Insurance & Financing

I have BCBS and they will cover my surgery, but they say that they want notes from the Dr showing at least 6 months of a supervised diet. Has anyone else gotten out of this? I have been on a lot of different diets, but I never went to my Dr and checked in with him. He has written a letter of medical necessity for the surgery, but will this be good enough? I would really like to not have to spend more money on unneccesary Dr visits and have to put off the one thing that will really help me keep the weight off. My weight is fluctuating between 287 and 300. At the rate I am going I will be over 300 if I have to wait.

Has anyone won from an appeal with United Healthcare??? I have United Healthcare Choice Plus and I was denied getting ready to appeal and was just wandering if anyone has had any luck with this???

:help: Don't want to go through the hassle of calling your insurance company, waiting on hold for thirty minutes, only to find out you're not covered for the LAP-BAND procedure? Shoot me an e-mail; we have a team of insurance specialists that can help verify your benefits and work with your insurance company to have them cover the lap-band procedure at one of our Texas outpatient surgery centers. Don't be shy! Justin True Results: Weight Loss for Good http://www.trueresults.com P.S. Not in Texas? We are building a facility in Phoenix that will be ready to open in less than a month! Also, we have other facilities scheduled to be opened this year so visit our s…

STILL waiting.... paperwork sent on Friday I was in for my preop this afternoon... The girl from the office put a call into BCBS...was told it was still under review. UUGGHH!!!

went showed up 15 mins early watched the lady try and set up a projector screen, Im hopeing she is a better Medical assisant then she is dealing with Computers and projectors! LOL Claudia Weighed me in, there scales said 303lbs Mine at home say 298 (I like mine better). The Dr was 20 mins late, he was stuck in OR. No big deal. He finally got there did his speech. We went in and talked to him. He thinks my insurance (state insurance of Medi-cal) will denie me. Because I have no complications from my weight that could cause me to die, such as high Blood pressure, sleep Apena, High blood Sugar. Im to healthy, lol. So we are going to submit it and see if they denie me,if…

My insurance requires a year long Dr. supervised diet. I have been on more then my share of diets/exercise plans. Unfortunately my dr.'s have never been willing to follow my progress. The normal response when I requested help with losing weight was "eat healthy and exercise", I'm thinking if that was all the help I needed I wouldn't be asking for help. My question is has anyone needed this same year long diet and been able to get around this (without private pay)? If so how did you do it? Thank you in advance for any help!

<p>I need to vent, big time! I am flipping out here!! I have been done all of my procedures and waiting for approval since...ready?...MARCH 9th!!! I want to scream about the 2 months of one ridiculous incompetency after another, between my docs office and the health insurance...I've been the only person working!! I AM FURIOUS! <img src="http://www.LapBandTalk.com/images/smilies/mad.gif" border="0" alt="" title="Mad" smilieid="9" class="inlineimg" /> </p> <p> </p> <p>Now I found out today that I've been rejected because Horizon needs 5+ years of morbid obesity. Not that easy to get med records from 5 years ago, especially because I've mo…

I can’t believe it I got a call this afternoon to let me know I am approved and my insurance (BCBS TX Federal Basic) will be paying at 100%!!!! I have an appointment Thursday to complete my pre-op testing and then next Thursday I meet with the surgeon. Then I get to schedule my surgery for 2 to 3 weeks after I meet with the surgeon. So hopefully by the end of May I will be banded! I am stoked!!!! Good luck to those of you still waiting! I did not have to do a supervised diet or provide 5 years of medical history. I can’t believe this is finally happening. I have been wanting to do this for the last few years and my insurance just started covering it in January. Ha…

Keep being told, "you have benefits" by the dr's office, BMI 36, no high bp, cholesterol, no apnea, no real problems. Have had all the test accept stress test, told I need to have one problem! Doesn't 20 years of being overweight count, have UHC-choice plus.

