Insurance & Financing

Hey guys, So I know this question has been addressed in other threads but none of them have answered my question. Has anyone had success with receiving any benefits from Alfac for the LapBand. I have read other threads about the Sleeve and Bypass. But I was in and out of the hospital in less than 24hrs. I also have documentation of medical necessity and none of my paperwork list the surgery as cosmetic. If you did get re-reimbursement, how much was it? Thanks

I have bcbs ny. Does anyone know when the out of pocket is due or will I be billed. I am responsible for 20% and my date is 12/27 Sent from my iPhone using the BariatricPal App

I have been reading a lot of these post about paying out of pocket or co pays. Why is anyone paying out of pocket of the insurance covers the cost. I would go nuts if I had to pay anything additional to what my co pays have been with all these requirements. Does anyone have BC/BS PPO and live in Maryland ? I would love to know if you had to pay anything extra. I'm all types of confused. Please help me understand. Sent from my iPhone using the BariatricPal App

235 weight 5' Bmi 41 Sent from my SAMSUNG-SM-N910A using the BariatricPal App

Hello, im currently in the insurance acceptance phase but my dr office is procrastinating in submitting my info. My package was supposed to be submitted to my insurance last Tuesday. I called yesterday and my patient advisor gold me shes working on it & hopefully it will be submitted yesterday. That really pissed me off because she had a week to submit it & im trying to have my surgery done at a strategic time. I try to call her several times, always get vm. Im getting really frustrated. Am i tripping or should i leave it alone Sent from my SM-G935V using the BariatricPal App

Things I wish I had known about my insurance going into my initial appointment with my surgeon: 1. BCBS TN requires 6 months of nutrition classes ( 1 per month) 2. 1 Psych eval that is good for only one year 3. Your nutrition classes have to be done through a doctor other than your surgeon 4. BCBS TN will deny you if you submit nutrition classes that were done through your surgeons office 5. Your primary physician must have some documentation of you wanting to learn about bariatric surgery and/or nutrition 6. If your BMI is over 40, no proof of premorbitities are necessary, but they can always help your case 7. You don't have to lose 10% of your body weight befor…

Anybody here from Maryland and have Kaiser. Getting sleeved soon? 《BreBaby》

Hi all, I was just coming here to tell you my insurance approval story. I'm currently 300 lbs. Fighting with my insurance, Fidelis for the last 6 months. Got denied twice, then I hired the Lindstrom Advocacy Group, they drafted a letter for the appeal, it didn't take too long, and my insurance company approved me before it was even reviewed by the appeal company. I must give my shout out to Kelley Brown at Lindstrom, I wouldn't be here without her dedication and expertise. I'm now at my last appointment with the cardiologist and off I am to my sleeve, am so excited. I was on the yoyo diet train all my life will finally iy"h reach my goal weight soon. Cheers …

Wanted to know how your process went if you're an employee of Aurora. Sent from my iPhone using the BariatricPal App

Prefacing this by saying I'm not sure there's any more I can do for now, but this is kind of a vent, too. CIGNA denied me today. My surgery is December 20. My work has a stipulation (and the insurance is through my work) that you must work there for over 1 year before insurance will cover bariatric surgery. I have been working there since July of 2015, so well over a year. My surgery nurse called me today saying CIGNA denied me because I had not been with the plan long enough. I called my company healthcare advocacy line. The woman there called CIGNA and we had a four way conference between me, her, CIGNA rep 1, and CIGNA pre-cert rep. Both the advocate and I were…

Anyone have issues with getting approved with this insurance?? Sent from my SM-G530T using the BariatricPal App

Hi Im new here and I need help figuring out how to get this surgery for my lady. Its a dream of her's and I promised her I would help. a little backstorry. she's 20 (21 in may next year) and Im 23. Shes been struggling with her weight since we where kids. shes 5'3" 350lbs. no major health issues. a year ago we were both on NV medicaid because we where homeless. now I have a decent paying job ($11.50) so now we no longer qualify for medicaid. I dont know where to begin. Should I try to get insurance yo cover her sugery? if which one is good? Should I just save up to pay out of pocket I have only 1k so far. we were consider in house financing in Mexico but we'll need…

