Insurance & Financing

:think I am having major problems with getting BC/BS HeleathSelect of Texas to pay for the lapband and after this last appeal I have decide to get an attorney, does any know of a Good Attorney that can help with an appeal,either in TX. or Can practice law in Tx. I have 2 names Gary Viscio of Viscio & Associates,PC and Walter Lindstrom Jr. the only problem I'm having is obtaining some credentials and ratings from the ABA.in my area. If anyone has retain either one of these attorneys and won their appeal Please put up a posting .:pray: :pray: :pray:

I have posted many posts,about how to get insurance approval or how to get a loan,I could'nt get either because of my credit score.I was watching ABC News: C:My DocumentsAbcNewsProsper.htm and they talked about People to People loans,borrowing from common people. It's great and it did work for me. The link to this site is below: http://www.prosper.com/public/groups/group_home.aspx?group_short_name=ProsperNLose

I hate to say it but I'm giving up the insurance battle ... really before it began. Thanks for all the advice and info from everyone here. I probably won't be visiting this site any more ... I think it's depressing me even more and I'm getting very jealous (and dare I say bitter) when seeing people complain about having to do the 6 month diet or pay a co-pay or or or ... Anthem BC/BS won't cover the band since it's an exclusion w/ the small business plan. I contacted a few lawyers and other than send me paperwork to fill out and a BILL, can't really get them to talk to me and give me any REAL information and/or odds on beating the insurance co. I big fat BOOOOOOOOOOO t…

Hello, My name is Janie, in Nov last year, I got a "Surgical consult" denial letter from pacificare hmo saying that I had not gone through the six month nutritional program. So I started that in Nov and I now have only 2 1/2 months left before they will concider talking to me about what to do next after the 6 months program. I was wondering if you think pacificare will let me do all the other pre op appointments like psych,surgeon consult,sleep study...ect...before I actually finish my 6 months, maybe my last month in the program?. I just don't want to waste any more time waiting for appts that I can get while I am doing this 6 months of nutritional counseling? My thoug…

My insurance policy covers one weight loss surgery, but not the Lapband, it covers the Gastric Bypass, does that mean I will not be able to have them pay, or is that worthy of appeal, and what would be my first steps towards appeal?

I live in Utah, but my insurance is through Alabama, but what I wanted to know, is if anyone has any luck appealing them and getting the surgery? Is there hope? :nervous

I just found out last night that my employer has an exclusion for weight loss surgery on my insurance. Does that mean that my hopes of getting it covered are over or can I still appeal an exclusion? Thanks!!

thats my insurance.... anyone have any luck w/ getting them to approve?

Hi Everyone, This is my first time posting but I have been following this forum for a few months. After much deliberation (and years of obesity), I have decided that I would like to pursue the option of weigh loss surgery. Last week, at my PCP's office, he said that he would submitt me for insurance approval of the lap band. I am currently 5'3 and weigh 272 lbs. I have been overweight all my life but over 200 lbs. the last 5 years. I am elated that my doctor is supportive and would like to see me have the procedure however I feel overwhelmed by the documentations he is requesting.I received a letter from my PCP today that says this: The following documentation must b…

Hello All, I am am waiting for the approval of my Lap Band surgery from Horizon Blue Cross Blue Shield PPO. Does anyone know how long they take. It seems like forever I have been Waiting. Everytime I call to see about the update, there has yet to have something documented in their file. Do they have a contact phone number. Does anyone have any information on that Dept. What should I do. Are they good with approving. My Drs. Office says that they faxed over the information on the 24th of January and I have called alomst every couple of days to see if they have received it. What should I do. Someone if you could help me please respond.

Has anybody been approved this year through UHC without having a 5 year history with a BMI of 35 or higher? I called my insurance 3 times to make sure this was not required for me, because I do not have 5 years of history because I have not been to the Dr. every year the last five years, and they said no I did not need a 5 year history for approval. Well when my Dr's office called my insurace this morning to fax in my paperwork they said they need it! Grr. I am so frustrated right now.

