Insurance & Financing

I started the process in 2014, but as a single mom with a toddler still in a crib, I was moving at a snail's pace. No point until she was out of the crib, right? Fast forward 9 months, and my kid was in a bed, so I thought I was finishing my insurance requirements. Only to find out that, in 2015, my insurance added a 6 month physician monitored diet. Ok. Changes my timeline, but nothing to do but follow the rules, right? Well today, after jumping through every hoop, repeating the steps I did in 2014, they tell me that I will probably be denied. Because of a scheduling issue, my sept appt ended up happening in October. So I have July, August, 2 October appts, nov, and …

Does anyone know if BSCA uses the weight from before the 6 month supervised period, or after? I'm getting started at a gastric bypass center and they told me that I'd need to do 6 months of nutritional check ins, but I didn't get a clear answer (in hindsight) regarding whether my starting weight would be now, before I go through that program, or after. I'm worried that I will lose the few pounds that qualify me for coverage, but I do want to totally commit to the program! Does anyone have experience in this? Or advice? I wasn't able to get an answer from my insurance company yet because I've only just started this momentously exciting journey! Thanks!! Go team!

My insurance coordinator just told me they can't submit for authorization until 30 days before my procedure ???????????? its scheduled for Jan 18. So we have to wait two weeks. I'm nervous and really anxious. I don't wanna push my date up.

Hi, I have a question and wanta know if anyone has been through this before, I had gastric band done 4 years ago and was under my boyfriends policy Cigna, which you can only have weight loss once in a lifetime, so I had to have the band removed, now my boyfriend company has UHC but he's still with the same company anyone know if that once a lifetime max would apply to a totally difference ins company but under the same employer, I'm trying to get the gastric bypass?

Hi, I am hoping someone can help me. My work insurance has a specific exclusion for ANY weight loss surgery or programs. Not covered, no way no how. I thought I would buy an Illinois Insurance Exchange plan because they all cover Bariatric surgery as required by the state of Illinois. Unfortunately, since my work offers an insurance plan, an exchange plan for me and my family is too cost prohibitive - like $1300 a month or more for a good plan. What I am wondering is: if I buy an ADDITIONAL exchange plan just for myself, while leaving my work coverage in place, will the exchange plan likely cover the procedure? I had read somewhere that if a "primary" plan excludes cove…

Hi! I was just wondering if anyone has had UnitedHealthCare and NOT had to do a 6 month diet before getting surgery? I've been looking at previous posts here but it seems like everyone that has UHC has had to do the diet. My insurance is ending in 6 months so REALLY hoping I don't have to wait! Jules

Has anyone successfully switched insurances to find one that does cover WLS? Mine through my work does not. I know if I switch the monthly payment will go up, but I thought it might be worth it.

Anyone in KY area have self employed insurance meaning they have to buy it theirselves and it cover WLS? My husband is self employed and has Anthem, it doesn't cover. I have Anthem through my work and it doesn't cover it either. Really needing new plans!

Hi, I am new here. I am on Oregon Health Plan - My doctor sent in a referral for Bariatric surgery Dec 4th and it was denied because I didn't have Type II diabetes. I filed an appeal and it was approved! I was so excited. But the approval says I am approved for consideration for surgery. I am assuming I have to pass through all the other hurdles before they actually approve it? I am on Kaiser and then are sending me to OHSU Bariatric Progam and it says I am approved for 1 appointment.. ? I am calling in the morning but it will break my heart if I have to fight for each step of the process.. UGH! B

My insurance BCBS through my husbands Union requires 6 months weight loss program that can be WW or Jenny Craig or nutritionist. I have 3 and half months of WW online weigh ins and tomorrow I have my 2nd month NUT visit. Can anyone tell me if I can combine both to count as my 6 months requirement?

Hi, I was wondering how much did you pay for your surgery in southern Cali? And what surgeon do you guys recommend? Thanks.

