Insurance & Financing

I have uhc choice and my requirements are to be 40 bmi or 35 bmi with a CM. I was pre-approved due to my wt only. I'm on supervised month 4 of 6 and my wt has dropped below the 40bmi. Will this be a problem if it was documented at month 1 the required 40 bmi wt?

Its open enrollment with my company which has been bought out by another company...I was excited to renew my benefits but to my surprise this new company excludes bariatric surgery in ALL of their plans. I'm 75% complete with preop visits. I currently have to do a 6 month supervised diet with MD, which will not be complete until March. Any suggestions on what to do? This has been devastating to me.

I had my lap band in 2008. I lost weight, but gained back a ton after I had my son. I found a surgeon who was willing to do my revision. I had the consultation, I started doing my surgical clearances. My insurance (HealthPlus Amerigroup) changed to BCBS HealthPlus. Everyone was made aware of this change happening. I was scheduled to have my lap band out on 10/27. On 10/05 I called the office to ask a question, and they informed me that they no longer take my insurance. I was floored that no one even bothered contacting me to let me know I wouldn't be having surgery in two weeks. So for a couple weeks I sat depressed, until I found an awesome Surgeon willing to do m…

Does insurance expect you to lose weight in your supervised 6 month diet? I know you can't gain weight, but what if you only lose a few pounds in those 6 months? Anyone been denied for this?

Since I'm still under 25 I'm able to be covered under my parents insurance plan as well as my own. I will be covered under Aetna as well as UHC. Does anyone know if I have to follow both guidelines in order to be approved for the sleeve? or just my primary and have the secondary pick up the extra? I have no idea how to do any of this & I can't talk to anyone until after the 1st of the year as my coverage won't go into effect until then. I'm so lost

As I sit here at work not focused, today I received notice I was denied by Anthem Blue Cross. They feel as though I do not have any life threatening illness due to my weight; UGH. BMI is 36, I have mild sleep apnea, fatty liver disease, GERD, infertility issues, joint pain, ulcers and a long family history of obesity. I am so devasted. My doctor's office has scheduled peer to peer conference call for next Monday. Has anyone heard of success after a peer to peer review? Thanks.

I am waiting to hear back from my insurance with approval right now. I have been assured that I would be approved. So much that I am.actually scheduled for surgery on the 30th and I'm on day 2 of my diet. Does anyone else have Humana and has anyone had problems with this insurance? Age 40 Hgt: 5'2 Weight ;244 BMI; 44.9 Goal is 129 lo

My health insurance doesn't cover bariatrics, and even if it did I was looking at plication which is a more experimental surgery and probably wouldn't be covered anyway. I think the cost of plication is about 10k, which I could pay out of pocket. My big worry is that I spoke with my insurance company and they said if I had any negative effects that insurance wouldn't cover it. So if I needed the plication removed, or if I developed gangrene, etc insurance would not cover any of it. Does anyone run into this problem, or have a way around it? Can you buy insurance to cover gastric complications? My big fear is that if I get the surgery I will be in that minority who n…

I'm still researching to see wether the lapband is a good choice for me, but if anyone has financed the procedure with occ in Tijuana Mexico I'd like to get an idea of the monthly costs of getting the surgery. Thanks in advance.

Today I had my EGD completed and no hernia. I was told to talk to my patient advocate for true results because there may be another way? Any whom anybody on here used True Results and no hernia was found?

I feel like this entire pre-op process has fried my brain. Literally, things that prior to this I would just say "Let me look this up" or "I will call the doctor" or whatever are now causing me all kinds of distress and second-guessing...I think it's because I have been working really hard to make this happen and I want it so badly that I've convinced myself it will all fall apart at the last minute! Here's my question: my surgery will most likely be scheduled for mid- to late December, according to my patient navigator. But say I get everything done, get the approval from the insurance company, and for whatever reason can't get the surgery scheduled until early 2016..…

Is anyone paying full price cash pay for their surgery? I am because my insurance doesn't cover it. How much are you roughly paying?

I'm not really sure what i should do now. My insurance doesn't require a pre op diet. What do i do now?

ok so i been trying for months to lose the reqired weight and i have two weeks left and i have takin the liquid diet also 10 miles on my stationary bike and that i am trying everything to get my 9 freaking pounds down... my question is will i be denyed if i dont get them down????

My insurance covers vsg but my out of pocket is more to stay in the States than it is to pay cash for Mexico. I just borrowed the money I needed for the procedure plus airfare and got my direct deposit this morning. Who Hoo! This is finally within reach. I'm going to schedule for January.

Is there anyone out there who has gone through Aetna insurance? I just want to make sure I have all my ducks in a row because they have a lot of requirements. Thank you in advance!

