Insurance & Financing

I had my consultation a couple weeks ago. My surgeons office sent in for approval and have not heard back yet. I know they will deny the first attempt, as this is the only way for the surgeon to find out what specific criteria I need to meet. We have tried and tried to find out what criteria I need to meet, but the only thing they will tell me is that we need to submit and they will enter it into InterQual smart sheets (So much for transparency). I'm wondering if it is a good idea to just have my attorney write a letter right away? I realize I am getting ahead of myself, but already they have been a pain to work with. Has anyone here had any luck hiring an attorney to hel…

Does any one have a medical savings account through work,.. And can you get reimbursed for vitamins through it since they would be considered medical required?

Wanted to ask anyone if they had changed surgeons after getting approved for gastric sleeve by the insurance. Has anyone had problems with it? Also has there been a timeline of how long the wait is prior to getting the ok from the insurance. The situation is that my wife got approved by BCBS of NJ for her sleeve but now wants to get it done by another surgeon and she is afraid that the insurance will make things complicated and she loses out on getting her sleeve done.

Has anyone been denied by their insurance for a lack of showing effort during the pre-op phase? I am about a month away from being submitted for insurance approval. My doctor told me that although I have met the requirements for the weight loss (5%), losing only the 5% over the course of 10 months shows very little lifestyle change and it will probably be denied. I understand what he's saying, and I guess I did drop the ball on this one. But I've been waiting a year and I will be crushed if this is denied. If the insurance company wanted more of a loss, why don't they require it? I don't want to make excuses, this is entirely my fault. I didn't fix what causes me to eat…

My Weight loss clinic had to get an approval from my insurance company first before I could be seen. I got "approved" and I am required to do a 3 month weight loss management before I can go into surgery or get scheduled. I just would like some clarification... So after the 3 month WLM you still have to submit to the insurance to see if it will be covered? If you meet the weight loss requirements you can still get denied? How often does that happen? Sent from my iPhone using the BariatricPal App

Has anyone ever used emedical financing to pay for their surgery? I have to pay a 500 dollar deposit to my surgeon to secure my surgery date ( I'm going to mexico) so I was trying to figure out all my options. Thanks!! Sent from my SAMSUNG-SM-G530AZ using the BariatricPal App

It's been a week since I got the call that everything was being scanned to be sent to insurance, but my insurance hasn't gotten anything yet. I started this journey in June of last year, I'm just so impatient and ready to start my new journey!

Hey everyone, I've got a quick question about appeals. I've been denied by my insurance twice and I've already resubmitted for a 3rd time and am waiting. I meet all criteria so I'm hoping this 3rd time will be the charm. I keep thinking though eat if they deny me again? How many opportunities do I have to appeal them? I'm so heart broken by this whole process. Any info would be greatly appreciated Sent from my SAMSUNG-SM-N900A using the BariatricPal App

I told my boss (owner of our small company of less than 30employees) a few weeks ago that I was going through the steps for qualification for weight loss surgery. He was happy for me and said to let him know for there was anything "they (the company)" could do to help. I let him know I'd have a lot of doctors appointment leading up to it but to it but that was all. This week i found out that the surgery is excluded from our group insurance policy (even though i myself as well as the surgery center confirmed t was covered) and I will now be a cash pay patient. I even checked to see if it could be added to our policy. My boss would agree if so. Our insurance broker sai…

I apologize in advance if this has been addressed, but I couldn't find it. I am currently on Medicare for disability and have qualified for WLS because of co-morbidities and BMI.I am in the process of completing my surgeon's requirements; the last one I need before my scheduling appt is the full 3 months smoke free (Dec. 16th is 3 months! Go me!!! ) I have done labs, mammo, shrink, cardio, endo, support group etc. My question is: if I were to choose to get a Medicare Adv Plan that starts January 1, does anyone know how that would affect my WLS that is scheduled In January? That is going to be a huge factor in my decision as to whether I add one or not and which on…

I just received a call from my insurance company asking if I wanted to join their bariatric nurse program. I have a call next week will a nurse to go over the details but has anyone else heard of this Sent from my SAMSUNG-SM-G920A using the BariatricPal App

Medicare and medicaid is paying for my surgery they say around August am like I'll pay for my 6 class getting nowhere Sent from my VS880PP using the BariatricPal App

Requirements: 40 BMI or 35+co-morbidity 3-month physician supervised diet within the last year. Must be 3 consecutive months. Must include dr. notes, exercise, weight, height. Mental health evaluation Echocardiogram and stress test if co-morbidity is heart related, mine is hypertension sleep study if diagnosed with sleep apnea Labs (including stool sample for H-pylori screening) Pap test/well-woman/well-man check within 1 year Mammogram within 1 year if 40+ Colonoscopy if 50+ EGD if diagnosis of GERD I must say that my insurance journey was not difficult. Once I had all the documentation, it was turned over to my surgeon on a Friday and I had approval from in…

Anyone have success with joint pain/arthritis as their comorbitidy for insurance purposes (when BMI is < 40)?

Hey y'all! This is my first post on this forum and I have a question for those with Aetna insurance: how long did the approval process take? I'm a little ahead of the game since I still have on more weigh-in in April but I'm excited and I'm trying to plan my summer classes around this surgery. I've been seeing my weight loss surgeon since November and have had 5 weigh-ins. I have a BMI of around 41 I think and I've gained 15 lbs since I started this process however I've lost 7 of those so far. I'm just wondering what I can expect in terms of insurance. Thanks y'all!

GREAT NEWS! The doctors office submitted my paper work to Humana and I got approved in less than 24 hours! I am soooooo hyped! God is Great! Now I just wait on a surgery date!

Hi all! I am new here, my name is Jennifer. I am wondering for any of you who work for or have had surgery and have Tricare, if you know of any good surgeons who are great with checking insurance and moving forward quickly. I want to move quickly. Thanks very much!!!

And the wait is on!!!! Paperwork has been submitted to insurance. Anyone have this insurance and know how long it typically takes for approval?

Looks like I'm going to be 100% self pay. Which sucks. It's not fair since my husband and I actually work for a living we can't get Obama care and have WLS paid for. Irritates me beyond no end. Anyways... What are some positives of being self pay? Any suggestions on new insurance companies in KY that would cover WLS? TIA!

Has anyone gone thru skin removal surgery and were you covered by insurance? I've seen there are some ways to get it covered. Sent from my iPhone using the BariatricPal App

Hi, I was wondering can I have both private insurance my Platinum D PPO and Anthem Blue Cross's Medi-Cal at the same time? I was wondering because I qualify actually for Medi-Cal but I also have a fund just for my medical expenses so I also got my Platinum D PPO. Please note: I am very obese and the fund for my medical is not that much no more than $5-6,000 just for 1 1/2 years of coverage and I still do not have enough for the co-pays and specialist visits. That's why I ask because I'm having a hard time paying the $520 a month alone. But my bariatric doctor DOES NOT take Medi-Cal that's why I bought the insurance because I was closer to getting bariatric surgery on priv…

I was wondering if anyone had Blue Cross of PA PPO which from my understanding is a subsidiary of BCBS. I've been working with Kim Bariatrics in Frisco, TX for assistance with qualifying for the gastric sleeve. Initially when I spoke with my coordinator, she advised me that my insurance does cover gastric sleeve as long as I meet the guidelines set by insurance. I'm 42.1 BMI i think and that alone was enough for potential coverage. She confided to me that my plan doesn't require a 6 month diet plan, but they do want to see previous attempts of weight loss. In the past I've used phentermine and weight loss programs through several primary care physicians since 2010. I've a…

Does anyone have bcbs of mass that has gone through the surgery? I am on my dads plan until I'm 26, and I'm trying to get an estimate of the cost. My ppo deductible is only 250 + 500$ hospital admittance fee. Sent from my iPhone using the BariatricPal App

Hi all- I currently have a UHC deductible of 3250, but my open enrollment is July 1. My other option is a middle deductible for 1650. I'm considering changing since I believe it'll be most beneficial. Can anyone share their perspective and offer advise? It'll cost me more monthly, but I'm hoping it'll save me having to come out of pocket for the surgery itself since I know that's super expensive. I'm in Florida and I looked at the average cost of 16k. Insurance will cover 90% once ded is met. I'll probably still have to finance the procedure. Hopefully the dr and or hospital take care credit Sent from my iPhone using the BariatricPal App

Hi I have Blue Precision HMO I chose this because this was only plan i could some what afford with my part time income. And it said they covered bariatric surgery. Then the insurance person at the place I will be getting the surgery done called me on Friday and told me there is an exclusion and it not covered.... I know it is a HMO i know I need to go through my PCP first but why is it saying it's not covered when i went through the exclusion packet part and it does not say anything about it. And right before I bought the insurance the reps said it is covered on my insurance, this was only reason I bought the insurance and paying a whole paycheck for it... idk any info or…

For those of you insured by Tricare, how hard was it to get approved (any details, advice, warnings appreciated)? Was it easier to get approved under the Tricare Prime Plan or under Tricare Standard Plan? Did Tricare require you to complete a 6 month diet? Did Tricare require years of medical records showing a high BMI? How long did it take to get approved? Is it true that Tricare South is very flexible?

I have Anthem BCBS (in CT) through my employer as my primary, and United Healthcare through my husband's employer as secondary insurance. The surgeon's office called both and both indicated that the coverage is there. Awesome - potentially much lower out of pocket costs! But then I contacted them both by email asking for the specific requirements to be approved, and surprisingly, received a reply from United Healthcare that bariatric (surgical or non-surgical) is NOT covered under the plan! HUH? I provided the call reference # the surgeon's office was given when they said there WAS coverage, but UHC is like, "Sorry! No coverage!" I have asked repeatedly for the pla…

Hard to believe I had my patient advocate submit for my band to sleeve revision surgery today and I got a call a half hour later saying that Blue Cross/Blue Shield of AZ had already approved it! She said that it was hands down the quickest approval she has ever seen. Now I have to set a date.

I'm somewhat new here but have been reading about everyone's experiences for the last month and it seems like a great place to ask advice. So I thought I met the requirements of my insurance, bmi is 35.2 and I have had high blood pressure my whole life. I do take a bp med that seems to keep it under control. My insurance requires a bmi btwn 35-40 with one co-morbidity. They list medically refractory hypertension as one. I unfortunately got my first denial today saying my hypertension is controlled by one med and although I have sleep apnea it's only mild (they require severe). Has anyone been in a similar situation and gotten approved?? Of course I'm going to call …

Hi! In the last few months I finally came to the decision to undergo bariatric surgery. I've been driving myself a little crazy with all the research I've been doing into the possibility of doing it here in Denver, or going to Mexico, since the costs are much lower. My HR director had assured me that bariatric surgery was not excluded under our company plan... except that I found out today that she was wrong. I've heard of instances in which companies will sometimes pay for someone to get it done in Mexico, rather than having to add it to the insurance. Has anyone done this? If so, how did you approach your employer, or was it just offered? I'm just curious. St…

Hello I'm Diamond I have the ppo plan I do know that my surgery is cover however I have read a few thing some people said you had to wait the 6months other didn't what the step to follow for Michigan! Sent from my iPhone using the BariatricPal App

I'm on the NC State Health Plan through BCBS of NC. When I called last month, the consultant told me that there was a requirement of following a medically supervised weight loss program for 3 months. Turns out - that person was crazy. I found the Medical Policy (https://www.bcbsnc.com/assets/services/public/pdfs/medicalpolicy/surgery_for_morbid_obesity.pdf) and the requirement WAS 6 months... but it was removed in July of 2014. I called today to confirm. The only requirements now are when all four of the following requirements are met: 1) Have a BMI greater than or equal to 40 *or* more than 35 with co-morbidities 2) Have no specifically correctable cause for t…

I am beside myself with worry! I was sleeved March 7. I was approved by my insurance, I and my doctors office have approval letters. The insurance company now says VSG is not covered by my insurance plan. I NEVER would have had the surgery of it was not covered. They say I owe $42,000! They are even refusing to pay pre op tests and labs. Has anyone else had this happen? Did they have to pay? Am I up the creek without a paddle? Sent from my SM-G900T using the BariatricPal App

I have Bcbs carefirst and my stuff went in on the 3/19 and I found out today they left a message on the 3/23 to call them back because I got approved. However I hadn't checked my house messages and I called today and they told me. May 11 here I come! Sent from my Z970 using the BariatricPal App

I started exploring bariatric surgery in October and it's now it's almost April, and I'm only about halfway through the pre-surgery process. It would be easy to blame this on the hoops my insurance company is making me jump through, but the real culprit here is my PCP. Or my PCP's office. They are so terrible with referrals. And with my insurance (Tufts), you can't sneeze without a referral, or you'll be charged full price for it. For example, I'll call my PCP's office to tell them I need 3 more appointments each with my hospital surgical weight loss program assigned NP and dietician, and they say "Well, we normally don't do referrals for those, since we have NPs and a …

I have Aetna, a BMI of 41 and am pre-diabetic. April will be my last weigh in under supervised plan and then everything gets submitted for approval. I am so nervous. I need this approved so bad. By pre-diabetic - I don't meet the A1C blood work tests to show full true diabetes. I have taken metaphormin meds and an under primary care physician's care for pre-diabetes, depression, anxiety. Thoughts and feedback appreciated.

Does any one have in any info , it's like this insurance is a secret society when I call them to get info out of them , geesh! Just want some simple requirements, are maybe others with florida medicaid can give me some of there requirements from there medicaid experience in florida ... please help! Thanks

WLS is excluded on my insurance. For anyone that was self pay - how much did your surgery cost? And since I would be self pay - does that mean I could get in with a Dr and have the surgery quicker since I dont have to jump through a million other tests?

I understand that everyone needs some type of help and i just like others have medicaid with either molina, meridian, total healthcare, harbor health, United healthcare or etc etc etc.... but when you call and give them you insurance id number and they ask you your basic info name, dob, address, phone and etc etc.... they say what can i help you with today and sooooooon as you say i'm calling to get Bariatric Surgery requirements and all you hear in the back ground is smaaaccckkkk like you irritating them this is there job and they suuucckkk at it so bad then she says well you will need to have a prior authorization form and then when approved we can give you more inform…

Just curious is there is anyone else using Husky insurance in CT?

Do anyone have gilsbar insurance? ? Sent from my SAMSUNG-SM-N900A using the BariatricPal App

Hello! So far my doctor just sent in the package to my insurance company to wait to see if its approved or not. However intill then I was wondering if anyone has used BCBSRI before? What problems/sucess have you hade??I am living in denver, and so far they give no requirements for authorization besides a PCP. No classes, 6 months of dieiting or anything. this seems too good to be true. If it is true my tentative surgery date is for the 29th of February.

I was so worried about what I was going to have to pay for my bypass. My insurance company nor my surgeon's office could/would tell me what my out of pocket was going to be! My surgery bill from the hospital was only $99.82!! The anesthesologist was $160 something. I'm stoked!

Howdy! Been lurking on here for a little while and am posting for the first time. I apologize in advance - this is LONG. I have begun the process with a Bariatric surgeon and am still rather early on in the process. But I am already freaked out and completely terrified of making a misstep, largely because I've read so many things here regarding the different insurance companies and their reasons for approving and denying...and they are ALL DIFFERENT! Unfortunately (?), I am probably not what would be considered a "clear cut case". My BMI is not quite at 40 (but close), and I do not have any of the normal co-morbidities. In fact, all I really have is joint issues - …

Hi I posted this in another section but just found this and looks more appropriate here. Has anyone had experience with Amerigroup? I know they used to have a 3 year waiting period (nuts) but it is now 6 months. I started my time last month and am wondering if I am wasting my time. Amerigroup is Medicaid and I'm pretty sure I will lose it the next year so want to do this asap.

I'm sure this question has been asked many times but I'm asking again because my surgery is scheduled and I'm getting nervous. How long from when insurance company gets paperwork does it take for approval or denial? 48 hours, a week, a month??? Somebody give me good news.

Hello sleevers! I wanted to start a topic for anyone who has Kaiser and has or is going to have surgery at Kaiser South Bay. I'm nearing the end of Options and I'm looking into doing my surgery at South Bay. Any suggestions for surgeons? Are any of them really strict when it comes to pre surgery weight loss?? In case you can't tell I'm struggling with the weight loss during Options. I'm always a slow loser (hence why I need surgery) and of course that causes me to sometime sabotage myself. Right now I'm only at about 12-13 pounds lost and 10% for me is 30. I'm a little worried. I only have 1 more week of Options. HELP!

Greetings everyone! For those of you with GEHA as your primary insurance, how long did it take to get approved for surgery? I have none of their listed co-morbidities, but I have degenerative & protruding discs in my lower back, arthritis in my back & knees, IBS, chronic fatigue & chronic migraines...none of which they care about though. I'm 5'0", 204.8 lbs & my BMI is right at 40...so I can't afford to lose any weight or I will surely be disapproved! I've completed lab/blood work, 2 of the req'd 6 month supv weight mgmt sessions, psych eval, nutritional class, chest x-ray, abdominal ultrasound...the upper endoscopy is scheduled for next month an…

I just had my consultation today. I'm very much looking forward to getting started on this journey! I have tried contacting my insurance provider (Wellmark) and they could not give me any specifics about the approval process. Has anyone dealt with Wellmark recently? What were the prerequisites? How long did the pre approval take? I'm worried that I have not had three years documented at my current weight. Thank you so much for helping!

Hi all! I have a question about insurance policies purchased through your employer (UHC in particular). For the last 3 years I have been trying to get a policy that will cover surgery. I have researched, talked to people both at work and the insurance company, and made phone calls until I'm blue in the face. I even offered to get an additional policy and pay more for it so it would not cost my employer any more money.The policy that my agency has says that bariatric surgery is not covered even if medically necessary. I have a team of doctors who are behind me 100% and 2 even wrote great letters for me on why I would greatly benefit from this and what has been successful a…