Insurance & Financing

Hello All, not sure if I am typing in the right field but I have been researching the gastric sleeve for some time now and really think I want to get this. Is there anybody on here that has Info about individual insurance that I can get that would cover the procedure

HELP! ????I was denied in July for gastric sleeve. I met all the requirements (psych evaluation, BMI 49, HBP, Type 2 diabetes and PCOS) except I didn't have 6 monthly weigh ins which they required at the time. My PCP was floored! He was so upset at my insurance company for requiring the 6 monthly weigh ins, my health is in really bad shape for a 29 year old! However, I've been reading that Blue Shield of Ca just changed their requirement and that they no longer require the 6 months of weigh ins! I'm on month 3 and need advice! Should I call my surgery group and have them submit to insurance?! Has anybody had experience with this!? Thanks so much!!! The sooner I get this t…

Frustrated!!! I'm almost done with my 6th month supervision weight in. I called blue shield to get some up to date requirements over the surgery to my surprise l was inform that after they review my case then l get put on a "waiting list" l was never informed over this.... I have been through this journey almost a year.... Don't want to give up ,but I'm very frustrated!!! Has anyone been through medical approval (California) Any advice is Welcomed

I have BCBS-CA PPO. I had my first appointment yesterday, i have to have 6mths of nutritional visits. I have to show weight history for the past 3 years, I dnt know if I have all 3years. I have a BMI of 43. I will meet the requirements by end of November 2016. What were some of the challenges you experienced with meeting the requirements for the surgery? I am also using the OBand center which i believe is out of network, but they were not concerned. Share your experience getting approved or denied & appeals? Sent from my LGMS631 using the BariatricPal App

Hello all! Here is my ridiculous story involving the insurance end of things, and a few questions to follow. Back in August, I made my first call to start the journey toward surgery. I had UHC at the time and they covered the surgery and required every darn thing on earth, except the 6 month diet prior to surgery. My plan with them was ending 1/31/16 because my employer switched providers. My entire surgical team, along with every Dr I saw during the process knew that I had a deadline. And it seemed like I had plenty of time. Well, after many miscommunications, ball dropping, wrong fax numbers, etc my surgery was finally scheduled for January 27th. Talk about last min…

I have been approved blue cross (medical) California I'm so overwhelmed with happiness l have been approved for the surgery!!! I'm so ready for this #blessed

Hello, I am new to this whole process, and I need some advice or insight into the whole insurance thing. My pcp recommended I look into surgical options because I have struggled for so long with my weight. I cannot afford to have surgery if my insurance does not cover it, so I called right away. I was told it was covered, with an in network dr, with prior authorization. I was pleased, but unsure about what the requirements were. I went to the informational seminar yesterday, and was given the packet of info including all of the questions to ask insurance. I called and talked to another rep who verified what the previous rep had told me. I went on to ask if a medically su…

Hello everyone! I'm quite new to this forum, and I came across this awesome website, and boy, am I so glad I did! It has been a real help as I am currently in the process of trying to get insurance approval for the Gastrectomy Sleeve. I currently have BCBS of TX PPO insurance, and I received my predetermination letter in the mail saying that the surgery is a covered benefit under my particular plan and would be covered provided that I have met all the requirements needed. So I suppose it's pretty much safe to say that I have been approved for the surgery. I haven't heard back yet from my case manager at my doctor's office, but according to my letter and the phone conv…

I have my appointment set up tomorrow with my NUT. Found out that they don't bill insurance so I have to pay out of pocket. Does anyone know if I can submit it to my insurance company for reimbursement? Sent from my iPhone using the BariatricPal App

I have a bmi of 35 and was recently diagnosed with hypertension. I am now on medication. I have a family history of obesity, heart disease, high blood pressure,cancer. I completed all of my requirements and my surgeon sent in my info. BCBS denied me because they said my hypertension is controlled by medicine. My surgeon is going to schedule a peer to peer. I was wondering if anyone has a similar profile and were eventually approved. It is so disappointing.

Does anyone have this kind of insurance and their process on getting approval Sent from my iPhone using the BariatricPal App

So they said they cover bariatric surgery. I have called them several times and each time I ask what requirements such as nutrition visits etc they say they don't have any specific requirements. Sounds great but I can't seem to get any more details or anything in writing. My surgeon's office does not do the insurance research, which sounds typical but I would like to get something a little more reassuring. Or should I hope for the best and wait to hear when my testing is all done? The surgeon is booking four months out as it is anyway. I will do whatever is needed. I just don't want to go down one path and then find out later that there are some unforeseen require…

Okay you guys I lost my insurance coverage due to money problem or how my grandmother would say in between blessing, now the good thing is I don't owe bcbs of mi any money so I am always go back and because I went through marketplace they felt they didn't have enough information about my income so they canceled my insurance now because of the timing I can go back into enrollment no problem but here my issue I loss the money I have already put to my deductible now that loss I have to start all over I have pick a new insurance plan I still want my vsg but I'm getting very discouraged Sent from my iPhone using the BariatricPal App

For those that had to pay a coinsurance, was that due before surgery or was it billed to you? I know a lot of companies vary so I'm just trying to get an idea of what to expect. I'll ask about it at my next appointment. Thanks!

Well I had my last class I go June 10th to the surgeon for my last weigh in then they submit everything to my insurance. I'm so scared about not getting approved my BMI is 54.8 and the surgeon is acting like me being approved won't be a issue so I'm excited and nervous Sent from my iPhone using the BariatricPal App

Now the waiting is on. I submitted all the paperwork to get a conversion from lap-band to sleeve. I did everything they required and I pray that everything goes well! My only concern is my BMI. It is 35.5 BMI but they need only 1 commorbities (I have GERD, PCOS, Diabetes type 2, depression, anxiety, and high cholesterol). I hope this is enough for them Prayers are super appreciated! I will keep you posted. Sent from my iPhone using the BariatricPal App

So, I am covered under Medicaid in Indiana. But honestly I understand absolutely nothing about my insurance. Apparently my medicaid is called the Healthy Indiana Plan plus but under that you have to choose a health plan and mine is Managed Health Services. I'm at a loss of what I'm doing to try to confirm my requirements for Surgery. I've called my surgeon's office and gotten mixed answers about what's required. One lady gave me info for MHS requirements and either the same or different lady said I need to meed medicaid requirements when I called back a couple weeks later. I'm actually confusing myself more as I write this, but is there anyone from Indiana who knows what …

I have aetna and I went to my first surgeon office visit today. I have been to the dr for the past 2 years with high blood pressure and unsuccessful diet. My husband said I snore like a dragon but I am not sure if I have sleep apnea. The surgeon just put me on a High blood pressure RX today. My BMI is 37. I have been to DR a lot about my weight but I am not sure if it's been the required 4 months in a row I am nervous about getting approved... This is the part that worries me: BMI greater than 35 in conjunction with any of the following severe comorbidities: Medically refractory hypertension (blood pressure greater than 140 mm Hg systolic and/or 90 mm Hg diast…

So... I just went to the surgeon's office today for my first visit. I have had recorded high blood pressure for over 2 years and have been dieting with exercise with steady fluctuating weight. The surgeon put me on a rx for HB today. WIth aetna I was told I need 4 months of documented, consecutive, supervised diet. I am so nervous about getting approved. I am 5'7- 1/2 and weight 242 with a BMI of 37. My husband says I snore like a dragon but I am not sure if I have sleep apnea. I am 33 will be 34 in July...... So I guess I want to know if anyone with similar circumstances and aetna insurance was able to get approved... what did they make you go through and how long d…

I'm now half way through my required 6 month medically supervised visits, and as I am getting all the required tests completed I am worried I may not get approved. Although I have a bmi of 43, I have no co-morbidities (no diabetes, high blood pressure, sleep apnea, etc). I'm wondering if anyone out there has been approved with a bmi of 40+ and no co-morbidities? I work at a hospital and have insurance through them, nothing commercial like bcbs or aetna, it's Adventist Healthnet, and they do cover it at 100% after I've met the criteria. I know based on bmi alone, I qualify but I'm worried that they'll find a reason to deny me cause I'm not "unhealthy enough"...i hope i ma…

Has anyone had any experiences with Humana Family (through medicaid)???

I am in southern NJ and i am trying to get some type of help with the lap band procedure. I am 5'9 and 222lbs. I have always been up and down with my weight and can not get under 220 no matter what i do. I work out 3-4 times a week, i diet, i starve and nothing helps. I have amerihealth insurance through my employer but it seems nearly impossible to even get an appointment with a doctor.. Any suggestion?? anyone have any good experience in my area with amerihealth or at least a doctor that will do the procedure? My insurance covers the procedure. I am at a dead end and depression is winning. Thank you.

