Insurance & Financing

My cardiologist says I need the lap-band now. He knows I have been on diets and nothing has worked. Will my insurance still make me do a 6 month diet even if he would send a letter stating I need the Lap-Band asap?

Hi everyone. I may be switching insurance companies, and with that in mind, I was wondering -- What is the best insurance company (easiest to get an approval from, etc.) for lap band surgery? I have heard something about Oxford having more leniencies, though I don't know the details. Please share whatever insight on the matter you may have. Thanks!

I had my band 5 years ago...it has never worked correctly. My doctor and I are sure there is a slow leak and want to replace it. Has anyone with UHC or any other insurance had luck with them paying for this? Any advice would be great!!! Sharon

okay, so here's my issue. I have bcbs of al. Most of their policies will cover the lap-band. However, b/c my husband's company is so small they have an exclusion for all weight loss associated surgeries, treatment et. al. We are not really in a place to finance the surgery ourselves. i mean if it comes down to it, we can. But we'd rather not. So I have started looking for a new job that has insurance (my current does not) that i can take out on myself that will cover the lap-band. But in case that doesn't work... I was thinking of just buying my own policy privately. Has anyone took out their own insurance policy and done it that way. I started thinking about th…

:help:I need help!! I recieved information yesterday from my provider that my pre determination was approved, but my pre certification isnt? What does that mean? I am totally confused. I called the Pre certification department within Horizon BCBS, and they told me that the nurse was working on it as we spoke. hrm. I dont exactly know what this means. Why would they give me an approval number if the surgery wasnt approved. I work for an insurance company, and pre certs and pre dets are considered the same thing. Can someone give me some information on this? -A

I am wanting to have the lap-band surgury. What info does my insurance need to approve this? I see my doc. every 3 months and she is always on my butt about losing, but not really been on a "counceled" diet. Would this be good for BCBS insurance?

:help::eek: I just got an updated insurance packet from my employer yesterday. Tonight I finally sat down to check it out. So I'm reading all about what it covers (I have Cigna OAP). On one of the first pages it reads: "Outpatient Facility Services includes: Operating Room, Recovery Room, Procedure Room and Diagnostic/Therapeutic Lab Physician and Outpatient Professional Services" This is still listed as 20% which is what its always been and what I always considered what I'd be paying for getting banded. But then I go to the back where they list exclusions and this one is on there: "Medical and surgical services, initial and repeat, intended for the treatmen…

:thinkAlright I have Cigna and I have my dr. appt tomarrow with my pcp dr. I am reading more and more about having to see a nutritionist and being on a supervised diet for 6 mths. Oh please tell me this is not always the case. I have been on a diet my whole life. I have been on and read the following ww, adkins, 3 hr diet, dr. phil, curves. Bob Greens Best life diet, Biggest Looser. i have been on all of them . I was a member of curves and actully went for a year. I am member of our local gym and actully go three times a week and some weeks more then that. They all help me loose ten or 15 lbs but then it slows down to a pound or two a month and I don't have the will pow…

I am so excited, I almost dont believe I was just approved. I have been calling the insurance company every single day checking on paperwork, and finally, today, the customer service rep said it like it was no big deal, 'yeah, you've been approved' She has no idea how this is going to change my life :eek::) :whoo:

anyone have any experience with them???

Just got the news today. Now i can exhale!!!!:whoo:

Can anyone help me understand the point behind the insurance companies requiring a 3 or 6 month supervised program? (prior to approval??):help:

I went to a seminar last night and they said that Anthem requires 2 comorbidities no matter what the BMI. According to my member services manual AND the lady I spoke to at Anthem, with a BMI of greater then 40 then no comorbidities are required. Does anybody have any idea which is correct? I have some other minor things wrong (plantar faschitis, stress incontinence, aching joints,already had to have my gall bladder removed and had gestational diabetes with 2 recent pregnancies which puts me at a MUCH higher risk of develping type 2 diabetes if I dont get this weight off). I am now SO worried that I am not going to qualify. My current BMI is 44. What do you think?

After almost a year I have won my appeal against GHI PPO. This is with thanks to Walter and Kelly Lindstrom. I am so happy. I do not know how much I will be getting back, but the satisfaction of knowing I won is sweet. Health to all. Fran:nervous

I jumped through all their hoops and was okayed for surgery today:whoo:.I have Blue Cross Blue Shield through ADM.It has been a long 6 months ,but it was worth it.I have it done on Nov.16 at Clinton.Getting all nervous now:).