Does anyone know what the insurance companies are looking for when the PCP has to submit the 6 month diet stuff? My PCP is so....unorganized. I started with him and I had already been being weighed so I figured I'd finish it out with him, but I have a feeling he hasn't been charting what he needs to. Anyone know what they're looking for or what the doctor needs to chart?

Has anyone been on depression/anxiety meds and had this done? Has anyone seen the psyc while on these meds and was approved/denied?

Hi all!!! After a couple of months my pcp finally sent an authorization request to see a bariatric surgeon!! I am so excited! But I am getting a bit nervous the request states that I have uncontrolled high blood pressure ( taking 3 meds for that) fatty liver, and last morbid obesity. I am 27 years old, i am 5'3 inches I weight 216 pounds. I am wondering if that is enough for my insurance to approve the request? I have a medi-cal (LA CARE)

My surgeon's office submitted for approval yesterday. All is done, so it shouldn't take long, but I'm anxious because if I don't have surgery in early October, I'll have to wait until late November because of schedule conflicts. So, I just keep checking online, hoping status changes from "pending" to "approved".

I started the goal to weight loss surgery almost 3 months ago. Everything was rolling along smoothly. Me and my surgeon was on the same page I lost almost 40 pounds on the diet before surgery proving I can and will keep the life style. The date was set for November the 4th and we thought everything was checked and crossed. I did everything they asked of me and my dr said I was the perfect candidate for surgery. 2 days before surgery my Insurance send my doctor a denial letter. I will attach the letter to the post. Now I want to appeal but I'm confused on how I do this. My Insurance said to send appeal letter to them. What should I put in my appeal letter I would ap…

I'm insured by BCBSTX. They are very WLS friendly so I feel confident about getting approved but I was informed that I have a $5,000 co-pay. Does anyone know how this works? Will I have to pay the entire amount upfront if not, what does a payment plan consist of. I'm meeting with 3 docs here in the Houston area (Dr. Dexter Turquest, Dr. Robert Marvin, and Dr. Felix Spiegel) if any one has gone through this process and could give some info that would be great!

Anyone have highmark blue cross blue shield? Wondering how long it took for approval of surgery?

So, my file is completed, and I am awaiting approval from my insurance company. My current BMI Is 41.3, with no comorbidities. My prior year BMI's were in the 39s. Has anyone had an issue getting approved with BMI history under 40?

Wondering if anyone in NJ who is covered under Obamacare has had bariatric surgery such as the sleeve, lapband, etc?

Bmi is 36.88 with few problems high blood pressure, high sugar cholesterol high and high risk for heart disease doctor filled out my medical necessary for for a good candidate. I have uhc r they hard to get approval meet with sugeon he set my date for 4-5-16 . They said they submit it 2 weeks before my date. Any advise would b helpfull. Thanks

Hello everyone, my current employer's health insurance does not have any bariatric benefits, neither will the new health insurance for 2016. Any suggestions as to where I could get health care insurance? Other than Obamacare? I have a complication on my sleeve and I need revision. Thank you.

I've read here that people have found out the were approved for surgery before they got their letter in the mail. How do you find out? Mine was sent off November 3rd so it's only been a couple days. I'm in a time crunch to get it done before the end of the year because I'm switching insurance and new insurance doesn't cover WLS.

I am a newly military wife and am not sure of the ins and outs of Tricare. I am wanting to get the Gastric Sleeve and have heard that Tricare will not approve one to get the surgery unless it is at a MTF hospital. I currently live overseas but will be moving back stateside in January 2016 and we won't know where we are going until August 2015. I will be visiting my parents this summer and will be temporarily switching my tricare from overseas to prime south. The following are my questions: 1) What are the closest MTF's to or in Florida that do the Gastric Sleeve? 2) Is it a possibility to get the surgery while I am home this summer? I have gone to the nutritionist seve…

Do i need to go to my primary care physician first or can i go to the Bariatic Clinic and start my journey ? IThank you

For the sleeve? Hopefully with no diet requirements? I may have messed up my Cigna diet (see other post) and open season is soon for January (in case I need to switch)? Thanks!

Anyone familiar with Medcost? Is there an average everyone is paying out of pocket for the actual surgery?

I cant believe how fast this is going. Just started process and already have all my pre req appts completed. Drs office is already submitting to my insurace. Although I have been told I have the best insurance that has very minimal requirment, I'm still nervous about getting denied. I am just over a 35 BMI and last year I was under a 35 BMI. Anyone else with the same insurance have any stories to share. I know, I just need to be patient.....but I cant. It all seems too good to be true.

I thought my last visit was tomorrow, but am now devastated because my surgeons office is telling me I have to start over because I "skipped" October. I went July 27, August 27, September 29, and have an appt for November 3. I could not go on Friday, October 30 which was the only business day that would have given me 30 days between visits but still have he last visit in October. Any insight as to whether the surgeons office is correct and the 11/3 date is too late?? Thank you!

I'm in AZ. Submitted for auth on friday. Anyone have experience with them? I've heard both good and bad things. I'm wondering how quick the turn around will be.

Just wondering if anyone got approved for wls through Medi-cal La Care? How long is the process? And what was your experience?

I was researching what was covered with my insurance and it states that Gastric surgery is indeed covered (YAY). Only thing is I know that *** likes to give people a hard time authorizing such surgeries. Does anyone else live in the LA/OC area in SOCAL that has healthnet and had success? I don't see my doctor until next month and I am afraid he is going to give me a hard time.

I have BCBS of Alabama, but apparently only their super high leveled plans will cover WLS at all. I was told that under any and all circumstances that surgery is "categorically excluded," meaning no chance at all that they would cover. I've already had my surgery, paid for with CareCredit and the help of some friends, but I'm seeing all this stuff about appeals and the like and wondering if I was stupid to assume I was just out of luck with insurance and just went $16,000 in to debt for no reason...

Does anyone else have this insurance? Called my agent and said they will pay as long as I can prove that I'm morbidly obese. Has anyone had any experience with them?

Has anyone run into this? My insurance covered the surgery and I was approved with no problem. Unfortunately, about a week out I had an infection and then a leak. I was in and out of the hospital 3 more times over 5-6 weeks. The last time I was probably in for a couple weeks straight. I don't really remember because of the meds. I had to have another procedure to put stents in and another to take them out. There was a picc line that the insurance said they would only cover in the hospital while taking nutrition. They paid for a visiting nurse when I was released and used the picc line for antibiotics. They are currently paying for nutritional supplements. My doctor or…

Does anyone know what the average deductible is for Cigna?

So nervous awaiting their answer ... Anyone have a good or bad experience with a Cigna PPO?

Hello, In 2016 I'm will be on my husbands insurance and it covers up to 80% for Bariatric Surgery. Does BCBS Anthem PPO require you to do the 6 -12 month supervised weight loss? I'm trying to get a primary doctor now to start if that is the case.... Does anyone have any information on this or what steps do I need to take? I'm looking forward to healthier 2016.

I know my packet was just sent to insurance Monday, but OMG I was hoping to be one of those lucky bastards who heard back within 24-48hrs! I'm going crazy thinking about it, but I'm trying so hard not to be one of those people who speed dials the insurance company everyday, but I want to be one of those people so bad! lol please someone put me out of my misery! I can't wait to get rid of this fat body!!!

My surgery date for gastric sleeve is September 14th and I am still having problems finding out how much my portion of the surgery cost will be. My insurance has approved me, but its coverage for bariatric surgery is pretty limited. Even after I pay my $5000 bariatric deductible and then my co-payment maximum, my insurance will only pay up to $13,000 for my surgery. I will be responsible for paying anything that exceeds that. The problem that I am running into is that I cannot get my insurer to tell me the contracted amount for my surgery and neither my surgeon nor the hospital have been able to tell me that either. Between the hospital financial counselor, surgeon, and h…

My insurance does NOT cover any bariatric surgeries, but what if I self pay and then later have complications? Would having it done in Mexico change anything? Sorry if this question is old news, I'm still figuring out this app...

In July I attended a group information session at Marina Del Rey Hospital about the VSG. I sat in the dingy waiting room with several other people as Dr. Misra gave a brief overview of the surgery. What she presented was generic information readily available on here, YouTube, and other sites. I hadn't expected any time with the physician but dutifully came back when asked. I was weighed and then ushered into a small patient room. All the doctor did was say that my BMI was low for the surgery but I would possibly be a candidate. My total time in the building was under 16 minutes, and that included waiting for the session for the begin. I know this because of the cost of pa…

anyone know of any surgeons in south florida or central florida that would do a hernia repair on insurance and do gastric sleeve at the same time self pay ? Of course my insurance wont cover my surgery its Obamacare Florida Blue even though its deemed medically necessary by my primary care physician due to diabetes, high blood pressure, cholesterol and fatty liver. I was hoping this would cut the cost of the gastric sleeve a little bit

BC/BS of Tennessee changed policy 2 weeks ago. The 6 month supervised diet is now really 7 months. The time from the very first weigh in to the last must be 180 days, so this is technically 6 months and 2 weeks. I completed my 6th visit yesterday and submitted to surgeon and was advised of the changes. This practice is top notch and on top of things! They had no warning from BC/BS of the new requirements. The clinic coordinator stated that she has 7 denials on her desk, but lucky for me I can attend one more visit with my PCP. Others not so lucky!! If I had to start this whole waiting game over, I would be devastated!

Does anyone have BCBS of Tennessee?