Insurance & Financing

Hey guys, i'm about 2 months before surgery and i'm nearly done with all my insurance and surgeon requirements: as per insurance i have had to complete 6 monthly PCP visits, 1 psych visit, structured nutrition plan as overseen by my PCP/surgeon. As per my surgeon i have had to have, 2 chest x-rays, bloodwork, EGD, sleep study (was then diagnosed with sleep apnea), 1 psych visit, EKG. My question and what i've been worried about is payment after all is said and done, i have a balance of $600 after my sleep study i am to pay (after insurance) which i'm signing up for an FSA through my employer to pay for these costs, i'm just not sure how much to put on my FSA or credit ca…

Does anyone have this insurance. Just wondering the waiting time after approval. I have 1 more nutrition class, 3 life skill classes, sleep apnea test and a breathing test. Sent from my iPhone using the BariatricPal App

I received approval to be seen at INOVA for 6 visits. Does this mean I will have to wait for another approval for surgery, after these appointments are completed? If during these 6 visits, I drop below the 40 bmi will I be denied?

I just sent off my paperwork to start the process towards surgery. I have Anthem BCBS in NC- and can't seem to get a straight answer from them about whether they require a supervised diet for 3 or 6 months. Or maybe not at all? Anyone have any experience with them?

I'm new here, just starting the beginning stages of pursuing surgery. Does anyone have PEIA insurance?

Hi I'm looking into getting the gastric sleeve surgery and I have Tricare prime. Has anyone has Tricare approve the surgery? What are the steps? I'm still waiting for an appointment to get the referral since I see an off base dr. Thanks for you help in advanced

I just had my FINAL 6-month weigh in, Monday and i'm down 49/50 lbs since i began! I could not be prouder of myself. I'm "slated" to have gastric bypass in mid- to late January and my surgeons office just submitted all my information to insurance yesterday (Tuesday). Anyone have Highmark BCBS of Pennsylvania that could give me a timeline of how long i'll hear if i'm approved? I'm so nervous waiting, i can barely sit still! I still have 2 pre-op appointments, one EGD procedure and an eco of my heart. I'm 90% there!

Do you guys think I will get denied if I started the process at 36 BMI and now after 2 months I'm down 20lbs and still have 4 months before surgery. Should I keep losing or just maintain? I have comorbities

Hello Peeps, I am wondering if the first visit to the weight loss surgeon counts towards the six month waiting period. I saw him in January. So I am wondering is it 6 visits after that and then can submit to insurance for approval? Or is it 5 visits after that and then can submit for approval? Essentially what I am asking is, how many visits total before can submit to insurance? Initial consult plus six more? Or initial consult plus 5 more? Thank you

Regarding previous post..... (stupid auto correct!) "Any Mass GASTRIC SLEEVERS out there" (and) "6-8 weeks for APPROVAL" Geeze!

So.....I spent my 6 plus mos jumping through hoops to fulfill all requirements requested by Mass Health. Request from my PCP, support group meetings, psy analysis, blood work, meeting with nutritionist, and losing weight through out this time frame. I met with my surgeon this past Monday, got the ok and was told our final step is to submit all these verifications to Mass Health! It has been a long journey and I am so ready... Then, the kicker!!! I was told it takes an ADDITIONAL 6 to 8 weeks to get the appropriate v all! Wth? ANY sleepovers out there from Western Ma on Mass Health? Did it truly take 2 more mos? I am so frustrated right now. Input, PLEASE!

