Insurance & Financing

So I am patiently waiting for my first consultation with the surgeon on September 21st. I have already attended a Lapband seminar and have gotten my referral from my Primary Care Physician. I called Amerihealth and asked if they cover Lapband...their answer was simply...Yes. I feel that is too simple of an answer...considering all the bad insurance stories I read on this site. Does anyone have any AmeriHealth stories to share? Thanks

I am now in the progress of just getting starting. I go next week to do my lab work and other tests. I have UHC and they said that it covers 100%. Though after I get my tests done, I have to go through insurance clearance. Do I still have a good chance at getting this ? Does it take a long time before you get an answer from them ??

OK, I have been on this yo-yo for years! I have had a bmi over 40 then lose a little weight and it would go down, only to gain it back months later. I have done the pills/shots/ combo., Nutrisystem, Atkins, Phentermine, Merida, and Xenical, but I don't have 5 consecutive years worth of 40+ documentation! I am now at a 42 BMI. Here's my question. I have been diagnosed with HBP. I have fascitis in my feet and cannot walk for exercise without agrrovating it, and I'm pretty sure I have sleep apenea, though I've not been diagnosed. Do you think my insurance will approve without the documented history of a 40 BMI?

How do you get an exclusion off the insurance. My son talked to the HR and she seems to think it is not a big deal. Does this have to be changed at the renewal time or can it be done anytime. Does my DIL need to submit something in writing to them of necessity? Any information on this would be greatly appreciated. thnaks

Has anyone out there EVER been approved by Aetna or Amerihealth?? Did everyone have to do the diet process?? PLEASE GET BACK ASAP U GUYS!!! It's time for annual enrollment!! :help:

:help:My sister works for Walmart, they have Aetna we called today and the representative said that Walmart doesnt have that added to their policy. Do anyone know anything about Walmart/ AETNA insurance.??

I was getting worried since my surgery is in a week and a half (Nov 19) and my doc's office had just sent in my paperwork to Aetna last week... I got the call this afternoon that I have been approved :confused: I seriously thought I was going to have to fight and appeal and fight some more and not have surgery until next year. I told the nurse that I'm a little offended that they approved me so fast - since it technically means that I'm SO fat that they had no excuse or "loophole" that would allow them to reject me I'm excited and nervous about the surgery

Lap Band from me because my company has Small Business Insurance and it says that its not a covered benefit. How can I get by that ?? I feel I shouldn't be discriminated by that just because my employers are cheap and truley could opt for the large business insurance but I know them ( partially family) and they won't employ over the 50 people minimum to get that insurance just because of that am I am to suffer. I would have thought that PPO would be agreat insurance. But you can bet the boss gets everything of "hers" covered once it's denied and she's lucky she can manipulate the health plan to suit her needs and not the needs of the employees. WHAT can I do ? I am…

I called them to verify that the band was covered as well as the bypass, and it is! 100% covered! i am so excited! hopefully they will approve it the first time.

<p>Anyone have HEALTHNET? How did the process work with them?</p> <p> </p> <p> </p> <p>Very overwhelmed and I need all the help i can get</p> <p> </p> <p>Thanks</p>

So I thought I was making the right steps to get the lapband and now my husbands company will probably be changing insurance plans at the beginning of the year. Since he is with a union everything still has to go to vote, but the company has offered Unicare PPO and so we may end up with that. Does anyone have any experience with that company? I swear I have been working on this for a couple years now and I feel like I am not getting any closer. LOL! Debbie

That's right. Until Forever. That's what my insurance told me. They have "forever" to decide on an appeal that I sent in on 10/08/07. Is that right? She said they have sent to the company I work for to see if they will pay for an outside agency to review and that they have for FREAKIN' FOREVER!!!! I"m SOOOO . If anyone has ANY advise, please :help:.

Does anyone have Cigna's Open Acess Plus program? Im in the middle of getting my ducks in a row and have read some of the posts.I want this surgery so bad I can taste it...lol.My BMI is 40.2 and Im on high blood pressure meds,have had 2 series of facet injections in my lower spine,have hip pain(sciatic nerve issues)am incontinent,so very tired and worn out all the time and have an awful family history of heart disease and diabetes...we're a mess after seeing it all wrote down!Any advice good or bad would be most helpful.Thank you.Tami:cry

Hello. I was wondering if anyone has dealt with BC/BS of California? Were they pretty generous with coverage? Do they make do a 3 or 6 mo. supervised diet? :help: Thanks

I am changing to United Health care, HSM at the first of the year. I called and they said they would cover 80% with 40+ BMI or 35-40 BMI with co-morbid. Has anyone used them? Anything else they wanted that comes up later? Any help would be greatly appreciated.

Hello everyone, I have blue cross ppo right plan 40, I'm on California. I had my surgery on 9-19-07, I was approved with a letter for the lap band, my cost was to be 40% all good. Now, today 11-02-07, I received a letter from blue cross, saying that they are not going to cover my surgery. HELP!! what do I need to do?? Any help would be appreciated. Thank you.

My plan is pretty confusing. It says weight loss is not covered except in cases of morbid obesity...yet in another spot it says that weight control doctor visits are a $25 co-pay and limited to 26 per year. I was wondering if anyone has had the lap band approved with HealthSmart PPO? TIA

I understand that Medicare can pay for Gastric Bypass? Does anyone have knowledge of whether it will pay for lapbanding?

Anyone had any problems with their surgery being covered by Aetna? Any restrictions etc?

Well hey y'all I am Apples!!! Yet another person that's interested in the band surgery! I just had my consultation today and the Dr. is saying that he wants me to have a 6 month supervised diet ... so that I can learn how to eat once I get the surgery. Or I will fail or have complications! Do you think this is fair guys or should I go to another Dr? :cry Also it's annual enrollment time at my job and if Aetna isn't going to cover me than I will happily switch plans!!! I have Aetna Choice POS II!! Any help here guys?? Does anyone know which insurance will cover this for me? My BMI is 48!!!!!!!:phanvan I don't have any other options here I have tried everything! And the onl…

I have Cigna Insurance and currently have a BMI of 42. I have had a BMI greater than 40 for over a year and have been more than 100 pounds over my ideal weight for about 5 years. I have tried various diets over the years and nothing works. I was wondering if anyone who has had this done had Cigna insurance and if so what your experience was like (finding a doctor, payment process, your out of pocket cost, etc). Thank you for any help you can provide!

Hi everyone, This is my first posting and I am very optimistic with all the new developments I have been reading regarding Insurance and Lap Band. My company is switching from UHC to Anthem BCBS come Jan. 1st. UHC has flat out denied me and I wasn't aware of the power of appeal until I starting reading everyone’s postings. So far, from the inquires I have made, my new BCBS carrier maybe allowing for the procedure and I am so happy that I am almost in tears! My BMI is 46 and I am only 34yrs old with two little ones that I want to be around for. And last year I was diagnose with Severe sleep Apnea and in recent years I am suffering from all the joint and back pains. I hop…

So my SIL has called a few insurance companies because while her insurance doesn’t cover the lap-band, she is considering taking on additional insurance that will, but in all her calling a few different places told her that if you have the lapband done with an insurance company you have to stay with that company the rest of your life because no other insurance company will cover you… Does anyone know if this is true or not? We get our insurance thru my husbands employer if they switch us over will we be left without insurance or is what my SIL was told completely untrue?

