Insurance & Financing

Hello, I recently got a job with Aetna insurance, I didn't have insurance before but was bummed when I found out there is no bariatric coverage. I have a BMI of 39 and really want to get the surgery soon. Is there any way to get insurance to partially cover the surgery? And does anyone know a really helpful surgeon in either NYC or Long Island that will work with me? Thank you in advance!

I had gained a lot of weight on steroids and was experiencing joint pain and my pcp sent me to a rheumatologist. I saw him for 3 years while I lost weight and came off the medication. Would this count?

I am going through Hernia repair to have insurance help with some of the financial burden since I have Hiatal Hernia. I have a high deductible plan with Blue Cross Blue Shield of Illinois. Has anyone had any trouble with getting BCBSIL to pay a portion for the surgical procedure? I checked my plan and it looks like they were billed $17,500 and only paid $118.90 to the claim? I am NOT going through with this procedure if this will be my out of pocket expense. Waaaayyy more than what I was told to expect by True Results...on top of owing the $3900 for the sleeve itself!!

Any couples who have had surgery under same cigna insurance policy. I had surgery in june no problem. They are saying my husband is not allowed to have it. He was suppose to have first consult appt in am and was just told this. Me and my plan admin are having a come to Jesus meeting in am as he told me there would be no issues of him trying to start this process

Can anyone help with how long it took after completion of your last requirement pre op for insurance approval ? Thanks In advance WILL

I tried this in another forum and got no responses, this looks more appropriate. This is a question for a friend who saw my success and began his own journey through weight loss surgery. Has anyone else had problems being approved by the insurance company (Aetna)? He was required to have all the tests done and to attend 6 months of supervised diet with a nutritionist, he's done all but with a big problem, he gained weight during the six months. I had been telling him it might be best to begin getting his head into it, I was cutting back on fats and carbs three months before my surgery, so I was in full swing by the time I was recovering. He's morbidly obese and has co-mor…

Has anyone had any luck getting their surgery approved thru BCBS of SC?

I'm 18 years old and have been in this process for about 4 months now through classes and appointments to receive the RNY gastric bypass. Everything is done, now just waiting for insurance approval. It's been a week and I'm super anxious. Help.

Anyone been denied so you changed your insurance? Just wondering if the "medically supervised diet" process would have to start over if I change insurance plans? That would be another longgg 6 months

In researching VSG I came across an interesting explanation as to why some insurance plans cover weight loss surgery and others do not. I can't confirm the accuracy of this explanation but it sounds very plausible. There are generally two kinds of insurance plans: employer funded and commercial plans. Employer funded plans are used by many employers with more than 500 participants as it is more cost effective to fund their own plans. They will use an insurer to administer the plan, but since most of the funding comes from the employer they have a big say in what is covered (within lawful restrictions). Commercial plans are offered by insurers to the general public…

Anyone with BCBS-IL know approximately how long it takes for pre-auth approval???

Okay so I have met my insurance requirements, (waived 6 months of supervised diet because of BMI over 50, and a cleared psych evaluation). I just heard from my caseworker today that she submitted the claim to the insurance company but that they can have up to a 30 day turn around period. My question is, how long was your turn around time? I know we all hope for a one or two day turn around lol but what should I expect realistically?

Anyone know the requirements that nned to be met to get approved for WLS on Anthem BC California?

Hey, so, here's my situation. All the various people have signed off, so now it's just off to insurance. I talked to the team member doing the insurance submissions, and she said her goal was to submit to the insurer Blue Shield of CA, not BCBS) by the end of business yesterday. My insurer has a 5 business day turnaround for responses on bariatric pre-auths. So, here's my question: is it okay to call the insurer and ask if it's been submitted? Can I call after the five days? I ask because we're trying to get me on the schedule before the end of August, but they can't schedule my pre-op apt and surgery until they get the approval. I'm going on vacation for part of Augus…

This question is for anyone who has had VSG performed in Western Washington State and had to pay out of pocket. How much was your total? Which surgeon did you decide to go with? Are you happy with the outcome?

Just waiting for my surgeons office to submit my file. Ive don't all that was required of me from surgeon and insurance that i was told. Anyone have any help or suggestions for me Greatly appreciated Will

excellus blue cross blue shield NY teamsters plan thy have been so good to work with thy had no problems with me having the surgery. I will pay $100 Copay for the DR $30 copay for the anesthesiologist Then 5% of the Hospital stay I have a no deductible plan with a 1000 max out of pocket per year for the family and seeing we had a baby before my surgery I don't know yet how much of that has been used Sent from my SAMSUNG-SM-N900A using Tapatalk

I am going to be a self pay patient and have Tricare insurance, anyone know if I run into complications ,,,,,, days, weeks, months years later will my insurance cover costs?

