Insurance & Financing

Does anyone have UHC Tricare? I'm got my Lap Band out last month and am going through the step for gastric bypass. I've heard conflicting information on how long I need to be on a weightless plan before I can be submitted for insurance approval. Is it 3 months or 6 months?

I'm calling out to all WLS patients who were with Kaiser Sunset. They have their own way of doing everything and wanted to see if anyone has any experience or tips to give me. Or we can discuss how it went. Thanks!

Insurance Carrier Medically Supervised Diet Diet History Notes Aetna 6 Months OR 3 Months 2 Years 6 Months-nutrition and exercise OR 3 Months-dietician, primary care physician & exercise regimen Blue Care Network 6 Consecutive Months (180 days) 2 Years BMI ≥50 criteria for diet waived Blue Care Network Advantage Documented unsuccessful with medical treatment for obesity 2 Years At least one co-morbidity related to obesity Blue Cross Complete (Medicaid ***) 6 Months Current (Greater than or equal to 6 months) BCBS MI & BCBS Messa 6 Consecutive Mo…

I'm 24 and 5'5 and I'm 182lbs with a BMI of 30.0. I have always delt with my weight loss and gain it and gain much more. I join sports and have gym memberships and diet, diet pills or teas. Nothing works well. I have never been this big before and I'm scared I'll reach 200's . I am waiting for my first visit with a Bariatic surgeon and I'm really scared that I'll be dismissed. As far as I know no cormorbitiies. I can't afford self pay no matter how much I save up or work, that's beyond my reach at this point. I have Affinity Health Insurence , does anyone have any idea how this may pan out for me ? Also, what are your opinions ?

I'm in the process of doing the requirements to have the sleeve. I'm just curious of this because I'm the heaviest I have ever been and I'm in the 37-38 BMI range with sleep apnea. My insurance requires 2 years weight history and I was wavering between 210-215 for the most part and at a few points as low as 198 which is not in the BMI range. I'm at 220 now. Has anyone had any experience with this? I'm wondering if they would deny me because I wasn't in this weight range the last 2 years, or is it good that I have shown that I can only lose a little bit and then go back up?

I posted this in another forum before I realized there was an actual insurance & financing forum...go figure! Hi! I'm in the process of getting things ready to submit to insurance and just curious if anyone was denied on their first or second attempt. And if so- why? I hope for approval on the first attempt but am trying not to get my hopes up as I have seen plenty who were denied and had to appeal. I'm trying to be as prepared as possible, but with most insurances- you never know what to expect. Aside from my weight- I've been a semi-healthy person and never really had to go through the authorization process for anything before. So this is all new to me.

I'm new to a FSA. I signed up for one last year to pay for LASIK surgery, but now I am curious to know if it can pay for bariatric surgery. My insurance covers the procedure, but you have to go through six months of hoops. I began that process about 18 months ago, but then I developed a staph infection then dealt with gut infections. In Sept, I asked my doctor to schedule an appointment for weight loss and her office scheduled an appointment with a student nutritionist (working on clinical hours) who never followed-up with the plan. Then again, it was nothing new that my doctor hadn't already told me to do. A paleo diet. In a nutshell, I have been working with my doctor…

I went to see my surgeon today it was also the last required appointment with NUT. All required testing are completed the blood work, EKG, chest X ray, H-pylori breath test, sleep study, cardiologist clearance, psychiatrist clearance, psychologist clearance. All my paperwork will be submitted to my insurance company and now I just have to wait to see if I'm approved for surgery. Doctor said the patient navigator will be giving me a call with surgery date. Time went by fast and another 1 or 2 won't hurt to wait for decision.

I have Federal BCBS standard, my bmi is currently at 35 with comorbidities of sleep apnea, hypertension and high cholesterol. My first appointment is Feb. 19th. My question is, within the past two years my bmi has fallen to less than 35, will I still be able to get approved for gastric sleeve surgery?

Hello everyone! I am new to TriCare and haven't had much luck on finding any info. I had my surgery before I had TriCare, but I have now moved to a new area and need to find a doc for maintenance (fills, etc). Is this at all covered by TriCare? Thanks!

Hello my name is Felicia, and I finished all my requirements January 13, 2016. My insurance coordinator said she submitted on Tuesday but It takes time because it goes to different dept. Mind you she is my surgeons wife so I figure she is telling the truth. I have been calling my insurance twice a day and they still say they haven't received anything and that it takes 3 days to upload faxes into their system! Can anyone confirm this? I'm getting impatient and I'm about to freak out! I wouldn't care if the "review" took long I just hate that they say that they don't have it at all!

* Anthem Blue Cross of California, Covered California Plan through the individual marketplace. Silver 95 plan. remember, if you have anthem through your work your requirements may be different. Share your experience with this insurance and let's help out each other! There is nothing so stressful as the beginning. I was so confused by this insurance process I am doing this to help other's in my situation. Let's help out! 1 what was your doctor and hospital 3 what medical requirements were there? 4 what medical tests were required? 5. Did you have to do a supervised diet? 6 how long for approval? 7 what was good about them? 8 what was bad? …

So excited surgery is scheduled for Jan 27th paperwork was submitted to ins. co. D. 22nd and was approved on Dec. 24th I couldn't wait so I called ins. company.

Hi, I have been trying to follow the threads...but if people can post on if they had United Health Care Insurance, and how long it took to get approval once you filed all appropriate paperwork (6mo diet plan, psych eval, and letter of support). Thanks I will greatly appreciate it. I submitted 11/16 and trying to still get surgery by the end of the year...so I'm hopeful. Thanks!

Hi! I've mentioned this on a forum in the pre-op gastric sleeve group but am hoping for more information from this one. So basically- I have UHC which covers bariatric surgery as long as I meet the requirements which is not a big deal or concern for me. However- I have learned that once my precert is submitted, I cannot schedule surgery any sooner than 6 months from that date. So if I submit and am approved in December, I cannot have surgery until May of 2016. I made sure each time I spoke with them that they are not referring to the 6 month diet/weight loss supervision. This is a year long process...apparently. Has anyone else seen or heard of this? I keep praying th…

I have CIGNA. But my employer did not buy the bariatric surgery part of the insurance. I do not qualify for Medicaid. Does anybody know of a coinsurance I can buy that will cover gastric sleeve surgery?

Hello I am new to the forum. I am pretty worried about my insurance covering my surgery. I have Empire BCBS -NY- and I just did my seminar. My first consultation is Wednesday and I am very anxious. I did my first of six doctor visits needed for my insurance and I weighed in at 227 making me just above 40 BMI. My doctor has been very helpful and listed my comorbities as knee pain, high cholesterol, and high blood pressure. I know my weight and comorbities should be enough but I don't know if it matters that although I do have high blood pressure and high cholesterol it's not high enough to the point that I need to take medication. Has anyone had a similar situation …

I received my approval letter over the weekend. It didn't clearly state an approval or denial so I called the insurance company and they confirmed that I had indeed been approved. Now, im waiting to be scheduled for an upper endoscopy and gallbladder ultrasound. Has anyone already had these done? Is it as bad as it looks on you tube?

Hi does anyone have experience with uhc choice and the amount of time it takes for them to approve surgery. I completed my psychological evaluation on 1/12 and the doctor told me he'd have the report to my surgeon on 1/15. Well today I called them and they are saying that they were waiting for my insurance to approve the psychological... shouldn't that have been approved before I completed the evaluation? Well my dilemma is that I am scheduled for surgery on 2/1 and I don't know how long it takes for uhc to approve once my report is submitted.

Can anyone that lives in VA, suggest individual self pay health insurance that will cover the surgery?

Don't get me wrong. I AM GRATEFUL for my new life. However, I was told by my surgeon that his price was all inclusive. Now I self payed, scraped scratched, borrowed and suffered financially in order to get the money paid. Now, I keep on getting bills, one from the surgeon and another from the hospital from the day of the surgery. I am a bit frustrated as it adds up to another 500 bucks. It doesn't sound like all that much, but I'm already 11,000 into this and was orginally told 10,000 max. Should I protest, or just suck it up and realize it was the best decision I could have made?

My wife and I met with the surgeon in Jan 2016 to begin the journey for the sleeve procedure for both of us/together. We were feeling positive about insurance approval and now feel very concerned and are looking for thoughts/feedback from you all. We have Aetna POS II. My wife spoke with our primary care yesterday. He is and has been very supportive of bariatric surgery for us. However, as a result of yo-yo dieting and the timing of weigh-ins at the Dr over the years we are not at a 40 BMI for two consecutive years, but likely are above 35 BMI for two consecutive years. At our first weigh-in with the surgeon (for the 4 mos consecutive weigh-in requirement) my BMI w…

Did anyone ever utilize a GoFundMe to help provide for their surgery?

I started the Northern CA Kaiser program and was wondering if anyone else has had any issues with them paying or any hidden cost, so far all they have charged me is a few co-pays and they say no charge for the actual surgery.

1. Does GA medicaid pay for it? 2. if they do, what is the step? 3. is there a high fee copay for me to pay or do they pay for everything? 4. how fast is the approval process?

I'm currently in open enrollment through my work and I can switch to Aetna of AZ from the BCBS of IL plan I'm currently on. I'm not sure how any of this works I seems as though the requirements are less extensive in the Aetna of AZ plan although more expensive. The BCBS of IL plan I can self refer to a specialist but Aetna I have to get a referral from my PCP. This applies for the surgeon right?

Anyone out there on the local government Health Insurance Plan with BCBS of AL? I had my 1st appt with the surgeon's office on 1/15/15. I was told that the 6 month diet was waived with my BMI being 44. I have to pay 1,057.00 (50% of copay) to surgeon. From what I understand, I am waiting on medical records to be submitted from my PCP and I need to fill out a 5 yr diet history. After that, I don't know...Just wondering if anyone else has been through the whole process with the same type of insurance.

I have BCBS Alabama and they require 3 years of medical records showing a BMI of 40 or higher for 2012, 2013, and 2014. For every visit, I have had a BMI of 40+ except for one visit in December 2014. Last December I had a bad case of pneumonia and mono. I was very sick for over 3 weeks and lost a lot of weight from not being able to eat much. When I saw my doctor during this time, my BMI had dropped to 36. Will insurance disqualify me for this one weight not being high enough, even though all my other visits qualify? I've tried to contact the insurance person at the surgeon's office but I can't get her to call me back. Hopefully someone here has dealt with a similar exp…

I opted to self pay for my sleeve surgery. The package price includes 3 follow up visits/lab checks. Why would the office insist on seeing my current health insurance card when I come in for these follow ups? Is there a point to having my insurance info?

Anyone know how much this statement in my benefits brochure will cost me for a two day hospital stay for gastric bypass? "You pay 30% of the plan allowance for agents, drugs and/or supplies administered or obatined in connection with your care."

Got a call this morning from the insurance coordinator stating that Aetna approved me for the gastric sleeve!!! Woot Woot!!! It's crazy because I called Aetna yesterday and was told that a decision was still pending. The approval process took a week. Feeling pretty blessed.

My boyfriend wants the surgery but he keeps getting told his insurance doesn't cover it. He is self employed so has to use Obama care. Does anyone know of a certain plan that covers it? He is diabetic and high BP so he is a candidate. We live in Indiana and I have noticed it goes by state for coverage. Any help or guidance is appreciated!!

I just found out that my primary insurance, bcbs, requires a 5 yr weight history. My bmi has only been high enough for about three years. However, I have a secondary, Aetna, that is through my husband. Will it pay if I don't qualify through bcbs?

Good morning everyone! Brand new to these forums and if there is already a topic posted about my question, just point me that direction. So I am new to this entire process. I'm doing research, of course, but I am interested in having a dialog with people who have already gone through this. Does anyone know the specific requirements that Horizon NJ Health needs in order to be approved and how long (in genera) are the papers submitted for approval once you meet the surgeon? Is it during the first visit or sometime after. I heard that for my insurance it will take 2-3 months to get an actual surgery date (which isn't bad at all) but if anyone has any insight or can point m…

I found out defiantly my insurance does not cover WLS! Does anyone have any experience with self pay in Louisiana, preferably Baton Rouge? How much and which Dr. I don't like the idea of Mexico but that's just me!! I'm a big chicken would be scared of the bad things that could happen! Thanks for any help.

We have BCBS of TX and my weight loss surgery was approved, but we have the insurance through my husbands employer and they are requiring extra hoops including proof that I have been obese for 5 consecutive years. The problem with this is that I had achieved a large weight loss about 3 years ago. And gotten to a healthy BMI only to gain it all back. I've done this my entire life... Up and down. You would think they'd WANT to see that I've had success losing weight before?!! Anyways, is there any way to get around this? The years previously and since I've had a BMI of at least 38-42. Thanks!

Anyone get this? I'm having a hard time finding a decent plan. I'm specifically looking for coverage for a certain period after surgery, once I'm home to cover things like leaks, strictures, dehydrating, etc., not the "travel insurance" most of the medical tourism companies offer. my health insurance specifically excludes WLS and any complications.

Anyone have this insurance? Wondering how the process is. I'm just now going to a info seminar.

Hi everyone, I am from Alberta, Canada and I am thinking about getting surgery done in Mexico. Is there anyone on here from Alberta who had inquired and received coverage for their surgery? If so what did you do, who did you go thru and did you have to have the procedure done in Canada in order for it to be covered? All the info you can give would be awesome!

The other day. Like Thursday my insurance coordinator submitted my info to horizon and I was approved today. So exciting! My preop class is on Wednesday. Anyone else getting their sleeve done this month?? My surgery is January 18.

I've just started my Weight Watchers diet supervised by my PCP. I know that every plan is different but I'm wondering what experiences people have had with CIGNA; I have a few questions: We are changing our insurance carrier and my CIGNA coverage doesn't actually begin until Jan. 1; the plan requires A 3 month supervised diet, will I have to start over on January 1? I will if I need to but hoping it counts now since the policy is a 3 month diet within a 12 month period. Do I need to submit anything to begin with so they know my plans or do I just have my PCP and surgeon submit everything when I'm done and ready for surgery? What do I need to submit of my diet? Do the…

Ok...so I went to the mandatory orientation today at the facility I plan on having a gastric bypass at. If I understand correctly, FEP Blue requires 6 months from the start to the surgery. My question is, when does that 6 month period begin? I went to my family doctor three weeks ago to try to get the ball rolling and have my weight documented, along with the desire to have WLS. I have to have a phone meeting with the director of the facility next Friday, and after that phone meeting, I can set up a meeting with the surgeon. So, my question is will the 6 months start at my dr appt a few weeks ago, the orientation today or the appt with the surgeon? Thanks!

We have state ins that was covering everything. Just got a letter saying they are changing us from care to blue plus. Anyone know or guess if they will still cover surgery?

Does anyone know where I can get help paying out-of-pocket for the gastric sleeve or what can I do to get my insurance to pay. I have Cigna insurance and also have Medicaid through Molina Healthcare.

Hi, I'm sure most of you guys have bcbs or Uhc but requirements and plans are different for each state! I'm trying to pick a provider and plan for Alabama. If you guys could please tell the provider plan and requirements that would be awesome. I'm looking at the UHC Gold Compass 100. Also do they require you to maintain at least 40 bmi before surgery? Thanks!

I have BCBS FEP Standard insurance and I was told that I have to pay a $200 fee for a night in the hospital but I haven't received the quote from the surgeon's fee. Does anyone want to share information about how much they paid out of pocket for this type of insurance? I see plenty of answers for Basic FEP but not for Standard. I realize the cost will all vary according to the cost of the surgery, I am just looking for a few numbers to compare. Thanks in advance!

Hey folks...we're having open enrollment at my job for an FSA account and I was wondering if any of you previous sleevers have one. How much do you feel is needed for WLS supplies etc? I was going to put in $750 and was wondering if that's enough. Thanks ????

I'm new to this site and wanted to get some details on UHC. I'm enrolled in the choice plus program and can submit to my insurance on March 1st. My BMI is 40+ along with HBP and sleep Apnea. How long did it take to receive an approval letter? :-) Thanks!

I carry this insurance and wondering if anyone has used the same for their surgery. I meet back with my referring dr. on the 28th and was wondering how others liked Health Net Blue Gold. I am on the end of a 6 month waiting period.