Insurance & Financing

I have UHC Insurance and I have been approved for the surgery - YAY. I get my surgery on 1/18/07 (my choice to wait until January). The frist 3 months are basically covered with the price of surgery. My question is, there is not a CPT code for fills and I was wondering if they generally pay for fills? I have to 90/10 plan, where I pay 10%, $100 deductible, $1000 max out of pocket expense. How does the fills work with insurance? Do they pay? Do you pay 10%, do you pay a copay or what? Just wanting to know if anyone had experience with the insurance company I am using.....

OK..... My company is switching to BCBS in 2007..... we had the option to go PPO and CDHP (HRA) I went with the HRA, and I do already know that we DO have a provision for WLS in our Insurance SPD...... my question is... Has anyone used an HRA for WLS? The way I'm reading this is that my MAXIMUM out of POCKET ANNUAL should max out at $4850.......... which sounds like a lot, but faced with self pay it is better than $17,500......... and if this is true, I COULD possibly beef up my FSA account to cover that.... I'm sorry if this is sounding like gobbletygook... (I am a benefits person, and my brain is doing the math for what SHOULD happen):cry

I am just wondering if when insurance states you need a comorbity along with the weight, are they saying you must have one of them for at least 5 years aswell ? my insurance is Aetna , but seems I might as well not have any they dont want to cover anything:(

I had my surgery in April 06. At that time I had United Healthcare for insurance. They covered my procedure. In September, I started a new job and my new insurance is through Regence. The big issue is.......it looks like I will have to have my port put into my abdominal muscle. Where the port is now is risking erosion because there is no fat to cushion between the port and the abdominal wall. I was looking through my benefits book and it states, in the exclusion section "surgery (including reversals), treatment, programs or supplies intended to result in weight reduction, regardless of diagnosis." What to do? I can't get a straight answer from Regence. And I tho…

I contacted obesitylaw.com for legal advice and talked to Kelly Lindstrom. She told me there is a program backed by the makers of the lap-band that if you are denied based on "none life threatening co-what evers", obesity law office will do the appeal and not charge the patient. (I am assuming the manufacturers of the band reimburse the law office or maybe they are that supportive of the band) Anyway, the request for their help has to come from the surgeons office; therefore, I contacted my surgeons office today and gave them the information, they contacted Ms. Lindstrom in CA, she faxed the info to the surgeons office who faxed info to me. I have already completed the ap…

Hi! Someone in another thread mentioned a low-rate medical loan available from one institution (CareChoices or something like that maybe?)... I'm not having much luck finding anything available anywhere else without a 7% or more interest rate. For those who have self-paid and financed at least part of the procedure, or who have found available loans that look good, where's a good place to turn? Thanks! :girl_hug:

does anyone know of an insurance company that approves the lapband for people with a BMI less the 40? 5'5 bmi 36.1

Without going through a Job/Company,just apply for personal benefits? Like.. Anthem Blue Cross and Blue Shield,and be able to see a LapBand doctor,would Anthem pay for your surgery as long as you pay your deductable? any ideas would be great!

Has anyone EVER had any luck overturning a denial based on an exclusion? WLS is excluded by my insurance, but I have appealed on the grounds that I am NOT having the surgery to treat my weight, but I am having it to treat the MULTIPLE co-morbid conditions I have. Do I have a shot in the world, or am I beating a dead horse:deadhorse:? Thanks for your input!

I just received a devastating call today from my surgeon's office. I was told that my insurance (Aetna) would not cover the lap band surgery because it is considered "out of network". Have spent months going to appointments, support meetings, behavior mod classes, nutritionist, losing 18 pounds... I can hardly see to type this through my tears. I am a diabetic on oral meds and insulin (5 different diabetic meds in all). The next step is an insulin pump if I could not lose the weight and get my blood sugar under control. I already have some diabetic neuropathy. Last year, I was hospitalized for urosepsis, and was in septic shock and was in a coma for 12 days, on mechanica…

My insurance company covers lap-band surgery, but they require a 5 year history of BMI > 40, which I don't have. If I self-pay for the surgery, then later have a complication, will the insurance cover that? It seems like it would then be a medical problem, right?

My surgeon provided me with a list of criteria that would be required by United Healthcare, and the list states that UHC will require two documented medically supervised diets, which you have failed to lose weight. One the the diets must be within the last 12 months. Has this been your experience in dealing with UHC to get approval for the lap band?

