Insurance & Financing

Has anyone had trouble getting resleeved? Sent from my iPhone using the BariatricPal App

I am approaching the 4th month check in with my nutritionist. The first month was the check in, the second month I lost 4 pounds, but the 3rd month I stayed the same. This month I have lost 5 pounds. Will the fact that I didn't lose weight the 3rd month but stayed the same effect insurance approval? I must lose a minimum of 20 pounds by the first week of December. Sent from my SGH-T399N using the BariatricPal App

Ugh!! When I started the process my hospital called the insurance company to find out what I needed to do. I was told 6 nutritionist visits. Since they did not specify months or just visits I emailed UHC and asked. I had to take 12 weeks of group therapy for the hospital and the first week of the month was with the nutritionist in group. So would one group visit a month plus a one on one visit count? I have an email confirmation from UHC that as long as it's coded nutritionist for group, which it is, that 2 visits a month would be fine. Now the hospital contacted me and said I need to do 2 more months of visits. Has anybody had this happen and fought it? Sent from my XT…

So i have Highmark, BCBS insurance and i'm in PA. My surgery is slated for sometime in mid-January, this is my third almost fourth month of supervised PCP weight loss/exercise. My question is, how soon after will i have to pay my deductible for surgery? I've already paid my co-pays for doctor's visits and for my pre-op testing. My workplace offers a payment program loaded onto a credit card that is deducted from your paycheck, in manageable amounts every pay, i was thinking of taking advantage of that. Anyone know when actual surgery payments begin after surgery?

Everything is being turned into insurance today!!! Those with Blue cross, how long did it take to hear if you were approved? I have heard blue cross is fairly quick! Sent from my iPhone using the BariatricPal App

I have BCBS -OH and my daughter and I both are in our 4th month of the supervised diet. She is 22 with a bmi of 40 with asthma. I am 49 with a bmi of 36 with degenerative disc disease (fusion surgery)back pain, arthritis,sleep apnea (home test tomorrow to find out if its considered mild or severe) dvt, gallbladder removed due to gallbladder disease. I know these are not severe comobibtities which is why I'm concerned. Has anyone ever had their insurance approve 2 family members at the same time ? We really hope to be going through this journey together. Sent from my SM-N920V using the BariatricPal App

I have struggled with my weight my entire life. 3 years ago I hit my breaking point when I weighed in at 290 [44 BMI]. I'm 5'8. My PCP recommended WLS but I was too scared and was convinced that I didn't need it. Well, 3 years later and now I'm begging for it. No matter what I do, I can't seem to stay below 200. I was able to get to 190 with starvation and ridiculous amounts of cardio, but of course as soon as I reintroduced food, it came back. I've tried every diet under the sun. 3 rounds of nutrisystem, herbalife, Meal Replacements, medically supervised diets, HCG, and my PCP even had me on phentermine for a while. Over the past year I went from 190lbs to 212lbs and no…

Hello and I am a college student who is looking to start working overseas in China or South Korea. I have been wanting to get gastric sleeve for about a year, and I have medical assistance that allows for me to have bariatric surgery. However I want to start working early 2017 and I want to do the surgery now but my insurance guidelines is for me to have weight loss program or nutrition counseling 6 months before the surgery. Is there a way where I can file an appeal to my insurance company and show proof that I will work next year abroad so can expedite the process for gastric sleeve surgery. Thank you so much for your input. Feel free to post anything.

I was just told today that I have to pay the hospital inpatient copay amount of $250...ok, kinda last minute but I knew there would be something.... Then I was told that $250 is for the inpatient at the hospital but my surgeon also expects $250...WTH? Is that possible, I've never heard of having to pay 2 copays for one procedure. I pay my copay for the office visit, I don't then in turn pay the MA who does my blood work or the Dr. that diagnoses me. I honestly wouldn't care what they wanted if my surgery wasn't on 4/23 and they are wanting these amounts paid by 4/16. That's kinda last minute to just hear about this now after the entire 8 months and finally getting…

Hello, I am new here. I have an appointment 9/29/16 to begin the process of RNY surgery. I have BCBSIL through my husband's employer UPS. They advise that BCBSIL will only speak to the provider to give requirements and that they follow the BCBSIL guidelines for WLS. My question is if anyone has used BCBSIL insurance through UPS (team care central states plan U2) where you required to do a six month weight loss program and was there a specific number of years of weights that have to be documented?

