Insurance & Financing

I am so disappointed! I was denied! I have Blue Shield of California and I guess one of their requirements is to be one a weight loss medication for at least one year. My primary Dr had at one time tried to find me one that didn’t interact with my antidepressants but couldn’t find one and so he said I can’t take them. The surgeons office said if I get documentation of this they will turn it in with an appeal. Has this ever happened to anyone where an appeal got them approved?

I brought my cigna policy for my surgeon to read and it cleary stated that there were no 6 or 12 month long documentation of failed weight loss attempts required. My surgeon called the insurance coordinator and she says in her past experience of working with Cigna they require 12 months of failed WL attempts. There is NOTHING of this mentioned on the cigna requirements. I really don't need anything slowing down my process. Did anyone else run into this issue with cigna and getting approval?

Hi, I am new to this and I think my Doctor is as well. I saw my DR. and we discussed weight loss surgery. He told me to contact my insurance (Molina) and find out which clinic(s) I can go through. I did that. I then went to a meeting with the clinic closest to where I live. I filled out all of their info only to be told I needed to have my DR. send a certain paper, they attached it to an email and sent it to me. I gave my DR. the paperwork, and I followed up to make sure he sent it in. Essentially that paper was step 1 so I could get approval for step 2. ( Step 2 is connecting with the dietician and doing the weigh-ins for the next 6 months) Step 3 is the ac…

Hello! Semi-new here, just starting my journey and trying to get everything situated as much as possible. I am starting my journey in January after I choose/enroll in my job's insurance in October. I know the basic coverages for each insurance plan they offer, and (thankfully) they all offer bariatric coverage. I am having a hard time deciding on which to go with as I know they all have their own specific criteria. I am not having the best of luck getting further information on specifics from neither my workplace or the insurance companies on any specifics and they are both blaming the other party (my job stating the insurance company will have more info/insurance co…

My employer insurance has no bariatric coverage. My husbands employer insurance which I am covered does cover it all.

Anyone have partnership health plan ) weight loss surgery ?

Just curious if insurance will cover you if they want to do a revision from a sleeve to a bypass. 18 months out no weight gain buy having unbelievable GERD affecting my health.

I've pretty much decided I want to have the gastric sleeve. Now that that's settled I'm ready. I was already approved by Weight Loss Team in Mexico and It's $4200 including hotel stay in puerto vallarta. and I can schedule as soon as possible. I also found out my insurance covers it if I want to do it in the USA and my maximum out of pocket will be $6000 for the mayo clinic in Jacksonville, FL. The US one is $1800 more and they will make me go through the 3 to 6 months nutritional and dr. supervised, etc. I'm impatient, I don't want to wait the 6 months. I Also think the drs. in Mexico will do a better job because they do more procedures. On the other ha…

Hi Everyone! I'm new to this forum and just beginning the process for WLS. My husband and I are both researching this for the coming year. Has anyone gone through SurgeryPlus concierge and wouldn't mind sharing your opinion? I have coverage through Anthem, but my company requires the use of SurgeryPlus specifically for bariatric surgery. The deductibles and procedure costs are waived, which is great. But...I haven't found many reviews for SurgeryPlus and I'm feeling anxious. I have to choose a surgeon from their network as well. Thank you in advance!

Hi anyone have sunshine health in Florida? I am going to pre-op stuff currently, getting stuff ready to hand in to insurance for pre authorization. Wondering how it went

I am currently pre-op with Sunshine Health insurance (Medicaid). Wondering if anyone has gone through the pre authorization process with them. When we’ve called to find out criteria for authorization they say they don’t have any. Finally after several calls asking this question I was told as long as your Dr/surgeon says it’s necessary they will approve. Any info will help.

Waiting on approval sucks!

I’m just posting this for posterity because I couldn’t find any relevant or recent information on my insurance NYS Fidelis/ Medicaid. It would’ve been nice to have a first hand point of reference. To start, the entire process has been a breeze. From the beginning: - They do not require a referral from your primary care but you will need a letter of support towards the end of your program. Meaning, you WILL need a primary care doctor that can get you in to do a pre-op assessment etc, towards the end of your program (that may just be my doctors requirements though.) - They require 3 bariatric doctor visits, 2 visits with a dietician, 1 visit with a bariatric psy…

Hello! I have attended my seminar and scheduled my initial consultation at Bailey Bariatric in Owasso, OK and the insurance verification called to say that the insurance will pay but mentioned something about 4 months, but said something about that being the average time it takes to get through the pre-op appointments. Does anyone know if this is a required 4 month waiting period through HealthChoice or if this was just an estimate. I also have a secondary insurance that will cover the expenses but I won't have it for much longer so I was kind of hoping to get the surgery done before the end of the year, but I am guessing that won't happen. any insight would h…

Now I'm just waiting on the Nurse to call and schedule things..

Anyone get approved from Anthem Blue choice open access PPO?

If I am required to see a therapist, then I want to actually get some benefit out of it instead of just randomly choosing a therapist. Does anyone have a therapist they recommend that: Accepts insurance Specializes in Eating Disorders and Bariatric patients Does sessions via Zoom/Teams/etc? Thanks!

Hey there! First time poster, so appreciate any insight. I’m wondering if anyone has had luck getting an exception from their insurance when their employer requires 36 months of employment. I’m at two years currently, but am anxious to get vsg sooner rather than later. Has anyone tried getting an exception? What did that look like for you and were you approved? My health advocate with BCBS TX said to have my provider submit with the pre-Auth why it is medically necessary to have the surgery now. I have a bmi over 50 and sleep apnea. I hope that is enough to get the pre-auth. I’ve also already done a lot of the surgery approval work, like diet and medication, EGD, etc. Any…

Has anyone been denied because your BMI was not 40, 1 year prior? My BMI is 46 now with two co morbidity that I am getting treatment for but BCBS federal is denying me because a year ago it was only 38.6 and I was only pre diabetic. Just wanting to know if anyone else experienced this!

I was cleared two months ago with all my tricare select insurance requirements and labs but Now my doctor’s office told me that tricare requieres an audit of my record and probably take long time with tricare. Whattt???? That is pre authorization? I’m very confused!!!!

Can you call the insurance company to see if you got approved

Hello! Does anyone have this insurance and can divulge more info about criteria/out of pocket expenses during the process? Looking into getting GB but need more info before hand - thanks!

According to the benefits brochure in the bariatric surgery section an "individual with a BMI of 35 or more with one or more comorbidities" is eligible for the procedures listed. What are the specific comorbidities have you been approved with if you had a BMI between 35-40. I have had documented high cholesterol in the last year, but I am not sure it is enough. I am currently at a BMI over 40, but that was only documented at a doc visit in May, I've been over 35 for years though. Additionally, were you required to show "Evidence that attempts at weight loss in the 1-year period prior to surgery have been ineffective". Has anyone used their data from Peloton classes?…

I just wanted to share... I have finally gotten my insurance to approve surgery after months of trying. At times, I really wanted to give up because each time I completed what they asked they would come up with something else that needed to be done. I am so pleased that they are now on board and I can get a surgery date! The coordinator at my doctors office should be calling me on Monday to schedule my date. ?

How long does it take to get approved. After the Dr. has sent it to insurance company.

Anyone use Medicare primary and Tricare for Life as secondary? Not sure if Tricare for Life has different quals as Tricare Prime or Select. Do not see any problem with both funding the procedure, just trying to deterime a time line of requirements. Do either or both require a set 3-6 month "controlled medical diet" prior to the surgery? Not impatient, just ready to get this done this fall. Thanks.

My insurance doesn’t cover WLS. I am making arrangements to be able to pay out of pocket and started the process at Duke in NC but then the surgeon said she wouldn’t do the surgery since my insurance wouldn’t cover the surgery due to risk of complication and high medical bills. Has anyone else experienced this??? I have an appointment with WakeMed BARIATRICS on May 10th, I explained to them what happened at Duke and they seemed surprised by it and said they except self pay. I am just terrified that I am going to be be crushed again for the 2nd time in 3 weeks and don’t know if I can take it. Any advice??? I have checked in to ACA insurances and multiple agents said non…

Hello all! I was wondering what insurance in Arkansas covers weight loss surgery? I do have Arkansas Works through Blue Cross Blue Shield, which is funded by Arkansas Medicaid. I’ve been told by different hospitals that it doesn’t cover weight loss surgery. But I also chose this plan because I was told over the phone it paid for the vertical sleeve. I’ve researched a million different types of insurance, and been told a million different things. I fit all the criteria, and have the weight loss attempts documented. I’ve seen a therapist, nutritionist, and have a letter from a surgeon saying I could benefit from the surgery, which is all the conditions of BCBS. I’ve dam…

I just started my journey and have 6 months of Dr appointments, evals, and nutritional counseling before I can get approved by insurance. Bariatric surgery is covered by my insurer. I am scared as hell that I will go through all of this and still not get approved ?. Is it common to get denied?

Hello everyone. I’m currently in the process, actually nearing the end, of the pre-op insurance requirements. I just received an “INITIAL ADVERSE DETERMINATION DENIAL NOTICE” from Fidelis regarding the REQUIRED medical nutrition therapy appointments (that I already went to). So my first question is WHY, WHY would they make this a requirement in order to be approved for surgery BUT not cover it? My second question is, has anyone had any luck getting it appealed? Thankfully, I have the funds to pay for it if I need to but my assumption is that maybe there is others that have Fidelis/Medicaid that can’t afford it. It’s such an odd policy.

I have MO Medicaid. Specifically Healthy Blue. Anyone with the same know how long the approval process takes? From first appointment to surgery. Also, any specific wacky things they request before approval. I have my first appointment next month. Just trying to get an idea of the time line.

Hey all! Been off of here for a while but I'm successfully maintaining so I went for a plastics consult. He is recommending an extended tummy tuck with liposuction of the flanks and muscle repair. Obviously, no insurance will cover all of that but I'm curious if anyone has had luck with BCBS Federal (Basic Option) approving that portion. Thanks!

My packet will be submitted to CIGNA next week. I have Open Access Plan, and my surgeon’s practice is a Cigna Center For Excellence. Has anyone been denied despite meeting every criteria/co-morbidities articulated by the insurer? Just curious. Thanks.

I know all insurances are different but wondering if anyone has guidance. I’m in Florida but have BCBS Texas. I have a BMI of 40.6. I can’t seem to get an answer to whether or not I lose procedure coverage if I lose weight on the preop diet and my bmi drops before 40. I’ve called my insurance twice, and reviewed the plan documents. Incidentally the plan documents do not require a diet at all preop. The insurers I’ve spoken to just recommend reviewing the documents but say they can provide no more guidance at this time. What should my next step be? If I don’t lose any weight on the preop diet is that an issue?

Help. Me. I currently have insurance through my husband's work but they have wls specifically excluded so I am looking to change my insurance when open enrollment comes up again. I have been trying to research what insurance companies and plans cover wls and have been spiraling down a black hole since. EVERY plan I have seen says that wls is excluded. I called BCBSTX and the lady said that all of their plans cover it if it is medically necessary but all the their plans online show it under exclusions. ?‍♀️ So I guess I am trying to find out, if you live in Texas, what insurance company and plan did you use to get an approval for wls? Or do you know of any resou…

I am finally to the point where I am just waiting for the approval from my insurance. I have bcbstx and the request was just sent in yesterday so I'm sure I'm in for a little bit of a wait. I am beyond excited. I hope this is a smooth and quick process. If all goes well my surgery date will be July 27th. Wish me luck!

Ok, so my husband started a remote job in Oklahoma where we live. The job is based in California. They are going to get us set up with Anthem-BCBS, somehow, although Anthem doesn't show that coverage is here. I guess my question is has anyone been in my situation? How will it go as far as getting approved for Gastric Bypass? Thanks! Malinda

I'm just wondering if anyone has it and what the process is?

Does anyone have any experience with United healthcare Optum program? They require a 5 year BMI of obesity, but are unable to give me a more specific answer of what they consider an acceptable BMI >30? >35? >40? It's very frustrating because it will determine if I'm covered or not. If anyone has some insight please let me know, I'm considering switching insurance if it's going to disqualify me.

I have Cigna and they do not just say on our ins that they cover bariatric surgery. There is a part that says you may be covered if your bmi is 40 or over and a couple other things. I have done all required and waiting on ins. Any one have ins anything like that and still got the go ahead?

I just got approved for nj familycare I chose the horizon hmo program.. Just wondering if anybody knows if they cover the gastric sleeve. Pretty sure it falls under Medicaid. I am too confused with this!

I am just starting the process at 48 years old. I tried when i was in my late 20's, fought hard, got an approval and then chicken out as my babies were all little. Now here I am again. I don't have my consult until March so i wanted to start thinking ahead. Regarding Anthem Blue Cross, am I going to have a documented supervised weight loss plan on record or can i just document my attempts at diets like 'keto';etc? If i do have to document, is doing Weight Watchers through the App sufficient? Any advice anyone can give me is great. My BMI is 59.

Good day everyone I am interested to know if anyone in here did surgery on Florida Medicaid if so can you inform me of the process.

Hello all, To anyone that lives in South Carolina, I'm looking for any insurance plans that cover bariatric surgery. From the research that I've done, I haven't found any that do. I don't qualify for any Medicaid plans, so I'm not sure what my options are at this point besides either paying out of pocket (which is a last resort possibility) or going outside the country. Any help regarding finding any insurance plan that could cover bariatric surgery or a way to get my current healthcare provider (BCBS South Carolina) to somehow cover my surgery is appreciated. Thank you.

I have Arkansas Medicaid and I am looking for a specialist in Arkansas that would accept my insurance (Medicaid) to cover gastric sleeve or bypass.

Has anyone used AL Medicaid for surgery? What was your experience? Any hints or tips?

I was told this morning that I was denied because the co-morbidity I have isn't "severe enough". My BMI is 37, and I have sleep apnea. I also have Rheumatoid Arthritis and Fibromyalgia (Which I know they don't consider). I have been not been able to lose more than 20 pounds in over 20 years. I need to lose roughly 80lbs. There is a "peer review" today with my doctor and the insurance company. Has anyone had it overturned by this action? I'm devastated.

Hey everyone! I'm sure there are many posts on here for revision but I'm in need of some help. I'm 7 years out of VSG surgery and am embarrassed to say I've gained everything back. The only excuse I have is life got in the way. I've been in touch with my surgeon and have been discussing revision surgery. My issue is, I do not have the same insurance (Aetna) now that I did when I had my original surgery. I'm having a hard time finding an insurance that will cover a revision. My current employers' plan does not even remotely cover anything bariatric wise so I'm hoping you fine people can give me some info of where I can turn. I thought I found a decent multiplan but I…

Hi! This is my first time ever doing this so bare with me! I started my process with trying to get bariatric surgery officially April 2021! My first meeting with the doctor is on May 7th 2021. I’ve done all of my pre op tests that are required for me to meet the doctor and I’ve done my nutritionist appointment ( I have independence blue cross ppo, not too many requirements with this insurance). I am very nervous because one of the requirements I have to provide for weight loss surgery is medically supervised documented weight loss attempts. I’m only 21 years old and tbh the job I’ve had now is my first full time job and before that I didn’t have ins…

Hi, wanted to see if anyone has gone through blue shield of CA PPO process. After years of dieting with little sucess, I am seriously thinking about getting the gastric sleeve done. But I'm afraid I won't qualify...I am right at a 35 BMI. So wanted to connect with other people that have tried to get qualifed with this insurance. Otherwise, I do think my alternative would be to go to Mexico. Thanks!