Insurance & Financing

Any

As I researched bariatric surgery I came across info that 'obamacare' will NOT cover the surgery in Arkansas. But upon delving further into it I came across THIS... Arkansas is among the states expanding Medicaid, but it is using a non-standard approach or waiver. Arkansas’ Medicaid expansion waiver allows the state to use Medicaid expansion funds to subsidize premiums for beneficiaries who purchase private health insurance through the health insurance marketplace. Arkansas refers to its Medicaid expansion as the Private Option and to those enrolled in it as the Private Option Beneficiaries. Private Option Beneficiaries are eligible for all Medicaid services (even if th…

I went to the bariatric doctor in May to get everything started on my WLS. At that time, the office called my insurance company (BC/BS) and was told everything that we required. Asked specifically about a 6 month regimented diet and was told that it wasn't necessary. Because my BMI is 50, I should qualify for WLS. Over the last 2 months, I've gotten all my pre-op work done and the doctor submitted all the paperwork for pre-authorization. They were then told that I am being denied as there is no documented proof of a 6 consecutive month exercise/diet regiment with a nutritionist. Of course, my doctor's office got involved and negotiated twice on my behalf with the …

Has anyone have Medcost? if so were you approved? I am having the sleeve due for Sept 2016.

In a few weeks to a month my surgeon's office will begin submitting insurance paperwork. Curious if anyone has experience with Anthem in IL and anything I should be aware of? My PCP and therapist think it will be fairly painless due to my high BMI (currently around 70) and co-morbidities (hypertension, sleep apnea, and pre-diabetes). But after scouring through the forum, it rarely seems all that simple.

Anyone have QualChoice? I have met all their requirements (i.e. BMI, 6 month health coaching, psych consult., etc). Wondering if anyone has been denied. Also, how long to hear if you've been approved.

I just spoke to someone at Aetna . They denied my request for revision to gastric bypass due to the fact that I didn't follow up for the full 2 years after my surgery. Yes we did appeal. Anyone in the same boat. Sent from my iPhone using the BariatricPal App

Just wondering- and I don't mean the process from first consult to surgery, I mean like after all of your appointments and requirements are done. So when you submit it to insurance showing what you've done, until the day they say they're good to go. I've heard some people say their insurances took up to a month to get back to them, others I've heard about a week. Just curious because mine will likely be during my school break and I want to factor in some recovery time. My last appointment is 12/4 and I have Affinity (Obamacare, non Medicaid) if anyone knows anything about my specific insurance. Thanks!! Sent from my iPhone using the BariatricPal App

Who should submit the prior authorization? Me, primary physician, or surgeon? My insurance policy does not include bariatric coverage, so I was going to appeal the expected denial but I need a denial first. Has anyone ever had experience or heard of anyone getting coverage when their policy excludes it? Thanks!! Sent from my iPhone using the BariatricPal App

Hi! I am really excited to start this journey and I was really happy to stumble across this website. I recently attended a weight loss surgery seminar, and I am really excited to get started. I (like a LOT of people) am extremely worried that I won't get approved through my insurance. Does anyone have experience with United Healthcare? Are they pretty easy to get approved through? My plan says I need complete a supervised diet and exercise program through the surgery team, but it doesn't say for how long. I'm trying to get this done this year, since my husband and I have met our out of pocket max, and everything will be covered at 100% now. Surgery included (I checked). I…

I have insurance through my husband's work. They do not cover any kind of bariatric surgery. I am thinking about getting a secondary insurance through Obamacare when it is open enrollment. My question is, do I have to wait a certain amount of time after getting the insurance to have the surgery? For example if I had all of my past diet info and psychology report and everything else the insurance requires before surgery, is there a wait time after purchasing the insurance before you can use it for major surgeries such as bariatric surgery? Thanks!

Very excited to have pre-approvals from insurance.For my program, I choose a Center of Excellence for 100% coverage. I also pay for flights, hotel, meals, and transport, and get reimbursed after submitting what is basically an expense report. Does anyone else have experience with BCBSIL (or your own insurance) with what is covered or denied in the end as far as incidentals. The economy flight, can it be flexible? Can it be economy plus? The meal coverage, can it include alcohol (not for me of course)? What was your experience? What did you have to fight to get reimbursed on? What went through with out question? I appreciate everyone's input. Thanks!

So my surgeon office has been playing games about submitting to my insurance which is Aetna ????, and I am so confused, I have been speaking with a surgeon office in Vegas and they were told by Aetna that I only needed 4 months diet program with my doctor and a ekg, ultrasound, upper gi and phys evaluation and clearence from my doctor, but the surgeon here in Alaska stated that I needed 6 month diet program with my doctor. So I am so confused... any insight would be wonderful and helpful.. I am very nervous that they are going to denie my approval because the surgeon here submitted today with 5 months and all the testing. I also have sleep apnea, chronic high blood pressu…

I posted here before about my insurance company dragging its feet and taking three weeks to approve my surgery last December. They managed to drag it out long enough that I couldn't get the surgery done until after the first of the year, but they DID approve it. So I had my surgery on 1/20/16. Now they are refusing to pay ANYTHING. Yep, they have denied all claims, saying that my surgery is not a covered procedure. WTF???? I requested an appeal and got the same answer. The doctor's office called them today, and they said that my coverage changed on 1/1/16 and the surgery is not longer covered. Like they didn't know that was going to happen when they approved it? …

Hi guys, I have just been approved for insurance through Washington state, due to my husbands unemployment and our recent financial hardships. I'm hoping to take this opportunity to get gastric bypass. I've tried googling to find out as much as I can, and I've made an appt to see my pcp on 8/26 so she can give me a referral. I was diagnosed with diabetes and high blood pressure in April, and I'm fairly certain I have sleep apnea as well. (I'm also going to ask about a sleep study!) my bmi is around 63, per the calculator I used. Any advice or tips? I'm anticipating that this will be a long journey, but I'm so excited to get started! Sent from my iPhone using the Bar…

So I have two insurances. My primary is United Healthcare Tricare Standard and the other is United Healthcare Community Plan. Does anyone have UHC Tricare and have u recently had the vsg surgery? I know tricare west recently changed to UHC and there has been some changes to the policy. Did u have to do the 6 months of weigh ins before u were approved? I checked the UHC tricare website and it does not say how long I need to have weigh ins. These are the requirements: So if anyone has had the sleeve with UHC Tricare Standard I would love to hear about it. I have called my insurance company and asked what are the requirements but they just say I need authorization and no…

There's a chance we'll be getting Cigna insurance in the next couple months. Does anyone know much about them? Are they like BCBS where there are a million and one different plans, or are they pretty uniform all around? We can't get more info about the insurance until my husband is hired on permanently so now I'm worried it won't cover WLS, or will have some ridiculous rule like a 2 year supervised diet, or something.

So I found out about 2 weeks ago that my insurance denied me because my BMI was not greater than 40 and the comorbidities that I submitted (GERD and Hyperlipidemia) they didn't consider obesity related - my BMI is 36.3 - and no I don't have hypertension or diabetes (although I do have an impaired fasting glucose which my MD says if I don't loose weight I WILL become diabetic) - but really - do you want me to 'be sick' first - what about trying to prevent these diseases?!?!?! So I'm wondering if there are any success stories out there with any of you who have been denied upon initial submission of your paperwork - only to be approved with a peer-to-peer - looking for a r…

So, I finished up all my requirements and my doctors office filed last week for my surgery approval. I called BCBS of MA today to see if it was submitted and they told me I was APPROVED!!! Yahoo!! BUT... They said I had approval for inpatient between September 26th-October 8th? What does this mean? Has anyone heard of this before? If so, can I push it up once I ask my doctors office? I was in there last week and they said they were booking for the end of July, so I know there is no way it's filled up 2 months in the past 4 business days :-( Now I'm stressing. Help me find some clarity! All replies welcomed :-) Sent from my iPhone using the BariatricPal App

Hi, my name is Taylor and this is my first post. Does anyone have Health Alliance connect in Illinois and get approved for the sleeve procedure? If so, how long was the entire process and what requirements did you have to meet? Thank you! Sent from my iPhone using the BariatricPal App

Finally they sent over my paper work and it's currently pending! I'm so excited but anxious. I'm hoping and praying for a fast approval. Id like to have my surgery in July . Anyone else waiting on approval. Sent from my iPhone using the BariatricPal App

I sent my coordinator all my test results and weigh ins so she will probably be submitting to the insurance Monday or Tuesday. I'm so anxious! I hope I get a quick approval. I'd like to get the surgery mid July. Sent from my iPhone using the BariatricPal App

My co-worker just got the gastric sleeve done on July 9th. We obviously work for the same company and we have the same insurance, same plan, everything. Well, I recently went to the same seminar she did, at the same hospital she went to and today I got a call from the coordinator saying that my insurance does not cover Bariatric surgery!! What the heck is going on!!?? So I called them myself and the representative gave me a "yes and no" type answer. He said I'd have to go through 6 months of medically supervised weight loss, a psychological evaluation, so on and so forth. All of which is done at the hospital where I went to the seminar! I am just confused. Sent from my…

Saw doctor today, informed me wouldn't have a cost estimate till approx 2 weeks before gastric bypass surgery, whenever that may be. Curious as to what this has cost others with federal bcbs standard. I will be at a bcbs centered of excellence+. I have found info on approx cost for federal bcbs basic but none for standard.

I have an insurance now that doesn't cover bariatric. Come January 1st I'll have Aetna which covers it. I'm doing the 6 month weigh ins according to Aetnas policy. Will they accept weigh ins under the insurance I have now? Sent from my SM-G900R4 using the BariatricPal App

Does anyone know how difficult or easy it is to get approved with Humana Premier H - M - O (apparently it thinks you are cussing if you take out the dashes and the spaces)? Per the booklet I can have WLS but I am unsure of what kind of hoops they are going to put me through. Also if anyone has experience with this particular insurance what was the out of pocket portion because the booklet is very vague but from what I am reading it looks like little to no money except copays (hopefully this is true because the premiums are sky high).

Has anyone ever got a call from a case manager from their insurance co before approval notification from the doctorsoffice Sent from my SM-G920P using the BariatricPal App

While I'm waiting on the insurance coordinator to give me a call from the surgery center...thought I'll get some input here. All my testing is complete except 3/6 month supervised weight loss program but my 2016 work insurance omit bariatric surgery BCBS. I found a plan through the market place UHC that would work. Have anyone used two insurance the Coinsurance is 0% after met $3600 deductible...oh how do I add a pic to my profile?

My insurance will not cover the cost of WLS, so therefore I had to take out a hardship withdrawal from my employer's healthplan. The loan is pending, based upon the surgery being medically necessary followed with a statement from the doctor. My doctor will willing to do the surgery using the selfpay option. I have a BMI of 40 but no commodities. I am soo afraid that I will be denied,this is my last hope. Not sure how to get around this hurdle. I am sure that bariatric WLS will be looked at as cosmetic. Any suggestions, before I contact my MD? Has anyone else been faced with this obstacle?

I have my 1st eval August 13th. My pcp is writing up a letter of recommendation so Ill be bringing that with me to my eval appt. Question about the 6 month supervised diet.. My pcp documented my last appt as a weight loss appt & she has me coming back next month so Ill have 2 under my belt Before my 1st eval with Beaumont So with that being said, will those appts count as supervised visits Or will it Not count thru my pcp & it has to be 6 visits from the beaumont weight loss place??

How doe sthis process work with Medicare? I have my seminar in 2 weeks which is my 1st appt going towards the sleeve surgery. Other than my Primary care, she is on board, but whats the steps with getting this approved under Medicare? Normally hard or easy? Wait time?

Hey All! I have Aetna insurance and their guidelines state that the wait is 6 months or 3 months with a multidisciplinary program. Is anyone familiar with Aetna insurance? Had anyone only had to wait the 3 months. For reference, my BMI is well over 40.???? Sent from my Z987 using the BariatricPal App

Folks, it is very tough to go through insurance. Look into this company BE-LITE WEIGHT. These people handle everything for you and the process is so easy. Sent from my SM-G930T using the BariatricPal App

My sleeve was done on 4/14. The week prior to my surgery I still had not been told what my responsibility was. I knew my deductible was met and that I had a max 10,000 benefit for the surgery. After several calls the surgeon called me and said my responsibility was 400 with them. The hospital finally called me 2 days prior and said my responsibility was 1100 and that was owed immediately. I paid that day..... 3 months later, yesterday I received a bill for 9,300. On My first call to hospital billing, the rep said I had a 10,000 maximum and so Humana only paid partially. And they wanted me to pay the rest. I said then why didn't they apply that when they called me to take …

Hi all - I have BCBS-MA. I looked into their bariatric surgery coverage, and I meet all criteria except I have a question about 1 in particular. It says I need to have documented morbid obesity for 5 years. From my research, that is a BMI of 40 w/ no co-morbidities or 35 with co-morbidities. I have the ability to look at my own medical records at work so I looked into myself. So the past 5 years my BMI was the following: Jan 2010 = 39.0 Oct 2011 = 39.2 Oct 2012 = 42.0 Oct 2013 = 38.6 Nov 2014 = 38.4 2015 = not sure why I didn't have an appointment here, so no weight recorded Jan 2016 = 41.4 This year, I've tried dieting since January when my last weigh-in …

I am having my lapband removed and revision to sleeve. Insurance deemed lapband removal was medically necessary so they are covering that but wont cover the sleeve revision. Surgeons ofc is charging me the usual amt for sleeve which is 14500. Surgery is being dine at the same time. Shouldnt some of the self pay be reduced since they cant double charge? I understand sleeve requires two night stay in hospital so i totally inderstand that. But anesthesiologist cant double charge right? And some of the same instruments, equiptment etc, surgery room, portion of facility charge shouldnt that be discounted on self pay and ins pick up some of it? My surgeons ofc acts like they…

Anybody assigned a Nurse Case Manager through your insurance? Thoughts on this? Good thing or bad thing? I've heard both sides from people, just wondering if anyone here is using one, or has been assigned one for your bariatric procedure and what your experience has been with it?

