Insurance & Financing

Hey all, it's me again...still confused and looking for help. So i live in PA and have Highmark BCBS insurance, this was my second month of supervised weight loss/exercise PCP visit. My question to anyone who is or has had sleeve or bypass surgery with this insurance, do i need 6 consecutive monthly visits with a dietician as well? The insurance requirements is so vague and i can't get a straight answer when i call my insurance company. It's frustrating and confusing, anyone able to offer help? I had a consultation with a dietician who gave me a nutrition plan to follow, she also read the requirements and said it looked like only a consultation was enough along with 6 mo…

I spoke to my HR department today about them allowing our insurance company to allowed me to receive bariatric services and they said they look into it as also check to see if I can purchase the insurance rider to cover it!!! I'm so hopeful they'll value me enough to let me have it! Otherwise, I'll have to cash out most of my 401k. Sent from my iPhone using the BariatricPal App

After I met w/ the 2nd surgeon back in May that Dr. office took forever to go through my records to see what else that Dr. wanted me to do....even after insurance had approved my surgery w/ 1st surgeon back in April. The 2nd surgeon submitted to insurance on 8/17. I just found out yesterday that the insurance denied the new surgeon because the facility he does surgery at is not a Blue Distinction Center. I wish the 2nd surgeon would have figured out my benefits back in May when I when to see him the first time. Sooooooo I found a new surgeon yesterday that is in my insurance plan in-network provider & performs this surgery at a in-network hospital that is a Blue Di…

Hello everyone! I am curious to know if anyone has magnacare and can tell me whether you were approved or not, and the process, etc. I haven't contacted them yet because of the hurricane but am planning to tomorrow. Thanks so much! Jennifer Th

I'm waiting for my insurance approval to come through and I'm so anxious. I just need a place to vent. I've met (I believe) all of the requirements for surgery. I had my last appointment with the surgeon on July 22 where we decided to proceed with surgery, and scheduled it for August 29. I had a few more things to accomplish (follow up visits with the health psychologist, visit with my PCP re: high blood pressure) and did all of that as quickly as possible. They finally submitted the paperwork on August 8, and now my surgery is in less than a week and I have yet to hear anything. I literally can't sleep. I've called the insurance company twice to check in. The first t…

I am curious if anyone has been approved in Florida with Humana Medicaid having gastroparesis? I have heard that's what the gastric sleeve was first used for. My BMI is 36.5 and I have severe gastroparesis and really bad acid reflux. Sent from my SM-G920V using the BariatricPal App

I had my surgery on 7/6/2016 and was told at that time my out of pocket after insurance was $230. That was no problem so I paid it that day. I get a bill yesterday from the doctor for over $14,000!!!! I am completely confused and extremely stressed out because I just don't have $14K sitting around. When I looked at the EOB online it looks like the doctor charged for something that was not covered by my insurance (BCBS Anthem of GA). How would you all suggest I handle this situation? Any advise is greatly appreciated.

I am going on Aetna on January 1st, has anyone done the 3 month multi discipline or 6 month supervised dieting? What did they require that you do?

Pick an experienced surgeon...by that I don't mean one who has a lot of experience with the sleeve operation, although that is a good thing too, but I am talking about an experienced surgeon who knows how to document and submit to your insurance company. My insurance company required 6 months of a controlled weight loss program. My surgeon's office told me that Weight Watchers would work. Trouble was, everything I read online said that I had to show at least a 5% weight loss on this program. My nutritionist also said I had to lose 5%. I panicked, but submitted the Weight Watchers booklet anyway. I then drove myself crazy thinking I was going to be denied because I d…

Hey all! I'm new to this community as well as to gastric sleeve surgery. I have been thinking about this procedure for months now, and finally after researching it, i've decided to go ahead with it. I contacted my insurance company, which is Highmark, BCBS of PA and this is what i've concluded is needed: BMI - over 40. Age of 18 and over. 6 visits (1 visit per month) with my doctor, who will monitor my weight and exercise regime. A psych eval. A nutritionist visit. Anyone know if there is anything else I need, or have left out? I need some help with this. Also, is it ONE visit to a nutritionist? Also, how will my doctor be "monitoring" my exercise? I can see wei…

I'm IN!! Heard from the Lindstroms today and Aetna approved me!! Kelly and Walter Lindstrom were absolutely incredible. My second level appeal was nothing that I would have ever come up with! So waiting for the surgeon to call me back, to get a date!! Thank you to all who have helped and encouraged me the past few months after my denials. I think I would have lost hope if it wasn't for many of you. I had a really tough year, and this is my light at the end of the tunnel. I cannot wait!!! Katie

Hi everyone, I called my insurance company (BCBS MA) to see what the requirements are for them to cover bariatric surgery, and they seem very... Loose. The rep told me I need: BMI of 40 w/o comorbidities or 35 with at least one. No weight history required. Agree to participate in pre- and post- surgical assistance program. Documented of failed non-surgical attempts at weight loss And then easy stuff like "is an adult that is willing and understands implications of WLS" And that was it, really. No 3/6mo supervised diet or documentation of multi-year history of obesity. I have a sneaking suspicion that something was left out, but I should trust what they said,…

Hi everyone.... Im new. My name is Jennifer and i have started my whole list of doctors appointments for surgery. My surgery date is June 10th and I am sooo excited. I have an issue though and I'm soooo nervous I wont be approved. It appears I am 36 on the BMI chart. I am 5'7 and 234. 110 it says overweight for my height . I am going through a great doctor in NJ who I hear rave reviews about but, for starters I was crossing my fingers I had sleep apnea lol cause that could have been my comorbidity for approval but, turns out I am a 5 I still have more docs and tests to do but, wanted to know if anyone else had Aetna hmo in NJ who is similar to me on the scale? Also, …

Well! Just had my last appt - all paperwork is being submitted for insurance approval. I am so nervous. They reassured me that my insurance usually approves. I am just nervous because - all I have is a BMI over 40. - no other health issues. I am just keeping my fingers crossed and praying!! Wish me luck Sent from my iPhone using the BariatricPal App

I'm just wondering if anyone has the cleveland clinic insurance and went thru or in the process of getting a approval? I'm confused a little! (long story)I went to a seminar & 2wks later my patient navigator called me to set up my 4 appointments with my last 2 being in November. As soon as I hang up another woman calls and says I must do a 6 month wls program, I explained to her that I would not have any insurance as of February. The woman put me hold did some research and told me that since my bmi was high that I didn't have to do the program and that she would would try to get me scheduled for surgery by the end of the year. But today case management calls and says …

I had my last nutrition/weight appointment before being submitted to insurance for approval. During the two weeks before my appointment, I passed a kidney stone and developed a UTI that went to my kidney so I was on a lot of antibiotics and pain killers - so I was eating crackers and things to settle my nausea and I was retaining a lot of the water I was drinking to pass the stone and clear the infection plus constipated from the pain medicines. I gained about 5 pounds between appointments. The dietician is going to submit me to insurance and explain my gain - so my question is, has anyone experienced a slight gain and been approved by insurance? I have BC/BS. Than…

Hello! I am new to the forum. I have a BMI of 37. I am about 5 ft 1 in and 201 lbs. Up until recent lab work I had no co morbidities to go along with my "low" BMI. However, my labs showed high total cholesterol and LDL. Neither my PCP or surgeon suggested starting on a cholesterol medication. I have UMR insurance, my surgeons assistant told me they seem to be less picky for approval. Just wondering if anyone else has been approved with lower than 40 BMI and newly diagnosed cholesterol, HTN or diabetes. Thanks!

I decided to opt for bariatric surgery in May 2016 and called to make an appointment with a surgeon. The first available appointment was over a month later, so I took it. The appointment went well and with a BMI of just 35.2, I was told not to lose any weight until I got approved. I did all of the required steps - the appointments with the nutritional dietician, the psycological evaluation and documentation from weight watchers to show my previous attempt at losing weight. I could have easily chosen Medifast or Nutrionsystem, but Weight Watchers was the most recent and the program had to be within the last year. When I was tryiing to schedule the dietician and psyco…

Anyone get denied by cigna because of mental health notes? Or any reason? Did you later get approved? So very anxious. This has been a very long journey for me and then to get denied I was heart broken but am hopeful mydoctor's peer to peer with ins. Will do the trick. Sent from my SM-G920P using the BariatricPal App

I thought it would be quicker but since I had not regularly visited the doctor in the past few years, I didn't have enough recorded weights. I have united healthcare. The nurse manager wasn't a big help. She initially told me the weights were needed from past 5 years. This caused some delay. My recommendation for those that do not have recorded weights is to make your appointment with your PCP, discuss your reason and show up each month to record your weight. This extra time it took was beneficial as it gave me much time to think about this procedure. Excited. Scheduled surgery for Sept. 27th. Sent from my iPhone using the BariatricPal App

Well, Cigna did me right. I'm approved for August 9-10. My doc's office said that they had to put a specific date on there or it would have been denied. They also said that it would be good for 6 mos. Does anyone know if that means I can't be scheduled before that date?

How soon after the 12 week options programs will I receive my surgery date? I have completed all labs, attended my mandated support group and had kept all appointments scheduled thus far. I guess I'm getting anxiously excited as I enter my half way mark to completing my 12 week classes.

I have APWU CIGNA. anyone with any experience on approval process? -Christy in NC-

With no comorbibitys and a bmi of 42.6 I cannot lose more the 16 pounds to stay at a bmi of 40. Any suggestions on maintaining weight on weigh in days? I just started so I'm just worried if I gain at a weigh in I'll be denied. Sent from my SM-G900R4 using the BariatricPal App

Hey guys!!! Omg I was approved. I couldn't hold it and called my insurance company (United health care, Oxford freedom plan) and they told me that I was approved! My Surgery date will be 08/24/2016. Who else has the same sugary date? Sent from my iPhone using the BariatricPal App

Is anyone dealing with Belight weight finance department? I have been having issues trying to get a phone call back. My online application says incomplete and I've been trying to get my issue resolved. Sent from my iPhone using the BariatricPal App

Can anyone tell me about their experience with prosper? I have been in a holding pattern that says "pending activation" . Everyday it says my loan will be listed in one business day, but it's been 3 business days. Thanks! Sent from my iPhone using the BariatricPal App

I've been waiting for my insurance to process the claims for my surgery which was a month ago. I know they were submitted, because I can see them on the cigna website, but they just say 'processing'. Problem is, I paid my deductible to the surgeon in a deposit for the surgery. I have other claims coming in and they are being processed and saying I owe for my deductible when it has already been paid. Its a real pain. I need to have a synvisc gel shot in my knee. Its over $700 if I haven't met my deductible, so I am waiting until my insurance has processed my surgeons bill to set an appointment to have my knee shot. Did it take much longer than a month for your insur…

How is highmark blue cross blue shield ? Sent from my iPhone using the BariatricPal App

ZOOOOMG I got my approval call today. I was originally told it would take 15 business days so when I got the call, I was in shock! September 14th is my big day. Now to process all the second guess feelings, anxiety, guilt and the other crap emotions that always show up after I make a big decision. Every day I wake up and wonder if I'm making the right choice for me. Then, when I get out of bed and feel all the weight of my body settle in with gravity and start to ache and hurt, I'm reminded that yes. Getting rid of this weight is the right choice for me. I had Cigna with a <89 days doctor supervised weight loss. 41 BMI with no co-morbidities.

Hi! I'm new here and I'm just seeing if anyone has had the gastric sleeve and has Medicaid? How long was your process? I meet with my surgeon on the 10th and I'm nervous/anxious about this whole process. My BMI is like 38.2 but I don't have diabetes/HIgh BP or anything like that. I just have arthritis in my back, bad knees and bad ankles. Did you get approved? Any kind of feed back would help! Thank you! Sent from my iPhone using the BariatricPal App

How is high mark B&B? Sent from my iPhone using the BariatricPal App

Quick question that I'm hoping somebody can help me with..............I am a borderline candidate for weight loss surgery; my BMI is about 38 with a couple of co-morbidities..............I have Aetna insurance and I went through an entire 6 month program at Geisinger hospital to have this process done. They kept telling me with every visit that I needed to keep my weight about where I started, 296.....I would fluctuate up and down a couple of pounds throughout the program, and they assured me I would be approved. I submitted my pre cert to the insurance company in December of 2015 and got denied in early January because I had actually gained 3 pounds during the program.…

So everything is done as far as the 6 nutrition classes and I've seen all the different specialist the surgeon required me to see. My paperwork was sent over yesterday to the insurance company and APPROVED the same day!!! So my surgery date is August 17th. Counting down the days. Follow my journey @beautyandaboss on Instagram. Sent from my SM-N920P using the BariatricPal App

Hoping I get approved..

Hello all I am in need of help covering my gastric sleeve. My insurance does not cover it and anything will help. I have been trying to raise money and it just seems like it will never happen. I know people do not like giving money to people they know so I know giving money to someone you don't know is asking for a lot. But I beg of you please help if you can. I will be forever grateful. http://www. gofundme. com/2gtb9c4

I have BCBS ANTHEM and I'm really not familiar with using my insurance however I think the prices for out of pocket with insurance are horrendous. I'm paying 1600 for my surgery after insurance and 1300 for my one night hospital stay that's 3000! How much did everyone pay after insurance. Sent from my SM-G928V using the BariatricPal App

Since Aetna denied my request for a revision I will be a self pay . What kind of complications Policy is out there to cover the potential of costs due to complications? Sent from my iPhone using the BariatricPal App

Hello anyone use health insurance through obamacare and got your weightless surgery, and if so what do they require? And was it hard to get them cover it?

