Insurance & Financing

Well it was all submitted this morning to Aetna and I'm so nervous about getting approved I'm shaking Sent from my iPhone using the BariatricPal App

Hello there! I am beginning my WLS journey with my first consultation appointment tomorrow! I am very excited, and pretty nervous too. My biggest worries are with my insurance- I have Cigna, which covers bariatric procedures. I'm 5'6" and about 258-260, so my BMI is a little over 40, which is the approval BMI of you have no other conditions. I know my insurance requires 89+ days of a physician supervised diet/exercise program for approval. My concern is if I do the 90 days, and then my BMI falls below 40, will surgery then not be covered? Has anyone else experienced this? Sent from my iPhone using the BariatricPal App

Just got the call from my surgeons office. My insurance does not cover bariatric surgery it's a plan exclusion. What are my options at this point? They said I can finance it and that there are other options. I need advise. Sent from my iPhone using the BariatricPal App

Anybody in IN get approved for surgery with Sagamore Plus? I've completed my 6 mo. physician guided weight loss program and everything should have just been submitted for approval. I'm driving myself crazy, worrying I will be denied. I know, I know- I need to be patient. But I've looked at so many forums and I've never seen anyone post about approval/denial with Sagamore. Thank you!

So I had my preop appointment yesterday where they told me that I'll have to pay my hospital bill of $1,083 the morning of surgery (next Thursday). I've met my deductible and that's my 20% payment. I was not at all expecting to have to pay this at once! They said it's due, but do you think they'll be able to do a payment plan? Of course I'll have to ask when I get there, but is it normal to have to pay your hospital bill in advance? I figured most people get billed afterward and then pay in full or make payments.

My insurance refuses to pay for the surgery as no matter what my doctor says they say it is a cosmetic procedure. I applied for a loan at a couple local banks but no one will give me the $20,000 I need because my credit score is low from all my student loans. Anyone have ideas? Please help me!! I need this surgery!! Sent from my iPhone using the BariatricPal App

It is required to have 6 months of nutrition counseling. No problem. Counselor said no back to back appts any sooner than 28 days. No problem. But if I count 6 sessions COMPLETED, would I be able to apply at the conclusion of that last session? Sent from my SM-N920V using the BariatricPal App

...I'm getting worried. I've read so many threads of people having problems getting approved by insurance that now I'm getting a bit scared that I'll be denied. I found these requirements for Colorado Medicaid: https://www.colorado.gov/pacific/sites/default/files/Bariatric.pdf It looks like I shouldn't have a problem getting approved. BMI over 40, have comorbidities. As long as I do the 6 month clinically supervised weight loss program, get medical and psych clearance, and show that I am committed to changing my lifestyle and have realistic expectations of the surgery, then I shouldn't have a problem getting approved, right? I'm so nervous right now.

Hello my fellow sleevers, So I saw a surgeon in January who I was authorized to see through my primary doctor. He was in my network and I only paid a $15 Co pay on the day of the consultation. Come June, I got a bill in the mail for $480 minus the $246 payed by my insurance. My question is, is this kind of charge normal for just a regular consultation with an authorized surgeon???? No one can tell me why the bill was soo much that my insurance couldn't cover it.

Hi everyone, I'm so new to this so please forgive me if this has been spoken about before. I live in New York and have Affinity insurance. From what I have heard, if you have a BMI over 40, you will have no problem getting surgery. If you have a BMI over 35 but under 40, you have to have comorbidity with other conditions... I am almost positive I have none of them but my BMI is just under 40. I'm really concerned I won't be approved. Also, does anyone have Affinity and know how they are with covering bariatric surgery? I have yet to get any answers from them and I'm really nervous that they aren't going to cover me. I was hoping if I do qualify for surgery, the…

Hey everyone. What does inpatient hospital pre authorization for a procedure is admitted to be discharged mean?? Sent from my SM-G360T using the BariatricPal App

Hello all, I had my lap band placed back in march of 2007 when it was all the rage and no proven long term research. I went to surgery at 283, and managed to drop to an all time low of 220 within 10 months. I spent the next 9 years battling with this lapband and all the CRAP that came with it. I remember feeling like I had hit rock bottom when I couldnt even swallow my own saliva, but was slowly seeing the scale creep up. Today I am right back to 274, which is NOT my highest post surgery weight. (I would have never guessed that 9 years ago) Any how about a year ago, June 2015, I decided something had to give and started seeing a new Dr. about my options. I honestly…

Any one use take a personal loan to pay for their surgery? I'm thinking about trying this so I don't blow my whole savings in one whop. Who did you use and how was the interest? Sent from my iPhone using the BariatricPal App

I was told I needed weights recorded from anytime in the last 5 years from any doctor. I filled the form out myself and faxed it back. Now they're saying the form needs to be signed and more recent. Any tips on how to get this form filled out ? I don't regularly see my PCP but have seen my GYN a lot in the past 3 years. My approval is waiting on this only. Sent from my iPhone using the BariatricPal App

So, I met every bit of criteria for the gastric sleeve. Did 4 months worth of required tasks and submitted for approval. Unfortunately, I had smoked but stopped a year ago. Apparently, by mistake, I checked I was smoking when I thought it said "have you smoked". There are no medical records of my smoking or stopping so now BC has denied me with the opinion that I have smoked in 6 months. I have written my own letter of appeal since I have no doctor proof and explained the timing and situation. Does anyone have any experience with this? Is there a chance at all that BCBS will take into account my letter? OR AM I JUST OUT OF LUCK? One more question....if they can tak…

I have Anthem Blue Cross of CA and based on what they've told me over the phone and the medical policy they directed me to, I have to show documented attempt at non surgical weight loss for 6 months within the last two years. So Anthem told me it could be WW receipts, or invoices for the medical weight loss program I used. But the surgeons office Told me that invoices aren't good enough, and that they need to see that I was counseled on nutrition, the actual numbers of pounds lost, etc. Does anyone know what passes as valid documentation for Anthem?

I have Tricare Standard - so I can self-refer. I've gone to two different initial consults with doctors AND have talked with Tricare myself of course, but I'm getting two different stories about how it all works from these offices. Office 1: psych eval NOT covered - self pay nutrition appointments covered - must take 3 consecutive months (surgery can't be any sooner than 90 days) Office 2: psych eval covered nutrition NOT covered - self pay & nutritionist appointments required but that they can be done quicker than the 3 months if you want to progress a little faster Calling Tricare myself today confirms what the Office 2 said…

The hospital system I had my VGS surgery required a $200 upfront payment for the nutrition class that was required before having surgery. This was in addition to the 3 monthly meetings with the nutritionist required and paid for by my insurance. Do most programs require a payment for the "class," where they go over the food plan that you should use for the first few months after surgery? If anyone out there has, I am interested in knowing what the class consisted of, and how much it cost. I am angry I had to pay this money because it was an hour class with a nutritionist who read off of the packet they gave me previously, and gave me again after surgery. There was no ne…

So thru my hubby's employer our BCBS of TX only requires 4 months supervised diet, 2 informational classes that the hospital conducts, a psychological eval and a letter from my pcp. I'm super happy about this. Doesn't seem unreasonable. Sent from my SM-N910T3 using the BariatricPal App

To whoever is taking the time to read this: I'm Kayla. I am 20 years old and 285 lbs. I guess that's why I'm typing this story. I've struggled with my weight my entire life, as has most of my family. My mom just recently underwent the gastric sleeve surgery, and I have been recommended for it. Heart disease, high blood pressure, and diabetes run in my family, and I'm going to exhaust every resource I have to prevent these things from happening to me. Now, I know that you're probably thinking I'm lazy or that I just haven't tried dieting. I have tried everything under the sun, and nothing has been successful. I'm already physically active, and this is just a tool I'd like…

Not quite there yet but just in case, if you get denied does the surgeons office take care of the appeal ?? Sent from my iPhone using the BariatricPal App

Hmmm....I have United Healthcare Choice Plus, bariatrics surgery is covered given my BMI, but one of the extras of my coverage is to have a case nurse assigned to you (can be for ANY medical situation, not just bariatrics) who will help you move through the process and be a more direct liaison...sounds nice. But....to set up there's a 45 min appt over the phone where u give an complete health history. My appt is tomorrow. I might be paranoid but I can't help but worry is there some way my insurance is trying to get this info and then trip up my process and find a reason to deny me? Maybe this is a nice benefit, I don't know. My husband works for a pharma company and we…

I can't believe it approved and looking forward to my surgery date! It only took 4 day to get an answer!

Hi I am going to get insurance through the marketplace and live in Illinois and use a doctor in Mo, anyone know if that matters, me living in Illinois and wanting to have my surgeon from a surgeon in Mo?

I hope it's ok to post this. I've seem people write about gaining weight or using ankle weights to make 40, so along those lines...does anyone know if its possible to skew a cholesterol test or diabetes test? Chug some wesson? Eat a quick crisco sandwich a couple hours before the blood test? Ok that's gross. I'm kidding here but since we have to jump through hoops to meet somewhat arbritrary cutoffs for insurance I wouldn't feel bad if I had to game the system. Like everyone here - My reasons for wanting wls are for health. Just watched my mom die after being obese her whole adult life despite doing every diet that came along. She had so many problems at the en…

I have an OBGYN, but they won't write a letter. I have a local doctor that I've been to a couple of times a couple of years ago for sinus infections or strep throat, but I have been going to CareNow or CVS Minute clinic for the last couple of years. I have Cigna (3 month process - 4 nutrition visits (2 completed), stress test (completed), psych test (completed), and EGD (completed). Has anyone had a similar problem?

I went on my insurance company's website and noticed that the lab work I had done the day of my initial visit with surgeon was denied. I also noticed that the actual visit with him has not been submitted...it was on 5/31. Could it be that they are waiting until I have authorization to submit for the office visit? All of this insurance stuff confuses me!! Sent from my iPhone using the BariatricPal App

In the short time I've been on these boards, the most common insurance question is "will XYZ Health Plan approve me?" Here is how to find out BEFORE you move forward. Find your insurance card. Call the toll-free number on it (member or subscriber services) and ask specifically whether your plan has any exclusion for bariatric surgery. It's rare, but it does happen. If you have your "Evidence of Coverage" or "plan documents" booklet shoved in a drawer somewhere, any exclusions will also be in that booklet. Sometimes the person on the phone needs to look up the surgery by Procedure code, or CPT code. The code for a gastric sleeve is 43775. If you don't already know that…

If you need help understanding your benefits, I can give you advice from the hospital/facility side of things. Part of my job is to get prior authorizations and calculate how much patients will owe for certain services. I haven't been getting notifications when someone posts on here so if you don't get an answer within 24 hours then send me an email at sseelbach@live.com.

I'm so excited! Surgery is 5/2!

I'm 6'2 and I weigh 421 now my BMI is 54.0 but I have no health problems will I still be approved ? I have Aetna PPO I'm waiting to hear from my insurance I'm so nervous I can barely eat which I guess is a good thing lol Sent from my iPhone using the BariatricPal App

Is anyone looking at the same time frame as me? And for people who have BCBS what was the process once you finished your 6 month diet. Did you get approved? What was your BMI? I'm on the lower scale just under 40 BMI but for my first official weight in I was like 42BMI and my coordinator said that's all that matters. I'm very anxious and worried. Sent from my iPhone using the BariatricPal App

6/10 is when I'm guessing my information was submitted and I'm so anxious I haven't been able to focus all week how long does it take Aetna to approve ? My surgeon seems so confident that they are going to approve he even gave me 4 prescriptions to fill but I'm literally bugging out this is such a huge life changer Sent from my iPhone using the BariatricPal App

Just waiting for my labs to get sent to my surgeons office to be reviewed and then I can schedule my bypass! I'm excited and terrified all at the same time knowing I could be having surgery in just a few short weeks! Sent from my SM-G900T using the BariatricPal App

So as of April 18th I was denied due to lack of having a co-morbid health condition. (I have to have a BMI of over 35 with 1 co-morbid condition) I am a prediabetic, I have high cholesterol, and I have a fatty liver, but these are all not considered co-morbid conditions?! I'm a mess after finding out I was denied, but my Dr has set up a peer to peer review for May 3rd. Has anyone heard of gaining a successful approval after the peer to peer review?

Got their letter today denying my surgery, saying that my current surgeon doesn't do surgeries at the hospital to which I am "capitated" (gawd, but I loathe that word). Funny, but they've been approving my monthly visits to my surgeon since last August, a surgeon THEY assigned me to when this whole thing first started in earnest. Now they're saying No, because he doesn't practice at a specific hospital. They sent me a referral to a DIFFERENT surgeon, and lo and behold, when I told the lady on the phone at that office what the denial letter said, she told me that this new surgeon doesn't practice at that hospital, either. WHAT THE HELL ARE THESE JACKASSES TRYING TO P…

I have been waiting 2 weeks, calling 2x each week and today I found out I was approved!!! I'm so excited and ready to start this journey. I was nervous because I had gained 2lbs at my last appointment. I had an overall weight loss of 7lbs. I guess that's what matters to them. Sent from my SAMSUNG-SM-J120AZ using the BariatricPal App

Today is my last weigh in of my six-month medically supervised diet...or so I thought. I called my surgeons office and told them that my last weigh-in was coming soon. They told me that the insurance likes to see you finish the program and weigh in one last time. Really!? If you say 6 months then it should be 6 months, not 7! Grrr[emoji35]

I'm curious to find out how long Cigna took to approve you for gastric sleeve surgery. My insurance specialist turned in all my documents on 5/18, I called Cigna and they said they received it on 5/19. I'm trying to be patient but I'm excited!! I called again today, 5/24, and Cigna said it is still pending like come on... I'm fat, approve me lol. Jk. I'm interested in hearing your story, please comment below.