Unless the bariatric center sent in my stuff w/o me knowing, it only took a few days for approval! I have to wait at least 6 weeks (i'm on birth control) for surgery, but have to come up w/the $350 "membership fee" before they'll even schedule the surgery. Looking at maybe mid February....Thanks for all the good vibes you all sent and encouragement. :update:

:angry Im trying to be postive about this but I cant even get my doctor to refer for surgery!already Im a full time student with Medicare insurance so its gonna be hard to deal with them(medicaid) what is it? she wont even put in a request to medicaid (Caresource)for payment. Im 5'2 ,200lbs,bad Asthma,heart palpatations, ~family history~ of heart diease and diabetes on both sides.Im just TRYING TO BEAT this illnesses that are waiting to devour me.:cry Anybody advice?relate?or just wanna comment?

:help: If your insurance company says nothing about a supervised diet, and just says to send in medical records for review/approval? Is that all I have to do?

Hi there, I'm still waiting for my insurance approval from United Healthcare for my surgery date of 10/23. The surgical coordinator said that they didn't ask for the 5 year health history (even though I have it) and she considered it a good sign. There are no exclusions in my policy and I was told it was covered. I also heard that UHC is one of the easier companies to work with. For those of you with UHC, were you approved quickly or did it take some time? She told me she'll contact them next week if we don't hear from them today and told me to start my liquids on Monday regardless. One of the reasons I'm so nervous is that my company may switchto a new plan on …

hello! just wondering if any of you have blue cross blue shield 'anthem' insurance? i start this plan on 1/1/07, and in the fine print on the back of my insurance sheet, it says 'weight loss surgery for qualified candidates up to $20,000...i'm also scared to call them and ask them about it, since i don't 'officially' have them as a provider for another 4 weeks! any ideas??? thanks!

Finally, 6 months later, my stuff is going to Blue HMO (FEP) for approval. PLEASE send me good vibes!!!!! :nervous

Ok, I have a question regarding the 6 months diet program that Cigna is requiring me to do. I started the supervised diet June 20. Monday will be my 6th appointment, but when you technically count it up, I have only been 5 months. June to July, July to Aug, Aug to Sept, Sept to Oct, Oct to Nov. But, I have had 6 appointments. Do insurance companies go by number of visits or actual months? I just dont want to screw this up cause I have already been denied once (for not having the 6 mos of supervised diets) This is really freaking me out since my 6th Dr. visit is Monday and I was hoping I was finished and could submit my paperwork. I have met all other conditions. Please …

Hello, I'm starting my research today and I was hoping that someone could tell me the approx out of pocket dollar amount they had using United Health Care? My insurance covers 80% and I'd be paying the remaining 20%. Thanks, Patty

Hi, I would like to know If anyone has had a BMI that was so close to 40 and how it was for the insurance to cover them. The problem I have is that I have a BMI of 39.1. and they want it to be at 40 to be qualified . I'm so afraid of being rejected. I finally made up my mind to get the surgery and It would be a great let down. I have two herniated discs and bad vains and High blood presure that I take a med for. I wonder If that will be enough, I hope so, because it sure is alot to handle for me:mad: I would appreciate any info, thanks:confused:

:help: i have bc/bs of ill. after months and months of testing, labs etc. following there requirements to the T. they approved me on 11/17/06 or should i say pre certified. approve the hospital stay and not the biatric surgery. on 11/18/06 they said i had a exclusion in my policy. my question is when they are review your case and requesting all kinds of information. do they not also review you policy. i am doing the research now to appeal my case. at the time of the so called approval they called my doctors office and schedule my surgery on 12/04/06. and now i am left hang and depressed. after years and years of being over weight i finally, after alot of research and soul…

I've got a question . . . I went to my Dr., he put in the request for me to see Dr. Spiegel and said now we have to see if you get approved. That was July 5th. Online it shows I was approved for 6 visits to Dr. Spiegel for "Obesity" on July 11. Does this mean they have approved me for the surgery? Or just to go see him? 6 visits seem like a lot if it isn't for surgery. I have Tricare insurance and was wondering if anyone that has gone through this knows. From what I have read, it normally takes a lot longer to get "approved". Thanks for your help and advice.

I am on the Choice Plus plan. $2500 deductible. I believe on this plan I have to come up with 20% after the deductible is met (it is this year). I won't be able to get it done by the end of this year if I have to come up with 20% because I know it's an expensive surgery. But, I come up on my renewel here in about a week and I could upgrade to the Performance plan to get the $1000 deductible for next year but I don't know if it's worth upgrading to. I don't have a bunch of health problems. The only regular meds I'm on is birthcontrol and Metformin I was recently put on. I'd hate to have a bunch held out of my check for insurance I don't use a whole lot, you know…

Know of any????

I'm crushed!! I've gone thru 4 mos. of behavioral classes, lectures, physicals, psychs, and pre-op tests have all been completed, and two weeks before my surgery bcbsMA denied me because of medically necessity. Letter of intent sent to them in early October, and denial just came thru after completing entire program!! I have a bmi of 36, with hbp, cholesterol, possible sleep apnea, (sleep test pending). I just don't understand on what basis I can appeal this decision as a lay person. My surgeon's program secretary said the appeal is my job. Anyone have this experience? To get this far and have it end just like that is too much.