My surgery is set for Dec 14th, or so I thought. I received a letter from Aetna today that lists the service dates for the procedure as 3/16/17 - 3/16/17. Is this the deadline for the surgery date or the date they expect me to have surgery? Notice the admission date at the top left is also 3/16/17. Hope someone can help. Sent from my iPhone using the BariatricPal App

It's been such a long road, which I started in June. Lost 55 lbs while waiting to fulfill all the requirements. I just met with the surgeon and scheduled my sleeve for 12/9, Friday. In the process, his secretary told me that my insurance apparently gives instant approvals to all bariatric surgery requests because due to their volume, they cannot process them all. Of course I found that out after I spent half a year worrying I would be denied. So, I thought I would post something in case someone has this insurance as well.

Anyone have BCBS Anthem cover lapband then bypass? Sent from my iPhone using the BariatricPal App

Hi, had my consultation recently here in Dallas for the sleeve and it's self pay. Just wondering if anyone has done self pay and gotten bills after surgery they didn't expect..specifically from the hospital or radiologist? Sent from my SM-G530T using the BariatricPal App

Hi all- I just finished my last preop appt. I had to do 3 appts in 6 months, a phsych eval and nutritional counseling. I have only lost 4 pounds and my BMI is 39. They are submitting today. But I am just curious if any one knows how long it will take for an answer? they told me up to 4 weeks.....Thanks!

Hello, so today my paperwork was sent to insurance!! Yay!![emoji4] I do have some questions for people with the same insurance: How long was your wait for approval? Did you have any problems? Also I have met my deductible and I'm in TX, does anyone know how much the cost of surgery was? If you have any more information to share please do. [emoji4] [emoji5]

Hi guys! So I'm all done my requirements per my surgeon. I should be able to submit my information to the insurance this week. A couple things I wanted some opinions on. 1. I haven't gone to the doctor for 6 months so they could track my weight. 2. I'm not sure what state my insurance is out of?? I live in New Jersey so I'm really unsure. Any ideas?? I'm super nervous and after reading all these posts I feel like I'm going to get denied. I'm at 40 BMI, but I feel like they're going to want me to do a 6 month documented diet. Sent from my iPhone using the BariatricPal App

Sorry so long! Has anyone gotten surgery in La with medicaid? If so, what plan did you have and were you easily approved? Was it recent? I have medicaid as my secondary (my BCBSLA wont pay!), and I have LaHealthConnections and the only provider for MLA in Louisiana is supposedly Dr. Dominquez in Covington, who doesn't take LaHealthConnections. The receptionist told me that I would have to switch to either United Healthcare, Amerihealth Caritas, or Amerigroup. I'm torn between Amerihealth Caritas and Amerigroup so I'm asking for advice on which one did not reject or give you trouble. Btw, my BMI is 44, so no co-morbidity is needed, but I know about the 6 month of visits an…

I live in New York and I have Fidelis Care (a type of Medicaid). How long does it take for a person to get approved with this type of insurance. My pre op testing is almost complete and will be submitted within the next week and a half.

Does anyone have VIVA health insurance in Birmingham Alabama? If so did you have to do a 6 month weight loss program before approval?

Does mass health cover gastric sleeve? Sent from my iPhone using the BariatricPal App

Out of Missouri. My insurance says it won't pay one cent towards weight loss surgery for anyone. Is this normal? I understand not having the entire thing covered but not a penny? Has anyone else ran into this? Sent from my iPhone using the BariatricPal App

Has anyone been approved by partnership medi-cal California? Sent from my LGMS631 using the BariatricPal App

I recently enrolled in healthcare benefits for 2017 at my job and they do not cover bariatric surgery. Dr. Maytorena from Long Term VSG is hosting a contest for a giveaway of a free gastric sleeve procedure. We were asked to make a video stating why we needed the procedure and why we thought Dr. Maytorena would be a good doctor. The winner is the contestant that has the most likes on their video via the Long Term VSG facebook page. I need your support by watching and liking my video submission on their page. I have included a clickable link to the post. Thank you in advance for your help! <3 https://www.facebook.com/longtermvsg/posts/10153842916770216?notif_t=like&am…

Has anyone had any experience using he sleeve. I am in Georgia and it is a federal plan but also open enrollment and I want to choose a decent plan to cover my surgery

Hi guys! I'm new here so I'm sorry if this is the wrong board or whatever, but I have a question. My insurance is BCBSFL and while researching, I learned that BCBS does not cover bariatric surgery in Florida. But I do have a BMI in excess of 40, and I was wondering if there was something I could do like submit a form or something that would get them to cover it? Has anyone had any luck or experience with this? Thanks in advance.

My date is finally Scheduled for NOVEMBER 22nd!!!! Just waiting on approval from insurance!!!!I'm so excited cannot wait !!!! Sent from my iPad using the BariatricPal App

Hello all, I'm still trying to get a straight answer from Cigna, and my doctor's office has been wonderful in assisting me.... Last week I got a letter requesting more medical info for my VSG procedure. The doctor promptly replied. Today I get a denial letter. Actually, it reads "The employee must have 2 years of continuous service with the company for coverage to be available" I've been with my company 25 years, Cigna only since 01/2015.…...I'm trying to find out what "2 years of service" they mean.... With my company or with Cigna. Very ambiguous. If they mean with Cigna, what are the odds they'd "bend the rules" 4 months early? I was scheduled for mid Augus…

Called insurance today, Health Partners, found out my husband's plan has excluded Baritric surgery. I am so devastated. I can not afford to pay on my own and I am not willing to travel to Mexico. Had anyone gone through this and if you have how did you handle it? Sent from my SM-G930P using the BariatricPal App

Insurance is changing at the first of the year. December will be my 6th month of supervised diet as my old insurance (Anthem BCBS Ohio) required. Now there are all new requirements with Meritain/Aetna, my new insurance that is effective January 1, 2017 Has anyone been through this before ? I am so worried and frustrated. Sent from my SM-N920V using the BariatricPal App

I can't seem to find any one with this unsurance who's had a sleeve. I'm in NH which is one of the state's where it's required that employers offer the bariatrics in the insurance, so that's a bonus. I checked on the ins Co website and it IS covered, looks like the norm, 35 with comorbids, 40 without. I'm 40, without. But that's it, it doesn't go into any detail about requirements , any one have any idea? Sent from my SAMSUNG-SM-G900A using the BariatricPal App

Sorry I'm going to warn you ahead of time, this will probably be a long post. So I was denied for surgery 2 years ago. I wasn't quite heavy enough to qualify. Fast forward 2 years and now I'm about 20-30 lbs heavier and I meet the weight requirement. BUT now insurance requires a 6 month physician supervised weight loss. I go next week and that will be my 5th visit. So far I've lost 8 lbs BUT due to hurricane Matthew we lost power so, not being able to cook, I fell off the wagon and gained back like 5-6 lbs. I have another weight recheck on the 21st and I'm paranoid! The dr doesn't have any record of me gaining the weight per say because I am in between appointments but wh…

Hi. At the beginning of my journey. I will be going to seminar in two weeks. Just wanted to get a heads up on what is expected and a rough estimate on how long the process takes. Sent from my SAMSUNG-SM-G530AZ using the BariatricPal App

Does any have this issuance how long did it take for approval? My bmi is 49 Im 5'3 279 38 years old High cholesterol high tic no meds High bp no meds Arthritis back pain can't walk ankles fibromyalgia GERD Sent from my SM-N920T using the BariatricPal App

Im in the process oftrying ti get approved by Aetna, but im nervous im going to be denied. Ive been having an issue with getting 2 years of recorded weight history. Ive have 2 medical history from 2014 and didnt go the the dr in 2015. I did however had a pre employment physical for my job in 2015. On my work badge it has my weight and start date of 4-30-15 but an issue date of 1-23-16. I also have gerd, hiatus hernia, gastritis, & diabetes on both sides of my family including my father. My bmi is 45. I had to do 3 months weight lose training, an egd, amonst other things. really nervous and don't want to get turned down. Does anyone have any advice Sent from my SM-G…

Hello is there any one from Illinois with family health network for there insurance? How long did it take for them to aprove you ? Did you have any problems with them not wanting to do it ? Sent from my SM-N920V using the BariatricPal App

How was your approval process with Neighborhood Health Plan of Mass? The waiting is killing me????????????????????????????

Hi fellow sleevers! I've been lurking since June and now for my first post. So I completed my insurance requirements today. My advocate told me the insurance approval paperwork would be submitted as soon as she received my NUT's report. That's the only document missing. She expects to get the report tomorrow (09/23). You've probably had this question asked about a million times before -- but I did not see an answer for my insurance specifically so here goes: if you had BCBS of AZ how long did it take to get your approval? Of course I want to have my surgery yesterday. Sent from my SM-T800 using the BariatricPal App

Anyone get approved with bmi below 40 with comorbidities besides sleep apnea, diabetes, heart disease or hypertension? Sent from my iPhone using the BariatricPal App

Hi everyone! Has anyone been successful in qualifying for bariatric surgery with the Scott and White Health plan? I have been frustrated with the process so far in my research. My hospitalization fees (includes all MDs) should come down to $250 a night, maxing out to $750 per stay per insurance policy, but the Scott and White Bariatric Center quoted my yearly max out of pocket (>$4500!!!). I have called insurance to verify, but the customer service reps I talk seem to be confused by the the entire policy (one stated only >40BMI but policy documents clearly indicate > or equal to 35 with at least one co-morbidity). Anybody recently approved? What are the requireme…

Does anyone have medicaid fidelis care? What exactly needs to be done to be approved I'll be getting insurance in December and want to start right away so any tips advice is welcomed please Sent from my iPhone using the BariatricPal App

I have my first consultation on November 22nd. I've contacted my insurance to find out if WLS is covered, it is if it's deemed necessary, along with anything needed with surgery (hospital stay, IV, IV medications, anesthetic, etc.). I also asked what the requirements were in order to be deemed necessary. They stated: --100+ pounds overweight (my BMI is quite a bit over 40...) --2 surgeons deeming it necessary (don't know if I go to see 2 different surgeons or how that works) --pre-authorization through insurance. I've read about many people having to do different tests, doing a diet, etc... Could that still be my case even if insurance didn't tell me over the …

My work has open enrollment right now for FSA and I am thinking about signing up for it for my co-pays and medications during this process. My orientation class for surgery is next week so I'm not planning to make any decisions till after that. I do have a couple questions that I'm hoping some of you can answer from personal experiences. I'm curious if any of you have use FSA during your surgery process and if so how much did you set aside/use? My FSA policy says it will cover vitamins and supplements if I can get a letter from my doctor stating that it's a medical necessity. Have any of you done this or had a hard time getting this letter from your doctor? Thank y…

Hello: I'm considering gastric bypass. My insurance is changing effective 12/1/16 to Blue Cross Blue Shield Massachusetts PPO. I know that bariatric surgery is covered, but I cannot tell what the requirements will be. Anybody know? Thanks for your help. I'd like to know now, but if nobody knows, I can find out for sure once I get my insurance card. Thanks. Sue

Has anyone gotten approved for surgery with aetna ins primary and medicaid secondary? The aetna which is primary does not cover bariatric surgery?

Ok....since I am self pay for surgery, I am looking for assistance in the total cost. My insurance through work has WLS specifically excluded. However, I can purchase supplemental Hospital Indemnity insurance which is suppose to cover services not covered in my group health coverage. This is suppose to cut some costs of the hospital stay and even surgery costs. Has anybody done this and was it a substantial savings? Sent from my SM-G920V using the BariatricPal App

I have geha but I'm contemplating getting fepblue because of the 6 month geha requirement. Fep blue is three months, should I switch?? Sent from my iPhone using the BariatricPal App

Has anyone used Dr. Dominguez in Covington, Louisiana ? Can you tell me about your appointments, surgery, etc. Has anyone used Medicaid? Did you have any bills after? Just curious I have my consultation onSeptember 29th. Sent from my SAMSUNG-SM-G891A using the BariatricPal App