Is there anyone here who has CIGNA health insurance? If so, after you meet the critera for the health complications due to obesity and finish your physican directed weight management program .... will the insurance company accept your need for surgery and cover you? Or does it depend on the type of plan you have? I am very confused. I went for an evaluation with a surgeon who said I am a perfect fit for lapband and I got a bill today for over $200 saying cigna won't cover that appointment (hence my large bill). I'm weary about them covering my surgery. I have really tried everything to lose weight and nothing has worked. It's predestined in my family genes for me to…

Does anyone have them? and. Has anyone here had any luck with getting them to approve the Lap-Band. :faint:

Hi all, I just found this board while conducting an exhaustive search online. There is so much information here, and I want to thank you for it. I have a question, and I am hoping that you all can help me. Has anyone been able to travel from approval to surgery in less than 2 months? My doc is in the process of completing the letter to request the surgery. Considering that I have Type II Diabetes, PCOS, depression, and Sleep Apnea, my insurance company insists that I have a 99% chance of being approved. My issue is, that I am over my out of pocket maximum for the year (surprise, considering that I have a thousand things wrong with me), and if I can get the procedure perf…

I am having issues trying to figure out if my inusurance will cover my surgery. When I call Cigna they tell me any weight loss surgery is excluded in my policy. When I contact my HR dept at work they say their are no exclusions on our policies! I am so frustrated getting 2 different answers. :mad:And of course everyone says their answer is right. I dont know what to do. Any suggestion?:help:

Does any one know what bcbs of michigan requires from Weight Watchers as far as documentation they require from them to cover the 12 month supervized and documented diet? Thanks. Patti

Hi all, I have a question for those of you who self paid for the procedure. I have Cigna and submitted all my documents to the 10/11/07. We have still not heard from them (they said something about taking 30days). Anyway, my BMI is 41, I weigh 235 and I am 5'2 with no co-ormobidities. I am a size 16 (comfortably) with most of it around my hips, thighs and butt. O.K, my question...I am so anxious to get this done (my surgery date is Oct. 29th). At this point in my life, I am 29 and have been overweight all my life, and I cannot afford to do another six months of anything- although I don't think that will be the basis of denial from Cigna. I won't be fat at my 30th bi…

Can you all share what the goal is on the monitored supervised diet program. I have to do 3 months and I am wondering how much I should lose? Any thoughts? How did some of you handle that?

I am so tempted to call and see the status of my surgery. I just want to call GHI and say "hi, I just wanted to let you know my life is in your hands. How's it goin?" :eek: Has anyone ever called and asked the status on your own?

I am thrilled that they cover the lapband surgery, but now it won't be for 6 more months. Any one else going through this? Also, I know this is a weird question, but what if I do lose weight on it and am no longer at a BMI of 40? Then I won't qualify! :faint:

woohoo I got my approval from BC/BS of NJ today. It took less then a week!! I thought I was going to be in for lots of back and forth but nope my dr office called and said all was approved I just have to call my insurance tmrw and veryify the number with them. :whoo:

My work just changed my insurance coverage to Empire BSBS, I did have CIGNA and I knew some about that but this is all new to me. Can anyone help?

does kaiser in so cal do the band as well. if not can we be referred to the northern california locations

Open Enrollment is coming in my office and I need to choose between the Aetna HMO and PPO. Does anyone have experience with either insurance? How hard is it to get approved on either of these plans? Also, I can't find any information on wether or not Flex Spending dollars can be used toward the surgery. If I can't get approved I can private pay, but I would love to use Flex Spending funds to avoid incurring more debt. Thanks, Meg

I am not sure which BCBS I have other than a PPO... How can I tell? I have it through my work. I know it's not the federal.:help:

I have UHC PPO and all Ive read about on here is UHC CHOICE PLUS. Are they different? Is one more difficult to get approved? IM going to see the insurance specialist at Dr adam Smiths office on Monday and I hope I have some luck.

:help:i know it all depends on your specific insurance, but how long is a good time line to wait for an answer? days, months, a year?? thank you!

anyone heard about this insurance? i work for the az state government. they made me do the 6 month pre-op diet. i hope they approve me quick! any experience??