I am trying to figure out which federal ee insurance provides coverage of lapband. I currently have BCBS, and they cover only gastric bypass. I plan on changing during the upcoming open season. Any ideas from other federal ees would be appreciated.

I have BLUE HMO now thru federal gov't and am THINKING of switching to UHC since Blue's premium went up to $214/bi weekly! UHC is comperable but $111/bi weekly. Anyone have lap band experience w/UHC, specifically FEHB? Any and all comments appreciated!:help:

I gave up, My insurrance company said they do not cover any kind of weight loss, pills, Gym memberships, or any type of W/L surgery. My husband called and complained, because we have insurrance through the union. He told them I work my butt off for the union and we can't even have good ins. He said fine my wife will just have to rack up a bill for ins to cover with all her health issues. One month later, We got a letter today- Says as of Jan 2007 we now cover Gastric Bypass types of surgery. YES!!!! :) :Banane33: :D :) :) :) :) :) :) :) :) :) So now 6 months of supervised diet and excercise and we are set.

On my statement from the hospital, there is still a charge of about $2,900 for "Lap Placement of Gastric Band" that apparently Medicare has not covered. Do they not cover the procedure laparscopically? I am confused. I am going to call tomorrow, but just wondering if anyone has this information tonight. Thank you.

Cmon somebody out there has to have been aproved by this group at some point? I'm sure I'm not the only one here! Just want somebody elses experience with them, and if not then I will share mine soon// should be hearing something else any day now.:clap2: :clap2: :clap2: :clap2:

Hi there. Well I got denied today for the lap band:( . My Ins wants me to go through a 6 month "telephone coaching" weight loss program. Has anyone ever had to do this 6 month thingy? I know in my heart that this will not work for me but I will give it a try. I hate to have to wait 6 months..I am sooo ready now!!

I am hoping for some guidance from those much more knowledgable than me :help:... I received a call from my surgeon saying that UHC had denied my pre-approval. As of right now we are waiting for the letter with the reasons, etc. so we can begin on the appeal process. However, before I even went for my initial consult I contacted UHC to see if it was covered. I was told that there was not an exclusion, but that I would basically have to have all my ducks in a row to show medical necessity for it to be approved. I spent the next month gathering every medical record I could find proving the necessity and submitted it to the surgeon. He reviewed everything, said I was de…

I've decided that I need lapband surgery. Interestingly enough it seems that you must first decide that you want it before you know if it will be approved. Since 8/11: PCP Referred to a lapband surgeon. Not seen yet, because I needed my medical records released to the surgeon's office/facility where the lapband procedure will be performed. All medical records were forwarded to surgeon/medical facility on 8/16. I searched for and found a CIGNA PhD/Psychiatrist provider. Saw her on 9/1, and passed the evaluation. The report will be forwarded to my surgeon within the next 5 days if not sooner. Allowed to schedule an appointment with the surgeon/medical facility f…

Hi All, I am looking for information. What is the point of a medically supervised six-month diet? I know some insurance companies require this and I am just wondering, what is the point? I have lost gobs of weight on diets over the years and I have rebounded significantly and painfully from each of them. I can't believe it is to determine if you can lose weight or not, I would not choose a serious medical procedure if I could keep the weight off. Is it a delaying tactic used to weed out those who are serious? If so, they are just making those who can't afford to self-pay wait. Or maybe they are hoping you will switch insurance companies before the six months is over. Be…

Does anyone know if you can use this financing for surgery in Mexico? Does Dr. Ortiz accept this? Thanks!

I went to the seminar with Dr. Spiegel on Oct 24,2006. They submitted my information and after me calling the insurance company I found out that I had been approved and that they had mailed out my letter on Nov. 1,2006. But I found out from UHC that they submitted for me to have my surgery at United General Hospital but there is one problem that is out of network for me, and I know that he does the surgery at Twelve Oaks. SO I called the Dr. office and I was told that is where he wants me to have my surgey at but then I told the lady that it was out of network for me and I wanted to know if I can have it done at Twelve Oaks and she told me that she would have to wait unt…

Not wearing my happy face today. After having a wonderful day off, 76 degrees outside, took my 93 year old aunt on a drive in the country, went down and got a pedicure, picked out a Christmas present for my hubby, I came home and found a denial letter from Humana. They said the denial was due to me not having life-threatening co-morbidities. I'm thinking, "no, not yet, but I am 47 years old and get rounder every year, I am attempting to prevent from having life threatening problems, hence the weight loss surgery!!" I am upset and need to know what the next step is. By Sunday I will be good and mad and ready to do what I need to do. My question is what do I need to do??:he…

I am hoping my Ins will cover the band surgery and I have a question. I was wondering if arthritis in my neck at the age of 41 constitutes a co-morbidity. I also have the usual, sleep apnea and high cholesterol at 310 and high BP and pre diabetes. And with all of my health issues I wonder if they will still make me go through a 6 month supervised diet? I could die in 6 months!!:drama: My Ins is Pacificare HMO through Northridge IPA in Calif. I could never afford the surgery and have lousy credit, so the Ins is my only option. What do you all think my chances are? BMI of 40 Thanks for any replys. This surgery is all I can think about!!

