Insurance & Financing

Has anyone been successful in gaining coverage for lap band with a written exclusion for it in their policy? I have Coventry of KS - and have been denied. I decided to self pay (4 days until banding:)). Any advice on filing anyway, just in case they start covering it in the future? Thanks for your insight!

Has anyone tried to get their lab-band covered by First Health insurance?

My Health Plan (OHP, Oregon Health Plan) does not cover lap-band or even gastric bypass. :think Looks like I'm gonna have to self-pay...any advice on banks, etc?

Hello All, i haven't posted much but i wanted to post this good news---to share---and to encourage anyone who has Medicaid. They turned me down at first which was expected so i went to Legal Services (for low income) and filed an appeal. Did much research and sent info to lawyer. Appeal was set up with Judge, Medicaid Doc, lawyer and myself in a four way phone appeal. i am a Christian and was praying that they would even overturn the denial on the phone---rather than much time and more paperwork. my lawyer said that wouldn't happen and they didn't do that. Guess what!!!! They approved me and my surgery is on Nov. 7. i am doing the HAPPY DANCE!!!! Just have…

Just trying to figure out how to pay for this darned thing. I'm having it done in 2 weeks. Has anyone had an insurance company say they just don't cover bariatric surgery and had it appealed successfully? Hey, I'm also curious. How the heck do you stay on the pre-op diet???? Seems like if I could do that, I might not need the surgery!

Since we are self employed we do not have health insurance. We are looking into getting it soon though. One of the cheaper and decent plans was unicare. When calling and asking about private pay insurance , Do you ask them outrigh" Do you cover for WLS banding surgery " Or do you ask them " Do you have any EXCLUSIONS" I guess what im asking is HOW Do I find out about it. Also someone said that since its self pay I could get the policy to COVER It since im private pay . How would I go about doing that ? Any suggestions ? Ive come to the conclusion prior to this that I was going to be self pay . But have been looking and saw that Unicare apparantly seems pretty good about …

I am not banded yet , We are in the process of getting private insurance as well. Here is my question... How do i find out with out "giving away too much info " if the insurance I want to get will pay for complications post op if i have my surgery and im self pay . In other words, Im going to be self pay , I'll get my insurance before getting ANYTHING done in regards to the surgery , that way they cant say it was a preexisting condition. Then If something goes wrong later on , how do i find out if they will cover it ? I knwo some insurances will cover it if its 90 days post op . I have the info booklet here , im just not sure what to look under. Thanks Mindy

We are doing our open enrollment for insurance coverage here at work and I have to switch from BCBS to Mutual of Omaha because of my zip code. I was almost done getting things ready for my third appeal with BCBS now I am going to have to start over. I did call Mutual of Omaha and the lady who answered the phone said that it is covered but must be medically necessary. I asked what they consider medically necessary, she didn't know. I asked it they require a 2 year medically managed diet, she said that she has never heard of it. She did say that as soon as I switch I could send in for my pre-certification. At the next support group meeting, I will ask the nurse if the…

No, it's not a river. It's longer, deeper and the waters are much muddier When I’ve just about lost all hope a tiny ray comes shining through. Yesterday after noon I received a call from my insurer (Highmark BC/BS). It was a girl telling me that she had my appeal and needed to go over a few things. I didn’t understand why SHE had my claim because the last appeal I made was to my employer (Alcoa). She said that Alcoa had contacted her because I had appealed to them in error. The appeal, at that stage, was supposed to be made to the insurer. The timeline went like this…..My doctor filed my initial paperwork. It was denied. :cry With that denial were instruc…

Okay, I have Anthem BC/BS, and they told me that my policy does not cover any weight loss surgeries. However, they said that I can appeal it. Has anyone here appealed the no coverage thing and won??? Please let me know.

I just looked up my policy information online and it says the following about any type of weight loss related procedures. I'm at a 47 bmi and I have type 2 diabetes, so from my understanding I *think* it would be covered, but I'm not sure. Any thoughts on this? Thanks in advance for your help.

Hi everyone. I went to my surgeon's office today and after having my psych evaluation, getting a physical, bloodwork, EKG, going to the nutritionist, having a letter from my PCP stating that she recommends the surgery, going to the nurse at the surgeon....the coordinator at my surgeon's office said that without a letter from my PCP stating that I've been on a medically-supervised program for the last 6 months, they will cancel my appointment with the surgeon, as my insurance company (Horizon BC/BS) requires the letter. Problem is, I've only been with my doctor for 2 months. I can't get the letter. I even asked my PCP if she would write it for me anyway (I know, bad…

They say the cover it 100 percent if they aprove you so I was wondering if anyone got it approved through them?

