Insurance & Financing

I understand Medicare will now pay for fills. Does anyone happen to have that code? I'm not at that point yet but will in about a month. My surgery is 12/31 and my one month followup may be my first fill. Thanks, Genea :help:

So I am preparing for my appt with my bariatric surgeon Jan 8th and trying to get all my records together to shorten the approval process for my ins. I am only 28 years old so the extent of my medical visits for the last 8 years have been ob/gyn visits for my 3 kids. Last year I did go to a "wellness" clinic for fatigue, exhaustion and just general well being, thinking that if I was not so tired all the time I might have energy to excercise, cook healthier meals, etc. I thought I might try a different approach since the dieting I have done since 1990 (10 years old) has not worked so far. I have been seeing this wellness doctor for 10 months about every 2-3 months and she …

I was on COBRA for the last 18 months & as of 11/30/07 I converted to the individual plan w/ united healthcare. I live in FL but the billing office I get correspondance from UHC is out of Dallas, TX. Anyone have a similar plan & if so, were you approved or denied & how long did it take to get a decision?

I was self-pay patient and I had my surgery in Mexico. I live in Northern California and I am a Kaiser member. Has anyone had success in getting Kaiser provide your aftercare if you didn't have your surgery with them? If so, what was the procedure? Was getting the approval for aftercare easy or difficult? Any information would be appreciated. Thanks!

Hi - I am really new to this and have just found out that Kaiser may cover WLS. I would like to know if anyone out there has used Kaiser in the Sacramento/Roseville area and can help me through this. My BMI is around 43 and I do have some comorbities. Also, does anyone have a doctor they can refer me to if mine is anti-WLS?

I have BC/BS AZ and I have a problem. Here it is: BC/BS of AZ: Current history and physical, psychological evaluation, nutritional consultation with licensed nutritionist, 5 years medical records, letter of recommendation from PCP, and continuous participation in a weight loss program for 6 months or longer within the past 12 months. Weight loss program includes: · A structured program that includes documentation of diet and dates of participation (a minimum of one face to face visit per week attendance for dietary counseling/education is required. And · A structured exercise program (unless medically contraindicated) designed and supervised by a c…

Hi. I have a question: I got approval, got banded, now what? How do I know whether my insurance will pay for my fills? On my approval letter, nothing was mentioned about adjustments-- only placement of the band. Do most folks have to make a seperate request of the insurance company each time they want a fill? I guess I could call the insurance company, but they are usually not too helpful on the phone and when I say the word "Lap Band" I hear crickets in the background.

:clap2:Yes, you read it right! I am approved and it only took 3 business days! I am so excited. I am sooo much more closer to being banded. Maybe I'll be a January bandster after all. My paperwork was submitted on Dec. 19 and I was approved yesterday. I just wanted to share my excitement.

I have had just as many problems with insurance companies as any one else has, but for the first time that I can remember I actually have something good to say about BCBS of california. I was going over my claims for the whole lap band journey. I've had some complications with a stay in ICU and was expecting a huge, totally unpayable bill. But it turns out that my total medical bills for this experience are around $93,000.00 and I owe a whopping $1300.00. Makes me almost happy to pay that weekly premium.Almost

Anyone been financed through Capitol One Health Care? Just wondering. Thanks.

Started this journey 12/05. Today, 12/20/07, I finally received an approval letter from Humana insurance. I am in shock!!! I don't know what to do!!! I scheduled an appointment with my surgeon in February (he's out of his office due to a horseback riding accident) so I guess we will go from there!! I'm Approved!!!!:whoo::whoo::clap2:

I currently have a BMI of 41, so I fit the guidelines for WLS. Aetna requires me to spend 3 months jumping thru hoops, including doctor supervised diet and exercise. Do insurance companies base approval on the BMI at the beginning of the diet/exercise or at the end? If my BMI drops below 40 by the end of the 3 months, will they then say I don't qualify because I followed all their instructions. Anyone have any experience with this? Karen

I know this has been probably asked about a million times, but I am just starting on my journey. I went to the information session this week. This is the 2nd one I went to. The first one I was not ready to move forward. I was not certain if this was the way to go for me. Well I am ready to move forward now since I have been diagnosed with High BP. I am having my MD fill out my paperwork today. They said that it can take "awhile" to get to me with an answer. What does that mean? She told me they have seen up to 3 months. Does this sound right? Thanks! Gilta

Hey I have Atena PPO (With the option to switch over to United in March, or BCBS is January...) okay, couple things, any opinions on which of the 3 is going to be the easiest to work with??? I really dont want to spend the next year fighting with insurance companies...what im most concerned with is my BMI...so i have 3 questions... 1. I am 5'5 245, BMI 40. But within the last 5 years ive gained circa 40LB. I mean i was still very overweight at 205-210, but i wasnt considered "morbidly obese" yet <----oy! what a term! So im very nervous that they will say i dont qualify...so if it that you need to have 40+ for 5 years? or just be very overweight? 2. The other …

Has any of y'all tried to get approve thur Atena? After you completed the 6 month medically superived diet, about how long after that did you get approved for Lap band surgry? I'd like to know what to expect. Thanks!

