Insurance & Financing

Cigna confirmed receiving my info on March 2nd. I've been calling every few days or so to check the status and just keep getting the same "it's pending". Well today, I said no more basic answers. I called and asked for details because I feel I've been waiting forever. The rep puts me on hold to contact pre-cert so she can give me some type of straight answers. When she comes back, she says she noticed they pushed my paperwork back to a receipt date of March 4th instead of the 2nd. However, because of that error, they will expedite things to give me an answer within 24-48 hours. I was relieved until she said "but I'll go ahead and tell you the rep in the pre-cert departme…

Looking for any help or experience with this issue! The pre-approval for the removal of my lap band has been denied as Bariatric Surgery (revisions, fills, etc.) is completely excluded from my insurance plan. So I suppose the initial denial is not surprising. However, my stomach has a hole in it. This will eventually escalate into an emergency-ER situation -- wouldn't insurance agree to cover in this case? Has anyone had luck with an appeal even though all Bariatric-related procedures are excluded in your plan? If there's hole in my stomach, does this not turn into something different? Any help or advice on appeal-writing is appreciated. My surgeon has a peer-…

I found out today that I have been approved for bariatric surgery!!!! I have been calling the Anthem pre-authorization line to check on my status for the last 4 days and I finally received clearance today. Hip hip hooray!!!! They confirmed that they received my paperwork on 1/26 so the review took about 6 business days. I just wanted to write a post because I, like many others, struggled with understanding the 6 month weight loss requirements in my policy. Basically the policy states you have to have 6 months of documented weight loss attempts in the previous 2 years. I am 5'4, 260 lbs w/ a BMI of 44 (also a 33 y/o female). When I visited my doctor (Dr. Jossart in Sa…

Spoke with my insurance company yesterday (Keystone Health Plan East). I was told that I need to participate in a medically supervised weight loss program prior to being precertified, but was unable to tell me how long that would be. A few questions...... Is there a fee for that type of program? I will most likely fall below the 40 BMI if I lose any decent amount of weight (I'm great at losing in the beginning, just can't keep it going!) Will this disqualify me for surgery approval? Will be attending free seminar at Einstein next week. Hopefully favorable answers!

Ok so I got denied my first time submitting to insurance because although I have a bmi of 53 ans I did all the nut visits psych cardiac and sono the said I needed pulmonary clearance blood work and info on my band procedure and removal.. Got all that and resubmitted with everything they asked in march 1st 2016 and still no word. Grr I keep reading about how people got approved in days or even hours and I'm just in lala land. I've called 3 times and it's in Peer review so I don't know what all that consists of. Just so frustrated. Sorry just needed to vent. Sent from my SAMSUNG-SM-N900A using the BariatricPal App

At the beginning of the process I talked to my insurance company, Anthem BCBS of Michigan. They told me that there would not be a 6 month diet wait program requirement. With 40 BMI, revision I need for bad vertical band, and co-morbidities, my Dr. did not expect any problems either. Insurance just came back and said medical issues of band has nothing to do with WLS. If I was having band replaced, then they would approve now. But since I need revision to bypass, they want the 6 month documented weight loss trials. I have been admitted in hospital 2 times in last 4 months due to banding problems, and cannot see waiting another 6 months? Anyone else has this baloney…

I am looking into going to Mexico and maybe even through this website. However, I am wondering about payment. Unfortunately with past health care bills, I do not have the best credit. Did anyone else have this issue? I am trying to see if any surgeon will take payments for the bulk of the fee before and then the rest after. There is just no way I would be able to have the full payment anytime soon and my weight is becoming a bigger issue since I stopped smoking. Thanks for any advice

So I started this process about a year ago. Got denied in July because I didn't have my 6 month Supervised diet. Completed the 6 month last month. Submitted on 1/20 and got denied again... My coordinator will set up a Peer to Peer Review w the Surgeon and my insurance company (Blue Shield of Ca) to put an end to this madness. My question to those who ended up having a peer to peer : 1) About how long did it take to get an approval / denial? 2) How was the experience? I am so overwhelmed and frustrated at this point. I currently have 2 comorbidities and my BMI is 50! I see many people get approved so easily with a BMI way less than me and No comorbidities! I need many pray…

Hi there! Hoping that some of you can help calm some of the nervous I have. I started my process through True Result Richardson last month. I have Cigna insurance and they won't cover my LapBand surgery because my BMI is not higher then 40. True results has instead recommended that I see if I have a Hiatal Hernia, if I do then insurance will cover almost have. If I don't I have to pay for all of it. Long story short I have my upper GI scheduled for July 8th. I'm super nervous! I was wondering if anyone else has gone through the Hiatal Hernia program. Any help would be great! Thank you, Tatiana

Hello everyone, I have decided to see a patient advocate at TrueResults in Phoenix to see if I am qualified for the gastric sleeve. I gave all my insurance information to them before my appointment (I have Highmark BCBS through my employer, Centene Corp). The patient advocate informed me that they verified my coverage and that I meet all the requirements for a bariatric surgery. However, my BMI is under 40 and I do have one of the co-morbidity mentioned in the insurance requirements which is HBP. My dilemma is that the patient advocate said that I am required to be on two blood pressure pills in order to qualify - which I am - but the customer service people at Highmark…

After 3 denials ( July '15, Jan '16 and Feb '16) and countless heartaches, my medical director overturned the decision and finally approved me today!!! The amount of joy I have is epic! PRAISE JESUS! ????

Hi hopefully someone can help me. I have Kiaser in southern California I'm scheduled for the Options information session on Wednesday. I was reading through the pamphlet they mailed letting you know the requirements to be a candidate for surgery. I see one of them states that you have to had 6 months of a weight management plan within the last 10yrs. Basically meaning it would have had to been documented by a doctor. Well.... I don't have that, I've only attempted various dieting and exercise on my own. Do you know what I can expect to happen if this the situation? Thanks in advance! Ps: I've attached a pic of the paper where the information is stated its #2

I'm new here and I've been trying to find out how to get approval with my insurance. I have Healthfirst with Medicad. Did anyone have gastric sleeve surgery with my type of insurance that lives in New York City

Does anyone have health net insurance ? I was wondering how long the process took and if there is any requirements Sent from my iPhone using the BariatricPal App

How long does it usually take the surgical coordinator to submit your information after its all been documented?

Please tell me if anyone has used Health Net Blue and Gold. It is very specific but need to know if anyone has used them and how difficult or easy was it? Thank you

I live in florida ( jacksokville ) and it covers 90% of my surgery but I was wondering the remaining 10% could I pay that after surgery and make payments ? Or is that due upfront ? Sent from my SM-G925V using the BariatricPal App

I am getting conflicting reports from my doctor's office and the insurance company about what is required. Dr says 90 days, phone call with agent says policy doesn't have that requirement. Additionally, I started this journey at a BMI of 41 but since being on the "required" weight loss plan I am scared of dropping below 40 and not being approved. Any advice? I have my psych eval and required post-procedure NUT visit done. I hate to wait another 60 days for nothing...

I'm in Alabama and I have uhc. I got the booklet and it say bariatric surgery is not covered. On exclusion list. Is this point blank or do I just need a doctors referral?

Got approved with GEHA today! Thank you lord!

OMG, they just submitted it (I think late Monday). I'm approved. I have butterflies. I'm not telling anyone at work, so I had to jump online to tell someone. I'm telling y'all!!!! My cardiologist had "cleared" me for surgery but in his notes, recommended I see a pulmonologist (I wheezed during my stress echo). The first available was Feb. 8th. Not happy so I'm going to look for someone outside the hospital. The surgeon said I have to see a pulmonologist before he gives me a date. If I can see the pulmonologist within a week., he'll see about scheduling me late January. Which would be perfect.

Just curious to see if anyone has been approved or denied with this insurance?

I have BCBSTX. Please pray this goes through. Thanks!

Hey all. I'm in the beginning stages of soon becoming a sleever. I will not be going to the insurance route since the plan I'm under AvMed (Florida) doesn't cover Bariatric. I will have to finance my gastric sleeve, which is fine by me. I was wondering other than CareCredit which other creditors have you guys come through? CareCredit is around 12.99% APR which quite high.

Hello everyone, new girl here. After months of searching and applying to various surgeons, I finally booked in with Dr Chris De Bruyne in Brussels. I'm in the UK where a sleeve costs about £10,000 and I can't get one on the NHS because I have no diabetes or hypertension etc - I'm mostly doing this because I'm really unhappy with myself and I have some other issues like arthritis and PCOS that could be so much better if I lost weight. So I decided to go to Brussels where the surgery is relatively cheap. Anyway, after applying for finance from lots of places, I still don't have the money yet. My credit score is on the low side, but only because I'm in my 20s and have…

My insurance does not cover bariatric surgery, however, I had a band done overseas 4 1/2 years ago and have since lost 110 lbs. Lately I have been having some problems with not being able to eat or even drink at times. Had my band checked (x-ray w/ barium) and it showed nothing passing and a dilated esophagus. The doc unfilled the band completely and recommends removal of the band and conversion to bypass but I do not really want to have major surgery (bypass). I am wondering if the insurance would pay just for the removal (laparoscopic) if it is medically required or do I need to wait for serious health issue and go to ER ?

Does anyone need conversion to sleeve because of band issues and have to do 3 month diet trial? Sent from my SM-N910V using the BariatricPal App

Has anyone with ky medicare had conversion from band to sleeve? My band "has to come out". I have a distended espoghas abd stomach. Gaining weight with empty band. Apparently I have to do a 3 month diet trial, seems crazy, i have a band. Worse part is, I should have been told this after upper GI, instead of 10 months later. I could be done and recovered by now. Sent from my SM-N910V using the BariatricPal App

Hi all! I'm in Houston and had a huge letdown yesterday when the surgeons office told me I had a 3 month waiting period, per my horrible insurance company. mHealth is the worst insurance I've ever had!!!!!. Anyone have a work around for this! I cannot wait 3 months! I finally see a light at the end of the tunnel but now is further away. I know you know how I'm feeling. I'm thinking I will pay out of pocket. Any advice????

Quick question, I am almost a month post-op, and I just received a bill from the Anesthesiologist for $850. I was told up front what to expect, as far as out of pocket expenses, I met my deductible and max out of pocket with my insurance provider (Humana) prior to surgery. Then, I receive this bill for $850 yesterday, and the bill says that insurance was billed, insurance paid $850, leaving me with the remaining portion, of $850. After some checking, I learn that the Anesthesiologist is out of network (as are most), and therefore I am stuck with the bill. What recourse do I have? After all the co-pays, and deductible prior to surgery, I am maxed out on credit and have w…

Does anyone else have this insurance? On my first visit, the nurse looked at the BMI listed from my primary care dr paperwork(41.9) and said that was all I really needed. I had printed out my paperwork that the insurance company sent me but I felt like I was reading a foreign language, the nurse didn't want to look at the paperwork, she said it wasn't needed because I had a BMI over 40 and some comorbidities. Today (3 weeks later) I went for my 2nd apt with the dietician and she said I've lost the 15 pounds needed and have done all the tests but she didn't sound very convincing that everything was in order. When I got home, I called and asked to the talk to the nurse …

I am currently in the process of my 3 month supervised diet, have a bmi of 40 and high LDL. But my insurance does not actually require me to lose any weight during the 3 months. Does anyone know how hard it is to get approved with Health Plan of Nevada? Sent from my SM-N910P using BariatricPal

Hi all, I am currently waiting on insurance approval. In order to prepare I asked my surgeon how much time I would need to have a helper at home. He stated 3 weeks! He said if I had a desk job he would recommend 3 weeks off, longer for an active job. My question is this, my husband can probably get a week off, Do I need to hire someone for two weeks post op? My son is 10 and I can get rides to activities. I know everyone is different. I had neck and lower back fusion, anyone out there have Vsg and these two that can compare postoperative recovery? Or any stay at home Mom's that can chime in. Thanks, Uberbuffaloegal

To make a long story short: I'm 23 & pre op. I suffer from severe depression/anxiety & I have lower back pain. I medicate using marijuana occasionally. I just prefer it over my prescription meds & Tylenol. Yes, I know I have to stop medicating(smoking) at least two weeks before surgery and it is not recommended to smoke after. I met a Pre Op VSG'er on IG who said her insurance company asked for a tox screen as part of her approval. I have Regence Uniform Medical Plan. Does anyone know if this particular insurance plan requires a tox screen?

I've been approved by Aetna however have a 3 month diet plan to follow per Aetna's requirements. Has anyone done this route and how soon after you started your process were you given a surgery date? Does the 3 months start on the day of your first consultation or the day you meet with a dietician?

I have aetna, I did not do the physician administered diet and exercise requirement, but was diagnose wit CHF in April 2015 and have been on a diet and exercise regiment since then. My cardiologist wrote a letter stating this and explaining that this surgery is medically necessary. Of course because this plan was to help my heart not to get approval on weight loss surgery it is not documented as need. I submitted it anyway to Aetna for pre-certification on 01/22 i found out today I was denied I have a BMI of 40 and sleep apnea, CHF, and now borderline diabetic. I have now wrote a letter to Aetna which I faxed today hoping they will reverse their decision. Any ideas on pos…

Hi, I was wondering if anyone has been able to get an exception to the insurance waiting period? I was planning to self pay but when I found out my insurance might cover it, I decided to look into it. Obviously I want to save myself 20K but really didn't want to wait any longer. I have Premera insurance specifically but would be interested to hear if anyone has had any luck with that, regardless of the insurance plan. I've seen a few things where the waiting period was waived but no one said how. Thanks in advance.

My doctor's office submitted my paperwork to the insurance company on 1/22.... I called today to check the status ( they told me that they should have the decision within 7 days) they said that they needed more information from my doctor. Specifically, the psych evaluation that was completed needed to be completed by a psychologist or psychiatrist. Well, my Doctor's office referred me to a person that has the certification to complete the evaluation but is actually a LMSW ( social worker). So now I'm out the $150 that I paid to have the eval done and I have to find an actual psychologist/ psychiatrist to do it. I would have probably been approved today if that was in ord…

Hey guys, I'm new to the board but have been following threads for some time now. I started this process in October 2015 and completed the 3 months required diet, psych evaluation etc. to meet Cigna's requirements. I even pay extra through my insurance to include this coverage. I received my letter today that it is not 'medically necessary'. I've been crying all night and so upset. Did I just do all of this and spend all this money on co pays for nothing? Has anyone else encountered this with Cigna and if so, why was it deemed not necessary and what did you do?

I have 2 insurance companies, WebTpa (had to have approval from Active Health which does medical determination for the procedure and BC/BS federal. I had a lap band in 2008 which did not work very well. I was having a band removal and RNY (which I actually had last week on the 9th of February). Active health approved my band removal but denied my RNY because I did not lose the required 5 percent of weight, which my surgeon said not too, I would be too close to the 35 BMI level. BC/BS approved everything ( they paid for the band in 2008) but are out of network. I would like expert advise if I should try the 2nd level of appeal and with what information? Or just let it g…

After hearing for years that Blue Cross Blue Shield of Texas was nearly impossible to get approved through from various people, I got approved in 5 days. They were very helpful, to the point of a representive calling me back when she saw the approval had gone through, they also recently changed our plan where 6 months of supervised weight loss was no longer needed. I got approved with one NUT visit, and Psych eval. I was shocked by helpful, and painless this process was. I never in a million years thought it would be this simple to deal with them. My surgery is now scheduled for 12/17, and I am so ready to start my life as a much smaller and healthier person! The quick ap…

Does anyone have any personal experience with Aetna approving wls. (Good or bad experiences welcomed just really interested in what I have to look forward to with them) I talk with a dietician and I think nurse practitioner. Did my weigh in & all. My bmi was 39 Aetna requires it to be 40+ or 35 with other health issues(they listed 3 things they considered serious) well I have a health condition that's not listed not sure what I'll have to deal with. Or if this officially disqualifies me. The nurse practitioner acted as if it didn't. Just a bit confused. I'm a student can't afford to do self pay at the moment. Any suggestions. A bit new to this.

Hello everyone. I have a question for anyone that has had experience with Carefirst BCBS. I am currently enrolled in a PPO plan. The doctor that I am using is out of network. My in network and out of network deductibles ( oon deductible is $3200) will not be combined. If I don't meet my out of network by deductible by the time I am due to have surgery, will I be responsible for paying the surgeon the $3200 upfront? Or how exactly does it work? Any response is welcomed

Typically how long after everything is submitted to insurance by the surgeons office are you approved? All they are waiting on is my sleep clearance letter, clearance letter from my family physician. My last dr appointment will be the week of February 15 so this will complete my 7 months weight monitoring required by insurance.

My official approval letter from BCBS shows 5 days hospital stay. My surgeon told me his patients stay 2 nights. I have no idea what they requested, I assume they must have asked for 5. Or does the insurance have standard days. I'm having the sleeve, not a by-pass. Do they just do that worse case scenario?

Just met with my surgeon today all he needs from me is any doctor visit in the last 2 years that shows my weight. The problem is that I didn't have insurance therefore I didn't have any doctor visits ???? I don't know what to do...

I blamed my surgeon for this at first, but now I think it might be hospital policy. My insurance covers 80% of my surgery minus deductible. I was told by both the doctor's office and the hospital that I would need to pay everything up front (the deductible plus that 20% not covered) by day of surgery. To make matters worse, they don't accept Care Credit (which has always offered 0% financing for 24 mos. when I've used it in the past). No one mentioned this at the seminar or at all except when I was called about my endoscopy. Later when the hospital phoned to preregister me, I was given an additional sum I would still owe or they would not do the surgery. It all sounds…

I've been on a 6 month supervised diet I'm on the 3rd month now and have lost 20 lbs and was told insurance would deny me for losing a lot of weight before the surgery. Is this true?

HELLO!!! I AM NEW TO THIS SITE! I had recently scheduled my first free consult with the TR office of Houston. I gave them my BCBS PPO of TX Edge Blue that I have through my employer. I received a call saying my insurance does not cover WLS. I told them I will keep my consult in hopes of being able to do the hernia program. My question is... has anyone with this insurance had an issue with having the hernia part of surgery covered? Also my deductible is $5000, how much would that cause me to pay??? ANY HELP OR ADVICE GREATLY APPRECIATED I AM DYING TO HAVE THIS PROCEDURE!!!!

Does anyone have this plan? Or even just Highmark BCBS in Texas? I'm waiting on our cards to come in but everything I've seen online says you have to have a BMI over 50!!!! I'm stressing hard and just wondering if anyone knows of the requirements for this insurance.