Insurance & Financing

Our work with Harrahs ihasw now officially paid off. Please check this link and read the chain reaction that has begun. We worked with Gina and Harrahs for over a year and were able to work with her company very well. WLS is now a covered benefit in 2006. There is now proof and you can use this when you seek your surgery. http://obesityhelp.com/forums/LA/postdetail/7000.html?vc=0 The Only Law FIrm on the Obesity Help Advisory Team Coverage Negotiator for Medtronics IGS The Only Attorney who has been able to single handedly change an employees insurance coverage. When they need to call, there is only one call to make Gary J. Viscio www.obesitylawyers.com -17…

my bmi is 39 i dont know if they will pay for it, has anyone had a similar experience?

I could use some help writing my own so-called "Letter of Necessity" to include in my packet that goes to my insurance to get initial approval. I understand the offical L of N will come from my surgeon, but I rec'vd some good advice today that it would benefit me to write a letter myself stating my personal reasons I feel the surgery is necessary. Even though I have many years of admin in my background, I am drawing a blank on verbage. Does anyone have any suggestions or places to find sample letters? I just want to cross all my t's and dot my i's to avoid the appeal process and get approval the first time around. Thanks a million!!

Hi, I was banded in July. At the time, I had to get a special OK from the insurance company, because my Doctor was not affiliated with any hostpital in program. The cost was about $50,000 with the hospital stay etc. Everything was paid. The problem is now I've received a letter from my insurance company asking me to sign a release so they can have a 3rd party company audit my case with the hospital. Does anyone know what this means? Will I be asked to pay now? They have sent me three request, the last one being registered mail. I'm so afraid to sign it, I don't want to get stuck with another bill. I'm a freaked out, and would appreciate any feedback from an…

:help: After an insurance company gives you an approval does any know if there is a time limit before it expires.

I have just received my first denial from Aetna PPO. They said they need documented evidence that proves I have been overweight for the last 5 years and that I have tried to lose weight from a doctor in the past. I have evidence from a doctor that I was trying to lose weight by taking Phentermine - does anyone know if that qualifies/helps? What would be good to submit to Aetna to appeal this? Please help I do NOT want to give up!!!! Thank you so much!!!!!!

I currently DO NOT have any health insurance. No independent insurance will cover me because "my build exceeds the limit of acceptance." I am currently 5'7" & weight 212. When I initially applied for insurance I weighed 258. I had the lapband placed to help me lose weight & qualify for health insurance. My husband is self-employed so we have to find independent insurance. My family is insured, but not their fat mother!!! I don't smoke or drink. Heck, I don't even drink caffeinated drinks!!! I don't have high blood pressure, diabetes.........NOTHING!! My doctor told me I was in perfect health except that I am overweight. However, when I went to re-apply for in…

I have my consulation with Dr. Jayaseelan this Monday, but I'm not sure if my insurance United Healthcare will cover. Here's the wording which I don't understand: Weight Reduction or Control. Adjustable or vertical banding not covered unless Preexisting anatomical or health conditions preclude gastric by pass. Gastric bypass or biliopancreatic diversion are covered under Care Coordination Guidelines. What preexisting anatomical or health conditions preclude gastric by pass? Any help you can provide is appreciated. T.

If anyone has BCBS of Tennessee that has had this procedure done then please send me a message.

I just got my letter! I am approved!

Well Folks.... don't think it won't happen! I am some 8 weeks into the process and my Insurance provider (PacifiCare/Prospect Medical) has changed it's requirements. The standard 6month supervised weightloss, dietician visit, psch evaluation etc, etc has now been upgraded for me. In order to have my consult with the Bariatric Surgeon I need to : Visit the Dietician and have 2 follow-ups (note thats 3 appts) and have a Psch Evaluation and 3 follow-up visits (note thats 4 appts). And each visit needs an offical referral letter. Who thought up this hair-brain idea. The medical group lady said that this was the answer to Cigna and some other company who has decided to …

Received notification from my insurance company today that they are going to require 6 additional months of doctor supervised diet. I am considering paying for it myself, (finance). My question is if I do that, does anyone know if the insurance company will pick up any of the hospital bill and what about fills??

they paid for my in 5/03 then we had to change ins and starting 2/1 I will have cigna again... same company and everything ... what are the odds of me getting my band maintenance covered?