Ok guys... I finished all my tests and everything for the insurance company. Everything is submitted. I am now just waiting for my Doctor's office to call me and let me know if I am approved. They said my issurance company usually takes 15 days to approve. I have started buying things as if I am approved and just saving the receipts. I won't have much time to do all that if I just wait for an answer to do all that. Keep your fingers crossed. :eek:

I went to Dr. Hamn's seminar last week and saw him today for my consult. They gave me a sheet that told me what my insurance (Aetna HMO) required. It had all the usual (BMI of 35-40 or more, 6 month supervised diet, nutritional eval, psyc eval) but the part that is confusing is they said I needed to show the 'presence of severe obesity that has persisted for at least 5 years.' And that they need a copy of at least one office visit for each of the last 5 years that has my weight on it. Not a letter from the doctor saying I have been over weight, they need to see the actual medical records. My problem--I have seen the doctor every year EXCEPT 2005! I saw them in 2001, 20…

Did anyone see the letter their doc sent to their insurance company referring them for surgery? The reason I'm asking is because I have no co-morbidities according to my insurance - I do have a very bad back, a bad knee and a family history of heart attacks, high blood pressure, diabeties, stroke, etc that needs to be brought to their attention. My doctor said he would help in any way he could do you think putting this info in the letter would help? It couldn't hurt right? Also has anyone included a personal letter with their submissions? If they could get a personal view on why surgery would help me I think it would be a help too. What do you think? I do not wan…

Hi Everyone, I have wonderful news with a bit of a spin! I started the process to get approved back in October 2006. At the time my insurance didn't cover LAP Band, it only covered GBP. And I asked if they planned on coving it in teh future, but the lady said they didn't know. After meeting with Dr. Earl Fox, I decided I would pay for it and then deal with my insurance. So, on December 22nd I had LAP Band at Auburn Regional Medical Center. I'm doing great! Now, it's March 1st and on February 26th I got an approval letter from my insurance company for LAP Band. Subject to all terms in the Plan, i.e. eligibility date. Well, I called my insurance company and asked whe…

I've been aproved. Surgery is March 30th. I could cry. :clap2:

Hey guys...I need your help. I have a job interview with a company on Tuesday...their insurance company is BCBS of WA...I'm wonderign if anyone knows what BCBS policy if for the lap band. I have heard rumor that they started to cover it in 2007 but I'm curious if anyone knows the specifics...like if u have to do a diet or anythign like that? Any help would be soo appreciated!

My file is being submitted to Medical Mutual of Ohio today. I've waited 6+ months now to get to this point. I'm getting excited (to get approval) and scared (of being denied) at the same time. All I can do now is :pray: Anyone else been dealing with Medical Mutual? How has your approval went?

Me again, just wanted to report my next hoop I have to jump through. FINALLY got my Dr records sent in and everything was sent into BCBSNC. Got an email from Dr. Moran's office saying the insurance comp wanted blood work done before they'd review it all which contradicts what their policy requires. So I called BCBS and spent 45 minutes trying to get someone to explain this to me. I finally got a nurse who told me how I can avoid additional test if I've had one done inthe last 9 mths. She was very nice but I my point is that these insurance comp put all these requiements on you but mine has already said if I don't get approved for surgery I will be responsilbe for the…

Just wondering if anyone knows off hand if they cover the Lap-Band.

Does anyone know a way around the DR documented weight loss attemps of 6 or months? I have been on Jenny C, WW, Atkins, Phen-Fen, Cabbage soup diet, you name it I have tried it, but never with a Dr's help. I currently have hypertension that is being treated w/ meds, GERD, and a BMI of 36.7. I contacted my insurance (BCBS) and I meet all criteria w/ the exception of the Dr documented weight loss attemps. I feel so frustrated.