Hi all, I'm new around here. I was just wondering if there is anyone in Canada, in particular Western Canada, who has had LBS and had it covered at all by their health insurance company. My health carrier is Pacific Blue Cross, and when I called them to ask them if they covered any kind of obesity surgery they got all snitty with me and said 'we don't cover any elective surgeries.' :cry If anyone has any info I'd love to talk to you about it! Thanks,

Well my insurance company sent a LETTER to my surgeon requesting the facility that would be used for my banding. So I guess this will now be the third attempt to present the letter of Pred? But in this day of advanced technology they sent it by POSTAL SERVICE instead of a FAX or EMAIL. They WILL NOT take the information from me only from my surgeon. I have HCA UHC!!!!!!!!! MY husband works for the HOSPITAL. It is part of our insurance contract that to be covered by insurance it has to be done at an HCA facility. The surgeon's office is IN THE HCA facility for crying out loud. Why would I submit for insurance coverage and then go ANYPLACE ELSE where it wouldn't be covere…

It has been a very long journey to me with misunderstandings @UHC. Not all plans are alike and varies through your employer. I would like to provide some numbers and slight information that has helped me these last eight weeks of waiting. 1. If your doctors office sends your clinicals throught the USPS this can delay your approval or denial. They have yet to get the original clinicals to care coordination for approval and customer service acknowledge receiving them on March 3, 2007. 2. Have the doctors office to fax them to Care Coordination. There phone number is 800-842-3920. My approval took less than 24 hours. 3. Be persistant! If you are frustrated let …

i was rejected by bc bs of oklahoma which has covered 25 other employees at where i work i have a bmi over 50 which is the reason for rejection and saying i could die on the surgery table.. they however approve gastric bypass which is more dangerous than lapband. any advce would be MUCH appreciated on exactly what my next steps would be in getting approval what kind of documentation should i obtain.

Hello! I have Blue Shield ppo 750, and I looked up what they cover for Bariatric surgery and this is what it says. <LI type=square><LI type=square>Prior Authorization: Required These provider networks are available under your plan. Provider Network: Preferred Provider Copay: $250.00 plus 30.0000000000% Per Admission, after deductible is met. Copayment maximum applies. Applies to Deductible: Yes. Applies to Preferred Provider deductible I understnad the copay but what do they mean by 30% per admission after deductible is met? Does this mean i have to pay 30% of the surgery cost? Please let me know!!! Thanks you!!! :help:

Hi, I am looking for any info you may have on this type of insurance. What they covered/what they didn't, did you have to pay upfront fees? What about meds, and HOW MANY HOOPS DID YOU HAVE TO JUMP THROUGH ? I am exploring this lap band thing, and to be honest, it is very scary. I weigh 265 and am 5'2" tall. I need help badly. Please let me know how it's been for you! Thanks!

I am considering the band since two others I know have been extremely successful with the procedure. I have Humana in KY and want to know if anyone else has had payments done by them.

My mother and I are seriously considering getting the Lap Band surgery. I've done many reasearches and have come to the conclusion that it's right for us. A woman she works with told her today that she got into some sort of program that she got paid to have the surgery done. Apparently it was through some sort of experimenting thing. Does anyone have any information relating to that? Secondly, If not, what are the steps to go through to get approved and get the surgery done? She and I both need to have this as soon as possible. I truly think it IS a medical necessity for she and I. Do I ask my doctor to do it? Or what am I supposed to do? Thank you in advance. -R…

Has anyone had to do this?? Cigna Authorization Dept wants to have a Peer to Peer phone conversation with my surgeon so they can discuss what additional information needs to be provided by my surgeon or myself. Quick recap: I was denied a few wks ago because of 6 month doc visits which was completed and submitted. I called Cigna to find out exactly what was missing and after talking to 4 people (on the phone 1 hr 50 mins) they told me I submitted everything and it's all documented. Not sure if this is normal request or if they just didn't have an answer for me so and this request would get me off the phone. Although the folks I was talking to today were wonderful!…

DH may be changing jbs and that is the insurance company. Well actually they are private I don't understand all this stuff but SouthCare PPO is what they said.

did you contact the Insurance company yourself at all? Or did you just sit and wait to hear back from your surgeons office?

Hey - Anyone out there ever gotten approved by Kaiser? I found out yesterday that Kaiser has a weight loss department in Richmond but I don't know if they do LB. I want to follow this through because if I have to I can change to BC in the fall. Can anyone advise?

:help: I currently have Tricare Prime but have the option of picking up a different insurance through my work as a Massachusetts State Employee. Are there any insurance companies you would recommend? Thanks!

Ok I just got got off the ohone with the lady from bc/bs and she told me that they don't do precertification for the lapband. What you do is have it done and then send it in to see if they'll pay for it. So what is the likely hood of them paying for it? If I do everything they ask, meet everything they want me to meet. They told me that it is covered if its deemed medically necessary. Has anyone ever dealt with them before, with this?? Thank you

:help: I was turned down by UHC....I am not sure how to begin the appeal process and what to ask or handle my employer.....any suggestions please would help out alot....Thanks to all of you for listening and helping us UHC troubled people!!!

