Insurance & Financing

As of friday the 32st, the have changed there clinic policy and are now covering the band...WHAHOOOO. Hopefully now my appeal will go through with flying colors.....................

Hi. I'm researching options re. a small group policy and looking for recommendations. I have insurance through the University of CA but it has been worthless for anything other than meds. That's partly my fault, but at nearly 35 years old, I don't want to go sit with freshmen in the campus health center so I pay privately for medical/dental costs. I am self-employed and have a few employees so I could purchase a small group policy. One of the surgeons' offices recommended United Health Care. I looked up some info and found out that the coverage isn't available "in my area," perhaps due to the small size of the business (3 FT employees vs. 3000 or something). Other…

I am glad to be here! I just found this website and think it is grand. I am currently seeking approval for surgery from the insurance in the title. Has anyone had experience with them? :help: the surgeon sent in about half of what is asked for in the policy book, but now insurance is asking for additional documentation. the surgeon's office is not calling my insurance. I am. And now I'm doing the legwork asking for more documentation from endocrinologist and internal specialist. Is this normal procedure?? Maybe the surgeon's office has some slackers working there?? Does it help to inundate with documentation? Should I send in articles from medical journals as well? I f…

Is there anything I can do (gather paperwork, contact insurance company, etc...)before my first appointment with the surgeon so that I can move the process along quicker? I do know that the lap band is available under my insurance b/c I called with the CPT code.

I have WONDERFUL news for all of the United Healthcare patients out there! **Dr. Felix Spiegel has come back into network with UHC!!** Tell all banded patients & future patients wanting to have the Lap- Band that they can come see the top LapBand surgeon in the country and receive their surgery with eminent results. YEAH!!!

Check out what I wrote here; http://www.lapbandtalk.com/showthread.php?t=20319 If you have Medicare and are looking for surgery or fills, you have to have it done at a rare "Center of Excellence" or they won't pay for it.

I have BCBS of Texas and I was told that morbid obesity is a exclusion in my policy. My question is: Is there a way around tis exclusion? I have tons on medical conditions.

I CAN NOT BELIEVE IT! I HAVE CALLED MY BENEFITS UHC LINE AT LEAST SIX TIMES DURING THE PROGRESSION OF GETTING MY BAND. THEY HAVE PULLED UP MY INFO 500 X AND NOT ONCE DID THEY MENTION "OH YEAH YOUR EMPLOYER EXCLUDES THE LAP BAND!" NOT ONCE! I am so frustrated. My employer does however cover the gastric bypass. I DO NOT WANT MY ORGANS REROUTED, AT LEAST NOT RIGHT NOW, I WANTED TO TRY THE BAND FIRST. I have spent many an hour since the investigating of this procedure reading up on everyone's highs and lows, what to expect, I've been to the seminar and to my first doctor appointment. I am so let down. I just really don't see myself going through the gb. SO DISAPPO…

I have found that writing an appeal letter to very difficult. I kept forgetting things and had to go back and add to it. I also didn’t know what all needed to be put in it. Hopefully this will help others when they are faced with a denial. Maybe you "pros" can help "tweek" us first timers. Please indicated what insurance you have/had, and what, if any, where the results you received after sending your appeal.:help: I have BCBS of NE and I and just trying to get all my information together right now before I send in my letter. Any input would be most helpful. __________________________________________________________ Name Street Address City, State, Zip …

Ok I have a delema. My Dr., who is IN network has told me he charges a 500.00 participation fee that can NOT be billed to ins. So I called the ins. company to see if it can be counted as my deductable, They said no because he is under contract with them and he should not be billing a pacient any more than the copay they agreed on. Then my ins. company said he could lose his contract with UHC if he is reported. So my delema is, This Dr. is known for his experence (over 3000 lab bands done) and for his crappy bed side mannor. I am afraid if I question his policy and ruffle feathers then he won't do my surgery. (lord knows he has plenty of other people who want him) So shoul…

HI everyone I was curious if your chances of getting the lap band through Tricare were better if you had standard. I know that with standard there is a co pay, but I would much rather co pay than pay out of pocket completely and start my new life. If anyone has any information or knowledge in this area, I would greatly appreciate it! :help:

I saw a sample letter that my primary care Doc. would write but can't remember where it was. Anyone else seen this????

Would like to know the following things from TX teachers stuck with the TRS Activecare from BC/BS: 1. How long did it take to get approval? If not approved how long have you been working to get approved? 2. Did they require a psyche eval? Nutritionist consult? sleep Study? 3. How many months supervised weight loss did you have before approval? 4. Did you have to call them constantly? 5. Were you denied the first time? Did you have to appeal? 6. Any recommendations for people trying to get approved? 7. What plan are you on (1, 2, or 3) and what was your total out of pocket? Thank you for your input! This will help greatly! Know there are a lot of teachers out the…

Ok, my ins requires a psych eval....What kinda questions are we looking at here?:help:

:help: This is the insurance I have. Anyone else have this insurance? If so, what has been your expieriences with this insurance and WLS. :help:

My husband's company changed insurance companies (again!!) in February...the new company will not cover my fills. How should I go about trying to get them to cover the fills...any strageries that might work???

I have been obese most of my life, I have a BMI of 40 and after a year of researching I have decided to have the LAP Band. I already have attended my seminars, nutrionist, nurse practioner, psyc doc and I have been seeing my doctor for about a year. Unfortunately, I have only seen her every 3 months, now they tell me the Insurance Company may require I see her every month for 6 months. Someone please give me advice about how I can get a round this.:think I am so disappointed to have to wait another 6 months and still not know for sure if they will cover me. Please advise.

Hi All, This is my first post. I received a very quick approval for Lapband last week. The doctor's office submitted request on Monday and by Wednesday it was approved. I have a surgery date of May 31st. Ready for this journey Chrisgtl

:help: Hi everybody- I'm a newbie here. I called my insurance (Blue Shield EPO) before setting up consult visit with the surgeon.....was told by BS that the Lap Band was a covered procedure. So.......after the consult visit, the office person who obtains insurance authorization said she had never seen Blue Shield EPO cover the lap band procedure. I called BS again and was told this time that they did not cover this procedure. Anybody out there ever have success with an appeal with Blue Shield EPO? Or, better yet, have the procedure approved the first time? Thanks in advance!:help: Yvonne2

http://www.time.com/time/magazine/article/0,9171,1196429-1,00.html Of course this is nothing new to this board, as many have already learned. BTW-- I received my hospital bill today for 26K-had to spend the night.

does anybody have this insurance? i was told i had to have a psych exam, and chest xray, blood work ekg 6 months of supervised diet which i finished all this then insteaad of sending me a letter of denial or acceptance, they send out a letter saying they need more info such as a dietition, urine test to test for drugs and a blood test to check for stomach ulcers. now im tryin to figure out if they are considering it since they want these extra tests or they just messing me around. im really confused.

I am researching the LapBand surgery and I just discovered that my insurance benefits handbook says bariatric surgery IS covered. I am blessed to have coverage under CHAMPVA (because my husband is a totally disabled veteran.) Is having bariatric surgery listed as a covered benefit usually a good sign of early or quick approval? Or do the insurance companies still make the insured jump through hoops? Does anyone else have any experience with CHAMPVA. (This is not TRICARE or CHAMPUS.) Also, can someone tell me the insurance code for the LapBand surgery? Thanks for helping a newbie.

Has anyone had experience with GEHA since Jan 1, 2006. I have a BMI of over 60 and am waiting for approval from them. I have been on a low gkycemic index for several years and hope this will suffice for a 6 month diet program. I have been very succesful in getting type II diabetes under control but have had only minimal succes taking off weight.

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Does anyone have any firsthand experience with GHI/HMO as their insurance carrier? I am in the begining stages of trying to be approved for the lap-band procedure and am very curious what pitfalls await and what I can expect. Thanks.

I have a pre-surgical BMI of 33; recently diagnosed with severe sleep apnea, have high cholesterol and have a significant family history for coronary artery disease, diabetes, and cancer ; will be banded in Mexico on 5/24 by Ortiz. I have Oxford Freedom and read the preconditions which included a BMI of 35 and just 'folded my hand' without even trying to get covered. I decided to do it in ASAP since it fit into my schedule. Tell me that down the road I won't have to kick myself in my soon -to-be skinny butt.

I haven't been posting as much as I used to, because I have made it my full time job to get approval from my insurance company. As my ticker indicates, I've been fighting for a long time. They have consistently given me false hope. (Well, if you send this in then... O.K. now send this in then) Time after time, I met their requests. When they didn't have anything else to complain about, they gave the typical parent response, "no, because I said so." No rhyme, no reason. My doc has appealed to the insurance company twice. I filed a grievance...denied again. I filed an appeal with the Plan Administrator, which is the human resource lady at my husband's job. All…

Hello all. Im posting this just to give EVERYONE some hope.Today I just found out I was APPROVED for surgury!Im a 37 year old male 5'9".I weigh 291lbs. NO health complacations from being over weight YET.Anyway...I did the medical report with my Primary Dr. whos report said I would benifit from weight loss surgury. I did an EKG. I did the physcoligist report who also said It would be benificial to me.The Dr.'s sectetary turned it in on tuesday afternoon......Thursday (this morning) I was told I got approved for Surgury.(NOTE: I decided & got approved for RNY Gastric bypass surgury)My Dr. is in network & charges $37,000 for this operation & ALL I HAVE TO PAY IS …

I am hoping to get the lapband in the next couple months. I'm going to pay for it myself. I have BC/BS of Illinois PPO. It will cover lapband if I've been enrolled for at least a year and have 2 comorbidities. I've only been with BC/BS since Jan, and have no comorbids, so I won't get the surgery covered. But I'm wondering if they will pay for the fills after I have the surgery. Has anyone had insurance cover fills after they paid out of pocket for the surgery? Is that even possible??? :help:

when I had my surgery I had UHC PPO I had no issues getting the surgery done. Jan 1 06 our work changed ins providers and we picked aetna. At first I was told no coverage for my follow ups. Now after reading the other post about Artna now covering Banding wls, I called this AM and found out that Ive already met my 200.00 yr dect. and Aetna will cover 80% of my fill visits! woot! Now my Dr is out of network so I have to call my works HR and get a transition of care form and get Dr to fill out this will make me receive in network medical benifits from my dr. ( 80% of my bills paid) So Im doing that now! So instead of 175.00 a visit it will be 20% of 175! THANK GOODNESS! …

Well I was excited when I read that my insurance covers lap band surgery. I went to the seminar and decided it was the thing for me. But when I called for my appointment they told me that I'd have little chance of getting insurance coverage unless I had 2+ severe co-morbidities. My grandmothers both died of obesity related illnesses but so far I only have high cholesterol and joint pain. Has anyone had success getting their surgery covered with a 35 BMI? Or should I just give up and go pay for it myself in Mexico? Thanks! Britt

Unicare requires a psych evaluation to which I must pay a $30 co-pay. Should this be done during the initial approval period to the insurance company or should I wait to hear that the insurance company approves the procedure pending the psych eval?

Just wondering if anyone has been approved recently. I was told by my surgeon's office that Medicare is now on board and covering lap-band, so Tricare will also. I will find out soon since all my stuff was sent in last week.

Has anybody on this form got approved with OXFORD Liberity insurrance QUICKLEY? My main question is, if anyone knows if OXFORD requires you to see a nutritionist for 6 months before considering/approving you for surgury? SOME insurances Companies require this......does anyone know if OXFORD is one of them that require this? Thank-you!

I am going to start an appeal asap. I Prepaid My Dr knowing that I had a preapproval letter in my hand. Then after the surgery the insurance company denied my Dr and Anesthesiologist claiming they never got the bill, 4 times!!! we have records of electronic filing also. Then after much phone work by me, my Dr insurance person and My human resource people they agreed they needed to pay. Then guess what, Because my Dr is not part of plan, my coverage drops from 100% to 80% coverage. Not to bad right. The customary charge that they allow for lap band surgery is only a little less than $2000.. I get 80% of $2000. Get real, who can schedule surgery for less than that? I cant b…

I just went to see a surgeon for the lap-band on Monday. He was going to send everything in for me on Wends. How long does it take for Carefirst in Virginia to give apprvl, if any of you have had to deal with them? Thanks, JoAnne

Well this is my first post . . . . I do want to Thank all of you for your daily entries. I have devoured this website since I made the commitment to go with a lap-band. I have UHC. My first try at approval was returned denied because my BMI was only 37.6 with several co~morbidities. (Hypertension, PCOS, Infertility, High Trigl., elevated sugar levels and of course zzzzzzzzz snoring:notagree .) I was not going to give up I called the health care line at UHC and their reply was that I needed to gain 18 pounds so my BMI would be 40. My GP physician was infuriated. He has know me for 18 years and since he knew me best he fired off a letter to UHC. (Don't forget your subscribe…

Has anyone been able to use a TIG plan to cover the lap ban

My dh is switching (possibly) jobs and the new co is cb&i in houston. just wanted to know if anyone is or has worked for this company and if their carier covers wls???:help: xelapaul

I have researched the lap-band topic for a year and recently went to a free seminar. I want to move forward, but obesity surgery is excluded on my United Healthcare policy. Is there any hope? Can something be done and where do I start?

We might be getting a new insurance from my husbands job. It is Signa. Has anyone out there had any experiences with this insurance carier??? Any info. would be greatly appreciated:) Xelapaul

What do you do if gp will not provide letter of recommendation for lap band surgery? Even though I am 100 pounds overweight, BMI 35, borderline diabetic, degenerative lumbar discs disease, foot problems, arthritis in my back and hips, high cholesterol, my general practitioner (primary care provider) is not in favor of this kind of surgery. Insurance will wonder why the gp's letter of recommendation is missing. My orthopedic doctor supports my decision and will offer a recommendation. Any thoughts on the subject? :grouphug:

I called my insurance provider today BC/BS of Oregan and they said WLS is an exclusion to the plan. Of course! However, my question is this... Many people that work from home or have small business often purchase their own insurance plans. Has anyone researched this method? Even with the hefty premiums, it's not as bad as a $20k surgury! Thanks

I have a Maximum out of pocket of 1,000.00 not including the deductible. Does that mean if I where to get the band the most I would have to pay was 1,000.00 + deductible??

Anyone with PHCS-PPO been approved for the lap band? thanks for all the help! :grouphug:

Has anyone heard of United American Insurance Health Insurance or used them? Their web address is www.unitedamerican.com They are half the price of what we are paying for a BCBS of FL policy. We have been in contact with them because I was calling around about insurers for our business. They said this pertaining to Lap Band Surgery: I know our insurance covers different treatments… Like for instance, it covers chiropractor, herbal healing, and different things like that. I also know it doesn’t cover cosmetic surgery.. But weight loss yes, as long as it is a surgery and done by a surgeon. You would have a $500 deductible and then it would cover it at 80%…

Hi, I am a self pay but I am wondering if any of this surgery is tax deductible. Does anyone know. Thanks

I had a question for those who are in their twenties - Was it hard to get approval because of your young age? :confused::confused::confused: If so - Did you have comorbidities? What insurance company did you go with, and was the process rocky or smooth sailing? :clap2:

Has anyone on this board used Gary Viscio, he's an attorney who specializes in getting insurance companies to approve weight loss surgeries. He came highly reccomended by the folks at Obesity Help and I thought it would be a good idea to get some legal help on this. So far all he's done is take my money and give me the run around. My insurance co denied my coverage for the surgery three months ago and Gary hasn't done a thing about it. I feel I've been conned out of over $700.00. I'm just going to try the appeal myself. Has anyone had experience (good or bad) with him? Suz

I have united healthcare and was notified today by my Dr's ofc and thru the insurance company that I have 80-20. Which they explained to me that I am responsible for 20% of eligible expenses? I can't seem to find out what my eligible expenses are. Are we talking 1000$, 5000$? Has anyone else encountered this? I just want to make sure I have my ducks in a row. Quack Quack:help: