Insurance & Financing

Unbelievable. Cigna cannot determine whether weight loss surgery is covered or not under my insurance policy. On the phone, I have been told yes, it is covered only be told later that there is a a specific exclusion in my policy for weight loss surgery. I was ready to self pay. I saw the surgeon this week for an initial consult and tentatively scheduled surgery for the first week in November. BUT the bariatric coordinator just called - Cigna called her and said they thought WLS is covered under my policy. The bariatric coordinator let them know that Cigna said it is not covered when she verified my benefits. So the Cigna rep is "double checking" and will get back to her. …

I have BCBS PPO and while the appointments for the monthly visits with the dietician for the 6 month supervised weight management is covered, the surgery is not covered. Because of the codes they used for the surgery. “surgery CPT codes of 43775 (sleeve gastrectomy), 43645 (sleeve gastric bypass), and 43644 (roux en y) would not be covered if billed with the diagnoses of E66.9 (obesity), E66.01 (morbid obesity), or any BMI Z codes. The representative did say the surgeries would be covered if filed with other diagnosis codes, but we specialize in obesity and morbid obesity and would only file these codes.” Should I find another doctor? My comorbidities are GE…

Has anyone been approved by medical or iehp in california. If so what is the process like. I'm hoping I get approved fast. I'm 22 with a bmi of 55. Already did a sleep apnea test and 2 months of weight watchers.

Hey Guys.. do you know if Empire blue covers the gastric sleeve? I live in New York, and has been hearing now that they don't. I went through the entire prep-stages only to hear now it's not a sure insurance approval. What are the requirements and how can I get this done?

I've been reading so many stories on here about people having to go fight for their insurance to cover things. I even started taking notes about things people said to their insurance so that I could just be ready for what I thought was inevitable. I even got a letter from them saying they needed all these pieces of paper that I know were submitted (turned out to be a kink in their process). But CIGNA approved my pre-certification in THREE BUSINESS DAYS. I just got the notification! Now we just schedule a date, do all the pre-surgical testing, whatever they require for a pre-op diet (it looks like just one day of liquids, which is weird) and pray it doesn't get…

How many times did you guys and girls have to appeal an insurance denial before it went through (if it went through?) I have Harvard Pilgrim, and they have determined that my revision is not medically necessary despite reflux that wakes me up every night with imaging and an upper endo to prove this. I plan to call my surgeon's office and find the best way to appeal it, but I was just curious if anyone had successfully appealed before - particularly with Harvard Pilgrim. Thanks!

Hi I'm new here just getting started in the process. Had my first visit with the surgeon and I'm currently working on my checklist. Sleep study scheduled for next month.My first visit with the nutritionist isn't until October(seems like a long time to me), I'm currently seeing a nutritionist on a referral from my pcp does anyone know if this can be used as my 6 months of visits with a nutritionist?

Hi! My husband may be changing jobs next month and so our insurance would change. (Both insurances cover wls.) I was wondering if anyone had any experience with this and if it delayed their surgery at all? Thank you.

I have not yet received any bills for the two issues I'm about to discuss, just the EOBs (Explanation of Benefits). For non-US readers, this is a notice that an insurance company must send the patient whenever the insurance has received a bill. It explains to the patient about the bill: the medical provider, the service rendered to the patient, the charge from the medical provider, how much of that charge will be covered by insurance, and how much the patient can expect to self-pay. My original surgery date was delayed/changed due to the hospital's COVID-related closure to elective procedures. I therefore ended up having surgery about 6 weeks after my original date. …

Hello, in the early stages of researching my options and coverage. Appears that neither my nor my husbands insurance covers bariatric surgery. It looks like this is fairly standard for Florida insurance plans (and that many other states have mandated its coverage, but not some of the southeast states). Have many people had success with their employer insurance in Florida covering it?

Hello! I am in Gainesville, Fl. trying to having surgery at UF Health Shands Hospital. I had my consult with the surgeon(Dr. Mann) Feb, 1st and have completed everything on my check list for insurance approval except my psyche consult which I have an appointment March 29th. When I went to preop for my required EGD they drew my blood for all the required labs. I was not expecting to have those labs drawn that day. I am not a heavy drinker, but I do drink moderately every other week or so. I have stopped drinking and was planning on getting those labs drawn a little close to the end of my check list to give my body time to eliminate the alcohol. So, of course I tes…

Hello everyone. Does anyone have medstar family choice? I wanted to know if you have to do a 4 month or 6 month wait until surgery. I’ve heard different things from different people. The program I’m starting this month is a 6 month process until surgery.

When does the clock start in regards to weigh in and you cannot gain any weight. During my consultation with my bariatric surgeon I weighed in at 218-219. Based on my height and weight and he said that if I dropped down to 212 I would not qualify just on BMI alone. He also advised me that if I didn't believe I had any co-morbidities that I should gain an extra 5-10 pounds for cushion (like I don't have enough LOL) So can anyone advise me on when the clock start. When the weigh in start being documented and I cannot gain anymore weight.

I have Aetna Better health of Virginia. I am trying to figure out what the exact requirements are. I have read the manual a million times. I've called 5-6 times in the last week. I was told that the amount of time I need to be in a supervised program would be at the discretion of my surgeon or what he puts on the pre-authorization. Has anyone heard of this? Also, how many doctor visits are required. I had my consultation with my surgeon on 6/30/21. Was approved by him at that appointment. I had my psychological evaluation on 7/5/21 and was cleared by her in under 20 minutes. Now i am waiting for my 1st meeting with the dietician 7/26/21 and my EGD on 8/4/21. Do…

Hi everyone! My BF just moved here from NY. He is on Michigan Medicaid and we chose aetna. He is Morbidly Obese. Believe his BMI is at least 50. He is 6 ft 2 and over 450 lbs. Can anyone give me any tips on dealing with insurance and some basic information about the process. He is interested in the sleeve and he is 36 years old. Thank you!!!

So I'm confused on the insurance thing for the requirements. I have went on my insurance page and printed off the requirements and it says I must meet the following criteria: preoperative evaluation that includes a detailed weight history with dietary and physical activity and Psychosocial-behavioral evaluation OR participation in a multi-disciplinary surgical preparatory regimen. So can I choose to do the surgical preparatory regimen for 3 months or does the insurance want you to do both??? Aetna also says the same thing. I have been on the phone with my insurance company almost everyday trying to get everything figured out. I go talk to the surgeon next week to talk ab…

I have united healthcare dual complete alabama and I'm waiting to hear if im approved i have a bmi over 40 and i also have high blood pressure . Has anyone else on here have unitedhealthcare dual complete /medicare and if you do how long did it take you to get approved?

This is so frustrating! I've been jumping through hoops since last SEPTEMBER to get all my appointments scheduled, and I'm almost at the last step: the EGD, after which my doctor will schedule my RnY. I just learned that neither of my insurance companies consider the EGD to be medically necessary. I'm double-covered with my husband's insurance because it's free at his work as long as it's secondary coverage, and my own insurance specifically excludes bariatrics. The actual RnY has been pre-approved through my secondary coverage. Both companies are different branches of Blue Cross, so maybe that's the issue? I'm really annoyed because it's a HDHP, so my out of pocket…

Cigna denied me for surgery. They said the surgeons office didn't send what they needed. Now the nurse won't be back to July 2nd and I do not know what to do. I feel like the surgeons office just left me sitting here. Any suggestions?

Has anyone used United Medical Credit to finance surgery in Mexico? what is your experience with them?

For the second time now I've been denied by Aetna. Their reasoning is lack of information. I started my whole journey at the of July/beginning of Aug. 2020. I did the required 12 classes as fast as they could send them to me, which at the time was acceptable. Had all the testing and everything done by end of Sept or there abouts. My hospitals insurance team got everything together and sent it to insurance and they denied it stating the didn't receive 6 months of dr supervised classes nor 24 months of documented obesity. So my Dr tacked on 4 months of classes one class a month and the nn said they would go to my previous provider for the weight history. Fast forward to now…

Looking to see if anyone knows of an affordable surgeon in the state of VA as I am a self payer. Thanks![emoji846]

My doctor is requesting a weight loss history letter to be sent along to insurance to gain approval what exactly is the insurance looking for? Because I was not 40bmi before.

Hi, I was wondering if anyone has experience Anthem BCBS claim denial for the 2 day hospital stay after the R-N-Y? Surgery was paid but, they are denying the $60K “Room and Board” for the 2 day inpatient stay afterwards. Ugh... I am so sick right now! Any words of wisdom right now would be appreciated.

I had a lap band under United Healthcare PPO in 2008, lost 250 pounds, then had to have it removed in 2018 due to terrible acid reflux, Kaiser insurance. Have gained over 100 pounds back. Now I want to have RNY gastric bypass, and was set to get this going through Kaiser but got derailed due to COVID. Now I just started a great new job which I am very excited about, but the downside is that they only offer one insurance option, Blue Cross Blue Shield of Alabama. I have to start the whole insurance process all over again, in fact find new doctors again, but today I called the customer service number for BCBS of AL and asked about bariatric surgery and they told me that…

Hey guys just wanted to update things. So last time i posted i was barely beginning the insurance process...Well sort of still am. I had my new patient consultation, met with my dietician, and just today had my psych evaluation. It went easier than expected! I just tried to be honest and it was more of a conversation than a test. The whole thing lasted about 35 min. The main thing they would hold off on surgery for is if you have an untreated mental health disorder or if you binge eat..... Which lets face it if youre obese that has probably happened a few times...But we all know thats not who we are! Lol Now im continuing on my journey with 5 more nutrition classes left a…

Hey everyone, i just recently got insurance that covers bariatric surgery through the state. Im having a hard time deciding which plan i should choose to run with during the bariatric process. They put me with coordinated care to start with, i have since switched to molina which starts april 1 2021. I scheduled my first dr visit with my new pcp for this coming Monday to hopefully get the ball rolling to get accepted into the program. Ive got so many questions, but i guess ill start with does anyone have advice on which plan is better for the bariatric surgery process? Coordinated care, or molina?? Thanks for reading my book [emoji51][emoji854]

Hello All, Quick question. I've read on here that you can get the Gastric sleeve paid for through Medicaid. I was told by my PCP as well who recommended. I originally was going through my insurance but due to decrease in hours I've lost my insurance. I am currently in medically needy Florida share of cost $1400. I am unfamiliar with the process but I think after calling enough places I have a better understanding. When calling around to local surgeons, I can't find anyone that takes medically needy share of cost or straight Medicaid just Medicaid humana. I am willing to drive around Florida if necessary. Anyone with recent success?

I had the sleeve surgery on 4/26 . I stayed two nights in the hospital, but I received a letter saying one night was covered....what should I do??

I am having trouble getting approved from Molina healthcare. My doctor has sent approval saying I need the surgery and they keep not approving it. Can somebody please help me. Thank you ?

Hi all, I was denied the first time because I gained a few pounds on the three-month supervised diet. I was/am a lightweight and I didn't want to drop below the 35 BMI. So they had me lose the weight I lost and they reapplied. Now I have been denied again. The language used is "The documentation does not support that you have fully committed to the medically supervised weight loss program that includes dietary and behavioral changes as well as exercise." I don't understand as I completed all that was asked of me in the nutrition sessions. Has this happened to anyone? Were you ever finally approved? My dietician is writing a letter for me explaining …

If you have Federal Blue Cross Blue Sheild, you should be happy! I'm on my dads plan and he has the basic plan but they paid for my surgery 100%. The only thing I had to pay was a $200 copayment to my surgery and $175 for my copayment for the hospital. I orignally was going to do the band, but they don't cover implants and it would have cost me almost 3 grand. I'm so happy it was so cheap for me. I'm so excited for the future. I'm currently 1 week and 4 days post op, I've been on a liquid diet for 2 weeks and 4 days and I've lost 25lbs since I started my liquid diet. I'm so happy. I had such a horrible time trying to lose weight because of my knee and back pain made it al…

Someone told me you could be fast-track surgery for BCBS if your bmi is over 51 and you have other medical issues. Has anyone heard this before?

Hi everyone, I'm new to all this, and trying to figure my way through Aetna's new 2020 policy on pre-op program requirements, which now say you can do 6 months of a program previously or 12 sessions over any period of time of an " intensive multicomponent behavioral intervention designed to help participants achieve or maintain weight loss through a combination of dietary changes and increased physical activity" (http://www.aetna.com/cpb/medical/data/100_199/0157.html). My surgeon's office is pretty disorganized right now because of covid, and they briefly brushed me off telling me that my Aetna insurance requires 6 months of supervision. I'm thinking t…

I am working on trying to find a bariatric surgeon in my area (Pittsburgh, PA) who is considered In-Network for my insurnace (Aetna), and having a little bit of a hard time. I don't know what exactly to search for on my Aetna member portal that will provide me with a list of In-Network bariatric surgeons, and so far doing a google search for local bariatric surgeons, finding the names and then searching for them in my Aetna member portal, isn't providing me with much of anything. Is there an easier way to do this? What am I doing wrong? Or is it just that there are no In-Network bariatric surgeons near me? TIA for any help..

Had my surgery on 3/10/21, this getting my denial overturned on 3rd appeal. I am now getting a bill for the full cost of anesthesia that states "we do not offer coverage for this type of sedation" . . .WHAT!? I don't even know where to go from here, how can this be something new?

I went for my first nutrition visit today. I have to do 6 for my insurance to cover my surgery. And I can't gain any weight. Well when I first went in for my evaluation I weighed 238 which I thought was lower, I usually weigh 240. Then I have been dieting and stuff and my scale says 233-236. So I'm thinking I'm good to go then today at the first nutrition visit I weighed 245!!! that's 7 pounds up from last visit and 10-12 pounds more then my scale says. And I have checked my scale and it is accurate with everything and every person who has tried it. Does anyone have any advice or tips, or similar experiences. I'm feeling very discouraged that this issues will stop me from…

Going through Dr Kia in Flint, michigan. I did my 6 weigh ins and consistently lost 1 or 2 lbs every month. In December I was put on Depakote and began to gain weight. Just received 1st denial due to last couple weigh ins I gained. Not only that was told none of my previous weigh ins can be used and I’m starting over. Writing an appeal letter. Does anyone have any advice? Mclaren Health Plan insurance.

Hello! I’ve just completed my 6 month monitored diet and group classes at St. Vincent. I have received the check list to complete before they send all my information off to insurance. I currently live in Indianapolis but my primary physician is in South Bend. I need to get a chest X-ray, go to a cardiologist, and a pulmonologist but since I’m in Indy, my doctor isn’t able to recommend any in here to go to. Who and where did you guys go to get these things done (people with HIP). These are my last steps and my doctor warned it could take months before I’m able to see a pulmonologist. Kinda worried and stumped on where to start. Thank you!

Hi everyone, I am new here and I have finally decided to go through with doing the Gastric Sleeve. My surgeon told me that my insurance requires a 6 month medically supervised weight loss with my primary care provider. I am scheduled March 24th for my surgery, but I have gained 8 pounds within the last two months of my supervised weight loss. The nurse told me try not to gain, and insurance can deny me if I do gain. I have tried to get answers from my insurance company, but nobody has been able to answer my question. I am located in New York, and my hospital plan is city of New York Blue Cross Blue Shield ppo. I am supposed to go on 2 week liquid diet on March 10th, and I…

Hi everyone, I had my first visit with my surgeon last week. At first, he said Aetna would require 6 months of sessions. I knew about Aetna's new requirement for 12 sessions so I mentioned that and he had his office check again. He came back telling me that the 12 session requirement means I need to do one session per month for a year. That seems to go against what I've read on here, not to mention the wording of Aetna policy 0157 which says "12 or more sessions over any duration of time". Aetna customer service just tells me to check with my doctor. His office is really insistent that even though the wording of the policy seems to imply that any time period is fine,…

Hello, everyone! So, after having little to no restriction for quite some time, I finally found a doctor here in South Carolina who was willing to do fills without charging a huge amount of money and making me jump through hoops like Roper St. Francis hospital systems did. After multiple appointments with this new doctor it became clear that I have some sort of leak or disconnection somewhere in my band. The very first appointment he pulled almost no fluid out, then even after adding fluid in the band for two more appointments in a row after that, the same amount of fluid was not pulling back out and I really didn't feel anything restriction-wise. On our 3rd appointm…

I was approved a d have Cigna. Can someone share when they file the claim is it listed as b bypass surgery on the insurance claim?

Does Tricare require a number of monthly weight visits with your primary doctor before approval? I've heard both 3 and 6 months and seen on posts from 2012 in here they don't require either. When I called Tricare the man told me he didn't see a number listed. And do they require Psychological evaluation as well. I've heard they dont.

So I have a question for you guys, i began this process in October and I have completed my dietitian appointments, fitness test, psych eval, sleep study etc and I’m just waiting for the surgery date. My husband recently lost his job and I no longer have the insurance with which I had started this journey. I’m now waiting for an answer about Medicaid Ohio application that we submitted two weeks ago. Has anyone been through something similar? Once I get approved for Medicaid , will they make me start the process all over again?

Hi everyone I will be Starting the process of my weight loss surgery on the 26th of this month I have first choice health insurance through the state of South Carolina I am going with the prisma bariatric institute in Greenville South Carolina and I would like to know if anybody else has went with them and use the same insurance I am using thank you in advance

Hello, I just contacted a surgeon's office & they casually mentioned that my insurance will not approve me if I get below 40 BMI. I am at 40 right now & I actually had to gain 5 lbs to get to 40. I do have high cholesterol, but I'm not on meds yet. My insurance requires a 40BMI or 35-40BMI w/ 1 comorbidity. I'm just nervous I would qualify at first weigh in, but loose a few pounds during the 6 months...especially if I am seeing a nutritionist. Anybody else have similar experience? What did you do? Insurance is Medicaid (Arizona Complete Health)

Hello, Looking for others that have Anthem Blue Cross PPO in California. At my initial visit with the surgeons office they instructed me to have 6 months of dietician visits. Anthem had sent me links to their policy document cg-surg-83 that (to my reading!) looked like 6 months wasn't required as of August 2020. The policy states: Documentation of all of the following: Past participation in a weight loss program; and Inadequate weight loss despite a committed attempt at conservative medical therapy (for example, comprehensive lifestyle interventions, including a combination of diet, exercise, and behavioral modifications); and Also: Revised 08/…

Dose anyone know of and insurance company that will pay for plastic surgery?

I recently asked my primary care doc to see if we can get a panniculectomy approved by Anthem because of the under the belly button chafing issue, and that I think the extra skin is contributing to chronic back pain from degenerative disc disease. Also, I think I might have an abdominal hernia. I had some non-elective skin surgery because of a bad injury, and the plastics doc I had was so great, I would like to deal with him again. My primary care doc agreed to refer me to him. When I talked to his office, they said they do deal with insurance for non-elective procedures, but not for cosmetic procedures—and they consider a panniculectomy to be cosmetic even if i…