Insurance & Financing

Hello, I'm hoping for some positive vibes.. Here's my situation... I work for a managed hotel company, and the old management company returned us to the bank and a new management company came in.. Unfortunately my luck, the old company agreed to pay Cigna premium through October 31st and my last nutritional appointment is Monday, November 2nd. The new company looked for a new insurance for us but it's "individual" and not a company "group" insurance through United Healthcare. I called the number they provided and they said bariatric surgery is not covered since it's an individual plan. I looked at Cobra and it's $738 per month. Yes, nauseating. I called Cobra and Cigna …

I just got my approval after only 1 day since the paperwork was submitted! I am soooo excited that I'm jumping up and down!

ANY ONE HAVE BCBS OF NORTH CAROLINA HOW DID THE PROCESS GO WITH THEM IM JUST STARTING ON MY JOURNEY AND WANT TO KNOW WHAT TO EXPECT. ANY INFO WILL BE HELPFUL. THANKS IN ADVANCE

Please send positive thoughts and energy my way. Doc sent records to insurance for approval. I'm super excited!!!

Does anyone know how long it takes to get approval for lap-band with BCBSIL PPO?

I am getting a bad feeling about this... I had contacted my insurance plan and they said that they covered bariatric surgery at 80% and the woman rattled off all of these criteria for me including a 6 month diet. She was talking so fast I didn't get it all though. Then the woman at my doctor's office called to get the specifics and they wouldn't tell her anything. So I called again and asked them to fax the criteria and they said they can only speak to the providers about the specifics and gave me a phone number for them to call. So she called back and they told her there wasn't really a list of criteria and they were just supposed to submit information about why I need t…

I have a few questions for anyone who has already had surgery and has Arena insurance ... how long was the approval process after your last nutrition class? How long did it take to get a surgery date? Thanks

I have been dealing with being overweight my entire life . I have been sitting on the decision to get this surgery for a year now and I finally did my research and spoke with my doctor . My doctor recommended Dr. Delacruz from University Of Miami, she sent the referral over and I just got an email from their office that my insurance (Florida Blue) does not cover it.. It actually excludes ANY weight loss surgery I talked to my employer and she said there is nothing that she could do... I spoke with my husbands insurance and they do not offer it either... I applied for financing through the hospital and they want to charge me 33% interest rate . I am so heartbroken. I don'…

I am still waiting on my denial to be over turned, If I go ahead and pay out of pocket for my surgery, if my insurance pays for it will they reimburse me?

Hi everyone, I have a UHC high deductible plan through my employer. My plan has a deductible of $1750 and a maximum out of pocket of $3250. This means I would never pay more than $3250 annually, even if I hadn't already met my deductible. I'm waiting on bills from the hospital so I can pay the remaining amount (out of $3250) I owe. Just as fyi - this is what the hospital, surgeon,etc. billed insurance and what insurance paid them. $4000 - Surgery; $2650 - insurance paid, remaining amount was labeled as "plan discount" $27691 - Surgery, hospital stay (2 days) and misc. services such as medication; $27046 - insurance paid; I owe $644. $270 - Pathology (hospital)…

I'm looking for anyone else whose saving for their sleeve. My insurance went cover it, I don't have a hiatal hernia, I can't take on anymore debt, and I'm not sure if I want to travel once I have enough saved to have it done cheaper in Mexico. I've met with and chosen my surgeon, completed and passed psyc eval, scheduled sleep study, and built my support system. I just need to keep saving to get my sleeve. If you are in a similar situation, maybe we can keep each other accountable and encouraged until we reach our goals.

Trying not to call the insurance company everyday to check on the status of my appeal. So far it's in Review by the Medical Team....

So i joined BCBS of texas because they assured me that WLS was covered then wahhh i join pay $165 a month and nope they dont cover it at all turns out its specifically excluded from my policy Yes i was so boomed due to i cant cancel it til a year Waist of money there. so my question is can anyone help me with finding an insurance that dors cover WLS in Texas plz. Thanks in advance

Has anyone used Medicare if so I know they only cover 80% but do you have to pay the reminding 20% up front.