Hello all, I'm new to BP, I started the process last year but was scared off and told myself I would do it on my own well here I am a little over a year later hating that I didn't go through with it then. Deep breath-sigh, but here I am today super excited because I met with my PCP during lunch and she was totally on board. She actually almost had me tearing up because of how far I feel like i had to come just to be were I am. I left feeling really good about the decision and the journey. Note: My regular PCP wasn't there so I met with another doctor and will be switching because she was so energetic and open whereas my regular doctor is really hard to talk to. Nex…

My surgeon sent the documentation this past Friday. I called my insurance company (Highmark BCBS) today and they said it shows in the system as "pending." I am so anxious to get an answer. How did you all deal with this waiting period? I am tempted to call twice a day, once at noon and again at 5pm... Sent from my iPhone using the BariatricPal App

I just called the BS of California to find out the status of my pre-authorization and they told me that is been approved! PTL! I'm still kinda in shock and waiting for the letter/call from the doctor but I'm so happy!!!! Thank you for all the prayers and good wishes! Sent from my iPhone using the BariatricPal App

Whew! Finally approved! My last NUT visit was 4/6. Submitted to insurance the next day. 4/11 get a letter asking for more info, basic stuff that I thought would have already been submitted like surgery date, hospital info, etc. Resubmitted by 4/15, got approval via automated system on 4/22 and finally got the call from the surgeons office today. I am scheduled for May 16th!! Yay! Let's get this party started!

Well I found out today that my insurance does not cover any version of the weight loss surgeries so I cannot afford to do the gastric sleeve like I so desperately want and I certainly won't be able to afford it anytime soon. Maybe if I win the lottery or if I start a go fund me account I can get close but oh well I guess I have to figure it out some other way Sent from my SM-N910T using the BariatricPal App

May have a problem???? Im scheduled for wls july 25th ..The nut told me to double check with my insurance to see My insurance do pay for the surgery (Emblem health) but 6 months requirements the clinic told me 3 months i hope i don't have to wait til November will be so hurt.????????????

I'm curious, is anyone trying to schedule a surgery through Medicare insurance and if so have you had any denials or any problems getting approval? Sent from my LG-H901 using the BariatricPal App

For those considering surgery who, like me, were investigating insurance coverage, the following info might be useful. Basically: <b>in about half of US states it is nearly impossible to get insurance coverage for bariatric surgery, regardless of your BMI or co-morbidities,</b> regardless of the specific surgical procedure and regardless of where you get the surgery. Prior to the Affordable Care Act (Obamacare), private insurers largely had free rein to exclude treatments (such as for obesity and other pre-existing conditions) and increase premiums for the obese. Only 4 states required insurers to cover bariatric surgery. So insurance coverage for weight-…

Hi all, i just had my band removed after 6 years of difficulty with it. I am hoping to get the sleeve in October but have concerns about my insurance. 1. I currently have a BMI under 40 (38) but suspect that will climb now that I am unbanded. I have been going to my dr monthly since February. He says I need at least 6 months of visits and should have at least 3 of those demonstrate a BMI over 40. He believes that my history of BMI and failure with the band will work in my favor when we apply for approval. Does anyone have any feedback on this? Do you agree or disagree? 2. Do you know if NYSHIP requires anything else other than a psych eval? I have seen refer…

I have surgery scheduled for 17 May 16. BMI is 39 - have Moderate sleep Apnea. Did medically supervised diet from Dec 2014 - May 2015 and every possible diet known to man, multiple times. Reason for denial is that the 3 month medically supervised diet was not within this last year. Nowhere in the 2016 FEP BCBS brochure does it say WHEN you had to participate in a 3 month program. I was also medically supervised from Apr 2006 - Dec 2006 when I represented Pennsylvania on Season 3 of the Biggest Loser. Can anyone advise on how best to challenge this? I don't want to wait another 90 days to check a block. I've been battling and battling and battling for years.... …

My isurance (a form of medicaid) denied me as they are saying they require comorbidity even with high BMI. My Dr is fighting for me and has a peer to peer scheduled. Wondering how many people have had a successful outcome from peer to peer? Did it or didnt it work for you? Considering hiring a bariatric attorney Sent from my SM-G900P using the BariatricPal App

*States that do not offer bariatric surgery, nutrition counseling, or weight loss programs in the State Health Insurance Marketplace are: Alabama Alaska Florida Georgia Indiana Kansas Kentucky Minnesota Mississippi Missouri Nebraska Pennsylvania South Carolina Wisconsin Source http://nofusa.org/news/health-insurance-cover-obesity-treatment/

I know that they are very busy specifically my insurance coordinator, but I think that a second to confirm you received my last email or to answer a question about my insurance is really not asking to much. I am the only one with this problem. They act like they aren't going to get paid for our surgery. It's so frustrating! Sent from my iPhone using the BariatricPal App

Is it true about insurance paying for nutritional supplements? I have been seeing the advertisment on this app Sent from my SM-N910P using the BariatricPal App

So I have been going to this surgery center since August. My insurance gave me the runaround but I finally got it in writing what their criteria were etc...my last weigh in will be April 5 and then we can submit to insurance. My surgery center has a policy that they will not start you on the four week preop diet until you get insurance approval so best case scenario I can get it at the end of May. HOWEVEr, my surgeon was in a car accident and is off work for 6 weeks and is booked up until July. Now I just got notified that they are discontinuing my insurance at the end of May and putting me on a high deductible plan with HSA. I won't know until April 4th if it covers bari…

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I just got back clearance on my nicotine test. They've submitted my claim for surgery to GA medicaid. Any idea on how long before they call with a surgery date? I am have gastric bypass surgery at Emory Midtown by Jamil Stetler of Emory Bariatrics. TIA Sent from my SM-N910V using the BariatricPal App

Hi everyone. I am new to this forum. I am actually new to this journey. I have finally accepted that I cannot control my weight on my own and am in the process of checking off the boxes for insurance approval to have the gastric sleeve. My main concern at this point is that I will be denied by insurance. My BMI is 38/39. But I do not have sleep apnea, COPD, diabetes or hypertension. I do have osteoarthritis in at least one knee, scoliosis, GERD, prehypertension, and fatty liver disease. Can anyone with a bmi in this range and none of the top 4 major comorbidities share your stories with me, whether approved or denied? I would be especially interested in any experiences wi…

Hello! I have a question for a friend that is wanting to start the surgery process. Her employer offers Aetna. I know there are some here that are through Aetna, could you please tell me which plans cover it? I think the options for her are Choice POS II or HHDP Choice POS II. I also advised her to call them but I figured there would be some who would know here! Thanks in advance! Sent from my iPhone using the BariatricPal App

It's been such a busy time preparing and I think I am at 7 business days pending. In the middle of finishing everything, I had a family crisis that just had me forget about it. But I need to get this done sooner than later. Work schedule, family obligations....praying it all works out. Would be great to hear by Friday. But who knows.

Hi there, I have Blue Shield insurance but my group is Hill Physicians. I have called the major hospitals here that do bariatric surgery and they all take Blue Shield, but not the group. I'm so frustrated and stuck. Can anyone help?

I'm so frustrated. I have done so much to get approved for this surgery and was just told I was denied due to not having a disabling condition that requires this surgery. I meet all their conditions stated in the handbook that says bmi over 40 doesn't require another condition. My bmi is 46, wven after losing 25lbs on my dr supervised diet. We are sending in an appeal. Anyone else go through this? Sent from my SM-G900P using the BariatricPal App

I received approval from Aetna within 48 hours!!!!!!! Anybody know what the preop and preop test consist of? Sent from my iPhone using the BariatricPal App

Hi all, I had gastric sleeve surgery last September 2015. In August 2015, I had the pre-op blood work done at Quest Diagnostics. Shortly after that visit, I got a $1113 lab bill from Quest and they told me that BCBS wouldn't cover the costs because the surgeon's office had coded it to "obesity". I don't understand why BCBS will cover weight loss surgery but not the associated lab/blood work. I called my surgeon's office to explain this to them and the nurse told me she would change the billing code and resubmit to Quest. Well, apparently she never did that. I thought she did because months went by and I never heard another word about it. This past Monday I got the same …

Okay so in 2013 I was going to get surgery through UHC and completed all the requirements, 6 month supervised diet, psych evaluation, meeting with the surgeon. Even had a surgery date. I was laid off and lost my insurance though and was not able to get the operation. Now in 2016 I have BCBS of Minnesota and I'm wondering will I have to do it all again? Any info about your experiences are greatly appreciated!!!

Has anyone tried to get their supplements covered by insurance? What does it usually take? I need to remember to ask tonight at WLS Support Group. pam

I am looking to have the sleeve, and was told by my insurance ho (south florida community care network) that wls IS covered. Anyone else had the sleeve in south fl, with medicaid coverage? If so, what were the requirements, aand hiw long did it take for u to be approved. Any info is greatly appreciated!

Although several co workers with thee same coverage I have have been approved and have had or will be having surgery shortly I am not able to have ANY bariatric services because many years ago I paid myself for a lp band. The surgeons office I wanted to use will not even allow me to see a doctor to attempt an appeal or do a doctor to doctor call because they do not 'get involved with insurance issues'! I will turn 65 this year, does Medicare cover band to sleeve revisions? how can I find this out?