Insurance & Financing

:rolleyes:Does anyone have Humana PPO and was it hard to get them to approve you. I have this insurance and am wondering how fast and how strict they are.:help:

I'm writing on behalf of my friend, who was denied by her HMO for anything weightloss related despite the fact she has high blood pressure, etc. She decided on the self-pay route and finally has the $ to pay. Now she is trying to get her pre-op clearances and had an abnormal EKG; the cardiologist is putting the charges through on insurance but stating that the stress test, echo, etc., are in order to obtain weight loss clearance. Her HMO won't pay. Does anyone have an idea on how to handle this? She obtained the necessary referral from PCP to Cardiolog; I think it should be covered since it's due to an abnormal EKG. She's trying to get the Cardio office to unders…

Call the insurrance company yesterday to see what they had to say before I even went the the lap band doc.I have Optima health and its thru work.Well when I called them they told me I dont have the morbit obesity rider on my policy!! So does that mean I dont have a chance on them paying for it?If anybody out there can give me any advise.Do I stop here or go ahead with the plan to see the doctor?I currently have a bmi of 43 with high bp. Thanks Jennifer

I know that my insurance will cover the procedure 100% but I don't know about the post stuff. I was just wondering if your insurance covers 100% too, do they also cover the fills?

Thats who I have and was wondering if they were much trouble to get to cover the lap band. Thanks Jennifer Despertly needing the lap band!!

Has anyone ever changed their insurance provider after having the band? I've been banded for two years now, been really bad on following fill dates and everything and feel like I'd almost be better off just eating good and excercising. I keep having to have surgical adjustments cause the stiches break and I never know why. From what I've read on here that shouldn't be happening. Any how, long story short, the band and the fills and everything has been covered by my parents insurance. I'm moving to Chicago in October and will be off their insurance in December. I'm wondering if anyone has had experience with having to change providers after surgery. Since it's pre-exist…

Anyone been approved in NY with GHI HMO if so with what doctor?

Hi, my name is Joyce. Today I received a denial :think from Medicare (NJ). This denial was from the hearing judge. I have also started another appeal process. Part of the problem is my age 41. The judge feels that I can sit for six hours and stand for two. I can't stand for more then 15min, I can sit for anout 10 and then my back locks up. Working as a secretary. I have 3 herniated disks, very bad veins that bleed just from touching them. must wear open shows or foot swells up, arthritis throughout my body, two knee surgeries on the left and one on the right, high blood pressure. oh, wait I forgot I am 5'7 1/2 and 377. Anyone been through this that can help…

Has anyone been appoved by Humana? Are they easy or a nightmare?

I just recieved my approval letter yesterday but in bold letters it said there is no coverage for complications related to the procedure/surgery. They pay up to 28,000.00 for the surgery itself but not complications. I was cautiously optimistic about the surgery before I got the letter but now I really frightened. I can't risk putting my family in financial ruins if there are complications and I have to pay out of pocket. I don't know exactly what they mean, what if I have complications while still in the hospital, does that count or do they mean afterwards, like months later. I'm kinda freakin out about it now. If they won't pay for problems later maybe they shouldn't co…

Can anyone who has had a lapband paid for by Medicare, tell me what part of the procedure Medicare did not pay for? :help:

I have been searching and searching...Does anyone have Health Partners?????

I have spent almost 6 months getting all the tests and paperwork together and I have been denied. My doctor had written a note of support and I had documentation of several comorbities. I also have several herneiated disks in my back which my dr has claimed would improve tremendously with weight loss. I was denied because I did not have 6 months of documented weight loss within the last 6 months concsecutive even though my Dr included all my weight loss attempts for the past 5 years!!! Ok here is the question, I have left my employer and will now have BCBS NC does anyone have them and are they any easier to get an approval from. I feel so depressed and hopeless- it …

:help:hi i am new here and wondering about bcbs of tenn will it cover lapband?

Do you think that since I have one more month to go on my six month supervised diet before surgery, that my ins will let me go ahead and get the referral for the psych and nutrition appts now?

