Insurance & Financing

Finally, I get to post some good news. :dance: The battle is over and I won!! :clap2: I have rec'vd verbal confirmation of my approval!!! I am shaking, crying, and overwhelmed!!:faint:It feels like the dream I had the other night.:notagree This is REALLY going to happen for me. I just got the word 20 min ago and had to make some calls, then couldn't wait to get on here to tell all of you!! :love: Thank you again for all the support!! I am convinced the knowledge I learned here played a big role in getting approval. I felt armed and ready for anything they threw my way. I was even ready to type up a letter of appeal. Praise the Lord for He is good and always know…

I have only recently purchased Sun Life insurance from the company I work for. I have purchased the comprehensive dental,vison, and medical. I do not know how to go about the process of applying for the lap band with Sun Life. Do I get my doctor to write a letter or do I request it from them..... I am new to the whole health insurance thing and I just need some advise to know what I need to do to apply. BTW this is my first post. My name is Mary and im from nova scotia Canada. I have been seriously looking into the lap band for the last 6 months. I know that the only way that I could afford it was if my insurance can pay a presentage of it. So anything you could tell …

Got denied by UHC six months ago. In that time I managed to lose about 15 pounds putting me in an even lower BMI category. I think I'm 34 down from 36 or 37. If I can prove 2 comorbidites. i might have a chance. So I made an appointment for sleep apnea and one to my primary physician for lab work to see if I have high choloesterol or hyperglycemia. I'm just hoping that this isnt one huge disappointing waste of time. But you never know til you try, right?

This is crazy! I recently left my job to start my own business and have been shopping for individual policies because Cobra is so expensive. United Healthcare denied me coverage because of "gastric banding surgery in past five years." Here's where it gets really funny: I had the band removed in March -- which was also disclosed on the application. If you've read any of the threads from the newly de-banded, you know that we go back to "normal" pretty quickly -- as if we never had the surgery! Oh well, just one more reason to hate insurance companies!

:clap2: I just found out today that I got approved. I feel so excited, I can't wait. Now I'm just excited in getting a surgery date. I've been reading some of these stories about bad gas pains. Is there anything you can take before surgery to prevent so much pain ?? I'm just so excited, I still can't believe it !!! :clap2: :roll: :roll:

Well hello everyone, a little about myself... I am a 24 yr old male, I currently weigh approx. 450 lbs, have asthma, and now have possible DVT in my right leg.. Anyways, for 3 yrs now I have longed for nothing but to get the lapband surgery from Dr.Speigel's I have tried every diet, and they do not work.. Well I got my new insurance and cards and Dr. F. Speigel was in the book, I was soooooo excited.. Well needless to say it was all shot to hell, I read the coverage, and it doesnt cover lapband at all, What do I do now... Does anyone know how much this surgery cost out of pocket, how else can I pay for this, I have to have it, please help me with any answers!!! THANK…

O.K. I really need to get this off my chest b/c I haven't been able to sleep and I'm trying to stay positive. I finally finished the requested (by insurance per psy eval) 3 support groups and faxed them to NGS American. When I called to verify the PreD dept got it, Patty (PreD dept taking care of my file) informed me that my Psy Eval and Nutritional Eval were incomplete and I needed medical records showing compliance. Knowing my insurance had sent these, I asked her to help me understand EXACTLY what she meant so I can address this with my surgeon. Here is what I was told: ~ Both evaluations were incomplete and were not favorable b/c they did not state whether I would…

Hello all you out there in band land future and present bandsters. I need some advice I feel lost and hopeless , I guess hurt more than anything because I had my heart set on getting banded. I just called my insurance company after attending a seminar and found out that my policy excludes all obesity related surgeries and treatments. Talk about feeling like I had been slapped in the face, I felt the sting before I hung up the phone. I was crushed, I was suprised because most BCBS of Texas policies cover the lap band procedure. They informed me thay my husbands employer choose not to cover anything obesity related. I feel that this is really dumb considering what they wil…

Joy had her surgery back in December. BCBS of Texas sent a letter saying that she was eligible for benefits. Doctor sent us to a medical facility who accepts BCBS. When the bills were all sent out, totalling $42,000, BCBS paid a whopping total of $1629....that includes what they paid the doctor. We appealed the payment to the hospital and they are standing by their original determination. What the heck? They say we're covered then pay PENNIES on the dollar? Is there a secret list of payments out there somewhere that I'm not aware of? Am I going to be stuck with paying off the other thousands of dollars, now? They only allowed $273.99 for the operating room. Where in the s…

Hi Has anyone found insurance cover for lap band and fills in the uk?:help:

Heya Everyone !!! I'm new to the board just curious to see if anyone knows about Horizon Healthcare... I got a date and very nervous about insurance coverage ... Good luck everyone !!!

