Insurance & Financing

I currently have united health care and they cover the surgery but there is a 6 month wait as you all know. My job is going through some changes and we have open enrollment coming up to choose health care insurance. What other company covers sleeve surgery and doesn't have such a long wait? By the time I reach the 6 month mark I may not be able to take off to get the surgery. Any advice? Sent from my iPhone using the BariatricPal App

My surgery is tomorrow, Nov 4th and I still have a pending case. It's been nothing but hell the last two weeks, between miscommunication with Bariatric Resource Services and UHC, missing paperwork and dozens of phone calls I still have no answers. BRS said they would have a decision by the end of today, but never heard anything back. Then my surgery center told me they never received medical clearance from my doctor. It's so stressful and I'm on the verge of tears because this should have been figured out WEEKS ago. Ughhhhhhhhhhhhhhhh.

Sorry this is so long. :-( I'm just starting my journey but wanted to just get this out. My BMI was 40.3 at my initial consultation. I want this, but I'm stressing about the thought of my BMI dropping below 40 and being denied by my insurance. I have to have a 40 BMI, do 3 months weight management, a nutritionist visit, 2 year weight history and. Psychologist appointment for my insurance qualifications. So the earliest my case will be submitted to insurance is October. I have health issues but none that qualify according to their list of co-morbidities. One member of the staff at the surgeons office said don't gain anything or you may have an issue with your insurance. …

After all the paperwork waiting and getting approved I try to do the right thing and let my supervisor know now they want to tell me to wait to January to have the surgery will remind me I work for the hospital so I'm told that November and December is not a good time at the hospital well I'm looking out for my health I am a PCT Tech so in order to take care of patients in the hospital I need to be trying to take care of myself and by me waiting to January my benefits we'll go back to the same I will have higher payment to pay out when I only have 2,900 to pay out now.... I still went own and files for my FMLA hoping I get approved I am so frustrated now. Because if I wai…

I have a surgery scheduled!!! And I was so excited until I talked to the financial person....... However I am confused. She told me they take what is left on the deductible and add it to the amount left for out of pocket maximum and that's how much I have to pay for the surgery. Isn't out of pocket maximum, just that..... Maximum? Well, my deductible is $3000 and my oop is $6000, they want me to pay $5700. I spoke with my insurance and they said the deductible counts. I've dealt with insurance billing for over 10 years and that was my understanding. I didn't think to ask because I was just overwhelmed with the whole day today. But you bet I'll be calling tomorrow. …

Hi everyone! I'm wondering if anyone has any experience dealing with CDPHP? I did a search on it, and there was only one person dealing with a denial and appeal. Was just wondering if anyone had dealt with this company before!

I'm new on here, but I've been following religiously. I've gotten a lot of great information from you all! The frustration is REAL! I'm 48, my BMI is 35.2. I have HBP. high cholesterol. GERD. and degenerative disc disease with scoliosis. My insurance (MVP) (I'm in NY) covers bariatric surgery. The insurance denied me because they said my BP was controlled on Sept 9,2016, and so was my cholesterol. For a year straight, my primary doctor has written that my BP is poorly controlled. I went back to her again a week ago, and she wrote me a letter of medical necessity.(not sure why they didn't ask for this before they submitted my paperwork) My BP was again high, so she adde…

Hey weight loss buddies! I wondered if anyone has found themselves in a similar situation as myself. I meet the requirements for bcbs to cover my surgery. My bmi is 36.7 and I have sleep apnea with cpap machine. I am currently on month 2 of my 6 month supervised diet, but I calculated if I lose more than 6 lbs over the course of the 6 months, I will no longer be at the required 35 bmi. But also, insurance wants to see I can follow a plan and lise some weight beforehand. I feel like this is a real catch 22. Any thoughts? Sent from my SM-J700T using the BariatricPal App

I'm in the process of converting my band to sleeve. I have (hopefully my last) appointment with my surgeon on 11/18. I have an echo scheduled for the 3rd. So here's my question, my left foot/ankle has been bothering my for about 8 months now. I've been putting off getting it checked feeling that maybe it was weight related. I've finally gotten to the point where I want to get it checked out because it's getting worse and inhibiting my life. But I'm worried if I go for an MRI insurance might not want to pay for the surgery. I know it may be irrational, but I'm concerned. Do you think anything will inhibit their decision. I have Empire Blue Cross Blue Shield. …