well i actually just started working for one of the bigger insurance companies and just was wondering what companies people have had the best luck with. I'm fairly sure i will be approved just wondering what needs to be submitted unfortunately i think im going to wait untill i have been there for 6 month and i dont know how i'm going to make it that long i was also wondering how long it took most people to get from requesting the pre-aproval to setting the surgery date? any input would be greatly appreciated :confused:

Hi there! Received my denial from Regence BlueCross BlueShield of Oregon today. Lap band is exluded in which I new! I am trying to fight it. This is a portion of the letter they wrote... We have reviewed your concerns and the information that you provided. Under your gruop contract, through (my employer), the treatment for obesity is specifically excluded from benefit payment, regardless of other medical condtions that may be related to or caused by obesity. When a service, treatment or supply is not covered, under the contract, the member.patient is financially responsible for the non-covered service. Our denial of benefits is not based on the medical appropiateness…

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 11/1…

Hi there! I am considering the Lap Band. I have insurance with Blue Cross/Blue Shield of Oregon and I believe they do not cover it, still researching that. My husband uses my insurance, but Aetna is available to him and a spouse with a monthly fee of course. His insurance covers bariatric surgery, so I was thinking of havin my husband sign up for insurance through his work and get us covered asap. Does anyone know if there is a waiting period from the time you sign up to the time you apply to have them pay for the Lap Band???? I would love it if both insurances would cover it....

My Dr. summitted all my paper work about two week ago.. And Still no answer.. My question is how long did it take you for your insurance to let you know if you were approved or denied?:angry

I had given up and was making plans and had a surgery date in Mexico today when RRRIIINNGGG It was BCBS calling to say I am approved !!! Right here in Houston ...no self pay...no robbing the 403B acct. I am approved in Houston GOD IS SOOOO GOOD.

I am trying to get new health insurance as my Cobra is running out in November. I have been denied insurance coverage and the reason they gave is "a medical history of weight loss surgery in June 2006". Has anyone else experienced this or do you know the reasoning? Am I doomed to be uninsurable? This is scarrrrry!

If anyone has a story like this (Catch-22), I'd love to hear it. So I was referred for a sleep study by my PCP a month ago. I never received the referral, so I called, and they said I didn't need a referral for a sleep study. So I said OK, where do I go, what do I do to schedule this thing? And she said "It will be on your referral paperwork." So I said, "oh, I'm getting referral paperwork?" And she said, "No - I just told you you don't need a referral." OK - after going around like this for a while, she finally says, "You don't need a referral for the study, but you need a referral for a doctor to read the study." So I said, "OK - so how do I get that?" She said to…

:clap2: MY insurance approved me yesterday -and i got a date for 10-09-06 9 days after my birthday-im happy but very nevous-- im such punk, yey lol. They approved me in two days.. I'll let you guys know how it went.. see ya.:clap2: :clap2: :clap2: :clap2: :clap2: :clap2: :clap2: :clap2: :clap2: :clap2: :clap2: :clap2: :clap2: :clap2: :clap2: :clap2: :clap2: :clap2: :clap2: :clap2: :clap2: :clap2: :clap2: :clap2: :clap2: :clap2: :clap2: :clap2:

Hi, Can anyone comment on their experience with these two companies? I just started a new job and have a choice. I wonder which would pay for fills or revisions in case of a complication. Thanks for any input! Olive

My insurance company, BC/BS of Illinois, requires, among many other things, that you go on a physician-supervised weight loss diet for 12 months prior to surgery. My question is, has anyone done this? I've been told that BC has very specific requirements regarding the diet. What happens if you don't lose weight? What happens if you lose a lot? Any experience out there?

Well...I got that bad news that my insurance denied me. They said morbid obesity is excluded from my plan. That it is a rider and my company elected not to opt for that option. Can you fight that? Another question? My husband's insurance (my secondary insurance) will cover it but there is a $10,000 lifetime maximum. Well...we all know that around $22,000 is billed to the insurance for the surgery. Someone mentioned a doctor in Colorado that does the surgery for $9950 - do anyone know how much he bills for the surgery? Any other suggestions? (Self Pay is not an option) Heck, I'll even change jobs just to get it to be covered by insurance. Willing to work in t…

I have to do a two year medically managed diet as per my insurance. I did LA Weight loss 12/04 to 6/05. They have just sent me a copy of my "chart documentation" with all my weigh in (I requested it in June and was told that they could not send it to me, when asked why they stated that it was "their property" and it could only be released to my doctor. Since my doctor never received it, I sent them another fax yesterday and they faxed it to ME today.) So, if my insurance accepts this as part of my two year medically managed diet, I should be ready to go by December. My question: Did anyone else who had to do a "medically managed diet" insurance accepted LA Weight loss?…