I heard recently that they have changed their requirements and no longer require a 6 month weight loss period. Has anyone else heard this or been approved since this? I have a friend who is waiting on her approval thru BCBS and is wanting to know what to expect. thanks all.

Has anyone heard that there BCBS of michigan changed their supervised diet requirements for the surgery? Did they lower it from a 12 month supervised diet to a 6 month supervised diet? My surgeon mentioned it but he wasn't sure and didnt elaberate too much on it. Any guesses??? I would love to get this aproval sooner than later. Thanks for any responses. Patti :ranger:

I'm looking for docs in the DC metro area that accept Unicare PPO. Thanks for your help!

Hi guys, I have Virginia Medicare and Medicaid. I think Medicare is my primary. Anyway, is 40 BMI pretty much required by most, if not all insurance (without having co-morbidtalities listed)? My BMI is 36. Thanks guys, Have a fun and safe weekend.

Hi - I have what I hope is a different question - if there's a thread for this already, feel free to let me know where it is. I'm 4 months post-op and am considering a move and job change to California, but I'm wondering about insurance changes post-op. Have any of you changed insurance after getting banded, and if so, did your new insurance cover fills and checkups or was it considered a pre-existing condition? I know every policy is different, but I'm curious as to whether there's a trend for this. I'd love to live my dream and move to Sunny CA, but it would suck if my fills and postops aren't covered!

My primary insurance excludes any kind of weight loss surgery. I have Medicare as my secondary. I was told by my surgeons office that everything was a go for lap band about 3 weeks ago. She said that I should be hearing from the surgery schedular anyday. I get a call today and now they are wanting to wait and see. They have never had anyone have a primary ins that excludes weight loss surgery and then have Medicare as the secondary. They have a patient that is in the same boat as me who just had surgery. They want to see if Medicare will pay hers before they do mine. They say that Medicare is usually good about paying them but they dont know how it will work in this cas…

My supervisor is going through the process of getting approval from the insurance company for the band. I thought I would post this question here since in January I start on the type policy and want to know what needs to be done so I have a few hiccups as possible. Our insurance requires a psych eval as one of the tests to be submitted for approval. Well, to have a psych eval, they require "precertification". Well, the psych's office submitted this to the insurance co and they denied it? What's up with that? How can they require it for lap band approval but deny covering it? Anyone have any thoughts?

Anyone have Anthem in Kentucky. I am thinking of changing insurance companies but before I do, I want to know if Anthem covers the band. Thanks in advance Casey

Yes, BCBS of AZ has dropped the 6 months worth of hoops to jump through. Which is really good - no need for us to wait so long anymore for something that we know we need. I was already 2+ months into my 6 months so I have all of the documentation for working out, the weekly nutritional visits, and the monthly dr visits to submit. Figure it all will work. All I need is my 5 year proof of weight and I am set. Yahoo!!!! :whoo::clap2::whoo::clap2:

For those of you that have Aetna .... DO NOT GIVE UP!!! I started my journey in April 2007 with the seminar and 6mo diet:hungry: , I competed all the paperwork turned in everything including 5 yr history.Finally finished diet in October and met with the surgeon in November. Well my case manager sent in ALL my documents to Aetna on 11/19/07 and ... I was aprroved last Thursday 12/6/07. I am now waiting to be scheduled for the EGD scope and my surgery date. So for those of you who have Aetna .... There is hope. Good Luck , Melissa

I just received my phone call from my surgeon that I have been approved by my insurance. I will see her 2/21/08 @ 130 p.m. She will schedule my surgery at that visit. I have been on my journey since August 2007. Yipppppeeee. Sharon/Memphis:clap2::bounce::whoo:

I am wondering at what point is your paperwork submitted to the insurance company? I have already completed all of the items on my checklist for preparation but my surgeon's office hasn't submitted to my insurance company. I must mention that I haven't gotton my results back for my sleep study yet. I'm thinking that the results shouldn't have anything to do with my approval just what I need for the surgery. Right?

does anyone out there have this kind of insurance?? How hard is it to get the surger with that?