I was just wondering if insurance companies will reimburse you if you pay cash for the lap band, and then filed a claim? I don't want to have to pay cash, that is the reason I have insurance, that I very seldom use. Angel :eek: :help:

Attention everyone who wants the lapband. It has nothing to do with the insurance company on why they deny you of coverage. It has to do with your company, they have restriction if they cover it or not. Don't waste your time going to the doctor, just call the insurance company first and if they tell you they don't pay for it, then you know right then instead of going to the doctor and being disappointed. This is what happened to me and I have been with 4 different insurance companies, and I finally found out the truth. So call the insurance companies first. This is the best bet. It is your company not your insurance, so there is no use on fighting with them any mor…

I have completed all of Cigna's requirements and LapBand is covered on my policy. My surgeon's office sent off the paperwork for approval just before Christmas. Cigna has until Fri 2/2 to respond - 30 business days. I called today (my 5th call this month) and it is being 'reviewed by a Medical MD" since 1/24. Most days I have the attitute that what is meant for me won't go by me and other days I'm happy there is the appeal process in case I need to use it. But today I'm worried... Is this a good thing that a Medical MD is reviewing my case?

Is high cholesterol typically considered a co-morbidity?

Well, my fiance is on a work policy on United Health Care but his particular policy does not cover the surgery. He had his work's insurance agent try to fight with UHC and she called back yesterday saying that they told her that they do not cover the surgery AT ALL. I know this can't be true because I've heard of many people being covered through UHC. Since he already has sleep apnea and is obese, he can't get approved with a new insurance company and we tried for a loan but only got approved for $6,600. Our local bariatric office has an insurance coordinator that we're going to get in contact with next week..hopefully they can help us out but if not, what other options…

After a denial the 1st week of dec. I was too low in the bmi for coverage.. so I really enjoyed the holiday feasts.... now I have a bmi of 42.5 and am ready to submit a new claim for precert.. now my poor surgeon has broken his arm.. sorry buddy I ain't waiting on anybody.. I have contacted the next closest hospital for bariatric surgeries and they have several highly qualified surgeons.. I am waiting for a call from them now.. I feel empowered once again.. I can have hope to reclaim my life.. and my health.. my future.. donnaco myturnow:clap2:

I am going threw the hoops to get the lap-band. Will having M.S. hurt or help my chances to get my insurance to pay? Any opinions?:sick Kitty

:pout: Got a letter back saying that my insurance will not cover the procedure due to plan "exclusion" of weightloss surgery. No way I can afford to finance it so I may as well give up. Or, at least, it's not something I can do in the near future.

A recent TEC assessment recognizes the benefits of the Lap Band when compared with gastric bypass. TEC (Technology Assessment Center) was founded by BCBS to evaluate new technologies in medicine. This is a non binding assessment that does not require any individual BCBS carrier provides coverage for a particular procedure, however one would think that it would make such coverge more likely. http://www.bcbs.com/betterknowledge/tec/press/tec-in-press.html This link may change as the announcement moves from 'in-press' status to 'published' status.

Hello all, I remember seeing on here that a couple of people that paid out of pocket or even Mexico Bands got fills covered by insurance? Does any one have any info on this, like what insurance companies covered it, and how did they send it through? I am getting my first fill this week and would love to know if it is a possiblity to send it to insurance as a specalist procedure? I have United Health Care which is supposed to be pretty good about covering band ( and would of coverd mine if my company didn't have a discloser on weight loss surgery). I was banded in Mexico, and plan on using Dr C in Cincy for the fills. Thanks in advance, Sara

well I got good news today.. My surgery has been approved!!! It took 2 tries 1st time I was denied low bmi... the holidays changed that; ). and now I am waiting for a date.. My surgeon broke his arm a couple weeks ago ... so I need to be patient cause he's not quite up to surgery!!! just wanted to let you all in on my joy.. keep trying... never give up..:clap2: myturnow...donnaco

Good luck today with your review! :gluck:

:help: I am curious as to what the total out of pocket you had to pay for this surgery, Psych, Consult, Deductibles, etc...and what ever else I am forgetting about. I need to get a good idea so I can start preparing. I know all is different, but a ballpark is better than nothing...for now. Thanks in advance, Rosanna

Help!!:help: I am in desperate need of finding any companies within the Seattle area....or ANYTHING close that have health insurance that covers the band. I know that ADP (payroll company) does but that's about it....Maybe Cingular or some national companies...if anyone perhaps works for a national or large company and they got approved please please please let me know. My mom worked at ADP for 7 years and had UHC and they covered the band but I had to be 18 So now I will be 18 in 2 weeks and she just got a brand new job still with UHC but they employer disn't chose to have the band be covered. Just my luck! So if anyone can give any advice it would be veyr much …

OK folks .. I'm trying something and I'll let you how it goes. I am a benefits/HR person for my company, and it was at the BCBS SC office this past summer that I was at their office for "train the trainer" meetings... it was there that I found out that our SPD ALLOWED for WLS, because I am HR, I am the main contact for my company with BCBS and we were given a special person to be our contact......... anyway... I just sent HER the following email: (btw thanks for posting the billing codes) Hello Lisa! Here at the Mother House location, we got our new ID cards in Tuesday’s mail. YEAH! I have a question for you. In 2007 I’m going to be having a Lap Band put in, CPT…

Hey I just saw this on another board!!!! New Center of Excellence in Kansas!!! Original Post by Carolanne S at 5:19 PM CST on 02/05/2007 SOMEWHERE IN..., KS Shawnee Mission Medical Center was approved as of 1/24/07 as a center of excellence. That will allow medicare patients to have bariatric surgery in the Kansas City metropolitan area. The only question is wheather a surgeon associated with SMMC will perform surgery. I attended a seminar from Dr Hoehn and Dr Hitchcock and they were sort of reluctant to do medicare patients if SMMC were to become a COE due to the reimbursments from medicare. Its all about the money!

I just got off the phone with BCBS of NC. The Corporate Medical Policy - Surgery for Morbid Obesity has been changed to include gastric banding (the Lap Band). The representative was most helpful and directed me to the appropriate section of their website. I now have a print out of the new policy in my fat little hand! Besides the same restrictions we've all read about a thousand times (BMI 40 or more, BMI 35 with co-morbities, etc.) there are two other restrictions, 1.) Patient must be over 18 yrs. of age, and, 2.) BMI must be less than 50.

So I went to my first seminar, and they stressed to make sure you call your insurance and see if they cover. They also said see if you need a supervised diet, ect. WELL...My insurance covers WLS for morbid obesity. NOW!:confused: What do I say? Do I give them the CPT code? Do I tell them my BMI? What do I say? Thank-you so much for responding/ or viewing my topic!:clap2:

has any one ever had mail handler insurance? i work for the federal goverment.

Has anyone had any luck in turning around an exlcusion for WLS in their employers benefits package? I think it is important that it should be able to happen, but really unsure if it is even possible. I have Regence BC/BS and their has been an exclusion for any kind of WLS and aftercare. If any of you have read my numerous posts on struggling to get the money to have surgery done in MX, then you can probable tell how desperate I am to have this done. I am waiting to hear back from the company handling our medical insurance and for sure let you all know what I found out. Judy

Another reason to get banded... Last week I received a letter from MetLife; based on my BMI, Uncontrolled Diabetes, Elevated Cholesterol and Hypertension, I have been turned down for life insurance. At the beginning of the year, my employer went with a new life insurance carrier. So, if I croak from an MI or a stroke, or kidney failure, I am going to be up a creek without a paddle. The only way right now that I can protect my family, will be to buy private life insurance, and that will cost an arm and leg. So - my quest continues to get this lap banding done... Wish me luck! Rachel

I have my 1st consultation w/the surgeon tomorrow. (It's my 1st appt. period). Aetna Open Access HMO (for Federal Employees), just told me that they will not pay for a dietetian unless you are diabetic. I was going to cancel my appointment, then I decided I'm going to go ahead and talk with this doc to see where I stand. If this visits sounds promising and he thinks I'm a candidate, etc. Perhaps I'll just look into self-pay for the dietitian. Anyone have any estimates they made have paid monthly to see a Dietitian?