Does anyone have GHI HMO coverage? and how easy is it to get the lap band surgery approved with them?

I live in AZ. I have BSBS and they have a six month supervised diet and exercise program before approval. I have gone to seminar and see PCP to get my letter stating it is medically necessary since my bmi is 43 and have slightly high blood pressure. Question is-does anyone know how strict BCBS is with this six month diet and exercise stuff? (It's not like I haven't been dieting and exersizing for the last 10 years anyway!!!!):phanvan

This is my wonderful insurance company! I was wondering if any of you have this same carrier, and what kind of "hoops" they made you jump through? I'm pretty sure I have all the paperwork they are requiring...but I'm sure there will be SOMETHING I don't have...and will have to continue jumping through these "hoops!" The insurance chick at my surgeon's office is supposed to be opening my case today and submitting it! Woot, I can only pray and hope it goes smoothly!

Has anyone found if you have Lapband surgery that you will never be able to be covered for health insurance if you ever lose your current coverage?

I called yesterday and was told by a rep from bcbs that they declined me for 2 reasons. 1. They said I need to have a 5yr history obesity, which i did all but one visit my BMI was 33 in 2002.. I asked them if they go by month so I know if I need to weigh in sometime this year to get my 5 years in. They had no clue. 2. They said I needed more information on being on a low cal diet. I went to my Dr for 12 months (found out it was only supposed to be for 6) to have weigh ins every month and she would memo that I was on WW or the 6 week body makeover. This was not good enough for them. I asked her what other proof I would need, she had no clue about this either. …

My only requirement before meeting my surgeon for a consult is to meet with a nutritional coach by phone for 6 months. I am almost there. It is all done by the phone and I talk to her once a week on Wed. Well I have about 1 month and 3 weeks left. I have not lost a pound. Is this going to hurt my chances of getting the lapband Surgery? My weight is 240 with very high cholesterol and borderline diabetes. My BMI is alittle over 40 I have Pacificare HMO Value Plus through Northridge medical group. Anyone have some advice? Do they want me to loose weight and then say "no" to the surgery...or will they see that I did'nt lose and kick me out by saying I did'nt take the…

Hi~ I have Oxford Freedom Municipality and I called them to be sure that I have no exclusions on my policy and THANKFULLY I don't. They said that all I need is a letter of medical necessity. My question is which doctor writes this letter? Does the letter come from my lap band surgeon or do I have to have my PCP write it. If it has to be a doctor other then the surgeon would I be able to have my gynecologist, who has worked with me on my weight for years write it instead of PCP? Any info anyone can give me would be really appreciated! Thanks!

My husbands insurance sucks overall and I was wondering if anyone has this insurance and had any luck with approval.

Hello all.:help:..I had a quick question about tricare compared to other insurance co's coverage for this procedure. I am enaged to a retired Navy man and will be covered with tricare after we are married. We live in kansas and will do all doctoring in Leavenworth. I currently do not have any type of insurance on just myself and was wondering if it would be worth it to just go to an outside company such as blue cross etc..and pay out of pocket premiums for myself or go ahead and get the tricare in hopes that one day they will cover this surgery. Also, is there anything I should be doing this early in the game to get prepared??? example, food journal for doc to go over, et…

Well, it's been a week since my first appointment with the surgeon (March 27th) and I've called a couple of times to see where they are in the submittal process. On Friday (March 30th) they said they didn't have my diet history done (which the nurse I befriended told me she'd do on Wednesday). I had taken every little thing they would need, it was totally organized, cross-referenced and color coded (No, I'm NOT kidding). So I anticipated this would go quickly, and was TOLD this would go quickly. Well this morning the person who answered the phone said they were still waiting on the dictation from the surgeon (the nurse had told me that he dictates the next day). I go…

I need some advice on how to approach this with my pcp. I was hoping to avoid getting her involved, as I think it will be hard to get her to "sign off' on this surgery for me. I have an appointment with her at the end of the week, anyone have some suggestions as to what I could say to her sway her decision? She's seen my attempts, and all the failures, I am just mentally tired of fighting this battle...I am not looking forward to talking with her about it again...I hope it goes well.

ok i have a question for you all... since my employer exludes weight loss surgery i'm checking on getting added to my partners insurance. she has Aetna. I was looking online today at the covered benefits and exclusions and limitations and this is what i found under exclusions and limitations... "Surgical operations, procedures, or treatment of obesity, except when specifically approved by HMO." what does this mean?!?!? i'm hoping this is a good thing! crossing my fingers!