OK, I'm just going to throw this out there and see what all the "experts" have to say about it. My DW was approved by BCBS of Texas, via her surgeon's office. When he sent in HIS bill, it was for $12,000. The Medical Center sent in their bill for $30,000. BCBS posted the explanation of benefits on their website and they are going to pay a grand total of......wait for it......for BOTH bills......$1,638.....? Excuse me, but, what the F*#@?????? Who are they trying to fool? According to the approval letter, with a ZERO deductible and only $1,000 out of pocket limit. What should I do? Wait and see if the medical center and the doctor resubmit? Get a lawyer? Call them my…

Who has used any and were they successful? I'm about to hire one and wanted to know some experiences with them. Thanks

Has anyone gone through Cigna insurance with success?

Anybody have FEHB and which plan is the best for coverage? Thanks!:clap2:

Have any of you had your surgeries paid for by your State Vocational Rehabilitation Program? If so do you know how it works? Someone had told me they thought it was similiar to Medicaid. Any info or advice would be great.:help: Thanks in Advance, Melissa-preband

:Bunny :Bunny Hello everyone. I am begining my journey of exploring lapband surgery as a weight loss tool to improve my health as well as my self esteem. I am concerned over the insurance process all together. I was wondering if anyone had any success receiving funding from BC/BS? Thanks:Bunny

Hello out there. My name is Rebecca and I am in the early stages of getting the Lap Band. I sent all my paperwork in and got a call from the office saying that my packet was incomplete.....I need 5 years of doctor documented and supervised weight loss attempts. This is very discouraging to me as I moved so much during my life...OH, NY, CT, RI, and three cities in NC. I have been pregnant for the past four years. My weight loss attempts are scattered about time and states. I don't know where to begin calling for records....who has tried to help me and who has given me the whole "just diet and exercise" bit. I'm feeling like I should give up the insurance battle and…

Does anyone have experience with Humana PPO??

Do you think that having been in TOP's (take off pounds sensibly) weight loss support group - off and on for the last 40 years would qualify as a prior attemp to loose weight? I could (maybe) contact their hd qtrs for registration information which would proove my membership. I don't know if all the weekly records still exist as - my chapter disbanded a few years ago. Thanks!

When I received notice of my approval, it was via phone. I didn't get the letter until several days later. Now that I have paid more attention to the letter, I have some questions. It basically says "We approve & will cover everything, but your employer might not." I have no idea how the insurance bus. works (ironically, that's the bus I support!). If I have policy X, and the carrier of policy X approves something, what does my employer have to do with it? How do I find out if my employer will "allow" my procedure to be covered? Ack, so confused... BTW, I am working with my company's HR to find out more, but we're a huge company and it's not as easy as calling a r…

Hi All, I in the process of finishing my tests for lap band. All i have left to do is the Cardiac clearance, Psy eval, Pulmonary test, and Nutrition class. I will be finished my the second week in Feb. My insurance (Blue Cross PERSONAL CHOICE of PA) requires this: The individual must participate in one of the following: <LI type=circle>Physician-supervised nutrition and exercise program (eg, primary physician, Optifast, Medifast) over three months consecutively prior to surgery, which includes the following: <LI type=square>Dietician consultation <LI type=square>Low calorie diet <LI type=square>Increased physical activity Behavioral modificat…

So I finally decide that getting banded is the best possible thing for me now. I have been diagnosed with Apnea, I am well in the severe range on my BMI. However I have BCBS of TX. They have strong stipulations on the approval process. I have the 5 year history of being over weight. But they also want 12 months of a documented lo-cal diet and exercise program initiated by my PCP. My question I guess would be does anyone know of a work around for this or am I going to have to wait another 12 months to get banded!? At this point I am so fustrated, I have been denied already once due to "Not having enough medical info". I am seriously considering quiting my job of 6 yea…