Got the call about a half hour ago, and I've been approved for surgery! It's scheduled for October 27, 2016, and I am completely over the moon about it. One week liquid diet beforehand. Damn but I'm feeling giddy right now. Sent from my iPhone using the BariatricPal App

I've completed everything that the office ask of me in about three months now I'm trying to figure out what's next or is this the part where I just have to wait for a response back from my insurance can someone help me out on what's next I live in Philadelphia and I have Medicare insurance. Thanks Sent from my iPhone using the BariatricPal App

Was denied because I didn't have 6 months weight ins my surgery was suppose to be july 25th now i have to wait until September.[emoji20] [emoji20]

Hi Everyone I'm new here. I'm in the process of being approved for Gastric Sleeve Surgery. I have been through a multitude of tests lung, heart, psychiatric, etc... All of the docs I've seen feel I need the surgery. Here's the issue... my current bmi is 38.57 so my insurance is saying they won't cover my surgery. I do have "co-morbidities" asthma, high cholesterol, lupus, heart murmur, reflux and a few others. These are not on the insurance company's approved "list". As of right now... my option is to try to gain 10 pounds to get my bmi to 40 or fight the ins co. Had anyone been in a similar situation? Looking for support or suggestions. Thanks!

I wanted to know how was the process with this insurance it is Medicaid....hoping when it is time for them to submit my paperwork I will get Approved

My husband and I will be relocating to the Charlotte, North Carolina area. I will be getting insurance when I get there. Can anyone give me some info about the process I need to go through in order to get gastric sleeve surgery approved. I live in Florida and insurance will not pay for it at all. Thanks for your help!

I received a call Tuesday from my surgeons office saying everything has been submitted and has scheduled a date for Oct. 3rd For my sleeve. Why would she give me a date before approval? I have Humana CareSource, TN. (Medicaid). I men I am supper stoked and excited but scared too. What if they don't hear back by then? Sent from my SAMSUNG-SM-N910A using the BariatricPal App

So I'm going to my orientation for my gastric bypass in 2 weeks .I had an appointment with My GI Doctor and he was concerned about my stomach which digest slowly after the first hour and after that it is fine.Im overall healthy and have really bad osteoarthritis on my right knee and I will give anything to be normal and walk again .My question is that a reason to be denied for the surgery ?Im so stressed out about being denied . Sent from my iPhone using the BariatricPal App

Just heard from my Surgeon's staff today that ABS has raised the goalpost and is now requiring a TWO YEAR monitored group nutrition program before they'll approve GBS. They also say that IPA hasn't approved ANY of their requests since the first of the year. Any suggestions? I could be dead in two years, with my comorbidities combined with a BMI of nearly 50, if I don't have this surgery. Sent from my iPhone using the BariatricPal App

I'm curious to know if there's any one out there with Medicaid though Washington State who has gotten approved with disabilities aside from the top 4. I've seen an extended list for regular insurance owners,but curious if medicaid adopts some of them on a case-by-case basis. (E.g GERD, Depression, etc.) Thanks in advance!

I have talked with my insurance and have been turned down 3 times now. I weigh 550 pounds and need to get bypass or I am going to die.... I have a go fund me account gofundme.com/donsilcox Please help save my life.... thanks and God bless... Sent from my SGH-T399 using the BariatricPal App

I'm thrilled to find this forum - and am hoping someone here may have some insight. My primary insurance is Cigna, which an exclusion on bariatric surgery. Aetna is my secondary insurance and covers 100% - but will not cover any if the primary doesn't cover. I will drop my primary during Open Enrollment this upcoming November. Then, Aetna will become my primary and I will be all set. But, my question is - how can I start the three 3 month nutrition program NOW? I don't want to wait until November and THEN wait three more months if I can avoid it. I'm trying to work with the insurance coordinator at my surgeon's office but I feel like I just play phone tag with h…

Hey there! I have my group intake appt on Thursday and am worried that since I barely qualify now (bmi is 36.7 and only proven comorbidity is high cholesterol) that after I do the 6 month weight loss and other testing... If I lose weight and my bmi drops they will tell me I no longer need surgery. Have you ever heard of this happening? I know I can lose the weight already. I have before a few times but its the keeping it off long term that gets me and its getting harder every time I try. Sent from my SM-G920V using the BariatricPal App

When I had my first surgery two years ago, they approved right away. Now here it is me having a hiatal hernia you would think they would approve. They stayed due to being out of compliance with the program I caused this. Umm no! The moment I had my sleeve I had heartburn and never went away. But I did wind up pregnant 9 months after surgery due to my birth control failed. My surgeons office have submitted multiple appeals and nothing! I don't know what they want from me. Sent from my iPhone using the BariatricPal App

Our stuff should have been submitted the 8th or 9th. How long did you wait for an answer? Sent from my iPhone using the BariatricPal App