Hi there I'm 24 years old and looking into getting a gastric sleeve in order to help me successfully lose weight. I've struggled with my weight since I was young and have never successfully been able to lose more than a few pounds even when trying very hard. I'm hoping this tool will help me! However, being able to do this absolutely depends on my ability to get Medicaid to cover it -- elsewise it's too expensive. And I'm nervous about at least one aspect of Illinois' Medicaid requirements for them to cover me. They say you have to have been part of a doctor supervised weight loss program for six months. This is the part I have questions about. My doctor asked me…

Anyone know the program and copay ?

The current written requirements for Blue Shield California state 6 month supervised diet is required. I printed the policy in mid-April. Since then, they have added a preview of their Bariatric Surgery Policies that goes into effect June 30, 2015 that seems to imply that the length of time required for the supervised diet is to be determined by the individual doctor and patient circumstances. Does anyone know if the requirement for supervised diet is really changing on 6/30/15? I plan to call Blue Shield on Tuesday to see if anyone can tell me, but my prior attempts at getting phone info haven't been great. I'd be thrilled if I can get approved before the end of the 6 mo…

I am new to this and have had my first meeting with the surgeon at which time I was told that I would need 6 consecutive months of documented weight loss with my PCP or Endocrinologist per insurance. I REALLY would like to have the surgery before this year is up and while I have already met my deductible with all the meds and dr. visits that I have been to and this is going to keep that from happening. I am feeling really defeated and just want to move forward! I ONLY see my PCP when I am sick (which is not often) but have seen her for 6+ years with documented weight and talk of weight loss and diabetes at the visits. I have been seeing my endo for 4 years (every 3…

Just got my packet from the hospital! There's is so many things I need to do and fill out! I'm just so overwhelmed and feel like if I make one mistake on the packet I will be denied because I'm barely matching all the criteria they need for the WLS HELP!!! I've been on a medical weight loss through my PCP I'm 205, 5'3 with only one comorbity

So next week I have my final appointment with the dietitian, and I'm excited about it. But I'm also worried that once it's all done and everything is submitted to insurance, they won't approve me. I've gained a pound or two since all of this started, and luckily I've finally lost a pound, and I'm hoping I can keep it off by the appointment next week. But is it true that Aetna doesn't accept someone because of weight gain during this time? I'm freaking out.

I got the call today after my paperwork being submitted on Friday that my surgery has been approved!!!!!!! I am so anxious/nervous and excited all at the same time!!!! The surgery scheduler is going to call back by the end of the week to schedule!!!! Wow!!! Its really happening and I couldn't be happier!!! I guess I always thought it would get denied for some reason.... I can take a deep breath now!!

Anyone have the insurance BCBS Horizon? The phone inquiry I had was ridiculous. I called to see if the surgery would be covered and the girl on the end gave me such a run around! She said "bariatric (with emphasis on bariatric) surgery is not covered under your plan. I replied" really? I can't believe you would rather pay for years of diabetic complication, possible stroke or heart attack". Once again she repeated the statement. I said what about appealing and she said it again. No other words. I then was a bit perturbed by her attitude in her voice and had a few suggestions. To make a very long conversation short, I kept asking about the appeal process and in the end she…

If this isnt allowed let me knos please! Will friends am looking for a little help recent lost my job and had to move away from my family, I'm living with an amazing family who have said if I can get my copays and after surgery money together I could live here till I heal.....I know we all have problems I'm just looking for a little help, I don't ever ask and to be honest I'm ashamed but I could really use a blessing. Below I have posted my gofundme link...god bless u all!!! gofundme.com/zy24u884

Would love to see a forum for self / cash payers. Including topics like BLIS insurance.

Has anyone ever heard of cigna requiring a BMI of 41 w/ no comorbilities? I'm confused by this thinking I heard her wrong... calling back tomarrow. Just thought I'd ask you guys first, thanks!

Hi All, How long after being informed that your packet was submitted to your Insurance company did you start calling and following up? Also has anyone had success getting their Dr's office to call and expedite things? I was submitted on Monday and have called about 4 times already in 3 days. Thanks in advance everyone!