Hi, I am new to posting here and posted in another forum but think this is where I belong posting my question. I know there had to be posts in these forums on this same topic but I cant find them I have BCBS of Delaware. My husband works for the union and it is self insured. BSBS at first told me that WLS would be covered if it was a medical necessity. Also, that WLS would be covered even if it was an exclusion on the policy. They gave me the criteria I had to meet and told me to have my doc submit all the paperwork. I called today and spoke with a different rep from BCBS. She said that it wasnt covered. She even called my husband Employee Relations office to…

I am a newbie here to the board and Well I have been researching WLS for a few years and have been keeping an eye on the Lap Band as I feel it is the best choice for me. I am a larger then most Bandster and I am researching 3 surgeons in Oregon, Dr. Emma Patterson, Dr. Steven Tersigni and Dr. Raul Mirande, I am at the point of consultation and payment options. This is where my problem lies. I am out of work and have been for 2 years due to a disability but Social Security is fighting me and I am in appeals and my loving boyfriend supports us, he has a low income job, but does the best he can, I have no health insurance, in oregon I am not eligible for there medicaid pr…

Just found out that the company my husband works for is changing health insurance companies AGAIN.....going from Humana to United Healthcare. How is this going to effect the coverage on my fills?

BUT yes to bypass surgery. What do I do? Should I go ahead and get the bypass? Im scared of the bypass to be honest. My insurance company said the band was unfounded.....whatever the heck that means!! They did say I was approved for bypass, but that means I need to find a new surgeon (mine does band only) and get new referrals. Grrrrrr why cant anything be easy???? Any opinions or advice are needed and welcome.

Hi everyone! I am kinda new to all this. I have jumped on a couple of times but I am really not part of the banded world yet. I thought I would be getting the word today and I did, but not what I wanted to hear! My insurance company is requiring a "6 month supervised program" in order for precertification. This means it cannot be Weight Watchers, Nuti Systems, LA Weight Loss, personal trainers, health club memberships or special food programs. I have been on a diet my whole life. I see my reg. doctor every three months because of the meds I take and they weigh me every time. And you know we talk about it every time. but that is not good enough. So all you folks …

I'm just in the beginning stages of trying to get insurance to cover LB can anyone tell me if they have HealthSmart which was formerly NTHN? There is an exclusion for bariatric surgery but because of my health probs I'm hoping to get past this. We have already received the 1st denial letter and all of my drs are busy writing letters to help me. I'm just curious to see if anyone has gotten this insurance company to pay and approve.......... I appreciate any help anyone can send my way on advice of this hard situation...... I was so ready yesterday to get this procedure and begin with my new year............:nervous

Insurance enrollment starts Feb. 1 I'd like to know what company seems to have the best track record for approving lapbanding.

:flypig: :flypig: :flypig: Hello Friends and Loved Ones... As many of you know, I have been trying to get pre-approval from my beloved insurance company for an Adjustable Gastric Band procedure... :confused: From September thru December, I was denied, appealed and was denied again. Blue Cross determined that I was too fat for Lap Band surgery for weight loss... (!) :mad: I researched, wrote fabulous arguements and sent it all to the State of California for an Independent Medical Review. I waited, and waited and waited some more. :rolleyes I got a letter in the mail the night before last - addressed to me, from the Center for Health Dispute Resoluti…

Anyone know how they are? Im meeting with the doctor on Jan 25 for my evaluation/

Anyone know how they are? Im meeting with the doctor on Jan 25 for my evaluation/

Hello Girls and Boys... Has ANYONE ever been approved by BC/BS of CA for this procedure?? I kinda figured with a BMI of 59.7 I would be a no-brainer - however, I received a denial for my pre-approval with this text: "There is insufficient medical literature to determine the safety, superiority or equivalency and long term efficacy of this procedure in comparative trials with gastric bypass or duodenal switch. For these reasons it is considered investigational. The Blue Cross of California Medical Policy for Surgery for Clinically Severe Obesity, which is based on published peer reviewed evidence based medical literature, was used in making this determination." So,…

Hallelujah!!! and Praise Jesus and pass the ketchup!!! Got a Explanation of Benefits from PacifiCare today. It states that the only amount I am responsible for is $900 so they paid for the bulk of the surgery. YIPPEE!!!! Gotta love Dr. Billy.