After almost a year I have won my appeal against GHI PPO. This is with thanks to Walter and Kelly Lindstrom. I am so happy. I do not know how much I will be getting back, but the satisfaction of knowing I won is sweet. Health to all. Fran:nervous

All my paperwork was submitted to my ins. co. for pre-approval. I supposedly only needed a BMI over 35 with a co-morbidity which I have. I got my denial back from Horizon BC/BS of NJ and they want me to do 6 months of supervised doctor dieting which i haven't done. Conveniently my employer is switching ins. co. Jan. 1 08' so I won't have the time. I'm bummed out but will try in Jan. with the new ins.co. :angry

Hi everyone, I'm a newbie. I've gotten a medical referral from my doctor but Providence Health Plan says there's an exclusion on my policy. Has anyone been to Tijuana for the lap-band procedure? My good friend has and she seems happy with her band, but I'm still kind of nervous since there's that whole "pre-existing things aren't covered" part of American health insurance. What would you recommend? Go to Mexico and get the lap-band, or find another insurance policy? Dr. P:help:

I posted earlier about problems with my insurance. I decided not to switch to a private pay but instead asked to borrow the money from my company. I may be getting my gallbladder out at the same time, in which case, it seems the insurance company may pick up the tab for the anesthesiologist, etc! which would save several thousand dollars. I have gallstones and have had some problems with them over the years, mainly nausea. Both my mom and my older sister had theirs taken out and I thought I would ask my doctor if he would do both at the same time. He said yes provided the gallbladder is "not too sick." So I am going in for an ultrasound on Oct. 12. I'm kind of confu…

I had surgery 2 weeks ago. I ended up privately paying for it. In January Dh has the option of changing our health insurance. Does anyone know if the new company will cover fills? My current one won't since I was self-pay. But will the new one? Thanks, Leena

I was denied approx. 2 weeks ago. I have EBMS (employee benefit managment services) I am now trying to get more convicing letters of support from my PCP (shes dragging her feet) but I did receive one from my OBGYN (for PCOS) and will get one on Monday from my electrophyisologist (specialized cardiologist, for my tachycardia) What did you do after a denial? Here is a list of my diseases : PCOS, (causes very low insulin resistance), tachycardia, acid reflux, infertility, sometimesy high blood pressure, depression/anxiety. I"m 5'1 and 220. What do ya'll think? Please let me know of any tips you may have. Thanks Alot... Oh, i'm new to this so excuse me if I mess anyth…

Hey I wonder if anyone else has run into this problem. I contacted my insurance company to make sure they covered the lap band surgery. The lady took my information, height and weight and all other info they ask you for. I was told it was covered and I qualified based on my BMI was 47. Well i knew it would be more than just that but she told me what deductible i had to me and everything. Well I went to a seminar and gave my insurance info and received a call stating any baratric surgery was excluded from my policy. So I called myself and was told the same thing. I contacted my HR dept and was told it was not excluded. OK who is lying. I am so confused and depress…

Hello everyone I am new here and was wondering if anyone ever heard from the insurance company you can do a 3 month monitored program with 2 weightloss plans instead of just one 6 month plan? I am reading the actual policy and am trying to figure out if I am reading it correctly. I am calling tomorrow to confirm and get it in writing.

Update: I was able to see my documents on myuhc.com and weight loss surgery is EXCLUDED... Has anyone had any luck with asking your company to change the plan so this is covered? I work for a small company. Would it just cost the company more or would it cause everyone to pay more each month? original message: <p>We just switched to UHC at work... Is there a way to check my benefits online? </p> <p> </p> <p>We have UHC Choice Plus. Where would the info be?</p>

I've completed all my required tests and had my final appointment with the surgeon and am now awaiting for insurance approval. My surgeon seems to think it will take a couple of weeks since BCBS is pretty speedy. My concern is I have to be on a pre-op diet for 4 weeks before the surgery and I'm not sure what the usual wait time is to get your surgery date after you recieve insurance approval. I don't want to start the diet until I receive my sample packet that has several different kinds of protien drinks to try out. I don't want to waste alot of money trying out different brands before finding one that tastes good, but at the same time I'm worried that I won't have th…

ok soooo,... i have been going to my doctor for the past 6 months(a requirement) did all the other dr. appts. etc. when it came to getting my notes and my clearance letter......he did it wrong... first the notes didnt specify any advisories for me such as "advised patient to do treadmill 30 min a day" and so on...... he was supposed to do that at the end of all my notes for the 6 months.... THEN!!!... the clearance letter he did wrong also!!!! i gave him a sample letter that blue cross/blue sheild requires... BUT NO he did it his way... sooooo back to the dr. to tell him he needs to fill in the notes and to please follow guidelines for the letter..... the son of a bitc…

I have to do a 12mth supervised diet(I'm now in mth 8) & am a little worried about having it approved. If I end up self-paying(Mexico?) I will feel I totally wasted this last year when I could have been banded. Anyone had any experience with this? thxs.

