Insurance & Financing

We are changing our insurance over to my husband's plan on 7/1/07. Of coarse my first fear is denial because we will have just gotten the insurance into affect, then I remembered out of habit ( I always lie about my weight) I lied about my weight on the forms we filled out because I was afraid my husband would look at them on his way to work. Anyway I knocked off about 25 or so lbs. Have I completely messed up my chances w/insurance?

What are some reasons insurance companies WON'T cover lap band? What are some reasons that gurantee they will cover it? THANKS

I just spoke with my insurance co. who 6 weeks ago said they do not pay for lapband surgery. Well guess what? They do pay and so does my secondary. :omg: Gee the next thing you know they will be fighting over who will pay for me. Thank goodness the Dr. I choose is a PPO for both plans. I can hardly believe it. I keep thinking I will wake up and nobody will pay. The insurance Co. said I should know in 30 days. I hope I dont' go crazy between now and then. JP

I got a message on my answering machine from BCBS nurse case manager for me to call her. Of course, its too late for me to call her tonight and its Friday.... I have to wait all weekend. My surgery was already approved. From experience--- does anyone know why she is calling-- is it routine???

has anyone gotten out of this by your MD writing a letter to the insurance company....basically stating that you've been under his/her care for years... Thanks for your input!

I have BCBS of CA Federal Basic. WLS is covered w/ a BMI of 40 or 35 w/ comorbidities. Ive had my surgeon visit and he thinks I definitely qualify. My BMI is 37.4. I have hyperlipidemia (high cholesteral AND high triglycerides, metabolic syndrome or prediabetes, depending on which Dr, they say different things. I also have infertility, stress incontinence, gerd, undocumented hip/feet/back pain and I just found out today that I have PCOS. Im hoping that PCOS diagnosis will help towards approval. What do you think? I will have my upper GI to check for hernia, psych and nutritional evals next week and then will be able to submit to insurance. What do you think my chances are…

Anyone From New Mexico With Bcbs Ppo (public Schools)? They Have Just Done The Initial Submission To See What Comes Of It. I Was Just Wondering? Thanks! Np

Anyone with BCBS Federal had experience with getting fills paid for? Someone on another forum told me they would not pay for one within 60 days of surgery?? I cant seem to find anything on it in my plan book.

All I needed was a referral from my primary doctor to Dr. Ren . Once Dr. Ren received his faxed referral I was good to go.

I read up alot on another thread about the plan. I wondered if people are over all happy and satisfied with the plan, excluding there lack of banding. I don't have the band and I'm thinking about self pay, but this is the insrance my husband has the option to get with his new job. thanks

Has anyone had anyluck with humana covering the lap-band ?

Hi everyone! I'm highly interested in getting "banded" and I called my insurance company (UHC) to see what the requirements were for me to get approved for the surgery. They said.... -I need to be 21 or older. Check -Have a BMI of 40 or higher. No check, my BMI is 38 and only 10 lbs will get me to 40. Maybe I should drink lots and lots of Water and wear heavy clothing on my weigh-in!:rolleyes -I need to have documentation that I have been morbidly obese for the past 5 years. No check, I'm a yo-yo dieter so there have been times where I was 160 lbs within the last 5 years and this weight has obviously, decreased dramatically since then. I'm feeling a bit discouraged …

Wehave BCBS UT Select through my husbands work (we works for University of Texas). Does anyone know anything about thier coverage of lap band or who I would call to find out if they cover it?

I have BCBS Alliance Select in Iowa. From what I've read on the company website lapband is covered if you have a BMI under 50. I'm at 50 but I think I can manage to lose 10 pounds to bring that down. Anyhow I know every insurance is different but if they say the procedure is covered does that usually mean your fills too? Or is this something that might be all out of pocket? I'm just realizing that this surgery is really something that could require quite a few visits and I just would like to know what I'm in for I guess.

