Insurance & Financing

I just heard from my surgeon's nurse today and she said that United Health Care (my insurance) covers the band but my employer excludes it. I don't understand. She told me it would be worth it to call them and talk to them about it. Is this common? What should I do?:help:

Hello, I am new.... Have been very interested in the LapBand. Been investigating for about 4 months now. Am very sure this is what I want. I have Aetna HMO and my insurance says it coveres with approval. I am covered thru MA live in RI. I am looking into Brigham and Womens Hospital in Boston, MA. Any body have any info they can give me on the hospital, insurance, procedure, what to expect.....I want the surgery ASAP..... I am attending the meeting at BWH on Tuesday evening. Wonder what to expect. Can anyone help.

I have been trying to find out from my insurance company why they do not cover the lap band. They kept calling it an exclusion, but...I found out from the Dr. office that will be performing my band that they talked with my insurance company and who ever she talked to said that it is not an exclusion. To me that is a big WOOHOO, or is it, what does that mean. To me that should mean that they should pay something. Can anyone help me so I know if it is a WOOHOO or a BOOHOO. Thanks, skinnyjenny:help:

I got my statement the other day that showed insurance company responsibility and patient responsibility. I only have to pay $155.84~~~!!!! My co-pay is $250 and then it goes 80/20 until my maximum out of pocket of $1,000 is met for the year. I have arthritis in my knees and go often for cortisone shots so I must have been almost to the $1,000 maximum because my 14,800+ bill said I'll only be responsible for $155.84! I am so happy!!! I know a lot of people have major issues with their insurance companies, and I feel really bad for them. I had an employer whose policy wouldn't cover gastric bypass and they wouldn't change their policy, so I got a job with much bette…

Hello, I have looked everywhere for an insurance appeal form. I was denied coverage for the Lapband and I am going to appeal it. I just don't know the right kind of page/form to send in with all of my records. I have tried obesityhelp.com and some other sites with no luck. If anyone can point me in the right direction I would appreciate it. Thank you.

got this on my email today, hopefully you or I WON'T have to use it.... http://www.fedweek.com/content/ev/rjones.php?ID=167&PHPSESSID=bjqv0vcbmrvdpldkk7erh8q7o3 :bored

I met a nice lady today in a line at a salad bar/buffet. I was behind her and picked up only a small plate. She picked-up the platter and small plate. She said your not having much, why don't you get in front of me. I said I am getting a baby plate of food. Then I thought the way I said it she might think I was getting it for a baby, so I confessed to having lapband surgery. She asked my how it was going for me. I let her know it was going great and that I had lost 40 pounds in 3 months. She asked me if insurance paid for mine. I told her no that my BMI was under 40 and only one co-morbity. I told her if I had two they would. She asked me what insurance I ha…

(Warning: venting/whining/complaining to follow) Uuugghhh. So even after my PCP submitted more info to overturn Cigna's denial, Cigna decided to uphold the denial. I read about the folks at ObesityLaw.com and filled out their online questionaire. They responded promptly with what I needed to pursue their services. But frankly, just the thought of trying to get the ridiculously incompetent medical staff to send me my charts/files/letters to me to pass on to the lawyers makes me want scream. I'm so mad at how little I am able to be involved. I can't even have my own medical records from Cigna. I can't get anyone to talk to me and discuss the denial. They just read m…

i know there are quite a few posts about Medicaid and i am in Pa. and appealing the deniel from them. i have discovered that many doctors and hospitals will accept Medicaid for Lap Band surgery but it's Medicaid that denies. Medicaid approved me for gastric bypass but i will not have that. If anyone from another state has have lap band surgery with Medicaid and that could help me with proof of this, please let me know. my lawyer says if i can find this out it would help my appeal when it occurs. Thanks for any help! cal <female>

I have walmart which is self funded, and being from florida I don't think that matters much anyway. BUT, I got them to approve me after appeal. I am flying to New York to have surgery with Dr. Kurian, which we also got approved. I wanted to say thanks to all who brought me here from the yahoo groups, and obesity help and also to Gary Viscio who got me approved and got wal-mart to change their minds and the policy. Ok, he is busy but he got the job done. (www.obesitylawyers.com) Now, let's hope my fills are covered without any problem because I know that can be a problem too. B