Okay guys this is it! Today they submit my papers for approval!!!! I have united health (Oxford freedom plan) ugh now the waiting game. I hope they are not hard. I also got a surgery date of 8/24 might be sooner depending on approval. Please send me lucky dust guys!!!! Oh I am nervous wreck Sent from my iPhone using the BariatricPal App

OK, so this has less to do with my own insurance issues, but is more a philosophical/social rant. Partly because I'm deathly afraid of getting denied by own insurance as I'm just starting out my journey. I'm super fortunate because my plan covers VSG. I know the requirements, and I meet them (for now), but I'm afraid of getting pulled a fast one and getting denied anyway. I digress... So, I've done a lot of research on this. If I were to pay out of pocket for a VSG, it will run me about $14k - $20k. I have health insurance through my employer and pay about $8k per year just for myself. I've had said insurance for about five years, only requiring an annual doctors' visit…

I called my insurance company (UHC TX medicaid) and was told the only requirement is a letter of medical necessity. I called 3 different times to make sure I got the same answer. When I went to my consult, the benefits coordinator said I will need 6 months of supervised diet. She said we can try and submit it early to see if it will get approved. Which info is right?

My surgeons office told me that because of my bmi I would only have to do 3 months presurgery for insurance. Then I spoke with someone at my insurance today and apparently that's the case for regular blue cross but I have blue cross blue shield of New Jersey. I WAS ALMOST DONE WITH MY PREOP WAITING PERIOD I'm so upset. Now I have 3 more months to wait before I can submit to insurance. Disappointed and frustrated. Sent from my iPhone using the BariatricPal App

I signed up for Aflac yesterday. For accident and hospitalization. I know there is a 12 month time frame prior to a claim that anything can be considered "prior" illness or whatever but I'm hoping I can sneak a few in. lol Do any of you use Aflac? How helpful is it?

Hello I was wondering if anyone has filed an appeal for a revision? I had to do a pathway program in order to get my original surgery and fell to a 34 BMI but was able to still get the surgery because of my starting weight. It's been two years and my new doctor says they screwed up my sleeve and I need a revision but Tricare denied me do to being only 34 at the original surgery. Any tips on what to put in my appeal to get this done would be appreciated. I had my original surgery done in an Army Hospital if that helps anyone Thanks

Hey loves, My name is Alexandria and I am currently looking into getting the Gastric Sleeve Done. I've struggled with weight all my life, and now at 26 I currently have diabetes along with high blood pressure. Hell, I may even have sleep apnea (going to my first appointment for that next week). Since I've been looking into getting the surgery done, I contact UHC to see if my plan covers it. Unfortunately it does not via my employer. I'm so upset and honestly just bummed out. The agent that i was speaking to a UHC told me the surgeon could write an appeal if they feel that its detrimental. I've been doing a lot of research, and I've seen so many people say "You ca…

Hi all! I am scheduled for Gastric Bypass on August 2nd..in 2 days!!! I just got a a terrifying phone call. Some lady said that she was calling from the hospital where my surgery is scheduled. She said my insurance is covering 80% and I'm responsible for the 20%. (I was already aware of that) Then she said that my 20% comes out to $6,630 and that I had to leave a deposit over the phone of at least half. My surgery center required a deposit to meet my deductible of $3,000. I paid that last week. I told the lady on the phone that I had already paid $3,000, she said it wasn't showing up on her end and that it might've just been the surgeons fee which is not included in t…

I just wanted to share my experience in case anyone else needed it. I have BCBS anthem as my insurance. They required 40% or 35% and comorbidities. I qualified under 40% no comorbidities. They did require a 6 month process which I undertook with my dietician and saw my doctor 3 times in the process. They also required a psych eval. I had my final appointment June 24th and my psych visit June 29th, information was sent to the insurance June 30th. I was approved July 11th! Sent from my SM-T807V using the BariatricPal App

Hello everyone, Today was my last nutrition appt and this week, probably tomorrow, my information will be submitted to Aetna. I did all that I was supposed to do. Now I'm simply praying that all goes as planned. My only jitters are about the surgery itself Advice? Input? Thoughts? Lol Dawnie_doo

I’ve been making myself a little crazy and losing sleep worrying, so I’m hoping I can get some of your thoughts on this. I’ve completed my six months of medically supervised weight loss appointments. I’ve had the sleep study, EGD, psych eval and all of that jazz. I called my doctor last week to ask how long it should take to hear back regarding scheduling my surgery, they said that they have to submit everything to my insurance company and then it will take 2 weeks to hear back after that. Okay, that’s all good, but then I did a google search for my insurance company, “McClaren” and “Weight Loss Surgery.” And I found a website for a hospital here in Michigan that…