Just filed with insurance. 35 bmi with sleep apnea. Sleep Apnea is mild but they did prescribe a CPAP. Worried might get denied since isn't severe sleep apnea. Insurance with BCBS OK. Anyone else have this & what was outcome? Sent from my VS990 using the BariatricPal App

Just wondering if anyone has Fidelis NY or Fidelis through Medicaid in New York.... how long did it take to be approved? and does fidelis stipulate that you have to lose weight in order to be approved?

So I've been going thru everything to get approved. I lack two diet visits and nutrition class. Anyone had any success or troubles being approved by viva medicare? My only hang up would be I did gain some since starting my diet program because of steroid injections. Sent from my SM-G900V using the BariatricPal App

I have Anthem Blue cross insurance. They cover 80% of the costs, and I have a consult with a preferred provider. How much would you expect my costs to be? Is there in house financing for this? Thank you!

See the link for more details but the expert below is from Blue Shield of California's website stating the requirements for bariatric surgery are: "Patients should have documented failure to respond to conservative measures for weight reduction prior to consideration of bariatric surgery, and these attempts should be reviewed by the practitioner prior to seeking approval for the surgical procedure (e.g., Weight Watchers, Jenny Craig, Optifast, MediFast). The timing, intensity and duration of the preoperative timeframe should be individualized and left to the discretion of the patient and provider. However, given the elective and life changing nature of these procedures,…

I've recently found out that I need to have my gallbladder removed. I was going to travel next summer to have the gastric sleeve done by a cheaper surgeon because my BMI (36) is not high enough for insurance coverage. Anyway, I was wondering if it would be worth it to try to get the surgeries performed at the same time here. If that's even possible. If all I had to pay is the surgeon fee since I will already be in surgery, it would be much more affordable. Has anyone done this before? I'll definitely be calling for more info. next week. Just looking for some advice in the meantime. Sent from my iPhone using the BariatricPal App

Omg been done with my check list about month still waiting on a date yes am happy only had to wait three months dam come on Sent from my SM-N900V using the BariatricPal App

So I just received a notice from my insurance that my psych eval was denied because it was not medically necessary. Once the requirements are met and I submit for insurance approval can I resubmit that claim for possible coverage? Not quite sure how all of this insurance stuff works!! Sent from my iPhone using the BariatricPal App

Can someone please help me? I'm trying to find a list of comorbid diagnosis that I could possibly qualify for. I checked my insurance website and I called my insurance provider which is Bcbs federal. They emailed me pros and cons or wls.... Not much help there. Is anxiety or depression a comorbity? Sent from my iPhone using the BariatricPal App

Hi everyone. I have been considering this surgery for a number of years, and the time has never been right. When I started to seriously consider it, it was prior to having kids. I was already facing some fertility issues (thanks to my weight and PCOS), and knew that I didn't want to delay starting a family further in order to have the surgery. I was heavier then, and probably would have qualified easily, as I'm assuming my BMI was close to if not over 40. Fast forward 7 years, and I have 2 kids and I'm ready to get my life back. My BMI is 35, but I do not have any comorbidities. I made an appointment at a Bariatric clinic that was recommended by a few friends who went t…

I got the call today from my patient advocate that my insurance approved my surgery! I don't have a surgery date yet. But I am SO EXCITED!!! Apparently, my surgeon has had many conferences with BCBS, and they have all denied approval to do the surgery without the requirements. So I am the first case to be approved right away!

Hello all. So my appt is coming up on July 18. I am 5'5 234 lbs. With a BMI of 38.9 Im actually trying to get up to 40 but I don't think I'll make it. I'm pretty sure I don't have any co-morbidities. I know my BCBSTX insurance medical policy for bariatric surgery states if im a bmi of 40 all I have to do is go through psych eval, and agree to the post op regiment and diet. But why do I think there are hidden requirements that aren't listed? Can someone who has BCBSTX tell me what they had to do to get approved? Sent from my SM-G935P using the BariatricPal App

Hi All, I am brand new. Going to my informational meeting tonight, provided by my insurance company. Health Partners in MN if anyone is familiar. My biggest concern is the requirements: Weight loss surgery is covered when the member has been evaluated and treated by an in-network designated weight loss surgical physician and all of the following are met: A member must have a documented history of BMI equal to or greater than 40 or a documented history of a BMI greater than 35 with associated health conditions that do not respond to medical management. Associated health conditions for the purpose of this topic are defined as: High blood pressure (BP) of 140/90 or greate…