I have been going to AIGB in Hurst since May and I noticed that Cigna has been denying the claims every month. When I went to my appointment yesterday they never said anything and they also made my appointment for next month. I thought that they submit everything to the insurance company when you first start to make sure that you will be covered. I know that LapBandSolutions handles the insurance part but I have not heard from them either. Is this normal?

I recently had the Lap Band surgery out of the country and called Blue Cross HMO of Georgia yesterday and asked about Dr. referrals nearby. (Thinking I had to pay out of pocket as I was sefl pay for the op) She said that they would cover any Dr. visit......and possibly the fills.....?????? I asked her to repeat it! She said yes, we pay for ANY dr. visit. you just pay the co-pay. I have to get the code for insurance billing for the fill and see if they will pay for a fill locally.....I am SO excited!! We just don't have a lot of money and have 3 little ones so this is like winning the lottery to me. I just hope she is correct in what she was saying. Gosh, it's gona be a g…

I was denied today, and my insurance company basically said "look at the book, it will tell you why you are denied" what the "book" - the catalogue of coverage of the insurance company says is "insurance will not cover anyone who is not 100% over the ideal weight for his hieght". my "ideal wieght" is 148 pounds. I am 299. 200% of 148 is 296, which is less than 299. so, I called the insurance and asked them where they got their "ideal weight", and they basically said from their medical consultants. I sent an apeal letter saying that according to my calculations,, I met the criteria. this was today, too soon for an aswer. any ideas what I can do?

can I get a self loan to pay for it? Will I have to see a nutritionist, therapist, and psyc? Or can I just find a doctor and get it done with cash? I do know in Mexico you only have to be 20lbs over weight but I am assuming in US I still have to have a 40 bpm, right? Kitty:faint:

I have Pacificare PPO here in Oklahoma and have been told to be approved for the band I have to complete the Healthyroads 6 mo. program of phone counseling. Anyone know what this counseling consists of? Curious to hear any feedback on Healthyroads and what to expect. Thanks in advance.

Ok so I posted in the intro thread but thought this would be a better area. I am trying to find out if anyone has any expereience of using another procedure to cover hospital and anasthesia fees. I had a friend who recently had a TT (No WLS) and got it done for $500 because she had a tubal ligation and bladder repair done at the same time. She didn't need WLS but looks great right now with the TT. She told me to check into all the stuff being covered but the WLSurgeon's fees. I want a tubal ligation and bladder repair is not a bad idea (although i was hoping WLS would fix that). Any ideas here? I am self pay so getting something covered might help! Thanks!

Hello- I am new here. I went to my consult today with Dr. Malley in Kansas. I am thinking I need receipts from my past attempts for the insurance. I went to this place called Turning Point Weight Loss in 2003 it was a two year program like L.A. Weight Loss but with exercise. Long story short, I didn't keep my contract or receipts. The place has gone out of business. I have researched and made some calls but I cannot get a hold of any one that has any clue. (HMMM... only lost 15 pounds in a 3 month time frame no wonder they went out of business) Does any one know if my bank statements will work or have any ideas for me? Thank you-

My insurance will only pay for this banding if I have Diabetes or heart conditon or Sleep Apnea. I am trying to not get my hopes up on this but I really want this done.

Does anyone know if United Health pays for the Fluoroscope part of a fill? If they will, what is the insurance code for proper billing?

Hi i forgot to add in my post that i already had my psychological evulation done and it came back that I would be a very good candidate for the lapBand, because I know so much in detail about the procedure and what my expectations are and so much other stuff, this was sent to my bariatric Center along with my inital application and questionaire that they gave out at the seminar I attended. I have high blood pressure, hyperlidemia (sorry about the spelling) I have DJD, diabetes type 2. My BMI is 40. I have been on a Dr. supervised diet going into my 7th month even though the Insurance company says it has to be for 6 months. I turned in all my medical records, except I have…

can anyone tell me if they have Firstcare Health plan out of Austin, TX? I do and I have followed everything that was in the hand book and I made numerious calls to my Insurance provider asking questions. Now I have my first appointment with my hopefully Dr. this Tuesday and on Thursday I meet with the Diet lady. My Dr. said I should have no problem getting approved but I don't know.