I posted thisin the general section, but have gotten no replies so far, so I thought I would post it here... I have a question about the 6 month medically supervised diet. I just went to my PCP this week and he is supportive of my decision to get the lap band, so I am beginning the 6 month diet. I really would like to lose some weight before the surgery and I am motivated to try and stick to a diet. I am 5'2 and weigh 277, so I have room to lose quite a bit and still be over the required BMI. My question is--say I lose 40 pounds. Will my insurance company deny me because I have proven that I CAN lose weight? Of course, I can lose weight, but keeping it off is a whole ot…

I am sooooo excited ( or should I b ?), he accepted my case ! He already sent me the forms . Has anyone had any experience with him or know of anyone thats dealt with him ? I cannot find anything negative on him on the internet....All I see is positive info ? Someone said that he never takes a case he doesnt think he cannot win ? I told him that I haven't been denied, per say, but my insurance says that "it's not a covered benefit" because we are small business... So, they won't even accept an appeal by a doctor, I can't even submit it. But I told Walter Lindstom this and he still sent me the forms ? So, what do you all think ? Should I go for it ?

I have preferred health systems, in Kansas. Weightloss surgery is excluded in my policy but you can appeal only after you've had the surgery. I am planning on paying out of pocket in January but I'm also going to go thru the appeals process. When I talked to my insurance they said to just make sure I have doctors recommendations, list of all diets, and all other related information. I have at least 3 doctors recommendations, been thru 2 hospital weightloss programs that I lost weight on and then gained back plus some, as well as 500 million other diets. I am 270 and 5'4. My family has a history of heart problems that are pretty severe. Do I have a chance????:help:

:help:Hi all I have fderal bc/bs and am trying diligently to get them to pre approve my lap band surgery. They keep telling me to have the surgery and then they will review it for medical necessity. Has anyone else had luck getting them to pre approve this? My surgeon will not do the surgery without it, which I can understand that he can't take the risk of not getting paid. Pleas help me if you have had experience with this, as I am at my wits end.

Will insurance companies accept major depression (weight related) as a possible reason to help get LapBand? David

I've heard elsewhere that some insurance companies do not require the 6 month supervised diet if you go to a bariatric center of excellence. Does anyone know anything about this? I have BCBS of Tx- TRS Active Care (teacher insurance). I do know that they have centers of excellence, but I don't know if this applies. I call them almost every day with more questions. I just thought I'd put it out here and see if anyone knew anything.

I have a BMI of 35 and was told by my insurance (UHC) that the surgery would be covered as long as I have "other conditions". I have pre-diabetes and insulin resistance, but I have never been treated for either. My OB/GYN did a full blood workup a few years ago, then when the sugars came back high she had me do a glucose tolerance test. Both tests showed my sugars about 9 points away from diabetes and my insulin levels were super high. All I got from her was a little note that said "It's NOT diabetes". It wasn't until I looked up the numbers myself that I found out they were all out of whack. My question is has anyone else here ever had a similar situation and had …

Well, I'm still gathering paperwork and I have a lot more than when I started. However, while I managed to come up with almost 7 years of records saying I was overweight. They don't go in order, I'm missing one year. Do you think this will have a big impact on my insurance's decision? I have medicare. Fae

If your insurance contract states it does not cover the surgery, is there any chance getting it approved? I have just started the process with my GP so I have no idea what is ahead of me. I just know that there is no way that I can pay for this out of pocket. I already have doctor bills up the ying-yang because I have a special needs son. Is there any hope? Thanks, Rondi

I went for my initial consultation today. I work for a faith-based non-profit which is self-insured - Wells-Fargo Third Party Administrators handles our claims. None of the office staff was familiar with my policy so they asked me to call W-F and see what their pre-op diet policy was. I called them this afternoon and was told that the surgery was covered but that there were no pre-op guidelines and that my surgeon would have to submit a request for prior approval with my medical history, explaining why this surgery was medically necessary under American Medical Association guidelines. The girl said sometimes they did initially deny pending more info ... I'm not sure if th…

has anyone had any problems with being approved with this insurance? Thanks so much, MindyLou:help:

I went to a Lap Band Seminar in Houston about 6 weeks ago. About two weeks later they called me and told me that my surgery was covered. It is covered at a surgery center in the Houston area. When I asked about what was included, I was told that any xrays, meds and the use of the surgery center was covered. I was told that the surgeon and anthesiologist would bill separately and she could not tell me if my insurance covered this. I haven't actually talked to the doctor yet, but don't want to waste my time jumping through hoops only to be told that there are additional costs that they didn't tell me about before I go through a sleep study and numerous other tests they wa…

I need to enroll in Flexible Spending/Flex Benefits for next year but I don't know how much to take out. Can anyone help me with a ROUGH Guess-timate of how much it may cost after insurance pays? Is it just co-pays & deductibles? Thanks in advance for help. My hope is to get banded next year when I get on my husband's insurance. Thanks, Kim

I'm new to this site but I've been reading as much as I can in hopes of finding the answer to my question without having to bother anyone...I currently have UHC but was told that the Lap Band is an exclusion to my plan. I'm wondering if it would be a wise move to drop my company's insurance and get private insurance that will cover the surgery. Any suggestions? Does anyone know of any private insurance companies that would cover the surgery? Any help you could give me would be sooooo appreciated!