Has anyone heard of any changes to tricare standard covering the lap-band? Any future changes? This sure is a long process to get coverage that should have been covered when the VA and Medicare started approving the lap-band.:cry Thanks, Don

<p>My company currently has Blue Cross / Blue Shield in Kentucky but our current plan EXCLUDES any kind of weight loss surgery. We currently have Blue Access (PPO) plan 332. I was wondering if some of you out there that had Kentucky BC/BS could share what plan number they had that DID NOT EXCLUDE weight loss surgery so that I could pass that information on to my employer. Thanks so much.</p>

I have BCBS NC and need 5 years of weight history in order for them to approve the band. So far I have something from 2002, 2003, and 2006. So I'm missing 2 years. My doctor's office said, I need atleast 4 of the 5 years, I could even try weight watcher's weigh in's, or something from Curves. I've done nothing like that in those years so I'm stuck! Anyone have any ideas? I'm willing to fabricate! Shhhhhh! I've gotten everything else done, even the yummy upper GI! I need one more year of weight history. Has anyone else been in this situation?:help:

I understand that BCBS recently accepted the Lap Band procedure. Is this for both BCBS and BCBS Federal? We have BCBS Federal & we just received our denial letter today saying he could have the gastric bypass surgery or gastric stapling procedures but not Lap Band or similar procedures. We're in TX & have been waiting patiently for the ins. to reply. Since they denied the Lap-Band, can we appeal?

Through my dad's work I still have Principal Financial Group, and will be getting my own coverage with the same Providence Preferred plan. They do not exclude all weight loss surgery, but becoming approved could take 6mo or longer. This is the information they need in order to consider approving me: Age CPT Code from dr./surgeon and his fee. Patiant History of Morbid Obesity/ Document Medical History of Failure to Substain Weight Loss 6/12mo supervision by family health care practitioner and nutritionist. Nutritionist visit once a month. Family health care physician visit once every three months to review results of 6month. Opperative risk evaluation by surgeon.…

Hey everyone - I'm trying to help a friend whose DH has Operating Engineers Health and Welfare for insurance. Has anybody had any success with this? Thanks!

My insurance uses the words "ideal body weight" as the qualifying terms. That seems very open to interpretation. Is there a generally accepted standard. I have seen the MET Life tables and also the BMI charts. I have no clue as to which one is correct. Both have a wide range of possibilities.

Hi. I thought I would share this link. My appologies if it has been posted before. Surgery for Morbid Obesity

Please post them here...I'm trying to throw something together but am having a brain freeze! Any help would be greatly appreciated!!! Thanks!!

I called my insurance, Healthnet, and they said it is a plan exclusion. They don't cover Lap Band at all. (Lap Band says they are a Lap Band friendly company) The guy even supposedly asked a suppervisor to make sure. Should I just take his word for it? What do I do next? Has anyone else had this problem? Should I change insurance? ~Kathy

Apparently, Aetna has the Lap Band surgery listed as an exclusion. While I sit over here and try to boggle over why a company would exclude surgery to eliminate morbid obesity, I turn to you all for help. I have another insurance option -- my company's insurance is under Blue Cross/Blue Shield of Texas. Anyone have any positive experience with them? That aside, is there ANYTHING you can do if they've listed it as an exclusion? Any kind of appeals process that's worth a hoot?

I wrote a letter to my insurance company...and basically all they told me was that they didnt cover the procedure :help: So now i bacially kinda stuck......I really dont know where to go from here...I havent been to a doctor yet....im really kind of embarassed I guess....I never ever really though people thought of me as being fat. But I know I am I cant oblviously lie to myself Im not really sure how to handle the insurance company either because I know im not going to get approved for a loan....Im pretty much lost.....if anyone has any thoughts prayers anything please write back........lost and discouraged

delete me mods!! i cant figure out how to contact u!

I'm confused... I went to my PMD for the "letter of medical necessity" and he said he won't write it until I have blood work, xray, EKG, maybe ENDO....etc. I thought the 1st step is the letter to get preauthorization, then all the tests came after that to clear you to have the surgery...??? Any input from the experienced banded folks ?? I'm in NJ with Qualcare as my insurance. Thanks for the help.