Trying not to stress. I had my pre-op yesterday and it was all systems go for December. Today they tell me they must drop me as a client because I have Medicare as a secondary insurance carrier. Has anyone else run into this? What did it take to get into another program/surgeon? Pre-op, 61 YRS, 5'5" HW 247, CW 223, BMI 37

Does anyone know anything about the new Medicaid and which plan is best for the sleeve surgery? I'm not sure of which one I should choose...does anyone have louisiana Medicaid if so which plan did u choose and what are the requirments for surgery.

File was submitted to BCBS Federal on October 12th; approved on October 28th; and surgeon scheduled me for Dec 1st!! Sent from my XT1585 using the BariatricPal App

I have gateway and I wondering what your exprience was with this insurance provider. I know we have an 6 month diet period and they must approve. What's my chances of apporoval ? What's was your exprience with this provider like? I'm 5'8 280 Bmi of 42 I have cornic joint pain I MOST likely have sleep apnea (sleep study next week) Thank you

Hello! I have IIH and my Neuro and Neurosurgeon is trying to get BCBS to bypass 6 month diet so, the surgery can be sooner. I am losing my vision and they think that the surgery will cure me so, I do not have to have brain surgery. Has anyone been able to bypss the diet?

I was shocked that my surgeon charged $50,000. Insurance immediately paid $40,000. There is $10K pending, hopefully they will work that out. I'm pretty sure I heard my hospital was charging non-covered patients $27,500. So I wonder whats up with that. I was in the hospital overnight which is the typical stay.

Once approved by insurance, how long did it take to get your surgery scheduled? I know every place is different just wanting to get some parameters. Thanks in advance! Sent from my SM-G928T using the BariatricPal App

I already had my sleeve surgery. I got a "preauthorization" from my insurance (Blue cross/blue shield of TX) for medical necessity (over BMI 40). I just got all the EOBs and every single one of them was denied. When I called the insurance they said that the "insurance" may have approved it, the "plan" didn't as they don't cover Bariatric surgery. He said I should appeal but because employer has that clause it's going to be a tough fight. Any information you can provide on what to include (or exclude) in the appeal would be great. I've not gotten a response from the doctors office (except surprise), so I think a peer to peer review is out. Sent from my iPhone using…

So.. I'm looking to switch to federal Bcbs. I know hey have a required 3 month supervised weight loss program. If I had been seeing my doctor about the weight loss previous to having bcbs, would they allow me to count that as the three months? Or would I need to wait until im covered by that insurance and then start the three months? Sent from my iPhone using the BariatricPal App

Did anyone have surgery done with Tricare insurance? Just starting the process now. Sent from my SM-N920T using the BariatricPal App

Anyone from Gainesville Florida or having their surgery in gvlle and has bc/bs? How do i find out if my insurance will pay for it or not? Sent from my iPhone using the BariatricPal App

After waiting for months, I am waiting for insurance to approve. I have bcbs of MN. They approved the whole surgery but denied the long band. The doctor said that the long band may not be needed but sent in to get it approved. They said the band is to experimental for gastric bypass. So now I have to pay $1800 to get my surgery approved. Anyone else have this problem? Sent from my iPhone using the BariatricPal App

Wondering how long it took them to approve your surgery?

Hello I had my surgery done two years ago and meet the requirements through a army hospital. At time of surgery I loss weight and was down to a BMI of 33.8 and I had two co morbidities. Fast forward to today and I need a revision because my sleeved failed( doctors error). Tricare denied me and my appeal because I don't meet the civilian standards from my original surgery. I meet them now though but because at the time of surgery I was under BMI. I am going to do an external appeal because I need a revision. Any help on what I can do or add to my appeal would be great. Also if you had an external appeal with Tricare could you let me know how the process was! Thanks

I have been to 2 weight loss clinics and decided on 1. They were horrible and I finished all of my requirements but I just couldn't deal with the way myself and others were treated so I switched to a different place and I love it. My problem is that the new place I am going through is stating that my insurance requires medically supervised diet which I thought I went to with a registered dietitian at the old place and even some with my pcp. I'm going crazy over this because I have all my other requirements completed. When I spoke with blue shield they have told me that it could be with a registered dietitian and it will still count. I've asked them to submit to insurance …

So, I called BCBS on my way to work this morning (Well, yesterday morning, Wednesday). I got denied. They said the only reason was that they didn't have proof of where I've been compliant with diet and exercise after my Lapband surgery. I then called my surgeons office and the RN, Helen, that deals with insurance stuff said she is aware, she already received the denial. She said she feels I've been very compliant and is going to review my file again. Then she said she'll decide whether she will request them to reconsider, or whether to have Dr. Miles himself do a peer to peer review.. I'm bummed... But trying to stay in good spirits that it will all work out in the end. H…

Anyone here from CA? Kern County area? I'm waiting to hear from Kern Family Health. Dont know their time frame. It's going on 2 weeks only, but the waiting is difficult.

I know this is a depends question but how long did it take for your insurance to approve surgery. Sent from my SM-G920P using the BariatricPal App

I've waited over a year to be able to write one of these posts. So without further adieu, I am happy to announce that I have been approved for the VSG. I am so happy that I can't even focus at work!!! Cheers to 2016 and a new healthy lifestyle. Thank God for blessing me with this opportunity. Thanks to insurance for approving me and my surgeon for having faith that I will do well. Eeeeeek! ❤️❤️❤️❤️❤️

OK so I was denied a lap band to sleeve revision by BCBS MN due to no issues (slip, erosion, etc) with my lap band. ???? Have had the lap band for 9 years, did OK at first, then a lot of obstruction issues. Surgeon consultation, EGD, NUT, psych evaluation all completed. My hubby is joining Navy and we will be switching to Tricare in December. What are my chances on getting approved thru them? Will I have to start process all over? #tryingtostaypositive Sent from my SM-G930V using the BariatricPal App

I am posting this here hoping that I can help someone else. I am self employed and live in Illinois. I purchased a plan on the healthcare exchange, BCBSIL PPO. When I selected a plan I purposely selected one that covered bariatric surgery. Timeline Informational Attendance 4/28 Appt with Surgeon 5/18 Appt with NUT and psychiatrist 6/8 Submitted to Insurance 6/10 Approved by insurance 6/22 Surgery Date 7/15 Surgery is covered 100% after meeting deductible, which was easy to meet doing the pre-op testing!

I have a bmi of 44 as well as hypothyroidism, depression and sleep paralysis I'm wondering will this qualify me for surgery? Sent from my SM-G530T using the BariatricPal App

I called bcbs of IL today and they said they approved and generated my approval letter today. Does anyone know how long it usually takes to receive that? I don't think my surgeon will schedule me until I have the actual letter. Sent from my iPhone using the BariatricPal App

Not sure if anyone on here has bcbsil HMO that can answer this - but the medical policy has THIS tucked into it toward the end, and I'm wondering if anyone else also interprets this to mean that there is no longer a requirement for medically supervised diet? 2011 Update Patient Selection Criteria for Coverage A requirement that a candidate for bariatric surgery complete a formal, medically supervised weight loss programs of specified duration has been a fixture of HCSC bariatric surgery medical policy for some time. The rationale for this requirement was founded on review and interpretation of available evidence in the scientific medical literature, primarily na…

Im just starting the process. I had my psych eval and nutrition consult today. I have to have a supervised diet for 90 days. So it looks like best case scenario surgery will be in mid to late Jan. A couple of concerns questions I have: 1) my BMI was 38.5 and I haven't got my sleep study results back yet. I am praying I have sleep apnea for the sake of qualifying with insurance! (Not too mention a lot of problems can have potential to improve if we know the source of the problem! 2) sleeve or RYX (am I abbreviating that right?!) I like the lesser invasive thought of the sleeve but hear that makes reflux worse. I have enough already! Plus the results are bette…

Well, everything over the last three months in regards to my procedure went off without a hitch. From one appointment to the next, everything went smoothly. So, I'm at my last preop appointment and they tell me my out of pocket expenses that need to be paid before my procedure and killed my whole vibe. I won't be discouraged that easily though. 3 weeks to come up with the money! Sent from my iPhone using the BariatricPal App

Hi guys!! So I received the dreaded denial. My doctor and I sent in an appeal so now I wait, again. I know the time frame is 30 days, but what is your experience with appeal time frame before you are notified? Also, I would like to how many were approved or denied after an appeal. I look forward to hearing from each of you.

Hello all, I have aetna insurance and when I started my journey I weighed in at 233 first app. I was under until the last two. I went up to 238. I have one more app till they submit paperwork and currently at 229 so I'll definitely be under my starting weight but I'm wondering how they look at net gain My doc said it's first weight to last so I should be fine..but I'm paranoid. Anyone experience gain but then lost it by the last app. Sent from my SM-G935T using the BariatricPal App

My Co-pay of $0 deductible of $800 Met $800 Co-insurance 20% Out of Pocket Maximum $3300 Met $1729.11 Policy pays at 100% once the deductible and Out of Pocket have been met in full So is the $1729.11 is what I would have to pay out of Pocket. I am trying for Dec for surgery

Does anyone living in Texas have an individual health plan that covers bariatric surgery?

Make me really upset that people with Medicaid and Medicare pay less than the people who work Hard with insurance !!! System all messed up. Sent from my SM-G928T using the BariatricPal App

Does anyone have partnership in California? Sent from my SM-G935T using the BariatricPal App

Hello all, I have just recently begun researching the different bariatric options for weight loss. I am currently the heaviest I have ever been. I am 197 and a little under 5'2". This puts my BMI right at 37. I realize that is not super high, though I'm curious about the comorbid thing. I have disc degeneration and a herniated disc, so I had to have 360 lumbar fusion surgery 2 years ago. Also, after my last pregnancy 4 years ago, I developed a stress on my heart, which has now led to lifetime medication to keep blood pressure in check. My yearly echos show my heart is doing fine and shows no abnormality, but every time we try to get off the meds, my blood pressur…

Arthritis? Sent from my SM-N920V using the BariatricPal App

Heeyyyyyy my first post (im a bit of a lurker)! So this is month 2 of my 6 month process. Ive had the initial class and meeting with the surgeon and my first nutrition class in September. The 2nd one is next week. 2 questions 1: Do i have to schedule all the tests and stuff myself--stress test, ekg, upper gastro, psych, etc during these 6 months? 2: If my 6 month process ends in February does that mean (barring any complications with insurance) i could have my surgery in march? Thanks for the help! ~chan Sent from my SM-N920T using the BariatricPal App

Has anyone got the surgery with Ga Medicaid? What was out of pocket costs? I was told dietician 100.00, psychological 300.00. what about EGD?

Wow I just got the bill from hospital and Dr. for RNY. Total was over $52,000.00 Even with insurance this is a huge pocket shock. Is this in line with what others are seeing?

Has anyone had this issue where you treating counselor does not want state in the letter that she is clearing me for surgery???? This is the last step and I am frustrated that they might think I'm not a good candidate!! I'm morbid obese and have been preparing myself for this surgery!!! I have done research took a while to convince myself that I wanted to proceed with gastric bypass!! Any suggestions?? The last resort is my surgeon Doctor is going to talk to my treating counselor and see if he can convince her other wise I'm shyt out of luck I think or might have to find somebody else to clear me. Sent from my iPad using the BariatricPal App

I wanted to find out if you can have GI issues and still qualify for a bypass or sleeve?My stomach digest slow for the first hour and after that my food digest fine.But I'm scared when I meet my surgeon they will say I can't do should I be freaking out or still think positive about it ?My GI Doctor got me feeling like this because he said it may be an issue .But you can have congestive heart failure and still qualify. Sent from my iPhone using the BariatricPal App

Hello all, Are there any self pay patients whose insurance covered the pre Op procedures such as endoscopy? Sent from my SM-G928T using the BariatricPal App

My dr said just a few short days. How long did it take for others? Sent from my SM-G935P using the BariatricPal App