Of course he is a fishing buddy of my dad's so he doesn't really take my requests seriously. Any help would be greatly appreciated.

So, I had my surgery in July which thankfully was covered by insurance. They also cover my fills, and I'm wondering if anyone out there is having to pay a Surgery Co-Pay for their fills. When the dr's office initially called to get the approvals they were told that my fills would be $30, but when I got my EOB's they said that a fill is considered a surgery. I am planning on appealing this (mostly because it costs me about $300 when I travel for my fills), but was wondering if anyone has had any other problems with this same issue. Looking forward to hearing from you, ~Nichole

Any here from Vermont who has had this insurance? It is new to me as of the first of the year because my company switched insurance.

I have UHC and thought I was all set. I called with the procedure codes and was told it was covered 90% with approval after predetermination from doctor. I was psyched! After reading about another State of GA's problems on this website, I decided to call back and verify. This person was great, but she said it was excluded from our policy and that it would not be covered. She did say I could gather documentation and appeal it, as I would any uncovered claim. I could also file an appeal before treatment to avoid uncovered expenses. So my question is - do I have a prayer? Is there any hope? Without insurance coverage, I know I cannot afford this - there is no wa…

I recently found out from my insurance provider that you can get a supplemental private medical insurance which will help offset costs of surgery even if the surgery is voluntary (This included plastic surgery). My insurance is Allstate and the policy is offered through American Heritage Life which Allstate owns. To provide an example of the benefits, for my premium of $84 (which is the most expensive) I will get back $720 for my ambulatory surgery (hospitalization less than 24 hours). I will then get back $130 per office visit. 30% of my anesthesia expenses will be reimbursed. For the surgery itself, I will get back anywhere from $72-$1,800 depending on the surg…

I was reading posts from people who "jumped through all the hoops" to get insurance approval. If approved, they were soooo happy and excited. There seem to be so many who are not so happy anymore. What happened to the "yippee! I got approved! I am really excited!". I am close to completing all of the Cigna insurance requirements. It is crazy to think that if I am approved, I would go through with this and then let myself fail. I hope that excitement never goes away and I am going to do all that I can to make sure it just keeps going and going and going.......... ..:smile:.

Hello Eveyone, I have Aenta insurance and my current BMI is 47. I just went to my Dr. last week and he told me to come back in two weeks for a blood work up and a physical. Aetna won't help me to find out if I qualify they say they can't tell me. So I went on there site and pulled the information. I was wondering if anyone has gotten approved without doing either the six month program or the three month program. I want my surgery like yesterday. Any experiences anyone can help me with?:help:

This is my story. The weight loss center sent over what I thought was all my paperwork on 11/19/07 to the insurance company. I received a letter from them on 12/7/07, after calling them regularly for two weeks with regards to the status of my file...stating that they need additional paperwork. I dont know whether or not to be pissed at the nurse at the wieght loss center or at my PCP office. The nurse said she knew exactly how Aetna works and would not send my packet to them unless she had the complete file. I gave them both the print out of what I needed to get approved. Well somewhere along the way our five year weight loss history didn't get sent. I called my PCP…

Hi everyone! I will have BCBS of Alabama beginning Jan 1, 2008. I know that they require a 6 month medically supervised diet. I was going to go ahead and get started on the diet this month even though I still have UHC insurance. Do you guys think that is ok or will BCBS make me diet from Jan-June? I am also concerned about losing weight while on the diet. I am afraid that if I do the diet and lose 40 or 50 lbs on the diet(I will be doing weight watchers) that BCBS will say "we are denying you for lap band surgery because you have demonstrated an ability to lose weight on your own". Am I being paranoid? Any advice you can give me is appreciated. I have not yet had my consu…

I just started my new job a little over 90 days ago. My company is huge (over 4,000 employees in 130 countries). They are a Self-funded Insurance with a third party administrator. We use MultiPlan as our provider and Allied Benefit as the administrator. (At least I think this is how it goes....lol) In my Offer Package was a copy of the "Medical Benefits Plan Schedule of Covered Expenses". On this sheet, the coverage reads: "Surgery or treatment for MORBID OBESITY only if the covered person is twice his/her ideal weight or greater than 100 lbs overweight and suffers from documented seperate conditions (i.e., severe diabetes, mellitus, hypertension, cardiovascular compli…

Hi everyone, I have been so so so so blue waiting and waiting and waiting for approval from my insurance. They made me go through a 6 month dieting program that I had to pay for out of pocket, even though I had already done everything on the planet. It HAD TO be "medically" supervised, and regular appointments with my doctor didn't matter. So, I paid out of pocket and had to make these appts last 6 months. What I learned was that I will not lose any weight and in fact gain on what the dietician had me doing. I cann't have carbs!! She doesn't get that. She doesn't agree with low carbing at all. But, I gained weight on her program and they just don't think I am trying hard …