I was approved back in mid January by BCBS, but had more tests results we had to wait longer than expected. Then I had multiple work trips to Asia, I had to take. My work is basically a lot of foreign travel and I did not want to risk being that far away. Now I'm ready to set up a surgery and even moreso if I can wait until early August because I won't have any travel until October. I've called my doctors office and the nurse said no worries, she'll get back to me after she reviews my package.. I didn't hear back and was hoping I'd hear so not to fret over this all weekend.

Ok so I just attended the information session yesterday and I'm pretty much ready to do it like yesterday but my insurance requires 4 or 6 month supervised diet (wasn't very clear) . My question is since My BMI is 41 so I'm borderline meeting the requirement if I lose weight on the 4 or 6 month supervised diet and it drops under the 40 BMI requirement will that mean that I no longer qualify? Do they just use your initial BMI when they submit to insurance or do they use your BMI from your last nutritionist appt? Sent from my iPhone using the BariatricPal App

As of yesterday I'm officially APPROVED with BCBS Federal!!! I am soooooo happy! I feel so blessed for this opportunity! Currently waiting for my surgeon's office to schedule a date!!! I just wanted to post all the requirements and stats for anyone going through the insurance process with BCBS Federal. I had a ton of questions and this website was a god send, so here it is... GOOD LUCK! Age: 30 Gender: Female Height: 5.6 Weight: 236 Insurance: Blue Cross Blue Shield-Federal (Basic) Surgeon: Dr. Lloyd Stegemann (The Better Weigh Center) Location: Corpus Christi, Texas Requirements: 2 year history of being overweight February 2014-204lbs (excluded fell below 35 …

Anyone on here have Humana or Medicare insurance? If so what were the coverages and payment by them. Any advice on this and how long it took to get approved would be greatly appreciated Thanks

Staywell requires you to have a 6mts weight management program. Does it have to be consecutive? Or can it be 6 month visit in the last 2 years? I called the insurance company but they couldn't give me that information.

Has anyone sent their papers off to Va premier? If so how long did it take to get a date? Thank you Sent from my iPhone using the BariatricPal App

I was feeling anxious about my approval because my surgery is a week from today, and my surgeon's office wouldn't submit the paperwork until after my endoscopy this past Monday. On top of that, the admin assistant for the office is out this whole week! So I called my insurance company myself to ask if they could tell me if it had been submitted - and she told me it had been submitted and already approved! Phew! One week from today, my life changes!

Rockwood Weight Loss Surgery Center This is the total cost (minus two night stay in Deaconess Medical Center) for sleeve/bypass/lapband. They also require a bariatric psych eval (around $300), an EKG and labs. Some people might need more testing. These are not listed in cost, as you get them through PCP. Cost for sleeve is just under $7000.

The insurance coordinator from my surgeons office didn't submit my stuff for approval! My last visit was may 19 and the surgeons assistant said she submitted the task to the insurance coordinator to submit to Aetna and I should follow up in 2 weeks. I called Aetna today to follow up with them and they have absolutely no record of a request for surgery approval for me! Because of my intense work schedule I needed to have surgery the week of June 20th. Now even if they submit today Aetna has 14 days to respond and then there might not be availability at the hospital for that week. I don't know what to do now... I can't afford to self pay!

Oh, this gets juicier. I made some phone calls today. The insurance company (Anthem Blue Cross) says I'm capitated to one hospital, while the approving people (Preferred IPA) say I'm capitated to another. I called both hospitals, who told me that they're part of the same system, but NOT the same hospital. But this is where it gets even more interesting... The one my insurance company says I'm capitated to does NOT do bariatric surgery, and one the approving body says I'm capitated to DOES do it, but I was unable to find any doctors who both practice there AND take my particular insurance. I may have found my way to demand a variance and get my surgery with the s…

I am new to this forum, and started considering the possibility of getting the sleeve procedure done. I just checked my Blue Cross of California benefit plan, and my employer chose to exclude coverage for bariatric surgery. Does anybody know how much I could expect to pay for the sleeve, including consults, hospital stay, post-op care, etc.? I know it is very city-specific, but I am just trying to figure out a general guideline. Thanks in advance for your responses!