Approval Waiting Period??? I'm almost done with required 6months weight ins/ Pysch Evaluation I'm going to USC bariatric Program,has Anyone gone through this program and if so how long it took to get approved so nervous been through this journey since march... Any advice welcome!!! Thanks

I saw my surgeon for the first time a couple weeks ago and paid an office-visit copay. I logged into my insurance and saw that BCBS denied the claim for payment of the remainder of that charge. I'm jumping through hoops to get insurance to pay for the surgery itself, but now I'm wondering what other out-of-pocket expenses will there be? I'm planning on the copays each month that I go for my PCP-supervised diet and I know I have to pay for meeting with the nutritionist...but what else? Does this mean I'll have to also pay for my sleep study? Ugh!

Does anyone have info or advice to share concerning the whole process with AvMed?

When my surgeon first submitted to my insurance they denied because they didn't get "sufficient information" so my office sent an appeal and resubmitted all of my paperwork. It could take up to 60 days to approve. If they decide to wait the full 60 days I'll either get my surgery the week of Christmas or wait until the new year and pay my $1700 deductible all over again. That's stressful and not to mention my whole life is scheduled around my current November 12th surgery date All this unnecessary anxiety when all my insurance needs to say is yes or no. I feel like it was such an easy approval ride for everyone else going through surgery. Feeling down, thanks fo…

does anyone know the policy and procedure to have approval to receive the sleeve surgery through them ?

Well today is the day my papers were submitted to bcbs of sc. Scared, excited, nervous all at once. I'm trying to not get my hopes up in case I get denied, but I'm thinking positive. When the surgeon ran my insurance it stated I only needed 2 supervised NUT appointments, when I called they told me 6 months. Idk let's see how this goes.

I have about 150 pounds to lose ... I'm currently about 290-300lbs. I was denied by my insurance back in July due to not having been on a 12 month supervised diet ... That has to be cosigned monthly by my primary care. I currently have BCBS Charter Care in RI, but my insurance is actually located in North or South Carolina. I'm wondering if anyone has dropped their primary insurance to get Obamacare. Rhode Island is one of the states that does cover bariatric surgery. I'm assuming that they follow the 6 month nutritionist appointments (which I already have completed along with my EGD & psych eval. & sleep study). I would have continued but since those 6 months …

Does anyone have this insurance I have alit of questions my insurance won't answer

i have medi cal.. with community health group.. has anyone been denied the surgery part? i was approved for the consultation my bmi is 52 pre diabetic back pain sleep apnea (not diagnosed) hypertension

I was SO stressed thinking they weren't going to submit until Monday, but I confirmed with Cigna that my file has been submitted and all pertinent docs were received! Woot woot! She said it will be a couple of days. I hope so, especially since after 20 yrs with Cigna my husband's company is changing insurance companies the 1st of the year! Please pray and send positive thoughts for what we all want...a quick easy approval!

I had an individual Anthem plan previous to the ACA and it covered the surgery. I was too scared at that point to do the surgery. Fast forward, after the ACA my plan was no longer available so I was forced to purchase another plan. Today I called to find out what I needed to do and found out that my plan doesnt cover the surgery in VA. Only 22 states do cover the surgery. Even if I self pay, they will NOT cover any cost if there is a complication...that is just too much of a risk for me to take. I am at a BMI of 45, my doctor actually suggested the surgery to me a year ago...I tried once last attempt with Ideal Protein and lost 40lbs but have now gained back 50lbs. I c…

Hi guys. I'm in the process of the VSG waiting for the sleep apnea test to send my file to BCBS California to hopefully approve my surgery. I'm so worried because I don't know if I'll get the approval because my bmi is 39 and I'm healthy except I'm pre-diabetic. Any one can tell me if any case like mine got approved. It's torturous to wait without knowing if I'm gonna get approved or not after months of waiting and tons of dr appointments!! Thanks

Hello, I have just begun the process of getting approval for bariatric surgery. My PCP submit a request for me to begin the process of surgery, and have since attended a group information session, and have scheduled my first meeting with the physician. I'm curious as to what experiences people have had with Group Health and their bariatric surgery coverage. Thanks!

I am heartbroken and discouraged. BCBS of AL denied coverage for VSG because my PCP did not include the fact that we discussed diet and exercise in all the notes for my 6 mo. pre-op medically supervised diet. In addition, the patient navigator at my surgeon's office did not send my medical records going back to 2012 because my BMI is 41 and she assumed that I would be approved. BCBS of AL requires a BMI of 40 or above for 3 years or 35 with co-morbidities in place for all 3 years. My BMI has not been 40 for 3 years, but it has been 36 and above with sleep apnea. I have used a CPAP for 5 years -- HOWEVER, BCBS requires that the sleep test shows severe sleep apnea. 5 years…

Can anyone tell me any success stories with your ky Medicaid plans of getting a painless approval for surgery?

Ugh! So I started this whole process this month with medical mutual and come to find out they refuse to cover any bariatric surgeries. Well, in January I am switching to United healthcare. The reason for this is because my current insurance is through my dads insurance and the new insurance is through my mom. My mom talked to her hr & to the insurance and their sure they cover it with NO requirements besides a BMI of over 40. So that's good news. But what can I do now so I don't have to wait until January to start the rest of the process? I don't want to postpone this any longer! Thanks !

Hey, everyone. I just got the referral to see a surgeon approved. Is it possible to get a pre approval from my insurance (BSBC CAL)? I am so afraid that I will have jumped through these hoops only to have the surgery denied. Thoughts or advise? Thanks!

Hi new to the group I have partnership insurance thru medi cal in California I found out that bariatrics is covered and they told me which hospital is covered. My question is I have to have my primary Dr refer me does any one know what the requirements are I currently weigh 270 with a bmi of 44 is that enough any info please and thank you

I'm looking into the small business kaiser plans and would like to ask if anyone knows what plan covers the gastric sleeve Bronze Silver Gold Platinum Thanks

Of course my work insurance doesn't cover the surgery and I'm not comfortable going to a different country. My self pay around my area is about 30k. During open enrollment next month I'm going to get a private insurance just to cover my sleeve. Has anyone else done this? May I ask what your monthly rate and deductible was?

My husband informed me today that his company sold to another company and our insurance is switching and my deductible is starting over. I had BCBS of Texas. My deductible was met and I was almost done with everything to be submitted to insurance. I am so frustrated and feel defeated. I don't know what plan we will have yet so I don't know if WLS will be covered or not. If you have UHC can you tell me what plan you had, if it was covered and what the requirements were? Also if you had UHC and used Dr. Nicholson in Plano that would be a plus since that was who I've started my process with.

I have bc/bs NC just wondering how much insurance paid toward a cpap machine I need one

If it matters, I am insured by the Oxford Liberty plan. I am using a very reputable NY surgeon, chief of bariatric surgery at NYU Hospital. I have some questions. Issue 1: I want to know my out of pocket expenses. I met all the insurance requirements for sleeve surgery except for the final medical clearance. My surgeon's office scheduled me for surgery in 3 weeks. I've asked several times if they could tell me how much I was going to be responsible for. I was told it was too early to tell. I hate to be a pain in the neck and keep asking, but I'm not getting answers from the surgical coordinator. I called my insurance company. Unless I can give them very specific info (w…

My BCBS of CT pulls up 'price estimators for Band and Bypass but nothing's under Verticle Sleeve or any other names I could think to search it. I will call to confirm its covered tomorrow because that's the surgery option I've researched and found fits me best. BUT I'm now freaking out that maybe my insurance only covers some types of surgery and not Sleeve. Is that something anyone has ever seen happen? My surgeon apt is in 2 weeks but I'm gin research mode now.

I heard from Cigna today stating I was denied because they did not receive my 3 month diet or other physician recommendation. They said they was now waiting on my surgeon office to set up a peer to peer? What does this mean and what do we have to do now bc I have completed those and had faxed them over to my surgeon along with all of my other stuff, I'm not sure if they lost it or what. I am devastated. If they do a peer to peer will I likely have a higher chance to be approved ? Will this push back my surgery that is set for august 28?

I have been going through the process for the VSG since April. The first step was getting insurance coverage information. When my dr office talked to the insurance company they were told that my insurance company would cover the surgery and gave them the requirements. I have since had multiple visits with my surgeon, nutritionist, classes, EGD, 2 psych consults and sleep study. I have a CPAP machine now as well. I decided to give my insurance company a call since we were still waiting for the approval, just to check the status. I was informed this afternoon that my surgeon was given wrong information and that surgery is not covered under any circumstance and not fo…

I'm not getting bypass, but the sleeve. Wanted to see if anyone else has/had gwh and if they experienced any problems? So in the beginning they told me that it would be covered and they also told the office manager and insurance lady at the hospital. Now that they submitted their saying in my policy that it doesn't say yay or nay for bariatric surgery. It just says that diet clinics r not covered, but medically necessary procedures/stuff would be covered for morbidly obese patients if deemed medically necessary. Any advice or comments would be appreciated!

Sooooo today was the day all my papers were submitted. Since day 1 the office manager and insurance lady and myself called my insurance company to make sure they would cover it. The policy states they don't cover diet clinics, but they cover medically necessary stuff for the morbidly obese. They don't deny or accept they cover bariatric surgery. Well today my insurance agent told the office manager to submit to Cigna and see what happens. Please any advice or support right now would be appreciated!!

I went through every step that my insurance required. The 6 month medical supervised nutrition counseling. All the tests required including pysch eval. I was told my surgery was covered up to 16,000 for a lifetime max surgery pay out. No problem, my surgeon office told me it was 18-20,000 so I figured worst case scenario I would owe 4,000. The hospital just sent me a bill for 32,000.00. They said insurance only covers for entire cost including hospital stay. I would have never done this surgery had I known. I am devastated and don't know what to do!

I am frustrated because I totally want to be obsessive right now and continuously check the status of my authorization for revision. Butttt I have BCBSNC, and I can't seem to find anywhere online where you can do this. *cue violin* hahaha

I'm a former band patient that due to complications had to have my band removed. Last December my employer changed our insurance from BCBS of Michigan to Health Plus. Health Plus refused to allow a second WLS saying they would only allow one per lifetime, regardless of what insurance paid for the original surgery. They covered the removal due to the health risk involved, it was not an elective surgery to remove the band, I was unable to swallow anything other than minute amounts of liquid. Now the issue: Health Plus has merged with Health Alliance Plan due to financial problems. I still do not know if my employer will stay on with the Health Plus/Health Alliance P…

Hello all! Just curious if anyone has had the surgery with Kaiser (southern ca) ? If so, any info on the process would be greatly appreciated ???? thank you

After what seemed like forever, I finally got my approval letter from Anthem. Now waiting to get a surgery date. I finished all required testing by 6/23/15, but apparently my hospital of choice was in prolonged contract negotiations for renewal with the insurance co. Starting to get excited...

I am so frustrated. My United Healthcare policy will only pay for a revision if there is a malfunction with band, which means I have to get some kind of scope to see if this is the case. The surgery coordinator at my surgeon's office informed me of this yesterday, when she could have informed me last week. For whatever reason, the surgeon won't order this scope, I have to go to my primary doctor and request one, which wastes more time. However, I am going there next week, and I am sure one will be ordered right away. Problem is, there is probably not going to be any kind of "malfunction" with the band. I doubt it has slipped, and I would assume I would have noticed …

Im new to all of this and trying to do all of my research before hand so i know what to expect. Has anyone had gastric bypass surgery with the Illinois medical card? What were the requirements? How much did you have to pay out of pocket?

I am starting the process for VSG and hoping to get some financing advice. From Montana, which doesn't require bari services to be covered by insurance...so I'll be going the self-pay route and planning on Mexico. I'm looking for any advice on reputable financing for medical expenses: I did an initial google search, but all the "sponsored" ads for financing are sketchy at best. Not sure what to look for regard medical financing, and getting a CCD is a last resort because of the interest rates. TIA! Really hoping my VSG is in the plans for summer 2016!