I started investigating the lab band procedure back the 1st of May. I contacted my insurance company to get all the requirements, etc. I knew that I qualified so I made the appt. with the Dr. They got all the required info for the insurance company and the insurance company sent a letter to the doctor and my stating that the procedure had been approved. She wanted me to do a stress test before they would agree to do the surgery. I had the nuclear stress test because of my bad knees and failed the stress test. The cardio doc wouldn't release me to have surgery until I had a heart cath to rule out any heart problems. I was sure glad that he insisted because I did have 90%…

I was planning on being banded in Mexico in Sept. I had finally made up my mind but then my mom's friend (who is a nurse) said she wouldn't recommend it. She said that if I were to have complications and had to go to the dr or hospital my insurance wouldn't cover it and could actually drop me for have a procedure out of country. Is that true? Any info would be appreciated. Thanks, Coreen:help:

:help: anyone familiar with Medicare's requirement for this certificate of excellance, that the hospitals have to have now??? I am waiting for Harper Hospital to receive it so I can get banded. Martha

My local surgeon has just submitted all of the required materials to Cigna. The insurance processor said I should have a decision in 2 weeks. I have a PhD (ok, maybe a Master's compared to some of you) in jumping through hoops at this point: 6 months supervised "diet" resting metabolic rate testing blood work EKG Cardio pulmonary work up Psych eval. mandatory support group Cigna is notoriously tough so I hope I have enough. The problem is, I learned recently that they want you to have a BMI of 40+ for at least a year. I hovered at 39 up until a few months ago. The insurance processor thought I acctually had a pretty good shot, though. I so so hope I get approve…

Hello everyone, I am new to this forum and have just recently started considering the Lap Band, (seriously) in the last 18 months. I see my Doc on a regular basis for ailments caused by my obesity, i.e. low back pain, knee pain, etc... and I have mentioned to him on more than one occassion that I am considering the lap band. Each visit, sometimes not on a monthly basis, my weight is documented. I even had a hospitalization in November of last year due to adverse side effects of the diet drug Fastin which caused me to have a positive EKG and hence an emergency heart catherization. My question is, has any one out there who has Cigna EPO been approved without consistent mo…

I went for my consultation and they called me the next day I was approved!! I get my band in two weeks ( Aug 28th) Wish me luck!

Hi everyone! I'm new here. My name is Virginia and I'll be attending the seminar on August 24, 2006 and hope to get the lapband. I was obese from childhood through junior high and have been morbidly obese ever since, with no luck with any diet plan. I remember so vividly being in first grade and being weighed in the nurses office in front of everyone. I weighed 140 lbs then and have always thought what a hoot it would be to get down to my first grade weight. LOL Today, I'm 37 years old and have a BMI index of 64, with problems of sleep apnea and high blood pressure. Being new to this, and knowing that I will likely find a lot of this out at the seminar, I was wondering…

HELLO Everyone... I have a little dilema, My BMI is 42 with no co-morbities, i want to know if anyone had a problem being covered bu bc cb on Nj with such "low" BMI. thank you all. im just scared that my surgery wont be approved

I just got off the phone with CareFirst BlueChoice insurance. My DH works for Montgomery County, MD, and apparenty their insurance policy follows the Blue Cross "National" policy and not the "Maryland" policy. Lap-band is covered in the Maryland policy, but the National policy lists it as experimental. They will only cover Gastric Bypass, which I really don't want. I thought I had researched this pretty well, but this totally through me for a loop! Has anyone else dealt with this? Is it possible to get past this via appeal? Thanks! UPDATE I got approved on the first pass! I had my initial consultation on Monday, and got a call Thursday that I was approved. I have a…

Hi all, just a really quick question: I saw where a doctor on a different post said that Medicare does not pay for fills and you must self pay; this was an older post, is it possible that it is outdated information or does Medicare truly not pay? (for fills anyway) Any help is greatly appreciated!

I received a denial letter from Highmark BC/BS on March 25th . I was denied because they deem the band procedure as experimental/investigational. They contend that RNY is more effective and has better long term results…yadda, yadda. It’s nothing that we haven’t heard on this site a million times before. Since my insurance company is self insured, I have been fighting with my HR department, to no avail, to get the policy changed. What is so outrageous to me, is the fact that if I lived in a different state (5 miles from my home) I would have Cigna and the policy would cover it. I happen to live in Mass and therefore my company offers Highmark BC/BS to people in MA…

Hello everyone! I just got denied by Cigna. I didn't have all the proper dr. notation of monthy weigh-ins and such that they require...which is a pile of horse sh*t! I've been obese for at least 9 years, and overweight since puberty. My bmi right now is 52. The center that I am going with for the surgery has been somewhat helpful, however, one of their employees had lead me to believe that I would have no problem being approved. Therefore, I waited until I heard back from the insurance. Now I have to go on another 6 month diet, which, the claims director at the surgery center told me "don't be too successful at it". GRRRR!!!!! If I would have followed my instinc…

Hi. I just rec'd eob form from insurance (who previously stated ALL testing was covered, including psych evals). They covered all BUT the "medical reporting of psych eval" (using CPT code 90889). Anyone know of another code they could use to get past insurance? I want to try this route before I dispute the non paid charge. If so, PLEASE let me know, $90 I don't have is riding on this! Thanks in advance! :faint: :help:

:help: :help: Is it hard to get Medicare to approve a LapBand surgery? I found a list of Seal of Excellence for hopitals but not Dr's. Any help that anyone can give I'd really appreciate it.I live in Maryland but would probably go to Pa. b/c it's closer. What kind of info do I need to take to a dr.? Also what is a list of diseases that would help me be qualified. I have Asthma,really bad knees, and Allergies. My feet are also partial numb.I have Arthritis of the spine, and the meds. doesn't stop the pain. Thank You All. Shirley:think

About six months ago I decided to give myself a second try at getting approved for the lap band surgery. I knew that my ins would be difficult. Aetna POS (piece of sh!t). No one told me they change the rules in mid stream. When I first visited AIGB they gave me a list of all of the tests and documentation I needed to have in order to get my approval. I completed them all except the 6 months of Dr. supervised weight loss. I visited my PCP and she was more than willing to assist me. In November I called AIGB to let them know I had 1 month left for the dr supervision and they let my know that I had been approved by Aetna and I need to schedule with Dr. Powell’s office…

Hello all, Since I'm thinking of moving to Florida, and since more then likely, if I do I'll be teaching, I started checking out BCBS of Florida. I read the federal employees policy and weight loss surgery is covered, but what about after care? I had my surgery done here in Portugal and I want to know if they will cover fills, and/or any complications I might have even though the surgery wasn't done there. Any one had any experience with this?

Hi all. I feel like I've reached the end of my ropes trying to fund this surgery. My insurance company covers lapband, but my employer has excluded it? Purchasing the rider is not an option for my employer because it is $52,000. If I applied, I know I would be denied, but through the appeals process, is there any way to still get them to cover it? If its excluded, am I doomed? Any advice is appreciated. I am READY!!! I've made up my mind and I'm committed. Looking at all the before and after pics just make me weap in jealousy and am so happy for all the success stories. HELP! Shannon

:nervous Anyone here have HealthSCOPE Insurance? I can't find much info anywhere on my insurance. I know from contacting this carrier that it's all left up to the medical reviewers. I'm just curious how long it will take to get approved. Tonja

Quick question...I just found out that the hospital I am planning to have my surgery is "not in my network." What does that mean for me?

I just learned today that Unicare HMO has approved me! Last week, they sent a letter asking for documentation of 5 years of morbid obesity (no problem...) plus 18 months of supervised diet. This last is a problem, as they'd told me that I needed 12. I sent them a list of my bmi's taken from my doctor's records showing a 40 pound gain in 8 years (boo!) with the particular weight loss strategy in use at the time, and my sleep study report showing severe sleep apnea. And today they called to say I'm approved! :clap2: :omg: :biggrin1: My surgery was originally scheduled for yesterday, so I'm not sure when they'll do it. The sleep apnea poses a new complication...But at least …

Who has had the most success with a FEHB--which plan. Same questions for plastics. Which plan has the bestcoverage? Thanks for your help

I have seen on many a sites that doctors will recommend that anyone trying to get the band surgery should get PHCS, and a few other insurers. Well, I was wondering how to find out if they have a supervised diet. I was reading the insurance hand book, and it said "Must be medically neccessary". Does that mean there is no other things you have to do except me medically neccessary?

Hi all, I am new. I just went to the seminar and was given a large packet to fill out, like all insurance info, medical questions/history and food diary. I dont have my 1st appt till august 10th and its 5 hrs long. So is this packet for the drs office only or this the one that goes to the insurance co? Also, anyone else have a very long 1st appt? what can I expect? Thanks Jenn

I live in New York, i make 817.00 a month, and i called Fidelis, they help people get medical insurance, and they said i make too much money, how is that too much money, i give 400.00 a month to rent, then i have the rest to pay bills with, im single, i dont have any kids, and i live at home with my family but i pay rent.... can someone help me out with getting medical coverage?, i would really like to be on the ball with the lap band surgery.

Hi all and Happy Saturday. I got a letter today from my insurance company. Acutally it was addressed to my surgeon. It is a letter of predetermination, but it is requesting an estimate of fees before final approval. Has anyone heard of this before? I have NYS employee Empire Plan so it's a combo of UHC and BCBS. The surgeon and pyschotheraphist both assured me I wouldn't have a problem getting approved and I have seen on obesityhelp.com others from my area with the same insurance who have been approved. Maybe it's just a formality, just anxious to get a date. Thanks for any help.

I am in the starting stages. I have already called once just to see if they would even consider. They do cover with bmi of 40. I tried to ask her if I had2 or more comorbs would they cover. I dont think she understood me. My bmi is 37 with high bp and chol. any info would be great so I will know what I am getting into.

was anyone else really scared that they will not get approved by their insurance?? im waiting for my first appt. with the surgeon. im just really scared that this is the right thing to do but it wont work out for me. i know i might be freaking out prematurely but i have a gut feeling. i really think im going to get denied. i live in mass and have health new england. im going to pioneer valley surgeons. anyone want to share anything with me about insurance?? i can give you more background if youd like. if i get denied what can i do afterwords?? thanks!! Marissa :help:

This is an article that appeared in the paper today. Maybe with studies like this insurances might like to take another look at how they classify WLS as Not Medically necessary or experimental. http://www.omaha.com/index.php?u_pg=1642&u_sid=2209182

So, anyways, as much as I hate to admit it, I was just dying over waiting on my insurance, Blue Cross Blue Shield of Minnesota, who I have through my husband's workplace. Well, all that is over now. Hurrah! I could hardly sleep over the fact that I spent 6 months going to Mayo out here, had a physcologist, worked out like crazy, etc. and it all would have been for not except for Blue Cross. Oh, I love them. And it wasn't that hard once I jumped through all the hoops at Mayo ( the craziness is, is that I did this for the bypass, and last month my surgeon said, "get the lap band" much less trama for your young body." ) And all these people said Blue Cross would never cove…

Has anyone on this website heard of Texas True Choice, it will be my new ins. carrier effective in the fall. Do they cover bariatric surgery? If you know anything about this carrier, please let me know. My surgery is already covered, I would need aftercare for fills, or complications. I will try to call the 1*800 number, but I'm not sure they will give me info, since technically, I am not an official member on their plan.

Hello! :wave: I am new here and needing some help. My new employer will pay for health insurance but I have to find my own. I am having a difficult time at this. I want to find a company that will pay for Lap Band surgery but am not having much luck. I was told that United Healthcare covers it but when I called to check with them, they told me that they don't. Can anyone recommend a health insurance company to me to try. I live in Missouri. Any recommendations that I can get would be greatly appreciated! Thank you so much for your help!! :grouphug: Niecy

Did anyone have get a Lap band with humana choice PPO? I don't see many approvals posted for this insurance company, which makes me nervous sinc this is what I have. I called and they said it was covered if it met medical necessity, but would not give me any specific information on approval requirements.

I am borderline BMI with no serious co-morbidities even though I am borderline diabetic, have high cholosterol and have a very arthritic back. My doctor wants me to do a sleep study but according to Unicare if I do not have 'severe" sleep apnea they will not approve. I am only 15 pounds away from the golden BMI 40 without co-morbidities needed for automatic approval by Unicare. Has anyone been denied and then gained the weight to meet the BMI 40 needed for approval? Do they see this as suspicious? With my luck it would take me forever to gain it.

Most of us are familiar with the standard for surgery of BMI of at least 40 (or 35 with complications). Well, here's a new one to me: Blue Cross of CA won't approve bariatric surgery for anyone with a BMI over 50! (This is scary -- mine is 47.) The rationale their medical policy gives for this is that there isn't enough literature documenting the value of doing bariatric surgery for a BMI over 50. NancyRN

Blue Cross of CA posts its requirements for bariatric surgery on its website. I printed out a copy a week ago but couldn't find it this morning. So I called Blue Cross for help locating this document on their site. Me: Hi, I need a copy of your criteria for bariatric surgery but can't find it on your website. Rep: I'll send you a copy of your coverage booklet. Me: No, that won't work -- it doesn't have the detail the policy does. What I need is the policy itself. Rep: Well, it's not on the website. Me: Yes, I know, that's why I'm calling you. I printed it out last week so it must be available somewhere in the system. Rep: Call the surgery center and ask them. Me: …

When I talked to my insurance company, they informed me that LB would be covered. They even sent me a new book outlining my benefits. In the book it states under Noncovered Services: Tretment and monitoring for obesity or for weight reduction, regardless of diagnosis, excluding surgical operations. I wanted to make sure that I understood that statement, so I called again. The person I was talking to said that they would not cover anything other than surgery. I asked again just to make sure that I understood her correctly "So Lap-band surgery is covered?" She said, "Yes". Well, today I got a letter in the mail that states: Benefits are no…

I called my insurance company Highmark BCBS on june 30, 2006. I followed these directions from bariatric center to a tee: " Your first question to yourinsurance company should be, "do I have a policy exclusion for weight loss surgery?" You do not want to hear that you have an exclusion. If you do not have a policyexclusion, then ask if you have coverage for the weight loss surgery procedure thatyou desire, either the Laparoscopic gastric banding (lap-band) with a CPT code of 43770 or the Laparoscopic Roux-en-Y gastric bypass with a CPT code of 43644." I was so excited to hear... YES an exclusion for obesity... but NO exclusion on MORBID obesity. He went on to exp…

Ok, I'm a newbie here and feeling a little overwhelmed...and don't really know where to post this.....so Does anyone have any insight as to what I should expect at the seminar & first Dr. appt? What I mean is if my insurance covers the procedure and I've met my deductible, will I have to pay anything upfront? Also do you know if I will have to obtain medical records from past doctors? I mean I could go back to when I was 10, 19 years ago and I'm positive it says "overweight kid." I have Carefirst BCBS, basically federal. I'm just wondering what to expect???? :eek: Thanks in advance.

Hi All, I have a question, I have GHI-CBP and BCBS. I in the 4th month of a supervised diet to be done in Sept and paperwork put in. I was denied the first time by GHI because my pcp who referred me did not write a decent letter about my weight loss attempts for 6 months. 6 months is a requirement for them. Anyway when GHI approves (hoping) do I need to notify BCBS for preauthorization for the hospital stay? I am not sure and the insurance companies make it very confusing to figure it out. I am trying to get it all in order so there will be no future problems. Thanks for the help. Joy

:help: :help: :help: My first step and the door was shut in my face!!!!!! Couldnt even get pass the NP. She told me that the doctor wouldnt even consider doing the surgery on me because of my BMI. It was 34.9. When I made the appointment three weeks ago I weighed 216lbs and today I was 207lbs. Im so depressed!!!!!!! I've been stressing the past few weeks over my ex and then today was told no surgery. Just listening to all the stories gave me hope. There is no way I could be self pay. I'm already in debt and have 3 small kids. Im really feeling sorry for my self now.