Hey everyone! I've been lurking for a little while, and I need to vent. I had come to the conclusion that I was going to pursue VSG surgery about a month ago, and I was under the impression that because I have Cigna, and Cigna is accepted at Vanderbilt Surgical Weight Loss Center, I would be a shoe in. I called Vanderbilt's Surgical Weight Loss Center to get the process going...and as soon as I told the woman on the phone my group policy #, she put me on hold, and came back to tell me that my insurance wouldn't cover the surgery. Needless to say, I was destroyed. I had put too much hope into the potential, and didn't live in reality. How many of you have had this…

How did you pay for your surgery? Did you use insurance? Did you go the hiatal hernia route? I ask this because I am trying to find a doctor that does low bmi sleeves by going the hiatal hernia route. I am willing to pay the fully price for the sleeve, but if I there is a way to have my insurance cover the hernia and I'm just billed for the sleeve.... that's a substantial difference. At this point Mexico is not an option, my SO is not comfortable with me being out of the country without him. And Google isn't helping much. Any advice or help would be greatly appreciated.

I'm curious if anyone recently got surgery with the insurance Blue Cross Blue Shield of Illinois? I'm aware a couple of years ago they required a six month medical assisted diet. But, now they no longer require the diet. What do you'll think about this? Does anyone have BCBSIL, how did the process go for you?

Does anyone have BCBS of FL? And was it difficult to get approved?

I made my decision to have gastric sleeve surgery back in October. I called for a surgeon's consultation but couldn't get an appointment until January 2016. I called my insurance company to get a copy of the bariatric surgery policy. There are a lot of things I have to do in order to be approved. I've been on Adipex for 3 months. In addition, I started my 6 month PCP medical supervised weight management diet. When I finally get to see the surgeon, I will have 5 to 6 months done for my supervised weight management program finished by a doctor. Will my insurance approve me right away? Has anyone worked with BCBS of Minnesota? I'm excited and nervous at the same…

I'm about to enter the world of jumping hoops for insurance approval. Ill be going to Dr. Neff/ Kennedy. Seminar July 7! Anyone have tips or experience as to what requirements to expect?

So l finished all the pre requirements asked from me for blue cross (medical) California. They have been summited on Friday December 11, l called today and they told me it's under review, Oh boy the anticipation is killing me slowly .... They will have the decision by Friday..... All l want for Xmas is my approval to start a new healthy lifestyle in 2016 ....

Wondering how much people are paying out of pocket for surgery with Blue Shield- I am looking at the plans and am so confused by the coinsurance etc... any advice appreciated!

One of the requirements for BCBS Federal Is you have to have a minimum BMI of 35 for 2 year consecutive years... I was wondering if anyone has been approved after falling below a 35 the previous year? My PCP has this as my weight record Feb 2014- 204 October 2014-214 January 2015- 215 September 2015- 225 Current-227 Any advice would be great

Hi everyone. I have been 'lurking' in the background reading up on all the insurance posts, especially regarding Fed BCBS. My husband is retired Federal employee and right now we have APWU (Cigna) which we picked as it was the least expensive of all our choices. However, my husband (and I) would like to get bariatric surgery and he had his first appt to discuss his options. The coordinator who handles all the precert said that BCBS Fed is the best for bariatric surgery. Therefore, I am trying to decide if we should dump Cigna and switch to BCBS Fed. and if so, should we choose the Basic or Standard plan? OMG, I'm about to have a panic attack over all this! Basic is less e…

Hi! So after reading about everyone's insurance struggles I called me Surgeon's office to find out if they submitted to my insurance company yet. They said that hospital will submit for authorization on the day of my surgery. Um what? LMAO what if I get denied? I shouldn't, my BMI was high enough that my insurance waived the 6 months weight loss plan and I completed the psych eval and med clearance pre reqs......but now I'm starting to freak out. My Surgery is on Friday. Has anyone else been told that this is what their hospital does?

Hi everyone. I am just starting my journey and looking for a surgeon. I will have to be self-pay because my insurance excludes wls. Any suggestions for a surgeon. I live in KY but am willing to travel to TN, GA, NC, IL, OH.... I also want a surgeon that has insurance against complications. Thank you.

So I call about every single day to BCBS AL to find out my status on my surgery , and was told on Nov 24th that my MD office had not sent in my sleep study(which is what will get me approved b/c I have a RDI of 53 ) and that is all they are waiting on. Soooo I called my doctors office today to ask when was my sleep study sent and guess I have to wait for a call back........ I'm so frustrated, my insurance changes on Jan 1st. Why do I feel so overwhelmed right now all I want to do is cry!

Tomorrow is my last weight IN I'm so nervous and upset l unfortunately didn't meet the pre op weight required by blue shield of California (medical),to be approved for surgery. I do have all the other requirements done, I been at this journey almost a year. Even do last visit l lost 6 pounds, but l feel wasn't enough... I just hope once my coordinator summits my paperwork l don't denied..... All l want for Xmas is to be approved????

I am going through the approval process with my surgeons office, and I have a question about my insurance. I have UPMC for you in Lehigh County, PA. I am getting conflicting information from call center reps about the requirements. Specifically the medically supervised diet, I have been told 3 months, 6 months and no diet is required. So, I found the Policy and Procedure manual on UPMC's website for my policy. It states that with a bmi over 40 (mine is 43) I need to meet one of the following requirements either have a co-morbidity, or have 6 months of doctor supervised weight loss. I have moderate to severe sleep apnea, which is a listed co-morbidity. So in my mind I meet…

It was a hell of a fight but insurance finally approved me to See a surgeon....7 months I have private insurance u would think paying for ur own ins they would be a little more lenient but sooo not I meet with surgeon Dec 18th a loop excited

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Anyone out there self paid? I have been fighting with Cigna for a year to get approval but still nothing. My health is getting worse and I am just ready to get on the track of a healthier me and better life. Are there anyway of getting a payment plan to self pay? I'd love to hear from people who have self paid.

I have BCBS Fed and have a question about their requirements...I had the lapband placed in Feb 2011. Long story short, I had it removed due to infection in November 2013 (2 years ago). When I had it removed, I had already gained a few pounds putting my BMI around 31. I have consistently gained weight over the past 2 years making my current BMI 40.1. Does anyone know how this will effect my approval for the sleeve? Since I don't have a 2 year weight history of having an "obese BMI". My patient advocate at my surgeons office is optimistic of my chances. I'm just having a hard time wrapping my head around the possibility of going through my 3 month supervised diet and test…

Hi everyone! After 3 months of nutrition visits my surgeon's office has sent my required information to my insurance company (Aetna)! My surgery has been scheduled for December 22, I am nervous and excited! I want this so bad. Please keep me in your thoughts/prayers! I will keep you guys posted. -Tiffany

So my insurance was submitted and after numerous calls I keep getting the run around first then told that there is no requirements as far as 3 months or 6 months my surgeon's office made me complete a 3 months. Everytime I call they say there's nothing specific listed just all the information to see if it would qualify I now found out that it is pending further information as on the phone they told me they didn't have information. The letter I have almost it is as if they have nothing. It states diagnostic testing results previously tried treatments and any other information you feel would support the request In the paragraph they talk about BMI and weight reduct…

Oh my gosh! So I just got approved through insurance and am about to schedule my first actually appointment!! Here's to a long, successful journey!!

Hey guys, I was submitted for approval to the on 11/6. I called almost everyday since then for updated. How long does this part of the process usually takes. I'm undecided if I want to have the surgery 2015 or 2016.

Does anyone have any idea what information I need to give to bcbs anthem for my pre cert. I was told I need one for them to cover the surgery and I'm clueless as to what is required please help

I just found out I am borderline diabete, will this help qualify me?

Has anyone in Virginia used UHC for gastric bypass. My wife's company starts with this company Jan 1st. I had anthem and they required a 6 month diet program. Does UHC typically do this? I am afraid of having to start over since I lost my insurance and we have had a few months of a gap in between.