Hello everyone I have submitted all of my paperwork my blood work my car cardiovascular pulmonary test my psych evaluation everything is good then my patient administrator tells me that I have to get another letter from my doctor that simply states I am cleared from a pulmonary and cardiac standpoint. But yet it shows in the x-rays that my pulmonary and cardiac exam normal. Then to top it off I was to have my nutrition A briefing yesterday and I was about 15 minutes late the reason why is because there was a 10 pack car crash and I was held up in traffic and by the time I got to the office even the receptionist was in the same accident and she even confirmed with the nutr…

Hi Fam - completed checklist - everything from psyc pulmonary, cardiac, blood, dietitian, seeing my surgeon, just for my paperwork - still sitting on the desk in my surgeons office - called but I all I get is processing. I called my I insurance before this journey and they shared decisions made within a week. Why do I feel that my insurance will approve faster than what my current situation is. #bmi 40 #tired and ready

My doctor submitted all of my information on Thursday, February 16th, exactly one week ago today. I'm going crazy, I know I need to have patience but it's so hard when you're excited and ready to start this new chapter of your life. Does anyone else have Blue Shield of California? How long does it normally take to hear if you've been approved?

Where do I start? I am very new to wanting this surgery I have a bmi of 38 with no co morbities any advice on where to begin my journey?

I am curious how long it took for insurance company approval through BCBS MA?

I have BCBS of Alabama and I was denied because I do not have 2013 medical records. I was told to send in pictures. I have read their surgery manuel for obesity and it said something about getting a letter from your PCP. Everything is double underline so I'm not sure what this means. Have anymore had to send in picture documentations and did you have to send in a letter, too? The PCP is the one who referred me to this surgeon and he has already sent in documentation the first time.

Hello I was told on feb 3rd i was approved for gbp and surgery is scheeuled for march 8th But i just got a letter in the mail and it is worring me is this the approval lettet or are they saying they arent paying Why im worried is this letter was enclosed then an appeal page I cant seem to post a picture of the letter But it reads Important update enclosed Dear provider Based on the documentation submitter 43645 for laparoscopy gastric bypass is coverer under the members plan However' predetermination of benefits does not guarantee payment. Benefits are always subject to other applicable requirements such as preexisting conditions limitations and exclusions payment…

I have anthem bcbs, I live in Virginia and I got my approval today ! Hoping for a surgery date around April 20th. My surgeon is dr. Schroeder at advanced surgical in Henrico , va. They submitted my paperwork on Monday so about 4 days for approval [emoji4]

Hi everyone, If anyone is in the process of getting approved you have to read this!!!! I have medicaid, United Health Care Community Plan, all I have to say DON'T TAKE NO FOR AN ANSWER!!!! Background: I'm 5'8, I had a lap-band in 2008 in the USA (had great insurance at the time, all paid, got approved in less than 30 days) at 267lbs, lost about 140lbs but used to binge and purge a lot so the band slipped, I had it removed. Gained some weight back about 60lbs, so I panic went to Mexico (did not qualify for the insurance in the USA to pay) and had a gastric plication done where they fold the stomach. Didn't really work surgery is rarely performed in the USA and not …

Hi everyone! This is my first post here but I have been lurking for a little while on the boards [emoji4] I currently am in my enrollment period for new health insurance with my new employer and have 3 to choose from - Anthem BCBS, UHC and Aetna. They have CDHP and PPO plans for all 3 and I'll most likely go with the PPO even though the premiums are a little higher, because the deductible on all would only be $500 with a $200 OOP max. All 3 plans are very well priced for me, not much difference between them, and all have do have Bariatric surgery covered (at least from what I can tell. They all just say it's a covered service but weight loss programs are not). Also, all m…

Hi Everyone, I was just wondering if anyone lives in Florida and has CHP (Capital Health Plan) that has hypothyroidism. I am needing to know if CHP approved the surgery for you even though you have this issue?

The insurance coordinator at my surgeon's office left a message stating she spoke with the nurse regarding my "case" and had some things to go over with me. She told me to call her back, but it was after hours and she didn't give me her extension to reach her. ARGH! Anyone experience this? Does this mean I may have been denied? I'm trying to calm my nerves, so if anyone has any insight on why the nurse would call, I'd love to hear it (whether it is positive or not). Thanks!

Help!!! I need sleep apena to be approved by BCBS TRS Activecare. I don't have the 5 yr weight history so I have to have 2 comobs things. We are going to try to use high bllod pressure and sleep apena. I have to have a sleep test done. Is there anything I can do to promote sleep apena???? Thanks

Hello everyone any help is appreciated. I have Health First Medicad in NY. I completed all the requirments but I did my psych eval first and by the time the paper work is submitted the eval will be 6 months and 6 days old will they deny me for being 6 days past 6 months

Hi all! I'm hoping someone can help answer my question. I have Optima Health insurance. I started my journey in June of this year (2014). At that time my insurance required a 12 month wait period for approval for the Gastric Sleeve. During the 12 months I am required to meet monthly with a dietician, have a psychiatric evaluation, work on exercise and change my eating habits. All of this I have been doing very well with. My questions is this - we are getting ready to renew our insurance for the upcoming year and I found out that Optima has changed the wait period from 12 months to 6 months! I'm very excited about this! I'm just hoping that affects me for the go…

I have BCBS of MS and looking for any helpful information about surgeons and etc.... went to one consultation, which went well, however want to be sure I'm choosing the right doctor and place to embark on this journey...

Do anyone know if arkansas medicaid covers the gastric sleeve?? Thanks in advance. Sent from my SAMSUNG-SM-N920A using BariatricPal mobile app

Well it looks like I lucked out! I went through the 6-month pre-surgery routine and exhaustive testing and had my sleeve surgery on November 28, 2016. They billed the insurance company for $65,000 for the surgery (sleeve + abdominal hernia) and I ended paying about $2,500 +/- for my part. I just received word that my employer is going to another health insurance company effective May 1st. The only real difference in coverage is that the new company DOES NOT cover bariatric surgery. Couldn't have planned and timed it better if I had to..... Unfortunately, I don't think the new plan will cover skin removal either... (sigh...) Now if I can just get over …

Hello! Anyone with Anthem Medicaid for Wisconsin? Have my consultation Wednesday with the dietician..just wondering what the approval rate is and how long it takes? 3/6 months?? Thanks!!!

Hello, Does aetna require a endoscopy before gastric sleeve approval? Also what requirements did you do? 3 months or 6? Sent from my iPhone using the BariatricPal App

Does anyone have amerihealth caritas in Pennsylvania who already had surgery and could tell me how long it took for approval? Mine was just submitted on Friday so obviously it isnt approved yet lol just curious on how long so i know when i should start calling! My sleeve Surgery is scheduled for april 26th!

When did you start your 6 month plan and when did it all get submitted to insurance? Insurance has denied me because they say there isn't 6 months of a documented weight loss plan. I went to my PCP in October of last year. She weighed me and we talked about diet/exercise along with getting my referral to a bariatric center in our area. I started going to them in November and have not missed a month. So, March should have been month 6, correct? I'm not sure if they just aren't counting the PCP one or if they count their months differently (October-November, November-December, December-January, January-February, February-March would only be 5?). If anyone has had this sit…

Hello, My insurance does not cover WLS. I'm interested in having the Sleeve done and cannot afford any more monthly payments at this time, so I'm looking to take a Medical Hardship Withdrawal from my 401k. I've confirmed with my plan administrator that they allow for this and just turned my paperwork in. Has anyone else done this? How long does it normally take to hear back from them whether you're approved or denied? Please let me know how this process worked for you... Thank you!!

Hi all, I have two insurances, both will cover the surgery but I'm not sure at what percentage. My question is, can approval be submitted to both insurances? One is a little more strict than the other and I think i may be denied through one but approved through the other. Has anyone went through a similar experience? The insurances are BC/BS of AL and BC/BS Anthem.

Am I wrong for being upset and worried? I am in the process of getting a revision from band to sleeve. I did 4 months of nutrition class. I have documentation from all previous doctors and even my former surgeon. My info was submitted Feb. 8th. They have 15 days to make a decision. On the 16th I found out that one of the files did not open so Aetna asked that the file be refaxed. It was. I called today its the 24th still pending. I called 4 times and they said that they still have not received the fax. My dr office said that they did. I am pissed. Next Wednesday is the 15th day. I have all of the requirements. BMI, co mortified hell I just got diagnosed with Pulmonary A…

I was just approved for surgery even tho I gained 16 over the past 9 months I was approved don't worry I am more focused now that I was approved for surgery starting my pre op liquid diet Sunday for 8 days surgery is February 13th I am determined to be successful.. Sent from my Z820 using the BariatricPal App

I've appreciated this thread. Wanted to tell others that after my six plus months (actually 9 with paper work delays at dr's office), my pre-auth only took three days. My advice to all is to continue to follow up with the dr's office and insurance. Pleasant but firm advocacy for yourself. Sent from my iPhone using the BariatricPal App

I am not getting any answers from Surgeon, PCP or Aetna. Anymore get approval doing the 3 month diet? If so, can you tell me what you did?

I have BC/BS of AL as well and am just starting this journey. My very first appt is in March with a surgeon, my very first step, but... my PCP sucks, and the last one sucks even worse (they're ratings online are spot-on). I'm a little outside of Montgomery and use Montgomery docs, but it's SO hard to find a PCP who isn't indifferent and with a crummy and often incompetent staff (I don't say that lightly either). I'm scared because I have to either stick with the doctor I have, who is one of those who speaks with you for a couple of minutes with his hand on the doorknob, office staff that won't answer the phone half the time (No menu or option to leave a message) and do…

Hi, all! I am just beginning my journey to surgery, officially - I attended my surgeon's seminar last week and have my PCP appointment tomorrow for him to sign off on the surgery. Anyway, I have Cigna insurance and I know I meet all the requirements for them to cover me (I just spoke with someone at Cigna). Just have one question and was hoping someone could help. The "physician supervised" weight loss program/diet/nutrition/exercise portion of the requirement -- here's what they say: "Medical Management including active participation within the last 12 months in a weight-management program that is supervised by a MD/PA/NP or RD for a minimum of three consecutive …

Hello, I am meeting with my Dr on Monday and am just curious if anyone with BCBS MN had a supervised diet program from the past serve as a suitable attempt at weight loss. I did a Dr guided program that lasted a year, but that was 2 years ago. Anyone have similar circumstances that served as approval criteria? I just don't want to do something over again that I already know has failed and is adequately documented. Also, my BMI is 38. Comorbidities are asthma, hyperlipidemia, impaired fasting glucose, djd in r knee with rec to have knee replacement, depression & anxiety.

Apparently I was denied because there is no proof in my medical records that o haven't smoked in at least 8 weeks. Well, maybe that's because I haven't smoked in 9 years. I hate having to wait until tomorrow to get to the bottom of this one.

Just submitted packet to insurance!! how quick did everyone hear anything back?

Does it take long to find out if your approved?

I'm 35 BMI with comorbities I'm losing on pre op Diet will they deny me if I lose to much? Thing is I always gain it back ..

Hey all! I will find out if my insurance will cover my surgery next month so I'm looking at back up plans. I have been doing some research into doctors in Mexico, but I welcome any and all recommendations of doctors and facilities. If you have bad stories I welcome them as well. Also has anyone that had the sleeve surgery in Mexico opted to have Medical Tourism insurance?? I keep seeing stuff for it everywhere but I'm not really sure what it is and how much extra will it cost? Any and all input is appreciated!! thanks in advance!! Sent from my iPhone using the BariatricPal App

the surgery center in my community doesn't offer blis supplemental insurance, I've been looking for a comparable option but haven't had much luck. any advice would be greatly appreciated.

Has anyone one else had to to have 12 month diet documentation and if so what did you exactly use? I don't want to keep waiting. ?