I am preparing for my initial evaluation in a couple of weeks with a gastric surgeon. I’ve been filling out the pre-exam paperwork and getting copies of my paperwork from my primary care doctor and cardiologist. I have been reading the posts on this site. It’s very helpful. I believe that I am a good candidate for surgery. I’m 53, 250… about 95 pounds overweight. My BMI is 40.2. I have coronary heart disease and had a triple bypass 2 years ago. I have had high cholesterol and high blood pressure for 20 years. I also have severe sleep apnea and type 2 diabetes. All are currently under control and under treatment. From what I have read, I hit most of the main qualification…

im reading on here that some people called their insurance for the status of their paperwork right after it was submitted. how long shouls i wait before i start "harrassing"? LOL TIA

<p>I am in the approval process with UHC. I am worried that I will not get approved. My BMI is 37, but I have sleep apnea. I provided the 5 year documentation, had my nutrional and psychological evaluation. I got a letter the other day requesting a letter from PCP and the letter stated that I would be notified w/i one business day. Any similar experiences?<img src="http://www.LapBandTalk.com/images/smilies/ranger.gif" border="0" alt="" title="Ranger" smilieid="301" class="inlineimg" /></p>

:help: Does anyone know if Medi-Cal will cover the surgery?

Has anyone had to do it? Is it just what your surgeon wants you to do and then you weigh in monthly like some with other insurance did? I have a BMI over 40 but not sure if they'll consider past BP readings to mean I have hypertension as my BP is good now.

So I had my first appt yesterday with doc Turnquest in Houston.......I was so nervous....the bariatric coordinator (a medical asst??, I thought she would have been a nurse, but she was nice) is who I met with first. I have been gathering a TON of records and info in preparations for this vist for MONTHS and it was a B***H, let me tell you! I am a nurse and usually have a lot of patients with office staff, but it was a nightmare to get my records (one office tried to charge me $50!!!!) Anyways, so I go in TOTALLY prepared and almost more knowledgable about my approval process than her and she still tells me that I need: 1. letter from PCP 2. Medical clearance form PCP 3…

Hello All ! If I am interested in getting LapBand and my employer offers United Health Care,which plan should I choose ? Traditional with Deductible-20/500/80% Plan 7EK ? Balanced Value -20/2000/80% Plan 7RS ? Balanced -25/750/80% Plan 7OJ ? or Balanced -20/1000/80% Plan O3O ? for a single member ,no dental ,no Eye needed . -Your input would be great-

My insurance covers LAPBAND, but I need to be approved for it, My doctor sent a letter to the insurance, but I'm not if what he did was right, what do you normally send into the insurance?

I have Cigna and am starting the process for approval for the Lapband. I did Jenny Craig for six months last summer on my own and wasn't thinking about the Lapband at the time. I lost 60 pounds but then I had to stop because it cost so much. I have now gained almost all of it back and I am at the end of my line. I can't keep doing this to myself. My question is: Will Cigna accept those 6 months on Jenny Craig? Or will I have to do a physician supervised diet for the next six months? I have called them and one lady said Jenny Craig was fine but when I read the policy it stated it was not sufficient, but it was worded weird... What have your experiences been?

Anyone used BC/BS that works for General Motors? What Dr did you use, what city, state? Do you know what diagnosis code was used? thanks

I am new to the forum and to the journey of lapband and am looking for some information regarding HealthNet's coverage of lapband? I can't find too much online, and just joined my work's group policy last Thursday, so kind of wanted to let my policy settle in a little before I start calling HealthNet and asking big questions. Thanks! Sarah

does anyone know if cigna covers fills?

Hello everyone! Reading the subject line sounds like a no-brainer, doesn't it... I'm wondering if anyone has had any experience, or has any thoughts on how to deal with US doctors and insurance companies who know - or who might need to know - that you had surgery in Mexico. Does anyone know if there are any laws that protect us from discrimination by doctors or insurance companies for that reason? I had a slip a few months ago and am fighting with my health insurer to cover the slip surgery. Thing started to unravel when I had to tell them last week that I pay cash to the doctor I see for fills. Talk about awkward. Things got more complicated when I consulted with…

is hyperlipidemia (aka high cholesterol) a comorbidity?

Question for you all... Will insurance freak out if you gain during your 6 month diet? I totally screwed up on month 5 of my supervised diet during the holidays. I gained almost 10 pounds. Youch! I still have one more month left and I'm confident I can lose the 10 back again and end up slightly below where I started. Anybody have this fluxuation or even a net gain during the medically supervised diet and have insurance approve? I have United Health Care if it helps. Thanks! Jenn

The company I work for is self insured but uses BCBS to determine pre authorization. Today I was told that BCBS is requiring 6 months supervised diet. My company health plan says they won't pay for nutritionist visits. This makes no sense to me. How can it be required by the insurance company but they won't pay for it? Do you think I should skip going to the nutritionist and just ask my primary care doctor to see me for 6 months and document my weight. My health plan says they will pay for the psychological evaluation and they do pay for the Lapband surgery. Has anyone heard of a problem like this?

my paperwork was submitted yesterday, so i hope i hear back soon! i had all my paperwork and my 6 month program is all done! wish me luck.

