Insurance & Financing

I need all your help! My brother and sister in law were both denied by Blue Cross Blue Shield of Texas and told they must do the 12 month dr supervised weight loss thing. My sister in law wants me to write her an appeal letter to see if we can get this reversed and she can move on. She is at her largest and in pain physically and basically sick and tired of being sick and tired. I was wondering if some of you who had to appeal might have appeal letters that you'd pass on to help us construct one that will work for her and my brother. I realize we'll have to personalize it to their own issues, but seeing other people's who were reversed will help immensely. Please feel f…

Just curious if anyone has been able to get approved for coverage with United Health Care PPO using a non-innetwork physician but in network hospital. So far they are saying the hospital is covered under my insurance but the full surgeon bill would NOT be. Leaves about 7,000 to 8,500 for me to pay. But, they said if he is the only surgeon with in 30 mile radius of my house to do this there is a chance i would be covered. ( currently he is the only one with in 25 miles. ) But, not sure if they mean bariatric surgeon or lap band surgeon.. Argh... Insurance companies.. such a pain!

undefinedundefinedWell,I talked to my doctors office yesterday( Dr.Cribbons, Plano Presby Hospital. They had sent my request to the insurance via certified mail about two weeks ago and have still not received acknowledgement that the letter had been received. The office is in Dallas and so they should have receive the request the next day. Doc's office said they are going to resubmit again today. I just want to get it over with. Do any of you have this insurance? If so, what was your experience? Thanks!

Agencies considering changing policy on payments Friday, November 5, 2004 Posted: 10:59 AM EST (1559 GMT) BALTIMORE, Maryland (Reuters) -- Obesity surgery has helped many patients lose weight and improve their health, a panel of experts told U.S. regulators Thursday, but they added there was not enough data on how well it has worked for elderly patients covered by Medicare. The Centers for Medicare and Medicaid Services (CMS) is considering whether the government's health insurance plan for the elderly and disabled should change its payment policy for the surgery, which shrinks the stomach by removing part of it or implanting a removable band. "I didn't see a…

I can't believe this but I just found out my insurance, Keystone East will cover the Lap Band, if medically necessary. When I first called them on 10/15/04 they said no, they would only cover by-pass. I saw the Dr. on 11/2 and his nurse said to double check, and sure enough, as of 11/01 they will cover the lap-band!!! (I didn't believe them at first so I called back and spoke to a supervisor) If anybody else has heard no from Keystone, check again! Yeaaahhh Good Luck! -Nora

I have tricare and it has been 4yrs + of rollercoaster heck. i am sooo depressed with this has anyone had any sucess in this area? If so please let me know what to do I have insulin resistance,pcos and joint problems with my knees. I have tried everything. desperatly seeking help.

OOOkkkay...here is the low down on my insurance. I called my ins. co earlier, and spoke with someone to see if my insurance covers this type of surgery. I was told by the lady that she would have to find out, and call me back. Well - no one called me back, so when I was on lunch, I was talking to my Aunt about it. Since she works in HR - she said that there is only one lady that she deals with at the insurance company. So she said she would call her for me and find out if they cover the Adjustable Gastric Banding procedure. My aunt just called me back a few minutes ago, and informed me that they ONLY cover the procedure if it is Medically Necessary. The lady tol…

Well - I've just spent the last little bit reading through my entire insurance benefit book. I read every page - word for word...literally. I came up with 3 different things - and they were all in 3 different sections. Here they are in the correct order in which they were found, and what section they were found in.... ------------------------- Hospital - Inpatient Medical Conditions "Confinements for the purpose of weight reduction (including gastric by-pass, stapling, ect.), unless Morbidly Obese." ------------------------- Laboratory / Pathalogical Testing "Tests associated with weight reduction or smoking cessation programs" -------------------------…

I was just doing a google search on Health Insurance and the Lap Band surgery. I found this article, and found it to be informative. I thought I would share with everyone what I read. (I'm sure some of you may have seen or read this already) but here is the link anyways I felt it dealt with insurance, so decided to post it in this forum. ~ Kari ~ The Article

When I think about the people that have been denied this life saving surgery by insurance I get so mad. I have been sitting here searching on this site those of you who have had financing experience. And then I just thought, that is just not right, if a person has insurance this should be covered. I am covered by three insurances and feel like I am probably in for the fight of my life to get the Lap Band paid for. It just shouldn't be this hard. If I went to the ER right now with a blocked artery, they would do heart bypass no question asked. This surgery could help me avoid needing one. I could go on. I know all of you know this. I just am really upset and I am …

I am now in the appeals process with my insurance despite the fact that my first denial was because "somebody" misplaced some key parts of my application (testing, Psych eval, etc.). Anyway, I know there's a great appeal letter on this forum somewhere, written by Alexandra I think, but I'll be darned if I can find it. Can anyone help please? Thanks much, hopeful1

I work in TN but my insurance is through BCBS of NJ. Has anyone delt with them in trying to get approved for the lap-band? If so what can you tell me about your exp... Thanks in advance. Katy

Has anyone with cigna been approved for this procedure? What did you do to get approved? Any advice from someone in Texas would be great!! Thanks

BCBS Federal only covers bypass since I just went throught the process. Does anyone know if NALC insurance covers this procedure. Being a federal employee you have several insurance companies to choose from during open season.

I got a letter from my insurance yesterday, but I don't really understand it. Can someone tell me what this really means? Here is the letter: We have completed our review of your request for coverage of Bariatric Surgery under the (company name) benefit plan. Based on the information reviewed, we are please to inform you that coverage is available. All covered charges are subject to screening for allowable charges. The final allowable charge will be determined when the bill is submitted and will be based on the actual service(s) provided. Please note this letter does not guarantee payment. Benefit payment is based on the provisions of the (company name) benefit…

I have an HMO. It has it's goods and equally it's bads. I am wondering if BCBS HMO in Florida will pay for the procedure. I have been told that they will starting Jan. 2005, but the rep only told my husband "elective weight loss surgeries" She wasn't specific. I was wondering if anyone out there has the same insurance, and what it took for them to pay. How much is Lap Band w/out ins.?

BANDLANDIA APPLAUDS LAP-BAND REIMBURSEMENT APPROVAL BY BLUE CROSS / BLUE SHIELD Cynthia Jones, founder of Dallas-based Bandlandia, Inc. (www.Bandlandia.com) said today, “We are extremely pleased that Blue Cross / Blue Shield has approved Lap Band surgery for its patients. The lap band procedure is the least invasive and safest of all weight loss surgery options and we have been working towards this day for quite a long time. The Lap Band will save many lives among the Blue Cross / Blue Shield patients.” Cynthia Jones, among the first U.S patients to have the lap band procedure, founded Bandlandia to offer after care options for those who have had the surgery. Blue…

I jest read the exempions in my helth insurancence book and it clearly states that the plan will not cover aney tipe of waight loss surgerys or counsloing or help . has any one wan a clame threw BCBS of Califorina. I am wendering if it is even werth it for me to fill a claim. I can't change insurance co. withch makes this even hader. thanks for all the help Ellen

New Hope, I just received my first denial letter today and I think (hope) what it's saying is the insurance doesn't have all my information and tests. My insurance required a psych eval, nutritionist visit, and some other tests - thyroid, glucose. I had heard they required documentation of 6 months of dieting under a doctor's supervision. I had proof of maybe 3 or 4 mos. at WW. Excess weight is 120 lbs., BMI is 42.5(?). I do have (17 yrs.) hypothyroidism and take synthroid and hope that's not the problem. But to get to the point - why did it take you eight months to get approved? P. S. Our insurance just approved a co-worker for gastric bypass with no problems. I …

Hi everyone - I am new to this board and new to this procedure. I went to see my pcp today for a referral to the surgeon which he happily agreed to with no problems. His office indicated that the surgeon (Dr. Scott Cunneen @ Cedars) would put the requests in to my insurance company for approval. I am with Cigna HMO through the Walt Disney Company - After reading so many of the posts here about the problems people have had getting their insurance companies to approve this procedure - I am just hoping that I am not setting myself up for heartache and dissappointment if it ends up being turned down. The "problem" is that my BMI is at about 33.1 - I am 41 years old and 5'…

Hello everyone! This in my first post. I'm very excited about the possibility of getting a lap band. Last week I went to a seminar givin by Dr. Chua and I have an appt. this Friday to see the nutritionist and the psychologist. When I checked with my Insurance they said that they do cover bariatric surgery however someone at Dr. Chua's office said that my insurance ( WPS ) will not cover the Lap Band because they consider is experimental. I would really rather have the lap band insted of getting a bypass. Does anyone have WPS insurance that has the lap band?:phanvan

Hey, Amy! On another thread, Alex said not to give up on Aetna. if you have any of the following, Aetna DOES cover LapBand: 1. Hepatic cirrhosis with elevated liver function tests; or 2. Inflammatory bowel disease (Crohn's disease or ulcerative colitis); or 3. Radiation enteritis; or 4. Demonstrated complications from extensive adhesions involving the intestines from prior major abdominal surgery, multiple minor surgeries, or major trauma; or 5. Poorly controlled systemic disease (American Society of Anesthesiology (ASA) Class IV). Here's the link: http://www.aetna.com/cpb/data/CPBA0157.html Sue

I am insured with Healthlink Open Access. My BMI is 38 and I have high blood pressure, 2 bulging discs and weigh 220. Has anyone else been approved with Healthlink that could offer me hope?

My insurance paid 100%. My neurosurgeon wrote the insurance a letter requesting that they allow me to have the banding and cover all charges and they did! Good Luck!

Has anyone here gotten the lap-band with medicaid? I found a doctor who will do it. I talked to him yesterday. He just moved here and just as of the 1st opened a clinic. He is gonna file all the papers but he dont think medicaid will pay for it? Hence he is trying to talk me inot ruenX and that scares me... Help

You know I just wanted to post this little tidbit of info for everyone. I was told at the facility where I have my band placed that there is this Texas based Claims company that will file the necessary paperwork if you were self pay to see if your insurance will cover the banding. I am in the process of this right now. My insurance co did NOT deny the claim they are requesting my medical records and hopefully will have an answer one way or the other soon. I self-paid for my surgery because I did not want to wait for the process of insurance acceptance / denial. I know some people can't do that but for those of us that can afford to just pay for the surgery and t…

ok so i kinda got the runaround from my doctors office the past two months... and I have sent a complaint to the office manager- hopefully she can straighten things out Anywhoo... i called my insurance BCBS TRS today and they said that i should have an answer by friday and to call back then.... ughghhhh its killing me! Also I was wondering if having my pcp send a letter would help... she said she would and i called and left that message with my Lapband dr's office but i dont know if they ever contacted my pcp. Should I call and ask my pcp to go ahead and send a letter of their approval of the procedure???? Fingers crossed Tammy

I had surgery on June 4th, 2004. My insurance company is BCBS MA HMO Blue of New England. My paperwork had been turned in on April 28th and I got a call at 8:23 am on April 30th that I was approved and had a surgery date. They are really great to work with. I called several times on the 28th and 29th to see where it was in the process. Their people were wonderful. They checked several things making sure to help me out. They started approving lapband on January 1st 2004. I hope that whoever has this insurance has as easy a time as I did. Kerri

i was just informed by my insurance co. HAP( Health alliance plan of mich). that i am approved for a by- pass. I meet all the criteria, but they do not cover lap-bands. Why i asked. Because we don't! I pressed on for a reason and i got they don't work as well and we get better results with the bi-pass. Obviously the feel that obese people are not informed enough and too stupid to make an informed decision. I have to write an appeal and as far as i know, no one has gotten a lap-band from HAP. most other insurance companies in MIch are paying for them but Hap won't. What can I do. I'm not going to Mexico. I can't afford that either. any suggestions, like a good la…

Hi, I am in need of some advice for my brother in law. He is 25 yrs old and weighs 450lbs. He has Cigna and of course they have denied him. I told him he must appeal this. Can anyone with appeal expeirence guide me, so I can help him? I have called Inamed and they told me that his surgeon would have to get in touch with them so they can work together on this appeal. He surgeon told him he does not get involved with appeals.I did tell him I think he needs to change doctors because this doctor does not have his best intrest in heart. Anyway can anyone tell me what he will need to do on his own to appeal this?

Has anyone had any luck getting an insurance company to reimburse a self-pay? My insurance company (Aetna) had very restrictive guidelines for lapband so I wnet ahead and self-paid. Two day after my surgery, I recieved an approval for gastric-bypass from Aetna. Gastric bypass was not the right surgery from me so no great loss. I would like to get some reimbursement or at a minium coverage for fills, etc. What do you think?

I figure I'd better start trying to get an answer to this question now. My sister and I are scheduled for our first fills 4/8 with Dr. Borao, Monmouth Medical Center, Long Branch, NJ. The director of the bariatric surgery center where we are having our post-op care informed me that the hospital portion of the fill (radiology) will be covered by insurance. But the doctor's fee, which is $250., will probably not be covered. Why? Because, according to her, a satisfactory code does not exist for billing the insurance company for the doctor's fee. She said that none of Dr. Borao's lap-band patients has ever been reimbursed for his fill fee. HELP! I feel like we are at the…

Ok, a quick run down of my deal so far. I want the LapBand. My insurance is BCBS of IL PPO and I have been denied 1 time and have not appealed yet. I also turned this into the IL state insurance board and they told me basically since my insurance was self funded that they could not help me BUT my best bet would be to appeal through my HR dept that BCBS of IL only managed the insurance for my husabnds employer "Georgia Pacific" and that the HR dept could overturn the denial. Anyone ever went this route? And if SO what did you submit to the HR dept? Did you have any luck? I'm so fustrated I have been working on this since October 2003 and my best friend was approved and is …

i call an dr office who will be doing lap band soon the first thing they say is that insurance wont cover it how can be so sure thank you

Well, I have BCBS of MN, and as most of us know they've put the band on an experimental/investigative status. They aren't denying all claims, but are reviewing on a case-by-case basis. My paperwork was submitted last Tuesday, and I called for a status update today and was told it was still in review with the medical review board. I'm more than anxious and am wondering if the fact that they're taking longer is a good thing or a bad thing. The other folks I've talked to that were approved prior to the BCBS change of mind were approved in less than a week. Thanks for listening!

A question was asked on another board about the lapband and insurance. If you have the lapband and end up changing jobs or insurance, will you be insurable? Some say that insurance companies won't cover you if you've had the band. Anyone know?

Hello All, I was banded on 12/29/03 and all the bills have been coming in to my insurance, UHC. I have been keeping track on the web, and one was for $19,000+, and I assumed that was the surgery bill even though it was billed as Lenox Hill Hospital. Today I received a statement for FOUR charges of $15,000 each for the surgery. Two were assistant surgery charges and the other two were listed as Laparoscopic Procedure charges. I did e-mail my doctor, Marina Kurian, because they sent the bill to an insurance company that I had to drop so that my husband's UHC would cover the surgery, but COULD THIS BE POSSIBLE that the surgery cost $60,000???? If so, no WONDER we will …

Has anyone had Bc/BS of FL pay for their lap band surgery? I am currently on a six month dr supervised diet which is part of their requirement for consideration, but I have yet to hear of anyone who has ever been approved BC/BS FL for Lap Band surgery. If any has gotten approval, please let me know. Thank you.

Has anyone had any luck with Blue Cross/ Blue Sheild of California(ppo) covering the lap-band surgery? My surgen just sumitted my pre-approval and I am waiting got a replay. I am giving them 2 weeks before I start calling them everyday. Thanks Lisa

Here I am only 3 days away from my surgery date and the surgeon's office just called... now I am sitting her in tears! Although my HMO approved the surgery, when the hospital went to my insurance company... they declined. I have Cigna HMO. My surgeon's office is now frantically trying to work with Cigna and my HMO to find out how this happened and to seek approval. Please say a prayer for me. I didn't realize how badly I wanted the Lap-Band until I got that phone call and as soon as I hung up I burst into tears. I know I can still appeal, but how could they do this only 3 days from surgery when I am sitting here looking at an authorization letter from my HMO??…

Hello everyone, I am hoping you guys can give me some advice. Trying to get insurace approval will take too long. I too have tried every diet and diet program, but don't have any professional documention on it, other than 2 knee surgeries and am facing knee replacement if I don't get this weight off. Anyway, I have decided to self pay and want to have the surgery done quickly. I have noticed a lot of messages talk about going to Mexico. Any suggestions on Dr.'s or websites I can research? Also, if anyone has gone to Mexico to have the procedure can you give me some feedback as to the care and quality of service you received. Thanks! Janet

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I go monday for my seminar for the lap band and was wondering if any one had been approved thru health reach ppo, I wa denied for the gastric bypass due to lack of evidince saying my weight was life threating however my family doctor has gave me a knew letter that sounds very convincing but know i am sure i dont want to get the bypass (thank God )i want the lap band more safer .but i was wondering what my chances are since i was denied for the bypass.and well i have to repeat all the testing i did for the bypass?probly so since it has been a year?thank you to those who have allready responeded to the questions about no insurance .I have decided to do it either way but we …

hi yall , i need some opinions on this ......... when i went to the seminar for the band ...... the doctor was giving us heads up on some of the insurance companies they have dealt with and their expierences on who pays and who doesnt .......... well i can afford to pay for the surgery myself , so i just didnt even try to see if insurance would , i guess in my mind i didnt want to wait ... especially since i was scheduled 16 days after my first drs visit ....im scheduled to have the band on 2/13/04 , i called bc/bs hmo yesterday , just to see if it was covered , they said yes it was , all i need was a note from my primary doc suggesting that this would be a good thing …

Hi Bob, I saw in a post that you are from NJ and were turned down by your insurannce.........I was hoping i could ask you who your ins. is with ?? I have Horizon B/C & B/S of NJ. I have gone for my nutritution appointment, my phyc evaluation and my gastro app. today and the office will not sumit till all this is done so i am afraid i will go through all of this and be turned down. Any help is appreciated........THANKS

My daughter (14) received her denial letter on the basis that the band is considered "investigative". I plan on appealing (to BC/BS also) but was wondering in the case that we win this appeal, is it possible to get another denial letter due to her age or does the Insurance company have to list ALL reasons for the denial in the first letter? Any response would be greatly appreciated! :confused: Thank you! Billie Branham

I am in the process of fighting for insurance approval right now. The case worker I am dealing with said that it would be helpful to complie a list of any and all names of previously banded tricare patients. I am hoping to be able to push this on through approval. I am very frustrated, because they are willing to pay for the more expensive and more dangerous rny, but not the banding. They don't even list a reason why they exclude banding, only that it is not a covered benefit. Would appriciate hearing from any bandsters out there with experience in dealing with Tricare. Thanks for your time, Trenda

Hi, I just received my letters declining benefits for the band. I wondered if anyone has had any luck appealing to Blue Cross. Also is there any point in having an attorney handle the appeal. I contacted Obesitylaw.com which came highly recomended, but they will not work on cases after the surgery is done. Thanks for your ideas

Today I received the dreaded denial letter and the reson for denial was, "Is investigative per our medical policy". I hadn't heard this one before. I plan on appealing but was wondering if anyone had any ideas where to start. I appreciate any responses! Thank you! Billie

does anyone know how much the procedure cost ?if there is no insurance