This process is so frustrating and emotional but I'm not giving up. I have Cigna Insurance -- the lapband is covered in my policy and I meet all of their criteria but am still denied. The first denial was because my surgeons office didn't submit all of my doctors files - yup! I was denied for stupidity :-) The 2nd time we submitted the info I was right there at the fax machine so I knew that everything was submitted. But when I called Cigna this morning I was told my appeal has been upheld. They couldn't tell me why and will have to wait for the letter from the National Appeals Unit in California. I've been working on this for a year now - since March 05 (Surgeon Se…

Hello All I have PHCS Benefit planners has anyone have any experience with them?? Thanks for any responces

Has anyone had Blue Cross/Blue Shield of North Carolina approve their claim? Gastric Bypass is covered and when I called insurance co I was told it may be covered, but Weight Loss Surgeon says they do not pay for lap band. Surgery is scheduled for April 21st and I will be self pay but hoping for a last minute coverage miracle...lol.

Just a quick question - has your insurance told you how many fills they would cover before they wouldn't cover them anymore? I know there is no CPT code for it...so I am wondering how they would know how many you are having? Thanks for any input!!!

I really want to have the lapband done. I'm not sure how i even go about trying to start this? Does my doctor have to submit the request to the insurance?

:help:ANYONE OUT THERE HAS AETNA MANAGED CHOICE....I HAVE NOT YET APPLIED. JUST WANTED TO KNOW IF ANYONE ELSE HAD TO DEAL WITH AETNA AND IF THEY GAVE PROBLEMS.

Got a fun phone call yesterday... About a month and a half after I received a letter and phone call informing me that my surgery was approved and that I just had to wait for the specific doctor to be approved, I received yesterday's call telling me they made a mistake. Federal BC/BS won't cover lap band but they'll cover the regular gastric bypass surgery. DH asked what would have happened if I'd already had the surgery...and the rep said we would have had a big problem. (sigh) Supposedly, I can write a letter of protest. Think there's any hope?

hello to anyone reading this. I am seriously considering the lap band procedure. i've attended 2 seminars on the subject and have a consult with a dr in April. according to my insurance's website, the coverage depends on the individual group, the company i work for has a history of fighting this type of coverage. for those of you who have had to pay out of pocket, what is a rough estimate of the cost? and how easy is it to get a loan for, or finance the procedure? is there anyway to push the insurance company,,,,,,,,,,*reeking of desperation* thanks

Well, I just sent out my appeal package to John Deere Health. Long story short, they have an exclusion in my policy stating that WLS for obesity isn't covered. I know that I will probably end up paying out of pocket, even my surgeons office told me it would be a waste of time(the appeal). But, I HAD TO TRY! You know? I'm not handing over $18,000 without kicking and screaming first. I just wouldn't have been able to sleep with myself if I hadn't at least tried. John Deere will be getting some interesting reading, thats for sure. The letter that I sent is 3 pages and the package with documentation is about 1 inch thick. They probably will uphold their denial, but at least t…

I've been approved and has a date of 3/23 was just curious if the insurance also covers after care ??

Upon hearing the news of my approval, my sweet hubby raised a question I thought I would ask here. If I were to change jobs and therefore change insurance companies would aftercare be covered or a pre-existing condition? I am so excited and never really thought about this. Anyone know?

I am sure this question has come up but does anyone know if Tricare covers the lapband??? Thanks. I am self pay but my office manage has Tricare and wants to get it done.

Have been calling my insurance company all week, as they have been telling me that my file is in "medical review". I finally asked today what that means. The lady said that once it gets thru the first person it goes to a nurse, once it gets past the nurse it goes to a doctor. The doctor then puts the final yes or no on it. It has reached the doctor at this point. My sweet hubby says that it sounds like it has rec'd two yeses at this point and waiting for the final ok from the doctor. My hopes are WAY up. I hope they don't burst my bubble... what do you think?

I got a message this AM from my surgeon's office that ins needs more info, which they have available to send ASAP. Ins is also requesting I attend the 3 support groups requested by the psychologist. I thought those could have been pre & post band, but now ins is going along with what he dr says and they must be pre band. :mmph: They have to be groups offered by St Vincent's. The closest one is the 3rd Tues of every month so I'm going tonight. Since I am not going to wait 3 mos to get a surgery date, I am going to travel to Indy, South Bend or Kokomo to attend other groups. At first, I was really ticked, but realized hey, they are going to approve me if I do this. :…

For those Houston-area LapBand patients who might not have heard (on the phone or on other online forums), local LapBand (and bariatric) surgeon Dr Hadar Spivak is no longer accepting United Health Care (or UHC) insurance. This might be of interest to other patients of his who travelled from out of the Houston area to have surgery with him. Also, if other surgeons follow his lead, this could change how many patients are approved for Lap Band surgery with insurance. This is a big revelation, as UHC is known as being one of the most LapBand-friendly insurance companies (for those members whose employers did not specifically choose to exclude bariatric surgery coverage)…

Just wanted to drop a line as a newbie :confused: I seem to be stuck in weight loss limbo and could really use some advice. My insurance will not cover Lap Band surgery stating that it is experimental. However, they do cover gastric bypass. Fortunately, the surgeon I have been seeing believes that I am an good canidate for either surgery. That doesn't really make me feel better, though. I want to make a well informed choice about which surgery to choose. Frankly, I don't want to feel forced into a surgery that is more invasive and therefore more dangerous when Lap Band can be another option. I have spoken to a rep form my insurance on several occasions and have …

:hurt My insurance rec'vd my L of PreD on 2/14/06. They told me 7-14 days for a decision. Last week I called, as I have every week since then, and apparently they have been short-handed and should have a decision this week. Today the lady from the PreD called me after I had LMOR (left message on recorder) for her. She told me to call back on Friday and they should have a decision b/c they are now making progress. I thanked her and told her I didn't want to be a pest, but I was anxious. She kindly said I wasn't coming across as such and just call on Fri. This is DRIVING me CRAZY! I understand being short-handed and even have a bit of sympathy for them. Some of y…

I have BCBS IL PPO through my husband's union. When I called the union benefits office - they gave me an unequivical "NO" when asked if weight loss surgery would be covered. When I asked if it was specifically excluded - it is not. When I pushed as to why it wouldn't be covered, they himmmed and hawwwed and asked if they could call me back - I'm still waiting. I then spoke to Bariatric treatment center who told me that they were in fact contracted w/ bcbsil and that they would cover it if I have 12 months of medically supervised weight loss. What a joke. Cover it or don't cover it - but you're going to make me see a doctor once a month for a year before you pay f…

I was reading and I heard from a members post that their insurance company sends their file through three different opinions before approval or denial, a regular guy, a nurse, and then a doctor for the final ok? I dont know what my problem but I kind of personify the insurance company. How much money do these companies have? I know that because I have a chronic illness I have gotten MORE than my fair share in what Ive sucked out of them, than what Ive paid. So when they get the files is it a panel of people with business suits on pondering and looking through it and prejudging you, or is it just a few coworkers checking off a criteria list? I know the local headqua…

Well, after waiting almost 4 weeks for my surgeon to submit my info to my Insurance, I called Tuesday to see if they had received it, they said "Yes, it was Denied". I said "When did you receive it?", "Today" was the response. Geez they didn't waste any time did they? I knew it would probably get denied because they have an exclusion in my policy that states " Surgical treatment and associated care for treatment of obesity" is excluded. I'm hoping that I can get arround this exclusion due to the fact that my diagnosis is NOT Obesity (Dignosis Code 278.0), but Super Morbid Obesity (278.1). Anyone else have this issue? Is it worth the fight? I immediately filed an appeal an…

Holy crap! My processed claim for my surgery just posted to my online insurance account. Check this out: So am I reading this right? If I had been self-pay, I would have been charged about $30,000. But my insurance company has such a significant discount that they only pay $1674?

It is open Enrollment here at work and I am thinKing of changing carrieres just because of the out of pocket cost. Does anyone have any info they can share regarding the carrier above?? The plan allots you 1500.00 up front for a family and you have no co pays at the Dr's office. All prescription cost as well as the dr visit comes out of the alloted money.. Cost wise it would save me but I do not want to change and regret it... The only downer right now is neither my band doc or my childs Dr's is in the net work so a little more would come out of my account.

Hi, here is the letter my PCP sent to Cigna. Do you think it is compelling/informational/persuasive enough to get the sugery covered? Is this close to what your letter looked like? I am writing this letter of medical necessity on behalf of my patient, xxxxx. I am requesting insurance coverage for a laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band (gastric band and subcutaneous port components) and the CPT code is 43770. She has tried numerous diets and weight loss programs for the last 15 years. She is successful for a few months but her weight loss was 5% or less and short-lived. She has gained the weight back and more time an…

i have rheumatoid arthritis (rheumatism) as a comorbidity -- do you think my insurance company would put me on a six month medically supervised diet if I cannot do anything but swim? :confused: (i have medical mutual super med plus). my weight history has been crazy from 180 to 250 (228,198,188,181, <diagnosed with rheumatism>242,248 approx) in five years (I had lost a lot of weight through strenous exercise about a year and a half ago). (I am 245 now BMI 38-40)

:confused: I was wondering if anybody has/had medicaid in Michigan for the lap-band. What kind of problems (games) and headaches they put you through? I actually have what they call a spend down account which is like a co-pay every months that I use the insurance, but ANY info I can get on the medicaid will help. Thanks in advance, Joh

Just when I think all I have to do is wait--wait for the hopeful "Yes, we approve you!", they ask for more information. My surgeon's secretary sent in all the needed info. :psych. eval., letter from doc. (that included all the info. that the insurance company wanted), etc., but after calling them (BCBS of TN) Friday, they said that they needed documentation that I had been on a weight loss program, monitored by my doctor for six months. The letter from my doctor said all of this--I guess they needed his clinical notes. I saw my doctor in August 2005--he put me on phentermine. I saw him again in Sept., October, missed November, and then saw him in December--so about fiv…

:welcomeB: :eek: :welcome: DALLAS,TX 28, 5'2, 250lbs tried all diets since age 15 been this overweight since I had my son at age 17 I am looking for a job and prefer the job to have insurance that covers lap band surgery,just in case. :help: IF YOU HAD THE SURGERY AND YOUR INSURANCE COVERED IT, Please let me know YOUR JOB'S company name.:help: I have done different types of office work,customer rep., a/r and have done some light industrial work. I have been offered some jobs, but insurance does not cover lap band surgery. About how much was your out of pocket cost? My mother was overweight like me,she had …

I have Medicare and am having trouble getting reimbursed for the psych and nutrionist. They gave me some forms and told me to send it in, but Medicare is not accepting it like that. They say the office has to send in the form.I don't know what to do. Anyone been through this? I'd like that money back, it was quite a bit when your not employed.

Well, blue cross, blue shield of Tennessee has denied me. Now, I have to start the appeal process. So, I may not be on here for a while, because this appeal will become my full time job. The nerve of them!!

I am currently going through my pre-op testing, in fact Wed. is my last test, which is very exciting. Just curious if anyone out there has any experince with Harvard Pilgrim HMO, and if so, how long they took to approve you. Thanks!

About 6 months ago I STARTED THIS PROCCESS AND HAD THE HOSPITAL CALL AND VERIFY WHAT WE NEEDED FOR A PRE-DETERMINATION,AND THEY SAID ALL THEY NEED IS A DOCTORS LETTER. SO I GAVE THEM THREE LETTERS,AND WAITED THE 30 DAYS THEY SAID THEY HAVE FOR MAKING THIS DECISION, SO OF COURSE YES I CALLED THEM A FEW TIMES TO SEE HOW THEY WERE COMING, AND YOU KNOW THEY SAID ,YOU KNOW WE HAVE 30 DAYS.THEY WAITED UNTIL THE 29 DAY BEFORE TELLING ME THEY NEEDED A SYC EVALUATIN,MORE DOCTORS LETTERS 6 MO MEDICALLY SUPERVISED DIET AND A FEW OTHER THINGS.DO YOU THINK THEY WERE STALLING FOR TIME ANYWAY I HAVE GOTTEN EVERYTHING DONE BUT THE DIET, MY HOSPITAL IS GOING TO RESUBMIT AND SEE WHAT HAPPE…

Hi everybody???I haven't posted in a while but have a question now. I was scheduled for consult w/Dr. Spivak(Houston), it's a 14 hr drive for me, so I called the day before to ask if they saw anything in my paper work that might be a problem for denial w/ins..(UHC-100% w/pre-d approval). My BMI is acceptable(low end). I am on bp med, borderline diabetes, GERD med, cholesterol med, tx for anx/depression...pcp documented joint/muscle aches and pains, slight swelling in one leg. (I feel like a basket case) I was told that I needed 2 co-morbidities for which I was taking meds. That to be on diabetic med, along with bp med would get the approval. Since it's such a long driv…

I'm not exactly sure when all of my paperwork was submitted, but I think it was about 2 weeks ago. I'm going to call my dr.'s office tomorrow and find out for sure, but I'm curious as to who I might call at the insurance company so that I can be the squeaky wheel. Lucky me, I've got BCBS of TX. It's not like they didn't ask for my entire life history anyway, now I have to wait for them to decide if I'm worthy of something that will help everybody in the end. Just wondered if anybody had any ideas???? Audra

I have been putting together all my info needed for insurance and have been keeping in contact with my insurance coordinator at my surgeon's office. I thought she was holding off on my letter of predetermination until all paperwork was turned in. Now, I rec'vd an e-mail from her saying that the L of PreD was sent on the 2/8 and my personal letter, psy eval, and dr records were being sent today 2/20. :angry This makes me nervous b/c I don't trust that these documents will get to the proper place TOGETHER. What do you all think? Has anyone had this happen b4? Should I start calling NGS to let them know more info is on the way? I hope they won't just shoot back a "NO" b/c…

I met with Dr. Spivak in Houston on Feb. 4.....my insurance approved me on Feb. 14th. It was almost too easy. I was told however that my insurance is one of the easiest to work with. I am very excited about my upcoming surgery which is scheduled on Feb. 27th. If you have this insurance..and you qualify...you will get approved. I feel very lucky after reading the problems others have had. Dr. Spivak is not in my network however, so he does cost more then a network doctor would...but I really think he is worth it!! Dena:clap2: :clap2: :clap2: :clap2: :clap2:

Medicare Backs Obesity Surgery U.S. to Pay for Three Types of Stomach-Shrinking Operations By Rob Stein Washington Post Staff Writer Wednesday, February 22, 2006; A08 Medicare endorsed three types of stomach-shrinking surgery yesterday, saying the controversial procedures can offer Americans safe and effective ways to treat obesity. The announcement was seen as a boost for the popular operations, known as bariatric surgery, which had come under a cloud in recent years because of concerns about their safety. "In the right hands, bariatric surgery can benefit patients," said Steve Phurrough of the Centers for Medicare and Medicaid Services, which sets policy for the…

This article can be found here: http://www.msnbc.msn.com/id/11488309/ WASHINGTON - Obese elderly or disabled patients are now eligible for a variety of surgical weight-loss procedures under the U.S. Medicare health insurance plan, U.S. government officials said on Tuesday. Patients must have tried but failed with other weight loss options, have at least one weight-related medical problem and have a high body mass index, the Centers for Medicare and Medicaid Services said. Previously, Medicare patients could only receive gastric bypass surgery, in which the lower part of the stomach is either closed off or removed and its contents detoured around the large intestine d…

I AM CONSIDERING lAPbAND AND MY INSURANCE TOLD THE PROGRAM RN THAT I NEED 12 MONTHS OF DOCUMENTATION. MY PHYSICIANWROTE A LETTER BUT THEY SAID THEY NEED TO SEE THE DOCUMENTION AND SHE IS A PSYCH. MD AND THEY DO NOT RELEASE RECORDS. CAN ANYONE HEPL ME WITH THIS. tHANKS.:cry

I was wondering if anyone else here has Medicare and any suggestions on how we can make sure they pay for it and not give us a hard time?