Hi! Wondering is anyone has Tri-State Teamsters/BCBS. I have started on this 6 month journey where I have to "check-in" every 4-6 weeks. I am extremely interested in knowing if it was easy to get approved. I am so ready for this journey, though after a lifetime of failing at various diets.:faint:Actually, losing the weight is not the problem - keeping the weight off is!

Hi everyone! I'm new to this website, but have been looking into the lapband for 7 months now. I recently got a new job with American Medical Response and now have Anthem Blue Cross Blue Shield PPO. I've been in touch with a few different Surgery Facilities, all saying that I will need documented medical history from a physician. One company said 6 months history, another said 3 years. My problem is that I've never had medical insurance before, therefor I haven't seen a Dr. since I was 15 years old. (I'm 25 now) Do most insurance companies want proof that you've actually seen a physician for 6 months to 3 years regarding weight loss? Or are they just looking for a physici…

We have our insurance thru BOEING UHC HMO, I was just denied on appeal from this plan because I did not meet their standard or 40 on the BMI, I am 38.8 with co-morbidities however since this is an exclusion on the HMO I am thinking of switching to the PPO Choice plan in November and was wondering if anyone knows if I would qualify on that plan. HELP!!!!!:help::help::help::help::help::help:

Okay, I have a second question tonight, as I cant sleep and my stomach is tied up in knots thinking about the prospect of having to lose another 6 months of my 20's on a diet that more than likely wont work. Has anyone gone out and purchased an insurance plan outside of their employer to have the procedure approved? Is anyone aware of how I can find information about these programs, and the estimated costs of them? Can anyone provide any suggestions as to what insurance company would be the best so that I can avoid this 6 month merry go round? Thanks again. -A:help:

Hey guys :eek: I got notification today that I needed to undergo a 6 month diet program before I could have my surgery. This is a little diseheartening to me, as everyone else I have spoken too who my insurance hasnt had to fill this requirement. My question is this, if you have BC/BS of New Jersey, have you had to undergo this diet program? Please let me know! I plan on calling the insurance company on Monday, and rasing a stink to holy heck. I dont know if this will make much of a difference, however, I figure its at least worth a try. Thanks in advance! -A:help:

This is what they sent me... We cannot do this rider, as it affects everyone's premium. Hope you understand. Sorry that it can't work out. I agree it isn't fair that everyone would have to pay more just for me... Can I get private insurance with coverage for this? :help:

I went to the Barix Clinic in 5/07 to start the process for lap-band surgery. Went to a seminar at the center and was told by them in person and via a form letter what my ins. required for surgery. Had my psych. eval., dietary eval. and my PCP submitted a letter. Now they are telling me I need my PCP to write a letter stating I've had a BMI over 40 for the last 5 years. I know they won't do it as my BMI is not over that now nor was it when I went to the seminar. I was told in person and in writing that <40 with a co-morbidity was what I needed. Why if they knew from the get go I wouldn't qualify did they have me even strt this process? I am so disgusted and depressed …

I finally made up my mind to explore the lap band proceedure. I have an appt with my GP next week to discuss how to proceed and who he recommends as a surgeon. In doing some leg work for this I called my insurance company (Anthem). They said that NO bariatric surgery, regardless of the reason is covered. I am absolutly devistated. I can't afford this without help from my insurance company. Even with the maximum flexible spending allowance next year. I have a friend who had this done and she has been a wonderful resource, but she paid out of pocket for her surgery. So she isn't able to help me very much with insurance. I just need help trying to figure out what to …

Just starting my own business and still using my cobra from previous work. Anyway, my wife had the lapband done about 2.5 years ago and worked great at first. Now we are being told that we can not get any health insurance what so ever because she had this done. Anyone else there running into this problem? Thanks, Stuart

and I am down to two months left of their 6 month requirement and I have not lost weight on the "medically supervised diet", I have gained 4 pounds and I am so scared they are going to deny me. It has me up at night, I can't sleep, I can't stop thinking about. I have done everything that has been ask of me. I exercise 5 days a week, I have cut out fast foods, pop, etc. I just want to cry at this point. Thanks for listening. :cry

Well today I got my first denial - I am very upset about it. I started this process in January, the paperwork was turned in on April 11. I called Friday (June 1) and it wasn't even in the system yet. I talked to the place where I am having it done and they said at least I now have a blueprint of what I need. One thing they require is a trial of a behavior modification program - anyone heard of that? Oh well, I will try to keep my chin up and see if I will have the surgury this year.