I am really sorry if this has been asked before, I searched but I still need some help. Up until now I have been going on the assumption that I would be a self-pay because of an employer exclusion. We just received our open enrollment packets for 2007 and low and behold the gods have shined upon Missouri state employees! :clap2: Qualifying criteria includes “documentation of at least two failed attempts at weight loss with a duration of at least six months each”. I know this is going to sound stupid, but I have failed many times but never documented these failures for prosperity so I am going to have to recreate these events. Can anyone give me suggestions on what the…

In order to receive authorization to see a surgeon for lap banding from Blue Shield, I had to provide them with 6 months of documentation that I was participating in a physicians managed weight loss program (Weight Watchers). Authorization was granted and I had my consult visit and was considered a candidate and proceeded with obtaining the various authorizations for testing to determine my eligibility. I am now waiting to hear from the insurance carrier and my surgery has been schedued for October 30. I have Type 2 diabetes, hi cholesterol, hi blood pressure and a BMI of 48.9. Obviously these are all co morbities and should qualify. Does anyone have experience with Blue…

:faint: I can't believe it! I just can't believe IT! I got the word today that I was approved! I will believe it I guess when I have the letter in hand! Man, It has been a long haul! Soooooo, I am going to see Dr. Carter on August 1st and then my surgery is August 11th! Thank you all for listening to me cry and complain. Somehow it makes it easier to wait when someone is waiting with you! Thanks everyone!:clap2:

My DH just found out that his insurance will cover bariatric surgery --- in 2007! Crap! I just had my surgery! A friend suggested even if your insurance says they don't over bariatric for any reason (Just like ours said) try anyway. Even if they deny it - if the approval comes later (like what just happened to us) - you might be able to seek reimbursement. Just sharing so someone else might save some $$.

Jeremy Gentles and I are pleased to announce that two new forums, created by us, with your assistance, are now open and ready for your use. The Exercise and Diet forum caters to anyone pre or post op, and is hosted by Fitness expert Jeremy Gentles. Get free advice. Peer support. GET BACK ON TRACK post op. Please join us at http://www.obesityhelp.com/forums/fitness Also, I have created an Insurance Forum that I believe anyone will find the greatest wealth of information, peer support, sample appeals and overall how to information provided freely on the web. Bariatric and Plastic Surgery. Get them approved now. Please join us at http://obesityhelp.com/forums/…

Hello, My name is Deb. I'm from Minnesota. My request will be submitted to my insurance this week for approval. Has anyone had any experience with Health Partners? Can you give me any idea if they will approve or will I need to jump through hoops before approval. Any help will be appreciated. :welldoneclap:

Hi Everyone! This is my first post. I am interested in having Lap Band Surgery. My primary insurance excluses WLS, specifically stating even with medical necessity:confused: (Imagine that?!) But, my secondary insurance, which is with my husband's employer, does cover WLS. I wondered if anybody else out there knew of a similar situation? Will the secondary ins. balk at covering since the primary doesn't? I could drop my crummy ins. and only have my husband's, but I hate to do that because my employer pays 100%. You guys are so helpful and supportive. I've been lurking for a couple of weeks and learned so much. I went to a WLS seminar yesterday and it was g…

ERISA is ..well, I don't know what to call it. It's, as best as I can describe, a federal law that governs companies who self fund their benefits programs...like my employer. Well, as you have read in my previous post, Highmark BC/BS has denied me 2 times. Because I live in MASS I have Highmark but if I work for my company and lived in CT (1/4 mile down my road) I would have Cigna. Our companies Cigna plan covers this procedure. It's in black and white in the policy guidelines and coverage position. Within the ERISA's wording are guidelines that all self-funded companies have to obide by. One is that "similarly situated" employees must be offered uniform benefit and …

Well, I have been denied a 2nd time by Highmark. I submitted over 40 pages of medical information and citations and they said they still won't cover it based on their stance of "investigation/experimental". They said they have only covered one other company and that's the Railroad workers. I have no clue what they did but I need to find out. I but they bought a rider for their policy and now it's covered. Now I appeal to my company. We'll see how it goes. I am absolutely not giving up and I'm NOT getting bypass no matter how much these insurance people push me towards it. God, I am just so sick of this never ending battle!!!! It almost feels hopeless but I…

Hello! This is my first post. I have been visiting this site for months in anticipation of having my lapband surgery. Aetna HMO denied my predetermination because at my 6 months worth of diet supervision visits with my PCP, he only wrote that we discussed diet and exercise. They also wanted the wording "behavior modification" in the records. The funny thing is that my actual policy (employer)covers the lapband surgery. So, now I am undergoing the 3 month multi=disciplinary diet and nutrition program offered by my surgeon to see if Aetna will be happy with what they do. It's good, they have me meet with the nutritionist every visit, and give me lots of tools and tips to…

Hi, This is a long post, but I need to vent! Does anyone have PacifiCare insurance? I can't believe what they are doing now! I had been so excited to find I could get coverage for LapBanding, as I have an HMO. (I was surprised to find out that PacifiCare PPO doesn't cover the procedure! ) Anyway, I spent my last 2 days happily setting up the appointments and getting my schedule cleared for all the long trips down to the city I would be going to for the surgery, when I got a phone call from the surgeon's office telling me that PacifiCare just implemented a new policy: Every potential Lap Band patient MUST go to a diet center set up by PacifiCare and be monitored FOR SIX …

If You has WLS because of the insurance company sending them any paperwork... im planning to have it done but no one in the office knows. And i just thought of that. Can some one answer me pls Thank u guys!

:angry In two days, my 30 days will be up and I "should" receive an answer from insurance on approval/denial. But, here is the catcher - after them giving me that line of bull - they are now saying that it is 30 days from the day the "reviewer" receives the request. If that is the case - nothing would ever get approved. And, my Dr.'s office told me that their attorneys say it is 30 days from the day the green card/signature is received on the "return receipt" is signed. AND, the people who answer the phones are so mean. I don't understand why people have to be so hateful! If they don't like their job - they should find something else to do. Come on HEALTHSCOPE i…

Hello, I had my consultation on Friday and I was denied by my insurance. I have HUC POS plan. I have many problems caused by obesity and I called UHC to see what I can do. The woman I spoke to said I can send them a bunch of information about my problems so they can determine if it's medically necessary. So far I have about 5 different doctors I can get records from. Wish me luck, I am super depressed about this. When I found out I wasn't accepted and had no one who would finance for me I came home and cried while eating a cheeseburger lol. Thanks for the support, you guys are the best. :faint:

jeopardy song in my head...im WAITING on my:censored: insurance to approve me for my surgery,my DR. just summited the paperwork today so i hope i don't get denied, please you guys send good luck vibes down my way..THANKS

I was all ready to jump in head first and get banded, I fit all the requirements by my insurance, BCBS, (two comorbids). Then find out I need 12 months of documented weight loss. My pcp, even tho he's been treating my for years for weight loss, won't consider that sufficient. I just can't envision waiting an entire year!!! Just wondering if anyone else ran into this? And blowing off a bit of steam!

I am a 100% Service Connected Veteran and would like to know if anyone has experience or knowledge if Dallas VAMC will do my Lap Band. I know that the Doctors at Southwestern Medical School have to practice on somebody?

I just got the hospital bill for my lap band that was placed on August 7. Unicare HMO paid $23,000, and I have to pay $285. They approved it pretty quickly, with minimal hassle (They lost the first two sets of paperwork but when the doctor's office faxed in a third set, they had it approved within a week.) One request for more information. I don't have the surgeon's bill yet. I think I got very, very lucky. Thanks, Unicare!

I called my insurance company (Carefirst BCBS) today to see if they've received my request for authorization and I was told that the nurse was reviewing it. Is that normal or does it mean they will deny it? Or does it mean anything at all? I am really anxious to get this done an over with. Thanks,

I have Highmark BCBS of PA and I was denied :think because it's experimental/investigation. has anyone have the same and have been approved? please help me:help:

Hi all, I am so upset. I just found out today that I was denied the surgery. They said it was not medically necessary. I have a BMI of 39. If I'm not fat enough, that is truly pathetic. My surgeon's office is appealing the denial. Is that usually the course of action. I was thinking about writing a letter in addition to the surgeon's appeal. What does the surgeon's office do as far as appeals go? I need help. Please let me know what you all think I should do. I was scheduled for July 11th and now who knows when I'll get it done. Emily

I'm so excited! I just got an acceptance email! I'm now represented by the Obesity Lawyers! ALSO!!! INAMED has an appeal program where if they feel you have a good case for appeal against insurance denial then they will cover the lawyer fees!!! I can't wait!!!!!!!!!! Cigna will PAY! lol :clap2: :clap2: :clap2: :clap2: :clap2: :clap2: Michelle BMI 52.5

Just thought I would ask here since I can't find this information anywere. Currently, BCBS of NC will not pay for the lap band because they consider it experimental; however, the policy indicates they last reviewed this in August 2004 and are reviewing it again in August 2006. Anyone out there have any clue when in August this is supposed to be? I keep checking the website and it still says the same thing. I'm hoping they update the site as soon as it is changed, but knowing them they won't. Any "inside" knowledge or just simple suggestions would be greatly appreciated! Thanks!

If you have bc/bs/anthem of nh, please post to let me know how your approval went. I have them and are waiting for approval for my upcoming surgery in September. My BMI is 35.3 with co-morbities..I'm 207 lbs!! I gained 3 more pounds!! Thanks for you help!