Hi, I have UMR (part of United Healthcare) and I live in NC. I have a bmi of 35 with multiple comorbidities. UMR requires a 6 month waiting period, tons of tests, and lots of hoops to qualify for sleeve surgery. Im doing everything they ask. I guess they can still turn around and deny the surgery. What can I do to keep that from happening? All this testing is going to be a good $10 grand if insurance does not pay. Plus I dont want to get everything set up just to get denied. Sent from my GT-N8013 using the BariatricPal App

I managed to make an end run around my former surgeon (lost due to stupid insurance issues), who decided he wasn't going to behave with professional courtesy and refused to send any of my records from my time with him to my new surgeon. His "solution" to his being unwilling to send those records was that I go back to him for my surgery. The problem with that, is that the insurance I have now is not part of the group he is in. I was fortunate enough to find contact information, for both the nutritionist who did my work up and the psychologist who did my work up before he attempted to get authorization for my surgery, and both were kind enough to send their reports to my …

Does anyone have this insurance? What was your experience? I had my first consultation today and the nurse practitioner told me that I have to see a nutritionist for six months,get a psych evalve and get blood work done. I thought there wasn't a supervised meal plan requirement anymore? She also said that they don't cover gastric bypass only gastric sleeve and lapband....again, I thought all 3 were covered.? I called bcbs to find out and they were clueless!

I called Aetna and they overturned my denial so in a few weeks its surgery time!! Sent from my LG-H830 using the BariatricPal App

I'm so glad I found this forum/app - I've read through a lot this past weekend. I just had my initial visit with the surgeons office and a nutritionist and have my next nut visit and my psych evaluation next month. Has anyone had experience with BCBS of TN? I'm worried that even though I have type II diabetes, I am at the bottom of the BMI range (within 3 lbs) and in looking at my past 5 years of weights at my PCP office, I was just below 35 BMI for most that time except for the past year. I guess I'm worried about denial and having to wait 5 more years!!! I've never ever been told I wasn't "big enough" before! Thanks! Sent from my iPhone using the Bariatri…

Anyone have any experience with using Premier Healths insurance??? I was just wondering how I could look up their requirements for the sleeve to be covered Sent from my iPhone using the BariatricPal App

I haven't posted too much on here especially since I was down in the dumps bc I was denied by my insurance and thought surgery would never be reality for me. Through posts on here though, I heard of lindstrom advocacy group so I contacted them and they recommended I do an external appeal of the denial with my state (NY). I just heard from Kelley Lindstrom about an hour ago that my external appeal overturned my insurance denial and they HAVE to cover my surgery! I'm so excited, anxious and just happy to have surgery as an option in my weight loss journey. I cannot recommend Lindstrom enough for anyone going through a denial, my insurance had ridiculous requirements…

My wife and I finished our final appointment required for our 3 month approval program on Friday and are waiting to hear from the insurance if we are approved or not. I am very excited and nervous!

Found out today that my insurance under no circumstances will cover my surgery. So now I'm working on paying for this myself. I may end up selling some of my stock in order to pay for my surgery. I'm worried about the tax implications capital gains and increasing my taxable income for taxes. Does anyone have any insight on this topic? I just don't want to be in a bad place when taxes are due. Sent from my SM-N910V using the BariatricPal App

I have completed my 6 months of insurance requirements and had my final medical clearance Wednesday. Everything has been submitted, just waiting on my approval (hopefully). Does anyone else have this insurance, if so, how long did they take for approval?

Does anyone have Cigna for a revision and didn't have them before? I'm wanting to switch to them but don't want to if they like to give the run around. I'm leaving BCBSIL and heard good thing about them but it was always someone who didn't have any bariatric surgery. Any advice would be loved! Sent from my iPhone using the BariatricPal App

I am just starting the process of getting WLS, my PCP sent a referral straight through with no questions - my BMI is 51.3 so she felt it was a good step for me to take. I called today to "activate" the referral and was told that the request is being reviewed for a second opinion. Has anyone else dealt with this? The person I talked to couldn't give me any information about how this process would work and I've never come across it before. Any help is appreciate.

It seems that once the surgery is approved they received a letter from the insurance company. Was it like that for most of you? I called my insurance,carefirst bcbs, and they said the request and after being on hold for about 15 minutes she's says they submitted it twice but the first request was approved. Called the surgeons office and they say it's still pending. What should I do? Wait it out or do some more digging? Scheduled for 9/26 Sent from my iPhone using the BariatricPal App

I recently started working with True Results of Dallas to start the gastric sleeve process. They took all of my info and scheduled my first appointment. 2 days in, I find out that they are out of network with my insurance. True Results went out the window. I then contacted my insurance company and asked for a bariatric surgeon/facility in my area that was in network. They referred me to the Baylor University Bariatric center, whom I contacted to begin the process. They had me complete a super long packet of information which I promptly turned in. By the end of the day, they called me and said "CONGRATULATIONS, you are pre-approved!" and proceeded to outline the req…

I have Blue Shieldnof CA and was denied authorization for bariatric consult because I don't have "documentation of a 6 month diet" Neither my PCP or my medical group or insurance company is being much help. I'm not sure if this means I have to do a physician supervised diet where I weigh in at my pcp for the next 6 months or if it's a diet I can do on my own. The surgeon program I want to go with had me weigh in at the info session and nutrition session and I have 4 more weigh ins with them before I proceed with their program. My pcp says I don't have to weigh in with her and those weigh ins count but I don't see how that satisfies a 6 month diet if its just weigh ins.…

I'm happy to say I got approved on the same day appointment to end my 6 month pre-op stage.... Hopefully when I get to my Surgeon to discuss details I could leave with knowing my surgery date. I'm ready for my new life. Every time I get up or finish rehearsal my knees buckle. I truly want to be healthy for my son Sent from my SM-G530T using the BariatricPal App

Hey! Let's start from the beginning... I live in NYC. I started this process with straight Medicaid after my prior private insurance (UHC Commercial) expired on 07.31.2016. I still had straight Medicaid as a backup so it automatically became my primary insurance. My pre-op appointments started 08.01.16. Blood work was done the same day as the initial appointment. My nutrition appointment was 08.08.16. I received a letter stating that I had to enroll into an HMO plan by the 15th of August. I received this letter the 23rd...I called and asked what were my options and was told that I can send in an exemption form. I don't qualify for exemption because all of my providers tak…

is any one from Vermont with the state insurance?? Sent from my LGUS991 using the BariatricPal App

Hi I'm currently in process of supervised diet and they been playing games with saying it is up to my surgeon how long it would be then the diet supervised girl is like you have 12 months of this when I just got done doing a year of calorie counting by myself, I pay 300 a month for this insurance just for the wls and I called bcbs and they act clueless to it all even talking to the bariatic people of bcbs I told the girl at the Kane a Center in Hoffman estates that it was bs when I just got off from a over a year of trying myself to just be told oh well do it again for another year.. I pay 300 a month for this bs and I can't even get anything I need done.. If anyone has a…

I'm having the worst luck and it's almost 2 years dealing with the process of different doctor's and HMO insurance clerks? Sent from my LGLS992 using the BariatricPal App

Today was supposed to be a joyish day for me, but instead it turned out to be filled with stress and sadness. Today was my last appointment before all my medical information can be sent to my insurance company for approval. Unfourtenaly things didn't go as planned. So a couple of months ago I had insurance through my employer and BCBS FEP became my secondary insurance. Well, I no longer have that insurance and it was terminated July 31st when I left the company. So since then I have been going to the doctors and realized that my claims were being denied because BCBS stated that I still had another insurance plan. So I called a couple of weeks to get this issue resolved. …

So I had my first appointment with my doctor yesterday. I absolutely love him! He's very blunt and to the point, which I found hilarious. I brought my mom with me because she was not supportive of this surgery at all. She thinks I can just diet and lose it on my own, but I have tried dieting for 3 years now, and I always fall back into gaining weight. I am 24 (25 in a few weeks) and I'm sick of wasting my young life being overweight. My surgeon got straight to the point and said, "This surgery has a 90% success rate of keeping the weight off for the next 10 years. Without this surgery, you will most likely gain the weight back." My mom asked him questions about my Pseud…

After your surgery you can deduct your costs for Vitamins and Protein drinks, mixes etc. because they are both required for a medical condition. This is addressed on the IRS website and I confirmed with my CPA. Save your receipts !! And just add them right into your medical expenses if you itemize. Sent from my iPad using the BariatricPal App

Wondering who out there had success in getting their initial denial overturned? Would love to hear your story! Sent from my iPhone using the BariatricPal App

I have BCBS when I first asked if they covered weight loss surgery they said no. Then after I met with my surgeon and then the financial person they ran my insurance and said it was approved they got a approval number. Then 3 weeks before surgery I got a phone call from the financial person at the hospital saying BCBS said they make a mistake and my surgery was not covered. Of course I panicked for an hour and then decided I was still going threw with the surgery. I had to pay $12,000 out of pocket I am 2 weeks post op am glad I did the surgery but pissed off at the insurance company. We will write a letter to the insurance company but I doubt it will go any where. …