Insurance & Financing

Anyone with BCBS TN have any issues with getting the sleeve approved????

Today marks my 180th day in the WLS program that BCBS demands for surgery approval. My BMI is 41 ish and I have high blood pressure and sleep apnea. I have blazed through all requirements and anxiously awaiting approval. I sure hope i hear something by weeks end. In talking to my WLS office today they said this is a pretty cut and dry case and BCBS is one of the easier carriers that they deal with. Please keep your fingers crossed!!!!

I got the lap band when I had insurance that approved it. Nine years later, now my insurance doesn't cover it (or any complications).... I'm having some complications - am I completely screwed and will be self-pay??

Ok I have Aetna and my last class was last Monday but I haven't paid the balance I have for my psych evaluation I won't be able to until Tuesday and then they will send all the information to my insurance. But I'm curious about 2 things is there a certain period of time where your insurance is like you've waited to long and have to start the whole process over again ? And 2nd is getting approved easy ? Or do a lot people get denied ? Sent from my iPhone using the BariatricPal App

Has anyone ever dealt with Medcost insurance? If so did you get approve?

I am starting the gastric bybass journey and wondering if anyone knows the out of pocket expenses in Colorado. I called Medicaid and the most horrific mean woman did not help and and was so mean I'm not calling back. Does anyone know what the requirements are to submit par for surgery? Does Medicaid cover the six month weight loss management prior to authorization Sent from my HTC Desire 510 using the BariatricPal App

Hi All, Looking to find someone who may be a teacher in NYC or someone else with this type of insurance. Had my first consult with the surgeon today, loved her. The guy who handles the insurance is giving me information not stated in the plan. I'm going to post what the plan says and maybe someone out there can tell me what kind of things fall under 6 months continuous. He's insisting it's medically supervised but I don't see that word anywhere. Sent from my iPhone using the BariatricPal App

During my psychic as well as dietitian consult. I was asked, how long have Ive been thinking about the surgery. I answered truthfully and said not that long just at the beginning of the year. But I've definitely done my research on it. Would this answer hurt me in the end when they submit all documents to insurance for an approval? Should I have said a couple of years? ..... Sent from my iPhone using the BariatricPal App

Has anyone have Medcost insurance? if so were you approve or had any problems getting approved?

My doctor's office said they sent my paper work to the insurance company for approval on April 28th but when I call the insurance company they still say have not received anything. I am at a loss on what to do. Any feedback or thoughts would be greatly appreciated.

Holy cow. Here we go!! Surgeons appointment Monday to set the date. Hopeful for the end of May. [emoji16]

Hey guys has anyone gotten surgery approved from Medical (community health group insurance ) and what did you have to do? Sent from my SM-N910P using the BariatricPal App

I heard if you have Medicaid and you fit under a certain criteria, you can be approved rather quickly. I have a doctor appointment this Monday and I'm going to suggest WLS because after being this overweight for this long I'm fed up and ready for a positive change forever. I have friends that joke and say if I have Medicaid then I'll get approve for surgery the following day but I'm not sure if there's some truth to that. Sent from my iPhone using the BariatricPal App

Has anyone used Priority Health ins through state of Mi for vsg? How was the approval process. Sent from my SCH-I545 using the BariatricPal App

Hi friends! I've had my surgery date, June 9, since the first week of April. My surgeon's office is submitting my file for pre-authorization this week! I've met all the requirements and the nurse who contacts the insurance company says my insurance only requires a phone call to get approval! I would appreciate all your thoughts, prayers, positive vibes, etc. for a big fat approval!! Sent from my iPhone using the BariatricPal App

I realize everyone has different situations but I have UHC community plan in Ohio. I have just completed all my prerequisites for submission for approval The included: 6 months nutrition classes Cardiac clearance Pulmonary function tests Pulmonary clearance Psychological clearance sleep study Nutritionist clearance sleep specialist clearance -proof of CPAP compliance Recommendation of primary care doctor I have met with the surgeon and had my one on one for post surgical nutrition Had blood work for Pylori H , Thyroid and a random drug screen My psych clearance is to be to my doctors by Monday. Then we can submit to insurance. I am wondering is there a …

Talk to me about your experiences with getting approved with Independence Blue Cross. Would you consider them super picky or more relaxed? I'm specifically curious about the supervised weight loss period as well as proving previous attempts were unsuccessful Sent from my SM-N910T using the BariatricPal App

Received a letter from BCBS TN stating that my surgery has been denied, the reasons are: My five year weight history does not show a presence of morbid obesity. I knew that I did not have this proof going into the process. I don't go to the doctor unless I'm seriously ill so as it happened my weight was down (Due to dieting) at the one time in the year that I was at the doctor. My surgeons office assured me that would not be an issue. I questioned this at my first visit and took paperwork in on a second visit and discussed it with the nutritionist. I also have it in writing with a PA in the office stating, "It will not be a problem." They did not receive documen…

I just called the insurance company and they said it was still pending but a nice girl in customer service looked through the notes and they could see that on 4/26 the denial was overturned and it was approved!! I don't have the approval letter but I'm so excited. I hope to get the letter soon!!!

I am still trying to get the money together for a lap band. My insurance doesn't cover WLS. I have been quoted $20,000 for lap band. I live in Wisconsin. Is that what other people in other states have paid/charged? Also, I have a hiatal hernia. HAs anyone had a hernia fixed and lap band surgery at the same time to get their insurance to cover it? If so how much did they pay for the hernia vs entire cost of lapband and hernia surgery? Any information will be very helpful! Thank you! Sara

I was thinking of changing surgeons after I'm approved through insurance. The surgeon I was going to use is out of network on my BCBS insurance and is going to require his $3700 up front and then they file my insurance for me & send me the funds when received back from insurance. I found a surgeon in my insurance network so I am figuring this would be more cost effective. Does anyone know if this would be too big of an issue to change after insurance has already approved it?

So the first thing I did was call my insurance (humana) last fall to find our what my coverage for surgery was. They told me its covered at 90/10 as long as you meet the criteria. Lady sends me a info sheet. I meet the criteria. I make my appt, go through all the steps. MD office submitted for pre-approval and I was approved within days. Had my surgery in January. Now am looking at claims online and finding most of them are denied. Called Humana...oh well, there is a MAX OF 10K lifetime for obesity coverage!! What?? This is the first I have heard of it. Called hospital billing and they will discount a certain portion for being cash pay, but still will owe around 30k. I fe…

I everyone I am new this and I am currently going through the process with Kaiser here in Oregon. I am wondering if anyone else has gone through or is going through the process with Kaiser and how things progressed for you and timelines. I am going to my second group meeting on Wed.

Anyone have them? Paperwork was submitted last Wednesday, dr office said we should know in a week but that sounds too good to be true seeing that its medicaid. Im on a timeline because of work, june is our busiest time of year so cant get off. So worried. If no answer next week I'll have to wait til the end of July Sent from my SM-G900P using the BariatricPal App

We submitted to insurance on 4/4 to BCBSOK. Should I contact the insurance company to follow up with this request? I emailed the Dr. office to see if they have heard but have not heard back from them. I was just curious if I should call the insurance or just wait. I'm going crazy I just need to know!!

I am getting so frustrated with my Dr's office. I had my last nutrition visit on 4/12. I emailed on Monday to see when my info would be submitted to ins. The reply I got was we can't do it same day due to PA taking 48 hrs to process the report. I understand that, wasn't expecting it done same day. She said they try to do it at the end of the week. I called Aetna today and they have not seen anything from the Dr. It has now been over a week. I emailed again and I feel like I'm pissing the person off but I just want to know when it's being submitted. Is this wrong of me? I know I'm not the only patient there . Sent from my iPhone using the BariatricPal App

Surgery: April 26 Primary insurance approved within a week so I think I'm in the clear. Nope. I get a phone call Monday morning that she has to submit to my secondary insurance. She said it might cancel my surgery. Now, please someone ease my mind, I have the same company (Capital BCBS) for my primary and secondary. I have a letter from my primary saying my surgery is medically necessary. That, to me, says I will be approved by the secondary as well, right? I have less than 2 weeks until surgery and I am stressing. This is far too late in the game to be worrying about this. Should I be worried? What should I do?

Anyone have any experience dealing with them? Just wondering what I'm going to possibly run into. Thanks!

I'm soooooo nervous! Today was my final nutrition visit, and I am on cloud 9. My insurance, Highmark BCBS required that I do 6 months of nutrition, and a phych evaluation which has all been completed. They plan on submitting to my insurance today. My BMI is 37.9, it was higher but I have lost a little weight during my 6 months nutrition. I also have other comorbities so I am praying I get approved. Let the waiting game begin, as I bite my nails[emoji23]

I just got the call from my Drs, I was approved by Highmark BCBS. I'm so excited! I was so nervous bc I do have a BMI under 40. So my journey continues!! My surgery date is May 10th!!! This has been the longest 5 days of waiting ever! Haha!

Hey guys!!! I am so new to this. So someone called me from the bariatric office to go over all the steps that I need to get insurance approval. For oxford united health I think that you need; -bmi of 40 and up ( My BMI is 42) -6 month of documented weight loss ( I am on month three now ) -a psychological evaluation. ( This appt is on the 5/16/2016) Now she tells me that I need the last 2yrs prior to surgery of doctor records of attempts to lose weight.... I went on oxford united health to see if this a requirement to get approval and I don't see it anywhere. Please see link below. https://www.oxhp.com/secure/policy/bariatric_surgery.pdf Has anyone gone…

Does anybody have any info on Vantage Health? I'm thinking about purchasing a individual insurance plan from them and just wanted to know any info anyone may have Sent from my iPhone using the BariatricPal App

Good Morning Everyone. I am just starting my journey and have my first consult with the surgeon next Thursday. I was wondering if anyone here has used Health Republic of New Jersey to cover their surgery and what your experience was like (requirements, etc.) They are a newer company that I switched to in January. They use the Qualcare network of doctors, but not sure the requirements are the same. I've been waiting for them to call me back. Thanks!

Hello Everyone, This is my 1st post and I need a little help with clarification on using a primary and secondary insurance. I'm going through Kim Bariatric and my primary insurance is Aetna (they have approved) and my secondary through my parents is United HealthCare. My question is, if my primary insurance only covers Bariatric surgery up to $10K, but my secondary covers Bariatric surgery up to $25K, will I even be able to go through with the surgery? I have asked my coordinator and she was suppose to call me back. This is the last thing holding me back from getting a date. Any advice would be greatly appreciated! Sent from my iPhone using the BariatricPal App

Tomorrow is my first consult, what questions would you ask if it were you?? Sent from my iPhone using the BariatricPal App

Hello Everyone I am in the beginning stages of trying to obtain approval for surgery. The insurance I have is Kaiser and I am hoping to have surgery at the Fremont location. Can anyone give me an idea of what the process is at Kaiser? Are Options classes required? If so, how many? I had my pcp send a referral to the Bariatric Departement. Sent from my SM-G925T using the BariatricPal App

My insurance (BCBS OF MN) is supposed to be making their final decision today. The surgeons office faxed the paperwork in on 4/5. Called on 4/15 and was told they will be making their decision today. I am a nervous wreck. I just want to know! Sent from my iPhone using the BariatricPal App

I had my last NUT appointment on Monday, the office submitted the paperwork on Tuesday and this morning I called Cigna assuming they would tell me it's pending but it was approved. It took only 2 days for approval. I'm just waiting to hear from the nurse so she can schedule me. I'm pretty excited. I was extremely nervous after hearing people being denied, and I didn't want to give Cigna a reason to deny me.

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

I have UHC Choice plus and was told I ONLY needed to have my insurance for two years which was March 1st 2016. My bariatric DR required me to have the sleep study, psych evaluation, labs, stress test and pulmonary function test. I have completed all the appointments. How long did it take for UHC to approve your surgery if you DID not need 6month supervised diet?

How does it work ?? Your surgeon submits your papers for approval? My doctor is confirming my insurance before I even come for a consult . What are the steps before you get a date? Sent from my iPhone using the BariatricPal App

Hey guys... My band removal has been approved by my insurance due to a leak and I'm thrilled!! However I'm going to have to pay out of pocket for the actual surgery and surgeon fees (Bariatrics isn't covered by my insurance plan) The hospital said they can't tell me how much I will end up paying cos it depends on insurance and benefits. Should I expect that since I have to get sedated for the band removal that insurance will at least cover anesthesia? Anything else insurance will cover for the removal? Also, what's the best route in terms of paying for it? Care credit? Private loan? I've done all the necessary steps and don't want to give up but it's A LOT …

Anyone get BC/BS to pay for excess skin removal surgery, ex: tummy tuck? I'm in the Chicago area. Please give me your plastic surgeon's info, thanks. Sent from my GT-P5113 using the BariatricPal App

Hi All, I just joined this site and have read all the posts about waiting to hear on approval. Well, I have finally made it to that step and now I wait. I have Cigna and I am nervous because I gained 1.4 lbs during my 3 month NUT visits. The NUT told me not to lose any weight since I was at a BMI of 36, with HBP, pre-diabetic, Hyperlipidemia, asthma. She said if I lost I was at risk of "losing my insurance benefit." It was so difficult to not lose and not gain, plus my scale differs from theirs, I fluctuate daily, etc. Fingers crossed. The automated system says..."pending." ARGH!

Got good news today. I met with surgeon and was given the all clear, they are submitting my stuff to insurance this week. When approved surgery will be a go [emoji4]

I have Aetna insurance PPO II. In the requirements it says that there must not be a net gain. What exactly does that mean? Like no weight gain at all? Or you can't be more than the first weigh in? Sent from my iPhone using the BariatricPal App

my info was submitted on friday! Im a nervous wreck of course. Anyone else have bcbs of nc if so how long before you heard a decision??? Sent from my SM-G900T using the BariatricPal App

So, I was approved for the sleeve but denied for removal of the lapband because it is not medically necessary. I am confused. Has this happened to anyone? Sent from my SM-G900T using the BariatricPal App

I have began my journey and so far have done my psych eval, I still have 4 months left of nutrition that my insurance requires. I am on the lower BMI scale, but do have pre-diabetes and some other weight related issues. I wanted to see what other people's experiences with Highmark has been like. I hate not knowing the outcome, my Dr. Seems to think it won't be a problem being approved, but the fear of the unknown is still there:)

Anyone have HIP 2.0? My insurance company (MHS) is telling me that I do not need to complete a medically supervised diet but the provider is saying I do. I found out today they haven't actually checked with my insurance company they just automatically make folks do the diet. This is frustrating to me because I switched insurance and prior to this was ready to schedule a surgery. I really don't want to wait 6 months unless I absolutely have to.