I have BC/BS of NJ....paperwork was submitted on June 8th....as of Sept 1st I had heard NOTHING....over 50 phone calls by my Doctor...nada....so I went to the NJ Division of Insurance and they had my doctor send a certified letter to BC/BS - that gives Ins Co 10 days to respond....well...BC/BS responded by denying me....saying that "lapband is not proven to reduce your BMI"....huh ???...NJ Dept of Ins woman said to appeal it but with BC/BS it could take 4-6 MONTHS...so I did what any rational person would do.....I called BC/BS back...got a supervisor...and proceeded to scream and curse at the person on the phone as if I was a drunken longshoresman....I must have used the …

Like many people on this board, I too have UHC. United Health Choice Plus to be exact. The plus evidently means nothing as when I called to check coverage for WLS, I was told there is no coverage for any type. The sad part is that I actually work for United Health Care and they chose to give their employees substandard coverage. Any suggestions on what to do next? I am so disappointed as I have recently been diagnosed with Type II Diabetes and know it is downhill from here.:think

I had my surgery on June 18th, and I will be going to the doctor's office on the 31st of July for a possible first fill. I was just wondering if this is covered or should I expect a big bill? thanks.

I realize that I posted this in the wrong section... So I have known all along that my health insurance company does not cover lap-banding, or appointments that go along with it, i.e., fills. I'm sorry to say that I had a slip - and a bad one, this week and ended up in the ER. I was then admitted to the hospital where they did emergency surgery and re-positioned my band back to where it's supposed to be. Thank God everything went great and they didn't have to remove or replace my band, and I was able to come home Friday. My insurance company has completely denied the claim, and although I realized that this could happen, I do wonder if anyone …

I have Cigna insurance in Arizona and they say that WLS is excluded in our policy. Has anyone fought them and won? Would it be worth hiring a lawyer? Please someone help me!! Steven :help:

My paperwork was submitted to the insurance on August 28th and as of yesterday there is still no decision on it. I am getting quite anxious, I know I need to be patient, I am just eager for some progress. I have UHC and I do have the benefit so that isn't an issue.

I just got off the phone with my insurance Company (Anthem BC/BS of NH) and they told me that WLS is excluded accross the board. I can appeal, but she warned me that because of the total exclusion I was probably wasting my time with an appeal. I am extremely disappointed. I have been reading these boards, I bought books on WLS/Lap band. I have been preparing myself both mentally and physically for this journey and now I am afraid it will never happen. If anyone has any suggestions I would greatly appreciate them. Thanks for "listening" Rae

When I thought I lost all hope, thinking noting is changing I tried on a pair of 16 jeans to show my mother I was right nothing has changed. OH GOD IT WAS GREAT! They fit........... I started in a tight 22. How something like this can make you feel better than great.:whoo:

Hello everyone, Currently I have Optimum Choice, Inc. and unfortunately the company I work for has a total exclusion for weight loss surgery of any kind, even if it's medically necessary. I am almost 39, 5'4", 250 lbs and have been on every diet possible with success for short periods of time and then total weight gain plus. I have several co-morbidities: high blood pressure, asthma, severe heartburn, depression, anxiety, major back problems, and possible sleep apnea. I am able to change health insurance companies in November to take effect in January. Has anyone had success getting all the prelimary work done with one insurance company (sleep study, nutritionist monito…

I have Coventry OA POS Plan B.... would anyone know off-hand if insurance would pay for lap band?

Are there any teachers in the Houston area who have had success with United Health Care coverage on their Lap Band surgery? If not how does one afford the $15000-17000 for the surgery? At this point I am desperate.

Did anyone have to write a letter to the DR. as to why you want the surgery....I have to do that and it is hard for me to put the words together.....i am looking for help.I have HBP,Tendenitis, BMI 45, back pain and pre-menopausal:help: