Insurance & Financing

So I got my second denial last week because 1. They need proof my obesity is not endocrine related, easy enough. I just had normal thyroid levels drawn last month. My swallow test showed mild gerd and they want that treated. Also easy, my pcp called in a script. My first denial was because I hadn't participated in the 6 month weight loss program and had not done upper gi testing. My insurance coordinator calls me today and says I need to re do the 6 month program because in the 3rd month I gained 2 lbs. overall I lost 14 lbs from initial weigh in to my 6th appointment. Anyone else have this happen to them?!?!

Anyone with experience with United Healthcare in Florida I was denied the Lap-Band removal because they believed I had no medical reason for removal. My doctor will now try to submit both surgeries, lap band removal and gastric sleeve together. Has anyone gotten approval?

I have just started my journey. My insurance just denied all my initial blood work and my endoscopy! Does anyone have experience with bcbs Tx that is familiar with the appeal process? Any suggestions as I try to get approval?

I noticed something in my approval ether today. I had surgery on Monday and stayed two nights in the hospital due to nausea. I noticed today the paperwork only preautherized me for a one night stay. Am I going to get a huge bill for the one night? Or do they usually allow the extra night? I'm so worried. I already have to pay my max out of pocket of $3500 which is a hardship for me because I still owe money from the preop stuff since it was done before January. Very worried right now

Hi - I am Canadian and had a gastric sleeve done in March 2016 in Mexico. Has any Canadian here claimed their surgery as a medical expense?

Hello family about to have my paperwork submitted to my insurance - anyone has Tricare prime? What was the turn around time.

My surgeons office nurse is recommending a letter from my physician to submit to my insurance company since I haven't been on my blood pressure medicine long enough. I have to think my physician will do this because what doctor would prevent you from being a healthier you. But my fear is he will want me to try their weight loss program in their office. I did look into it last year but I knew right off it wouldn't work for me because it requires weekly visits and their office is in another town so distance and time was an issue. I don't see him until the 20th so in the meantime my mind is going in all sorts of directions. Patience has never been my strong suit when I …

I just wanted to write this to encourage those who are fighting with insurance for approval. I fought with BCBSIL since Dec 2016 til Feb 2017. I was denied 3 times for various reasons, mostly paperwork crap! Don't give up fighting you are worth it!!!!! Insurance companies look for reasons to say no... dont let them tell you know without giving them the fight of their life!! I felt I have been paying my premiums and co pays for almost 4 years and never had anything major.. soooo they needed to pay for this! LOL!

Hi all I recently decided to embark on the gastric sleeve surgery journey. I am registered to attend the information seminar next week and meet with the surgeon 2 days later. I have a few questions... A) Aetna states that I need to prove my bmi meets their requirements through "contemporaneous" records. Any idea exactly what they mean by that? I spoke with an aetna customer service rep but she didn't understand my question at all. I am teetering within a pound or two of a 40 bmi and am the heaviest I've ever been. So, my recent Dr visits show me with a 38 or 39 bmi. Any idea which weigh in counts as the first official weigh in? Will they weigh me at the seminar? Thanks…

Hey everyone.... I have tricare (through the army) and I know they will pay 100% for the surgery but my nurse is worried we won't have approval back by my scheduled surgery date of 2/28. I am considering paying cash. But roughly what does the sleeve cost out of pocket and would insurance refund me? I plan on making calls to both the dr and insurance tomorrow but this is driving me crazy. Surgery is supposed to be in 9 days. Sent from my iPhone using the BariatricPal App

Does anyone know if bariatric surgery done in Mexico qualifies as a health expense? In other words, can I legally pay for the surgery using my HSA funds?

Whew! I have fedbcbs of NJ and I can't believe it but I was approved in 2 days from submittal! I called today to check up on it, (because I'm very impatient) and I was told that I'm approved and I made sure to get the authorization number. I'm scheduled for sleeve on March 6. Thanks to my surgeon's very diligent staff for guiding me through the many hoops that federal insurance makes you jump through!

Initial appointment with surgeon was last august. I was told all insurance requirements at the first visit and completed all of them in a little over a month. They told me my insurance did not require the 6 month supervised diet and submitted my paperwork. It was denied because I did not have 6 months supervised diet and upper gi scope done. While they appealed it I just started the 6 months of visits and scheduled the upper gi series. My last appt with my pcp was the middle of feb and I was down 10 lbs from my initial appt. they submitted my paperwork again with both things they required in my initial denial and today I found out I was DENIED again. Because I am hypothy…

So I got all my medical stuff done. I only need a dietician approval & This is my 4 month weigh in ,have anybody got approved before the six month weigh in? I'm prediabetic and have high blood pressure. I talked to a lady who work with Bariatric patients she said my insurance is easy to work with. I've been trying to call her back but she doesn't answer and her mailbox is full. But she also said the more problems you have your more than likely to get approved for surgery. Btw I live in California & have locally own insurance but its still medical. Do y'all know anyone who got approved before the six month weigh in?

Hi all I have made the decision to now investigate going privately for a sleeve, I live in Wales (UK) and doctor is not at all supportive or interested in assisting my journey through the NHS so now looking into going private and would like some feedback from anyone that has followed this path, where they went, would they recommend and also the cost please? I was on the waiting list in england before moving to wales and even got as far as seeing the surgeon at coventry city hospital but then moved, in hindsight i shouldnt have updated my address so promptly, but there we are. So now back to square one again. All reviews, advice and info most gratefully rec…

I am 31 Cw: 220. I have Hypertension and severe Osteoarthritis. I am curious if those are 2 comorbities considered by insurance. I constantly have heartburn including in the middle of the night. I am being sent for sleep apnea this week. I have a consult with the weightloss surgeon on Thursday. So nervous I am going to get denied.

Anyone have this insurance? Please tell me it really is this easy. I got everything done already that's required on the list.

I'm honestly at a loss for words right now. I started a new job a few months back with the most amazing benefits only to find out that bariatric surgery isn't covered under their plan. What do I do?! I definitely don't have 23k to pay up front for the surgery. Has anybody else had a similar experience and managed to get the surgery anyway? Sent from my XT1575 using the BariatricPal App

My first weigh in I was 253.5 Second weigh in I was 252 Third weigh in is on Tuesday and I'm around 256-257 because it's my time of month Will insurance deny me because of this? I'm so nervous Sent from my iPhone using the BariatricPal App

Hey gals and guys, I'm patiently waiting for my surgeon's office to submit my paperwork to insurance for approval. Feb 28th will be exactly 180 days, or 6 months, of when I started my classes required by insurance. Anywho, I am wondering if anyone has Anthem BCBS of CA? How long did it take for you to be approved? Did you find out from the surgeon's office or did you find out from calling insurance's customer service early and often? :-) I'm super anxious, as I've got a lot happening within the next few months (being a bridesmaid, work travel, etc) and I'm going slightly crazy trying to plan out things in my head. Sent from my iPhone using the BariatricPal App

Hey everyone! I'm new here and just starting out on my journey. My question is - right now my BMI is 41. If I drop below 40 during this process (I don't have another qualifying condition) will insurance deny my surgery?

I have Blue Cross Blue Shield of Texas. I can't figure out where on their member plan website I should look to follow the status of my surgeon's submitting the request for my surgery. I logged in and see my insurance plan however don't know the section I should be watching. Can someone please help me? Thank you so much! Sent from my SM-N920T using the BariatricPal App

Hello all! My paperwork was submitted on Monday how long does it typically take for a approval? Sent from my iPhone using the BariatricPal App

Have you been denied by insurance? If so, what were their reasoning behind it? What was your insurance that denied you for surgery? Were you able to successfully appeal their denial?

Anyone ever have their stuff admitted before 6 months of nutrition classes?? Or is there a way around having to do the 6 nut visits?? Sent from my SM-G530T using the BariatricPal App

Anyone have this insurance? If so, I have completed the 6 month program as required, met with surgeon last week and had paperwork sent in after. Scheduled all pre-op tests for 30th with surgery scheduled for 2/9. Still haven't received ins. approval so called to check. They say don't have anything and it takes 60-90 days anyway to approve once they get it! Seriously! Is this correct? Surgeons office told me it's within 15 days. Which is correct? Sent from my iPad using the BariatricPal App

I currently have Insurance under my Husbands employer. Their plan EXCLUDES this type of surgery. Has anyone ran into the same problem? I am wondering if I can get my own individual policy and he can drop me off of his OR are there secondary policies that would help me cover this?

Does anyone know of any Secondary policies that cover Gastric in NC? Cigna? UHC? I currently have Blue Choice and it is excluded from the policy.

Does anyone know if there are any secondary policies that I could add for my family that would pay for Gastric Sleeve? My primary plan excludes this type of surgery.

I have Blue Choice Insurance and with this plan, WLS is "excluded" from the plan. Does anyone know any way around this or loop holes of the exclusion?

I posted a similar thread about 6 months ago when I started my six month process, but now that I'm at the end and waiting to hear from the Insurance company about approval, I thought I'd ask again because no one really knew then ... Has anyone had HIP Plus through MD Wise and gotten approved? What can you tell me about the process? I've done the six month diet, submitted my five year medical records showing my weights, and my food journal, and had lab work (TSH, HgbA1C, drug test).

So I got approved, but getting the run around now. Originally I was told my insurance would only cover $10,000 toward the surgeon who does my Gastric Sleeve surgery and I would have to pay the surgeon anything above $10,000, but hospital would be covered. Did all my testing had date set and Now they are saying the will only cover $10,000 total for the whole surgery and I have to pay everything over $10,000. Which the hospital is telling me it will be about $27,000. Any ideas if there is anyway to get my insurance to pay more than $10,000? I don't have an extra $20,000 laying around.

Hi everyone! I am in the beginning stages of the process towards the gastric sleeve surgery, and my seminar is on Thursday. I live in FL, but have BCBS NC through my husband's work. I just got off the phone with their customer service and am very confused, so I am hoping you all can help me! I have been doing reading online about their requirements for coverage, and I know that BCBS NC just changed their policy to reflect " documentation of 12 consecutive months of active engagement in weight related treatment, as described above. Judgement regarding the scope, depth, and adequacy of pre-surgical treatment during the 12 months prior to surgery is at the discretion o…

Had my final consult. Papers are submitted to insurance. Was told it would take 4 weeks or less to hear back. I have missouri medicaid and medicare. Hope I get approved. Sent from my LGLS992 using the BariatricPal App

Hey yall, I have BCBS AL, and am trying to obtain insurance approval. Here is my issue... All my life, well, adult life anyway, I have been measured at between 5'11" and 6' at the doctors' offices. I always said I was 5'11", because I didnt want to be a giant! Haha. Well, about 3.5 years ago I went through a hard time and started gaining weight RAPIDLY. I also had to relocate and change doctors. When filling out to paperwork I put 6' on all my paperwork for the new doctors, because I was embarrased of how much weight I had gained. It was 80+lbs in under a year. They didn't measure me. When I had my appointment with my surgeon, the triage lady measured me and put me down …

Hi! I'm basically​ new to this form. Would like to know if any one out there has United Health care Insurance. And how did that go for you. I'm in Wisconsin and just very curious. On how it looks. I'm having a RNY for health reasons. Sent from my LGLS990 using the BariatricPal App

Hello, I have Meritan insurance through my wife's employer. I believe they are owned by BCBS. We live in AZ. The weight loss center said we have to do a 6 month waiting period working with a dietician and regular weigh ins. I asked the lady in charge of the insurance and billing portion of the weight loss clinic if there is any way around that? She said that you can write a letter to the company but it is usually not successful. My thing is, I am in pretty bad shape as it is. My BMI is 56, I have HBP, sleep apnea, fatty liver disease, chronic fatigue, chronic joint pain. I would like to think they could make an exception. If not, I won't be getting surgery until…

OK so i was initially submitted to insurance for approval(revision from lapband to vsg) in Dec 2016. I was initially denied because they said I didnt have enough documentation stating it was medically necessary to remove my band nor that I had followed up with the post op diet recommendations after my lap band. I went to meet with my surgeon and he submitted more info per BSBS request. Well they denied it again, this time I was told they thought my band was removed in July 2016.. ummmm no this damn thing is still in me. Sooo they submitted again.. so where along the line a peer to peer happened(which no one even told me we were at that stage), apparently that was denie…

Does anyone have any experience with Humana? How long did it take for you to hear back on your claim submission with them? I have Humana in Louisiana, if that makes a difference.

I have BCBS of TX. My surgery is scheduled for Feb 8th. I have done everything possible since August. Tons and tons of medical records. Dr said it was approved then today they called said they didn't know why but I was denied and we have to cancel that I needed to contact the insurance company. They had the receptionist call me and she had nothing to say. No answers. I cried all afternoon. Was on the phone with insurance for 3 hours and he got annoyed and hung up! I kept asking to speak to a supervisor and that I needed a reason for denial and nothing but a dial tone. I am so so so so sad. Anyone have any words for me? Sent from my Z981 using the BariatricPal App

Paperwork submitted on Wednesday and I called ins this morning and it was pending! Something told me to call again after work at 4:45... They tell me it's APPROVED! I still don't believe it I'm going to call again on Monday !!! lol. They did give me an auth # so I guess it's legit! I tried calling the drs number but they were gone for the weekend!! Surgery is scheduled for March 3rd. I had that date since my first appt Dec 1st! I think I can be excited but I am still in shock! Sent from my iPhone using the BariatricPal App

Hi! I have omnia and wondering how the approval process was?? My drs office told me that they are easy and not to worry but of course, I do. They said omnia just wants to see nut and physic and they will write the letters showing that I did WW, gym , Atkins..... I still feel like I should provide that but they said they just need to write it on the paperwork I don't need to get the actually paperwork. They also said I don't need a letter of recommendation. I have a surgery date of March 3rd and they don't submit until two /three weeks before ( I hate that). Can you tell me if they required a lot of extra stuff, how long it took for approval etc??!! Thanks…

I am going to be enrolled in fep blue January 1. Did anyone have a problem with bcbs federal? I have a year of gym membership transactions, two years of weight history, 3 month supervised diet (currently going), year of food logs, psych evaluation next week, ekg, labs, ultrasound all scheduled. Should I include anything else? Am I missing anything? Sent from my iPhone using the BariatricPal App

I am new on here and I have recently decided to have sleeve surgery. I am covered through Local Government BCBS in AL. When I called they said I didn't have to be pre-approved but it had to be deemed a medical necessity. There would not be a wait time on their end. Has anyone been told this before? My next step is to go to the seminar (2/07) before I make an appointment with my surgeon. I figured I won't know for sure about the insurance until I see the surgeon. Sent from my SAMSUNG-SM-G930A using the BariatricPal App

This is my first post here. So try stick with with me and my rambles. First off, I'm a 22 year old female with a BMI of 46 plus multiple health issues. Those include Pre Diabetes, Multiple Strokes, Hypertension, Severe Iron Anemia, High Cholesterol, And Kidney Disease. My doctor has mentioned that I get gastric surgery previously. (The Sleeve) Up until recently i was unable to afford it and my Healthcare Marketplace insurance didn't cover it. (I'm in Georgia) As of a few weeks ago, my husband was laid off so we were able to get Medicaid through the state. Does anyone know the steps to get approved the fastest with Amerigroup? I will probably only have the insurance fo…

Approved finally after 6 months of visits! Now waiting on a date!! This is killing me!!

I called medicaid and they told me as long as my primary care doctor gave me a referral and it was documented medically necessary by my PCP and weight loss surgeon that they would approve it, however I must go through 6 months of supervised weigh loss and see a nutritionist, a psychiatrist and get lab work done. I already got my referral from my PCP and got my lab work done. Unfortunately, I have not found any bariatric surgeons who would accept share of cost as of yet. I am located in Orlando Fl. Has anyone found a surgeon who takes Medicaid share of cost in Orlando, Fl?

Anyone have aten better health of Virginia and got approval with 2 lbs weight gain? Do you know what net weight mean I go to my last weigh in and I was told I could not be higher than my net weight I don't know what that mean Sent from my iPhone using the BariatricPal App

Hi All, Quick question..I have a member sign in on my BCBS website. It has a section for claims. Will it show there if my surgeon's office sent in my surgery for approval? If so, will I see the answer once they decide? Thanks. The waiting stinks!!

I was sleeved 9/7 approved by Aetna ins and also have a secondary insurance that I am covered by 100% . Today I received a bill for $2500. My surgeons PA billed the insurance co 40,000 and it was denied, keep in mind the surgeon also billed the insurance company and was paid what Aetna pays with no responsibility from me . I never saw this dr the day of my surgery before , after or any time during my hospital stay . The bill says that the PA appealed the bill and it was denied , and they have dropped the charges to $2500 that I owe . I don't know how they decided to adjust the bill by $37500. I called the insurance co and they told me I could appeal it and that it was no…