When I went to visit Dr. Spivak in Houston for a consultation back in June they were very persistant to tell me that Blue Cross Blue Shield would deny me. They said they hadn't had any approvals from them. I was prepared to pay out of my own pocket but I let them submit it anyway. I have no comorbities and my BMI is barely 40. When I got home that night and my husband and I talked about it, I had decided to just pray everyday for the same thing and believe that it would happen. My prayer was that the insurance would approve it as though they had never seen it. That there wouldn't be any denials, they wouldn't ask for any other paperwork and that they wouldn't dra…

Finally got the official word today.... It took TWO weeks after submitting all paper work. Good luck to you all. Qualcare NJ

Can someone tell me if that means that I won't covered for the laopband- I just went to my seminar yesterday?? Thanks This what is under my covered benefits in my certificate booklet Obesity Covered Services for obesity include up to two nutritional counseling visits when referred by your Primary Care Physician. Prescription Drugs and any other services or supplies for the treatment of obesity are not covered. Surgical treatment of obesity is only covered for patients meeting Medical Necessity criteria, as defined by us. Precertification is required, and coverage is only provided for gastric bypass or vertically banded gastroplasty. and the…

My insurance is Health New England. I was told it would be a year before I would know if I am approved for the lap band. A year!! I have already been to most of the required doctors and specialist, have attended support groups and seminars, even the psych doc says I'm the perfect nut for this surgery! I just started this journey in May........and I'm bummed that I will have to wait a year!:think

I just wanted to say how sorry I am for carrying on about my primary and secondary insurance problems. I have been very insensative to those of you who have no insurance or who have been turned down. Please accept my sincerest apologies.:faint: JP

I talked to my Dr. office today and they finally resent the paper work to my primary insurance co. Now it is time to wait again. I hope the time goes fast due to already being approved by my secondary ins. I want this so bad days seem like weeks. I realize I did not get this way over night and need to chill out. I will keep everyone posted.

What is going on with Medicare? There seem to be new requirements in Virginia. Is this nationwide or just the Medicare contractor that handles Virginia. This contractor seems to be acting like a HMO.

:help:Need to have lap band do to my health but I only have Medacid for my Insurance I'm looking for Dr. how will take my Insurance or is willing to work with me to have this perciger done. But just remeber I'm a stay home mom.

I have 3 insurance questions. I have good insurance now and am deliberating whether to have lap band or bypass. 1. My current insurance will cover both, but if I switch insurance due to changing jobs, will my future insurance disallow fills because it was a pre-existing condition? I don't want to go with the lap band and then be unable to afford the fills because I'm paying out of pocket. (By the way, how long does one keep getting fills?) 2. Does anyone know of an organization I can join to get GROUP insurance that does not depend on my job, such as AARP, professional organizaitons, religious organizations, etc.? 3. I have a friend who had bypass and said that she can no…

Hello everyone. I was just wondering if anyone else has blue cross blue shield of Iowa and if they had the surgery did you have to go through a lot of hoops to get it approved? Denials before approvals? I am just starting this journey. Done a 6 month diet with my family doc 2 others times and succeeded with them just gained all the weight and then some back. Surgeon at seminar said if it had been over 2 years I should start again. So here I am again going to the doc monthly and all that hoopla. I honestly think sometimes the reason for all of this is so that the insurance company can see how committed you are to pursuing this whole thing. Oh well......that…

New to the site and my first post. My question is this I called my HR Rep and asked if this type or any weight loss surgery would be covered by my insurance Anthem BC & BS. He stated no. that was an option the group could do but it would cost to much for all the employees. Has anyone ever had this problem? If so how did you go about getting this approved thanks.

I completed my insurance requirements today.... Now it's time to hurry up and wait. Does anyone have Great west insurance; if so how long did you have to wait for approval? :faint:

We currently have BCBS and the list of what you have to have to be eligible to be covered for lapband includes a history of five years of morbid obesity, or a BMI of 40. For real?! If they really stick by that, do they then look to see if you have been at the lower BMI with co-morbidities? I just crept over 40, and just added co-morbidities and I am not sure ow they would verify consistent BMI anyway as I have been pregnant twice in the last five years! Can anyone weigh in on this?