I finally got on a plan this year that's supposed to cover the band... I hope to have everything together to submit soon.... Anyone have any good or bad stories of getting approved by GEHA PPO ?? (also known as Alliance PPO, MAPSI PPO, MAMSI PPO, or United Healthcare PPO) ????

Hello! This is my first time to post anything on this site. I have been reading some of the post here since October. I was waiting to see if my insurance was going to cover the lapband for me. I found out this morning that they are going to cover it. I am very excited, and would just like to say this site sure has been helpful. Thank you all!!

It looks really bad-- everyone was great except this lawyer they had there she had every reason under the sun why they shouldnt have to cover it. Some of them were just plain untrue--- she tried to say that the band and the high number of complications related to the band is more expense the the cost of obiesity! She has no clue- I am a nurse- I see people with heart attacks, stroke, cancer and diabetes everyday run up hundreds of thousands of dollars in one hospitalization. It really seems like their mind is totally made up before you even appeal. I should know their answer with in a week but I am sure it in NO WAY, So I have to figure out what the next step is. …

GHP denied me!!! They say the surgery is excluded. Has anyone been approved with this situation?

Does anyone know if medicare pay for the Lap Band Surgery?

Hello there! This is my first post. I am disappointed this morning, learning that my insurance has denied my coverage. However, First Health is requesting more information from my doctor. Has anyone else had this trouble and what tips can you give me that may help the process along? :confused:Thanks in advance.

I am wondering if anyone has ever gotten Blue Shield of California to pay for their lap band by appeal? Or have you heard of anyone that finally got approval using Blue Shield of California? Thanks......I can hope I guess:(

I got a copy in the mail today and it says under Exclusions: "Weight reduction programs or treatment for obesity including any surgery for morbid obesity or for removal of excess fat or skin following weight loss, regardless of Medical Necessity, or service at a health spa or similar facility". So...do I still get my doctor to send a letter of Medical Necessity and try to fight it? Thanks! Sharon

I am self paying for my lapband in Jan. (Dr. Kuri, MEX). My insurance would not pay for it. If I ever have complications due to the surgery - what has been your experience with your insurance covering the cost involved to treat the complications. I will call my insurance company on Tuesday and ask this - but in the meantime would like to know if anyone has ever encounterd this issue. Thanks!

Hello, I have Cigna PPO through my employer which is basically a self insured policy. I have gone through 3 appeals - all denied because of a suposed exclusion on the policy. I have never seen this exclusion, but they say it is there. I am now appealing through my employer since it is self funded, they can override the policy. If it gets denied again, I'll probably go through the Department of Insurance and then a lawyer. The policy that is available to employees says that it can be covered for medical necessity. The insurance company and my work say there is an exclusion and they won't give me a copy of the paperwork. I am 32, BMI of 50, 5'11, 360, have severe s…

Hi ya'll. I am 61 years old, have diabetes (oral meds)for at least 5 years, psoriatic arthritis (on methotrexate)diagnosed 3 years ago, and have been diagnosed with high blood pressure since last fall and am on meds for that. I also have diverticulitis. I have had so many doctors visits I am just about sick of it. BUT....I really need to lose about 80 pounds. I know it would help my diabetes and my arthritis, but I can't seem to do it. I have had weight problems since I stopped smoking when I was 41 years old. My weight has gradually climbed from 135 to 225 in those years with diets interspersed where I would lose weight then regain it quickly after stopping the diet. On …

Just checking the web site out ...want to learn how to post

HI everyone Well I just found out the other day, effective Jan 01, 2006 The co-pay for the surgery will be 5,000.00. Right now it is 250.00...I still need the 6 month weight loss attempt documentation. My case worker seems to want to help and replyed to my e-mail when asked if the atkins diet was ok to list..the reponse was: Hello again, any diet followed, along with regular vs and documentation of your results by whoever is following you on this should suffice. And yes…..they would be looking for 6 consecutive months of documentation on wt. loss efforts……. So Hopefully I can get the doc to fill out paperwork on monday so I can fax them Any comments ????