Hey everyone, I was wondering if anybody was approved by Cigna that could not show proof of being obese for at least 5 years. I understand that this is a requirement and unfortunately I can show proof of obesity (this last time) for only a little over 3 years. I have all other documentation ready. Should I proceed and see what they say, of should I wait? Thanks for any advice, T

I have Humana PPO. I can't find anything about LPS in my benefit booklet or on the website. I will call tomorrow, but I really don't want to tip them off until I am better prepared. Has anyone ever dealt with Humana? I appreciate any advice.

:help: Hello...I have a question about Nationwide Insurance. My friend is wanting to have the procedure done and does not know if her insurance---Nationwide covers? Does anyone know anything about this plan? If you do, it would be of great help so I can let her know. Thanks.

Whoo Hoo!!! After 10 weeks & 28.1 pounds lost, the doc is submitting for insurance approval!!!!! They said to expect 6 weeks before an answer, but things look VERY hopeful!!! Needless to say, I am SOOOOOO excited!!!!!! :clap2:

Hi!! Just wondering if anyone has used BCBS of MN for their lap band lately? If so, what were their requirements to have it done? Would love any info anyone can give me. Thanks in advance!! Robin

Hello all, My parents recently switched from their civilian policy to TriCare Standard, in hopes that LB would be covered... it abolsutely was not covered with their civvy policy. I gave them the codes to call with and they were told it's not covered due to "experimental" rating. They kind of don't know what they're doing, they're lost when it comes to the online world, so I read through every post I could find around Tricare, MTFs, etc. And then tried to summarize the information to them. I have a question though. What's "PCM"? I get that MTF = military treatment facility, but saw a lot of reference to a "PCM" as a key factor in getting approval, and I have no …

How did your insurance company handle the doctor bills for the pre-op tests? The sleep study, cardiac evaluation, thyroid testing, etc ... did they cover those things because they are tests that could have needed to be done anyway, since you are over weight? Or did they deny the claims because they were pre-op tests for "bariatric surgery" I know I have an exclusion and I don't want to find out down the road BC/BS won't cover these bills. (I am switching my insurance co before the surgery. A policy that covers it.)

i can provide 6 months diet history and 5 yr weight history from my doc. i got the 5 yr weight history from my doctor... but... i have a question. i was told that weight watchers counts as history... so i have 4 months of it. all my weigh ins are hand written in..... ummm what are ya'lls thoughts on just completing the weigh ins myself??? my aunt told me to do it! she had to tell "white lies" to get approved so she said go for it! i need some more opinons!!!!

I have medicare and I read online that they cover this surgery. Has anyone dealt with Medicare before? Do they require dr supervised diets? any info would be appreciated. Thanks, this is my first time on this site and I am seriously considering have this done.

And I want it SO badly!

Has anyone hired either of the two attorneys that specialize in Obesity related insurance appeals? I would just like to hear some other experience on this matter. I was denied by UHC on 01/23 and am waiting for my medical records and highly considering hiring an attorney.

Thank you for your email. Dr. Barry S. Greene of Advanced Surgery PC is a participaing PPO provider with the Plan. Unfortunately, your group coverage with CareFirst does not include benefits for lap band surgery or gastric bypass. i want to look into having lap band surgery. i am 5'3", i weigh 245, i have sleep apnea, high BP and high cholesterol as well as irregular thyroid. i don't get how a doctor that does lap bands and gastric bypass surgeries could be a preferred provider yet the procedure itself is not covered. anyone eaver deal with this? I have Bc/BS PPO thru maryland.

Soemone told me that they had insurance through BCBSOK and it covered their body lift after they had the lap band... can anyone confirm this? I have BCBSOK and i called them and asked them about the lap band procedure and they said they cover it but i didnt think to ask about the body lift.

Hello, I am new to the forum and wondering if anyone that has Messa has just been banded. I plan to be shortly and this is what they are telling me I need. Letter from my primary care physician ( the hospital gave me a template for my Dr. to use) and an authorization letter from my surgeon. Is this all that you needed or did Messa require something else? TIA Jenn