Hi everyone.... Okay, since starting my little venture, I had decided to be a self pay patient, but am having a different view. Not to say that I won't end up being a self pay patient, so here's the deal. My DH's company insurance does not cover the band at all, heck, they don't even cover the bypass. Well, what I am thinking about doing so that I can get this covered is have my husband drop me from his insurance which is not cheap anyway, and have a different insurance pick me up. I have priced the different ones out there, and they end up being a little bit cheaper than my current insurance. For example, UHC doesn't necessarily say its covered, but doesn't say…

I have already had surgery and one my second fill today but i am changing to united healthcare to hubbys ins cuz im changing jobs. mine has cigna but its to expensive...anyone else changed ins co after surgery how does that work when you need fills etc??~Chantay

Does anyone have any ideas where to go to borrow the money for the procedure? someone told me once that the company that makes the band might lend money. My exclusion in my insurance is going to kill me. And, I am feeling really desperate.:cry

My Doctors office faxed the information to Great West at 11am yesterday, I got a call at 8am this morning that I'm APPROVED!!!! :clap2: I had a few requirments to complete, but nothing I couldn't do. Now I'm just waiting on the approval letter to set our date.

I may be getting laid off. I do have a chance to sign on with my husbands insurance, but my insurance covers much more. I know it will be expensive, but for myself I really want to stay with my current Tufts plan, which has been great. Does anyone know if the laws change from state to state? Is there a cut-off on how long you can stay on Cobra. Can they change the plan and not cover as much? I have been banded in April 07, but still need future visits, fills, etc. Any information would be greatly appreciated. I'm just afraid I will stay with Tufts and then find out I should have gone with my husbands plan instead. Thanks so much!

I meet w/ the surgeon next Tuesday and I need to write a convincing letter on "Why I want bariatric surgery". This letter will also be submitted to my insurance (BCBS of Ca Federal basic) and I want it to be really, really convincing being that my BMI is under 40 (37) with few co morbidities such as prediabetes and hyperlipidemia. PCOS testing tomorrow,if I'm lucky, I will be able to add that to my list of diagnoses. Anyone have any ideas as to what might be good to say? I have searched for some samples on here, but most of them are more appeal letters to insurance. Please help!

I went to my first Seminar with Dr. Cahn in Boise. I knew I had an exclusion in my policy for the surgery but after reading everyone's comments here for some time now I figured they would help me get through it. One of the comments in their instruction sheet in big bold letters says: If there is an exclusion in your insurance (my words, now, not theirs) You should not even fill out the paperwork . I even spoke to one of the secretary's from the office that was there and she said Obesitylaw.com probably will not help either if there is an exclusion. I am devasdated. Without the insurance even paying for the pre-lim stuff, I do not have a chance. After 2 years of looki…

:mad:Hi all. I don't know where to begin. The insurance is making this a very, very difficult journey for me. It has been full of red tape and misinformation. And I see no end to it in sight. The short version is that I'm 4'11 and weight 200lbs. I have had a documented over 35 bmi for the past 5 years. I have also had chronic high blood pressure / hypertension for the past 5 years. Also I was born with a congenital degenerative bone disease (Perthes Disease) that is affecting my hip and ankle. In fact, my left ankle is rubbing bone on bone when I walk. (very painful) So when I decided to go for the Lap Band System in February of this year, I contacted every …

My wifes insurance at work excludes ALL weight loss stuff. I have been told to get some private Ins that will cover a Lapband surgery. What insurance is the best for this?

CAN ANYONE TELL ME HOW TO START CHECKING INTO A DR ETC FOR THE LAP BAND I WORK FOR THE STATE I HAVE 2 MEDICAL CONDITIONS GERD AND JOINT PROBLEMS BECAUSE OF THE EXTRA WEIGHT HAS ANYONE OUT THERE DEALT WITH THE STATE BCBS FOR THIS PROCEDCURE? NEED LOTS OF HELP PLEASE:help:

Does anyone have Optima Health in Virginia? If so what steps did you have to go through to get approved? Shellie