:help: :help: So my insurance company denied me the first time....So I went ahead and paid cash for the surgery--12,500. So now, im going back to the hospital to get an itimized statement so I can appeal my insurance company and provide any and all info possible. I have the understanding that even if I was denied, they will many times cover things like the hospital room, etc. So thats what im trying to do now. BUT! The freaking hospital will not give me an ITIMIZED statement. Just a bill saying I paid 7500 to the hospital. Thats it, not the room, meds, pt, etc. When asked the girl with a crap attitude said, "the physcians center would get screwed" "WHAT?? how?? Did I NOT …

Our insurance (Anthem BC/BS) denied my husband because his BMI is 60. The policy states they only approve lapband for patients with a BMI of 50 or less! Ludicrous! I was wondering if this has happened to anyone else? If so, did you appeal? What was the result? The LapBand company is taking up his appeal and we're wondering what the chances are of the appeal being approved.

Hi, I am just starting out on this journey and was wondering if there is anyone out there who used Kaiser in Colorado, and if so could you tell me a little bit about the process they make you follow. I met with my PCP last week who believes I should qualify and is going to finish up my paperwork after my blood work comes in and send it in. What can I expect if I get an acceptance letter? Thanks for any info.

Hey guys: I just started a new job this week and the insurance offered is either Aetna HMO / PPO or Kaiser. Anyone had more or less or horrendous trouble getting approved for WLS with either of these companies? Just need some input before I make my decision. Thanks for all information.

I have been waiting for my surgery because I just got a new job, and they offer Excellus bc/bs, which I thought would be good. I called the company and they said they cover lapband, but I just got my manual in the mail today, and there is a page in there labeled "RIDER TO EXCLUDE COVERAGE FOR WEIGHT LOSS SERVIES" that says my company has opted to not pay for WLS unless "medically necessary". At the age of 21, I'm almost 300 pounds with at least 4 co-morbidities...I would assume that's medical necessity, right??? Should I start my riot act now, or wait and see if the insurance request goes through? Hahahaha. Actually, I was just wondering if anyone has been through this…

yay yay ya YAY YAYA YAAAAA maybe a few smilies will express my elation!:clap2::clap2: :clap2: :clap2: :) :biggrin1: :biggrin1: :biggrin1: :D :D :D Called insurance today, waiting for letter to be recieved by my doctor so I can schedule the surgery!!! Best wishes to all you guys out there still working on it! I gathered my own weight history and did all of the "leg-work" and faxed it to the insurance coordinator myself so it would go faster. good luck guys!

I am a United Healthcare patient in Kansas City waiting for approval on getting lapband surgery with Dr Hoehn at Shawnee Mission Medical Ctr. The hospital and the local United Healthcare office reached a verbal agreement to sign a new contract prior to the termination date of April 12, 2007. Because of a separate,unrelated contract dispute between United Healthcare's corporate office and Shawnee Mission Medical Center sister hospital in Chicago. United Healthcare will not allow it's local office to sign the agreement. We as individual members can only make our healthcare changes once a year. As you know enrollment is not open now. That leaves many of us without our chos…

After 2 previous "tentative" surgery dates, I have been approved! Surgery date of May 23rd!! Advice to some of you with difficulty getting insurance approval: Sometimes it is the surgeon's office staff that don't submit appropriate paperwork in a timely fashion. Call and follow-up -- regularly. I found out that my denial letter sat for 2 weeks in the surgeon's office and Aetna had requested a Peer to Peer Review within 14 days of receipt of the first denial letter, and nothing had been done. Secretary was out on vacation for a week and the second week, she did not act on it -- even after several phone calls from me. So, my May 2nd surgery date was cancelled. At this t…

I have Cigna and a requirement of their's is that you be on a doctor sponsored weight loss program for a minimum of 6 months. I have not done that. However, I have hypertension, high lipids, high cholesterol, pulmonary hypertension, obstructive sleep apnea, and diabetes runs in my family. Has anyone else not had to fulfill that requirement? You'd think the medical issues might be considered more important.

This may sound like a stuipd question. Just wondering. My surgery is scheduled for the 23rd. My insurance was submitted April 19. There is a possibility I may not get word back from the insurance before the surgery date (even though I fully expect to be denied and fully expect to be self-pay). Has anyone ever heard of someone self-paying and then being reimbursed if the insurance DID come through after the fact?

Has anyone had any experience getting approved for the lap band through Regence Blue Cross Blue Shield of Utah? This insurance is new to us, and I do know that the handbook states that no weight reduction surgery is approved. Our insurance came into effect 03/01/07. I know some of you have mentioned that BC/BS is covering it as of 2007. I was just going to check and see if there were any opinions on that particular insurance company. Thanks so much!

Curious...does anyone have Carefirst BCBS? If so, have you been approved for the procedure? Thanks!

My husband has PHCS insurance does anyone know if they often cover the lapband? I have a BMI of 35.5 and i know the insurance wants a letter of necessity and a psychiatric evaluation. What kind of questions will I be asked during this evaluation? Any advise?

My husband has PHCS insurance. So far I know that you have to have a medical necessity and a psychiatric evaluation. Does PHCS often cover this procedure? (BMI 35.5) and what is some advise in talking to the psychiatrist?

:help: I contacted Cigna today to see if they will cover the cost of the nutritionist for the 6 month required diet. They said that with the plan that I have they will cover a nutrionist for 3 visits within one year and they also noted the trend of Cigna denying to pay my primary doctor ( if I decide to do the diet with her) until the surgery is scheduled. How does this work? I will probably have to see my primary doctor for the diet but then when they send in the paperwork requesting payment Cigna will keep denying it for the next 6 months until I am scheduled for the surgery? What if I am never approved for the surgery? Will I then owe my doctor 6 months of back payme…

find out what the status of your case is??

Hi Folks, I am in Northern VA and have BCBS FEP plan 105. I just received a statement from BCBS Anthem from some initial labwork with my primary care Dr. The Bill was $340 for EKG and lipid blood profile. the reason for non-coverage was that BCBS does not cover treatment for Obesity. Huh? I have a Barium swallow set up for net week. I am afraid I'd have to eat that cost. Can anyone provide any help or guidance on this? Thanks

There's a new band coming out. Ethicon purchased a swiss company that made a swiss band. It is supposed to be out in the next few months. What does it mean. Just that you'll have more choices. (as long as insurance covers the new band with no problems) I'll try to find a link Gary

Hi Eveyone, I think it would be great if you all could please post the name of your insurance company when you talk about "my insurance company" it would be helpful to know which insurance companies are more difficult to work with etc. I realize every policy and Doc are different but it gives an idea of what we should look out for with certain companies. Thanks!

Well today I saw my surgeon (Dr. Naaman in Houston) and he agrees that I am a good candidate for the lap band. I completed all of my pre-op requirements for surgery, per Cigna,...psych eval, dietician consult, 6 month medically supervised diet (I actually did 7 though), diet history for the last 5 years, and 2 recommendation letters indicating that this is medically necessary. My BMI is 43 and I have GERD, chronic back pain, chronic knee pain, borderline high blood pressure, and depression. Sooooo the insurance girl at the surgeon's office said she will submit everything to Cigna in about 2 weeks...why it will take so long, I don't know because she has everything there…

my insurance said they did'nt cover any weight lose surgery, is there a certain way i need to ask for this procedure. its united healthcare and i was sure they would cover it

Has anyone tried to do both of the requirements concurrently? I really want to give the 3 month a shot but am so worried that it will be denied like the others at my clinic. I asked them yesterday if I could do them both at the same time. They said they'd get back to me today.