Hello everyone. My surgery is not scheduled until January 18, 2016. I'm a very budget/financially oriented person. I would like to know if anyone has been able to calculate their post op expenses. What's an average weekly expense about. Just curious.

I have United Healthcare Choice Plus insurance in PA through my employer. There is an exclusion for surgery for obesity. I wanted to get the gastric sleeve. I have hiatal hernia, reflux, sleep apnea, fibroids (requiring a hysterectomy), pre-diabetic, and early stages of hypertension. Is there any work around for insurance? Thank you!

Hi. Does anyone have experience with anthem? I have it through my employer and my bmi is 35 and I have sleep apnea and high blood pressure. I'm so worried about getting approved.

I started going to the doctor monthly for a medication & when I decided on WLS, I figured I could use those months as part of my pre op 6 month requirement since he always spoke to me about my weight. I never was actually weighed during these visits, and I would just tell a weight to the MA who brought me in. I never paid attention in the beginning because I wasn't doing this for surgery at the time. So I had 4 months done before I met with my surgeon. The NP told me I cannot gain weight from then on, which is fine. I can't remember the weights I told the doctor though. Could I be denied for gaining weight during the 6 month pre op diet, if it was before I met with th…

Hi everyone. I was wondering if some surgeons schedule the surgery while waiting for the insurance to approve. i would hate to wait up to a month for approval from bcbsnc and then wait another month for my surgery to take place.

Just wondering if anyone got their sleeve from meeting the doctor to surgery? With the insurance and pre op requirements?

so im on month 3 of the 6 month diet required by United Health Care. i gained 1.5 pounds between my first and second month and i wanted to know if i would get denied down the road or if i would have to do more classes or what the protocol would be

OK, so I have UHC as my insurance right now. But my current plan does not cover the surgery. I am switching to a plan that does cover it, but that will not be effective until Jan 1. In the mean time, I have been going to regular NUT visits (I have been working on this for over a year now, do to insurance changes). Over the last 3 months I have seen some weight gain, and my GP finally referred me to a vascular center. This new Dr. gave me the diagnosis of lymphedema that has gotten inflamed because of outside issues. These outside issues mostly revolve around stress (of a few different types and happened at the same time). I was told by my NUT that for most insuran…

Anyone who had surgery that used BC BS of ALABAMA how long after your first appointment with doctor did it take to get approval. What all type of hoops did they require you to jump through. If you didn't have to go through the 6 months that I have heard they make you go through how did you get through not doing that. Thanks

I currently live in Maryland and have insurance with my school in Virginia that will run out on February 28th. I will be graduating in February and moving to Texas shortly after which qualifies me for the special enrollment period according to the BCBS Texas representative I chatted with. Thing is, she also informed me that BCBS Texas does not cover bariatric surgery at all for the entire state of Texas but many people here on the forums have successfully had their their surgeries covered by BCBS Texas. I've just turned 26 so the whole insurance thing is all new to me and I'm only looking at BCBS Texas because from what I've read here on the forums, their pre-operation re…

Went to last appointment Tuesday. As of today insurance says they don't see in system but the visit is showing on the web page. They told me to call back Wed and I don't want to pressure but they are closed Thursday and Friday. They should at least have it by now, no? Also to add, my insurance will cost a lot more come Jan 1 so pushing for December

My Drs office called me and said insurance denied me because I don't have 2010 weight history. But when I called my insurance company they told me that it's still pending and don't know how my Drs office came up with it being denied.

I should hear tomorrow about my appeal with Aetna. I was denied over a technicality and a "deadline" for my clinicals to be turned in...they nev er even reviewed my info. So now I find out our insurance policy is changing with Aetna the first of the year. Of the four policies offered NONE cover bariatric surgery. I am trying not to freak out right now. The "what ifs" are getting to me. Please someone say it will be ????!! Lol