My niece (okay my favorite "little thirty-four year old) is in dire need of a lap band. She has some medically related problems but no medical insurance. She and I have been trying to qualify for the surgery for almost three years and she is getting tired physically and mentally. Since she cannot afford to pay a huge loan, does anyone know of some medical loan company that will front a low monthly pay loan for her to go to Mexico? There is a catch. She had a bankruptsy two years ago.:help::rain::omg:

I have Sunlife coverage through my employer. Anyone had any luck for coverage in Ontario canada for the lapband procedure? Tracey

Today, one month after having my surgery, I get a call from the billing dept at the hospital. My insurance company has denied my claim!!!!!! Man, my heart skipped more than a few beats. I told the lady in billing that I had a copy of the approval number, checked on thier website and all was in order. Seems someone at AETNA didnt have his head screwed on staight. One call back to AETNA from the billing dept and all was good. Man, I was looking at 33000 worth of bills that I didnt plan on. What a day. If I drank, I would have had a few....Dave

Hi there! I am a teacher from Georgia and I have UHC. My BMI is 40, I have Sleep Apnea, High blood preassure, asthma due to weight, knee problems, plantar fasciatis, etc, etc, all thanks to this excess weight. I have tried Phen-Phen, Meridia, Nutrisystem, 6 Weeks Body Make Over, among others. I need to know what are the steps to take if I want to have this surgery. I read some people talking about UHC. Will someone guide me, please, as what do I need to do. I do not know if my doctor will be a good help or not because he keeps saying that I need to loose weight, but he does not understand how difficult this is when you are feeling hungry all the time:hungry:. :confused::c…

Does anyone have experience what bcbs of michigan expects as far as the 12 month medically supervised diet? I have record with my primary dr. for the past 12 months and also I have wieght watchers on line but dont know if that is acceptable? And what would they want from my Phsycologist for meetings in the past 12 months in regards to my dieting issues? If anyone can help I would be so happy. I just want to get this done with out much more time passing by. Thanks in advance for any help, Patti:help:

How specific are the CPT codes? I have Delta insurance which includes Anthem BC of CA. Previously bariatric surgery was not included in our plan. We were sent a letter at the beginning of the year stating that it is now included. We just called our insurance company to see if the lapband was covered because I wanted to start the whole process. We gave them the CPT code and they said that it is approved. We then said, "so the lapband is covered right because that is the CPT code we gave you." She then said Ohhhhhhh, no the lapband isnt covered just gastric bypass. Is this CPT code just for lapband or does it cover gastric bypass also? It just seems weird that she sai…

well turns out that HPN aka Health Plan of Nevada is the ONLY insurance company out here that will not cover lap band. they cover gastric bypass but will not cover lap band. i just don't get it. it's like gastric bypass costs about 6,000 more, why would you cover that surgery and not this one? i hate insurance companies...it's like they just don't understand how much some people need this or want this. it's a terrible feeling. :cry

I need to vent. I just sent a letter to Cigna today telling them what I thought of the in-network psychiatrist they referred to me and ask them to pay the copay they say I owe. The psychiatrist (if you want to call him that) cussed, talked about his pains, his surgeries, his fast car, and wanted to discuss MY sex life and religion beliefs. Now what the heck does all of this have to do with losing weight and improving my health? Exactly!!!! Absolutely nothing. I had no intention of sitting in a strange man's office listening to him say f --- this, f --- that for two hours!!! I did not dare walk out because I want this surgery way too bad. Anyway, I hope Cigna see…

Help My husband's insurance(UHC Choice plus) does not cover WLS. So now I am back to square 1. I was thinking about getting BCBS from my employer. I need some advice on what to do. I desperately need this surgery.I have co-morbidities such as high blood pressure and BMI of 45 and my PCP stated in my last doctor visit that I would be a candidate for lapband surgery. Please help me:cry

My insurance wants a list of comorbidities. To my knowledge, I do not have diabetes or any of the other more obvious comorbidities. I do have plantar facitis (sp?), tendonitis in my knees, incontinence, lowered sex drive - that type of thing. Do these count? Do you have any examples of other comorbidities? Chronic Fatigue Sydrom? I really want to be thourogwhen filling out my medical history form.