Hi all, I am wondering.... My Ins requires : * Minimum of 40 BMI * Documentation from a Physician of a diagnosis of morbid obesity for a minimum of 5 years What my question is.. Has anyone not had 5 years of morbid obesity that was required by ins? I have been collecting all my records from all my Dr's. And for the past 5 years my BMI has been between 35 & 41. But not a steady 40 for the last 5 years. Anyone dealt with this? If so, what was your outcome? TIA,

I just received word that the insurance company will NOT cover the lap-band. High-lighted in the denial letter was no surgery for MORBID OBESITY, under the heading Physical Appearance. Well, I don't need the band for my physical appearance, I need it to live a better, longer life! sleep apnea, sore leg joints, border-line hypertension and possibly diabetes in the future are all good reasons to lose weight. We're self-insured here at work, so I had a nice chat yesterday with the HR lady and she said she would see if we could get that procedure coverage added to the plan. I have no idea of the chances, but do know that will take 2 to 3 months at least, if at all. End …

Ok, so my insurance payed 100% of a bill last year, which was $600.00. This year they put things to my deductable, 500, and then paid 60% of the other $100.00 which is $60.00. They put nothing else to a copay. The lady at BC said that next time they will pay 60% of the allowable amount. So if they bill $600.00 they will be paid around $360.00 next time, not putting anything to a copay. I have paid a copayment each time I have gone in there, and SCOR says that I am responsible for $150.00 per visit. From my standpoint, I am seeing that I will owe them money this time to add up to the $150.00, but should not have to pay a copay the next time, nor any additional money…

HAS ANYONE HAD ANY EXPERIENCE DEALING WITH AETNA FOR BANDING?:help:

I know many of you had to go through many appeals to get this done. I have been told by my insurance that my employer excluded it from coverage. My question is this: what happens if I lose some weight in the interim? My highest was 241, currently 231 but what happens if I lose, say 20-30 lbs and my BMI is no longer over 40? Do I not qualify if I win the appeal now? I am not well and cannot stay at this weight (pre-diabetic, high cholesterol, GERD, sleep apnea, multiple sclerosis) but I don't want to eliminate myself from this surgery altogether. I am at at BMI of 40.2 right now. Why is this so hard? When will people understand this is a health issue and not a "characte…

Greetings to all!!! My name is Silvia! I am just beginning my journey. I'm not sure how far I will get. Here are my stats......I am 5' 0" and weigh in at 198lbs. I have been fighting with high blood pressure for at least 8 years now. And last year I was diagnosed with severe arthritis in my foot. The arthritis is so bad that the joint is completely worn out and needs to be fused. The pain in my foot leaves me unable to excercise. I also have arthritis in my lower back. I have been battling with a weight problem since childhood. I am the chronic "yo-yo dieter". So I have decided to try to get the Lap Band System. I have an appointment with my primary care physicain on Mond…

Hi, I just got a copy of my benefits booklet. The requirements are: * Minimum of 40 BMI * Documentation from a Physician of a diagnosis of morbid obesity for a minimum of 5 years :omg: * Over 21 years old * Surgery is preformed at a network hospital by a network surgeon even if there are no network hospitals near you.. What my problem is.... I don't think I can get 5 years of documentation. I have only been with my curent PCP for a few (2-3 years) and went to a few different Dr's before him. Not sure if any of them put down morbid obesity in my file. Most of the time I never questioned my weight. Or they never questioned it.. Can anyone help or been in …