I am just starting my quest toward surgery. I live in southern CA and own my own business. I am shopping for a group plan for me and my employee and would like to know if anyone in my area has good sucess with a particular carrier. I appreciate any info I can get. Shelia

I am so thrilled that my insurance (BCBS AL) now covers the lapband! I just had a couple of questions for people out there who have been approved by insurance.. 1) They said it would take up to 30days to approve me, did it really take that long for people or did it take longer? 2) How long after you were approved were you able to get the surgery. I feel like a little kid waiting to find out when I'll finally be able to get the surgery. I have been overweight all my life, and have been on weight watchers since I was 15 and have played with losing 5-10lb. I need a change and I am ready for that change. I want to start my new fabulous life.

I have been going to my doctor since May '07 and getting weighed and my blood pressure taken. July's weight was skipped somehow but my blood pressure was recorded - I had to start the 6 month evaluation all over at that point. I might have seen my doctor 2 or 3 times in this time period but it's been primarily done by the nurse. I've recently read this may be a problem.Please let me know if you've been rejected or accepted with these issues?? BC/BS Illinois Thanks! Misty

I currently have arkansas medicaid and called my medicaid office today and was told that lap band was not covered... Are there any doctors that do take arkansas medicaid or is there a way to get this procedure done with medicaid.... I dont understand why arkansas medicaid wil pay for the gastric bypass but not lap band...Could someone please help me out.....Thanks j:help:

Is hyperlipidemia (aka high cholesterol) a comorbidity?

Is hyperlipidemia (aka high cholesterol) a comorbidity?

Okay.... My BMI is a 35 so I have to have 2 comorbidities to be approved by BCBS/TRS. I have high blood pressure. I had a sleep apnea test done but that was negative. So, my lap band center had me do a blood test today to see if I have any other comorbidities. So, my questions is... about how long does it take to get the results and will I have to wait until my next 'doctor supervised diet' appointment to find out the results. Thanks....

Just before leaving for holiday vacation, I got the letter from my insurance. They rejected me for not having 2 things wrong along with weight. I called the lady at my doctors office and she said I needed to get sicker. She said I could appeal it or be a self pay at almost $16,000. I have a herina at the same place where the band goes, but she said that didn't count. Couldn't they have told me 6 months ago before paying the $300 for the classes, etc.? I am supposed to see the Phys. next week, don't know if I should go. Any suggestions?

Hey all.. I wanted to get some experiences with Aetna. 2 years ago when I started this journey I had Aetna and proof of all the usual (high bmi, dr supervised diet, etc) but still had to go selfpay as Aetna did not cover my surgery or my policy didnt. I since had to have a port correction surgery which was also self-pay. I've had issues with the port ever since and it has never healed properly. The band will need to come out ... but I am wondering if my situation warrented an emergency removal (infection ... physical reaction to the port itself) if insurance might cover the removal? I had PPO at the time of my first surgery and now have Aetna HMO. I had the surg…

<p>Hi, I am on Medicare and am curious how easy they are to get along with for approval. Are there quite a few hoops to jump through? And does anyone have any help and quick approval advice. <img src="http://www.LapBandTalk.com/images/smilies/help.gif" border="0" alt="" title="Help" smilieid="256" class="inlineimg" /> I live in MT but all federal should be the same, I think!</p>

My FEP plan (NY) approved the procedure but as an out-patient. Anyone else encounter this problem? Doc says I spend the night at the hospital.

I am in the process of going to all the doctors to get ready for the surgery and I was wondering if based on just my BMI of 48.1 would you think the insurance company would approve? I have Horizon NJ Health does anyone else have this insurance? I have no other health problems but my family history is horrible, Diabetes, hypertension, and heart diaese on both sides. So far the pulmonologist has cleared me. I am just scared they are not going to approve. I have been morbidly obese all of my life and have been on every diet imaginable for the past 17 years since i was 12 nothing seems to work long term for me. :help:

Has anybody used this insurance? Will they make you jump through hoops. Examples: documented weight loss diet for 6 mths.,be overweight by 100 lbs for 5 yrs or anything else. I've got the pre -existing factors covered : 43 BMI, high blood pressure,acid reflux, high cholesterol I'm desperate for answers

Here's the story. I started out 11 mths ago doing a supervised weightloss to qualify for the 12mth supervised diet for ins. When I started my BMI was 38.6 & I was tested for co-morbidities. Found out I had none after the 2nd mth of weightloss appts. I was sure I had sleep apnea (hubby swears I do) but apparently I just snore alot. i brought this to the attention of the doctors office & said I don't think I qualify now. They gave me a copy of my ins requirements.BMI>40 or <40 with 2 comorb. They told me to keep coming they were sure I would have no problem getting approved. Now please keep in mind here, I HAVE NO experience dealing with insurance co. for heal…