Hello, It is always great to hear of approvals for the LAP-BAND. I hope that insurances are turning the corner and realizing the long-term benefit of paying for the band and saving on costs in the future regarding obesity related problems...You would think that it's a no-brainer to the insurance companies, but I think a lot of them are in the mindset of save the money we would have to pay out on claims now and worry about the consequences later...Hopefully, with the approvals I have seen on this site, that is changing... I was wondering just how much insurances are actually paying for the band...for the facility charges, as well as the anesthesia charges and the surgeon…

How you do make it thru the wait, while you are waiting to hear whether or not your insurance approved or denied the surgery? The "not knowing" is horrible. And the more I read various posts, the more scared I get that I am getting my hopes up for nothing. :phanvan The anxiety is driving me crazy....I don't want to be optimistic, and then be disappointed. But at the same time, I'm doing all this research and talking with people who have had WL surgery to see how they liked it, etc. I've even gotten the support of my mom and dad (and I thought my dad would be completely against the lap band-he shocked me with his support). And I've tried so many diets, and lost 40 or 50 …

I am new to joining but have been keeping tabs everyday on here for the last 3 months, so I went to my Dr. and explained to her taht I was interested in getting the lap band surgery. I have a friend who just got the lap band about 4 months ago and he loves it. So I told her the Dr. I was interested in using, she told me since I have HMO I will have to see one of the Dr.'s in Straubs network first then can be referred out since the dr. I am interested in is in a different network. So I go and see a nutritionist and it comes to be that this whole appt. is about seeing a surgeon for the gastric bypass surgery what i specifically said I did not want. So I had to pary the $85 …

I am so excited!!! I was approved after one week. I have BCBS Texas TRS Activecare. It took about three months to gather my 5 year medical history and complete the 6 month diet. The insurance coordinator at my surgeon's office would not submit anything to BCBS until everything the ins. co. required was collected. She submitted everything on a Monday and by the following Monday I was approved. I was really worried because my bmi is 37 and i have boarderline comordities and pcos but I guess it was enough for BCBS. Anyway, I just wanted to say that having this disussion site really helped my nerves. Good luck to everyone!

Called my insurance company today and got the great news - Approved! On the very first try! I called last Wednesday before Thanksgiving and they didn't even show they had received anything. But it was approved yesterday, the Monday after Thanksgiving. Took a little over 2 weeks from my first visit for my medical evaluation, to my final approval, and that includes the thanksgiving holidays! The doctors office did say I was lucky...approved on the first go around and they only required a letter of medical neccessity. I had typed up a list of my weight loss history and had it when I went to my initial appointment (i.e. different tries at Weight Watchers & Quick We…

I am so nervous! We just got a letter in the mail from my husband's employer stating that we will be moving from our UHC plan Definity Health to Cigna's Consumer Choice Enhanced Plan as of Jan. 1. Now, I have already started the process with UHC and have my all day doctor's visit on Thursday. What happens to me if UHC approves my surgery but I don't actually have it until early 2008????? I'm feaking out here! I just don't know what to do! I don't want to go through all of this and then have to start over with a 6 month diet next year to meet the hoops Cigna might want me to meet. Can anyone calm my nerves or at least share their thoughts? Thanks!

Me again!! Hey y'all!! I just had the 2nd well actually the first meeting with the surgeon that will be doing my surgery!! The first surgeon I met with he told me that there will be a 6 month wait for surgery if I used him. And I am so not trying to hear that!! I found another surgeon and I kinda like him better anyway!! HE answered all my questions I didn't feel as rushed as I did with the other surgeon. I am so excited! The said I just have to complete 3 appointments which is the psych eval, lung clearance, and heart clearance. And I should be approved. The girl Tina who submits all the insurance paper work said that I chose the best insurance for the new year and that …

Hello All, I have Blue Cross PPO Prudent Buyer in California for my insurance. I’m trying to find out if anyone else in California has this insurance and what their experiences have been like with this insurance provider and the lap band. My concern is that they will approve the Bypass but reject the lap band. I am 5’ 9” and shy of 271 which would have my BMI at 40 but I will drink 4 gallons of Water if I have to! I thinks its BS to be rejected because we keep working out to keep from getting even fatter. That’s sooo lame! Anyway, I have completed my nutritionist appointment who said I was a good candidate for the procedure. I have also seen the psychologist who also…