As of Jan 1, 2007, I will not be able to continue to see my present lapband surgeon any longer. I just wanted to know if anyone knows any other lapband surgeons who are affiliated to with SHARP health care (in the San Diego, Ca. area) that I can start seeing. Thanx!

Hi All..i'm new to the forum and have an insurance question. I'm on pins and needles waiting for HR to get back to me on this, so I figured I'd ask y'all if you had any thoughts on the matter. My company's insurance contract has an exclusion for "treatment of weight reduction or obesity." I've read that the Band may still be covered, as I'm morbidly obese, and the treatment is not for weight reduction, but rather treatment for co-morbidities that my Dr. feels will arise. Has anyone had a similar experience? I would HATE to self-pay, but will do what I have to. THanks Maureen

I just received my approval letter in the mail!!! :clap2: I am so happy!! It's been a long wait and now things can start to move forward. I am calling my surgeon first thing Monday morning to get my surgery scheduled.

:thankyou: I hope everyone.. progress and sucess! Q:I Cant Get Approval For A Car financing,Can I Get Approval For the Lap-Band? Q:Any Ways To Get Financing? Im In Cincinnati,Ohio....$10,000 to $19,000 isnt likely to be in my bank account at one time.--that's just truth. Q:I Have Medicaid(Caresource)and the employees at Caresource basically told me "No" before I told them my weight issues. ~~~Any Advice Would Help~~~ Current Weight- 198lbs Height-5'2

Has anyone had lap-band covered by Aetna? I'd welcome any info on what your process with them was.

:cry I talked to my insurance company and they gave me their website address to look at regarding obesity. It says that I have to have a 5 year medically documented history of obesity. I have been overweight my whole life, but just recently crossed over the 40 B.M.I. threhold. I am 5'7 and weigh 275. Has anyone else heard about this 5 year history of medical documentation that is needed? What if I don't have that? Am I not going to get approved? Am I wasting my time? :cry Any advice and help would be greatly appreciated..........

I'm getting tired of jumping through Aetna's hoops so guess I'm going to have to start playing the lottery! Does anyone have suggestions for fighting insurance companies? I've worked on this since June and just found out today that I have to prove I've been fat for more than 5 years?!!?!?! Hello, the 3 ring notebook of weight loss attempts for the past 15 years wasn't enough? UUUUGGGGH! Going to hang in there, I'm a firm beleiver that everything happens for a reason. Thanks for listening!!

Health America denied my surgery in Dec (I did it anyway-self pay) I hired Walter and Kelley Linstrom from Obesity Law to assist in my final appreal (I appealed twice myself). Found out this week that HA will REIMBURSE me for all charges and cover me for fills, etc. My advice to those of you fighting for coverage is DO NOT GIVE UP (I almost did after my second appeal). The BEST thing I ever did was hire Walter and Kelley for my final. They were wonderful. You can reach them at: walter@obesitylaw.com or kelley@obesitylaw.com P: (619) 656-5251 F: (619) 656-5254 Best of Luck all. Contact me if you have any more detailed questions!!!

Hi, I need help from someone. I am a 30 year old woman that weighs in at 275 pounds. I have battled my weight my whole life. Just recently did I cross over the 40 B.M.I., and need serious help. I have tried so many diets in the past Weight Watchers, Jenny Craig, Fit America, Slim Fast, Phentermine (prescription), counting calories, etc, etc. I have lost 30 pounds and then put it all back on and then some once I tried to eat regularly. I have back problems now front a car accident. My doctor told me that I need back surgery, but that I should have weight loss surgery before I have back surgery. There are more risks to the back surgery since I am overweight. I h…

My brother's girlfriend works as a nutritionist for a bariatric surgeon. She has said that she sees people that can't get health insurance now because they had weight-loss surgery. If your current insurance covers your surgery, but you have to change insurance afterwards for some reason, can you get insurance? I have also heard people say that as long as you get insurance within 60 days of your old coverage ending, the new company can't consider it a pre-existing condition and therefore deny you. I need to know because I will be dropped from my parents' insurance plan when I turn 24 next August, but I am hoping to have surgery before the end of this year, or at least…

I am in Dallas waiting on approval. I have been turned down before but the AIGB thinkgs the rules have changed and is applying for me again. Has anyone else had success with BCBS of Texas?