Just wanting to prepare myself and waiting for my doc appointment next week is taking forever! Has anyone else felt like something will go wrong and you won't be able to get the surgery? Maybe because I have failed so many diets, I just feel like this won't work out either. I have BCBS of Texas and have a BMI right at 40. No co morbidities. I now have my husband and family on board and I really really want this for myself. Everything I have read says its relatively simple process through BCBS but gosh I just want to be prepared!! I have obtained all medical records from my pcp back 3 years because before that I didn't see a dr, and even after I have maybe two visits a y…

Hi started this journey in Dec. 2015. Went through 1 appeal that was presented from my surgeons office. I called Horizon twice this week and they told me I need to send more information I'm 5'4 and 205 my BMI is 39.5. I have high blood pressure, veinous insufficency, been going to pain management for 1 1/2 years for 2 herniated disks and a tear above another and I'm on two different protonics for gastritis. I never mentioned the gastritis condition before, do you think it might put me over the top with the second appeal? Would appreciate any input. I don't want to throw in the towel.

Hi started this journey in Dec.wo different protonic 2015. Went through 1 appeal that was presented from my surgeons office. I called Horizon twice this week and they told me I need to send more information I'm 5'4 and 205 my BMI is 39.5. I have high blood pressure, veinous insufficency, been going to pain management for 1 1/2 years for 2 herniated disks and a tear above another and I'm on two different protonics for gastritis. I never mentioned the gastritis condition before, do you think it might put me over the top with the second appeal? Would appreciate any input. I don't want to throw in the towel.

Hey folks, anyone here have this insurance ( Humana Gold ) and have any advice for me as to how long the approval process takes ? Also what the co pays are Thanks Will

No evidence of erosion or slippage via ER CT....worried about being able to qualify for revision!Ingo Horizon Health NJ BCBS

On December 18, my surgeon's office sent my paperwork to BCBS fir approval. Wrll denial, so I can get the approval through my secondary. Anyways, I started calling the day after to makr sure they got it. Well 7 business days later they still dont have it. They said it only takes a day or 2 to receive. My question is should I call the doctors office back and keep hounding them? I called twice, and the lady said she sent it. She also said that she needs the denial letter from primary. But when I talk to secondary, they said all they have to do is do the surgery, bill them and they will pay. My secondary is Horizon NJ health. Anyadvice? I dont want to be a nuisance …

Does anyone have this ins and what was the process like? I know I don't need a referral and have already chosen my surgeon after attending a seminar.

I am a current patient at True Results. I had to change to BCBS TX HMO when I got married a couple of months ago and need to go see my doc because I have been having pain. Has anyone gone to TrueResults with BCBS TX HMO?? I need help because I am in severe pain. Thank you!

I was wondering if anyone else self paid? I was denied twice for my surgery. I have done all the pre op but everything stopped when tricare denied me. If you self paid with bypass what was your cost? Thank you!

I am almost done with my requirements. Saw the Primary Dr, completed the 3 month monitored weight loss program, saw the surgeon, and will be having my 3 evals (cardiac, pulmonary, and psych) with in the next few weeks. I don't have a surgery date yet but it should be early October. In October I am changing employers. My insurance is the same company to company, however I will get a new group number and member ID. The Dr has assured me it will cause no problems. I don't want to ask my new employer if it will because frankly it's none of their business. Does anyone know if I should be concerned? I don't want to waste all my progress. Thanks in advance.

Hi! I have been signed up to this forum and following so many of you for a looooong time! I previously had tried to start the process under my Insurance from work, but the company I worked for had a clause that did not cover bariatric surgery. I then attempted to do self pay but that all didn't work out so as you can imagine I felt pretty defeated for a couple of years. However, I am finally able to start going through the process due to the fact that I recently got married and my husbands insurance covers Lap Band!!!Yay!!! So here it goes I have a question. (I checked to see if I could find an answer but for some reason I haven't seen any mention on what I'm abou…

I paid for my surgery in full before having it. Facility 10,400. Surgeon 3,500. Well I have been receiving bills in the mail. One for pathology that was not included. Well then I receive one for $600 from hospital. Then one for 5,000 for anesthesia(included). Well I contact the hospital and they tell me I got a zero balance with them and they are going to contact the anesthesia place because that was included. So I am waiting for that. Well I just checked my mail and opened a bill for 59,000. WTF I am freaking out. Has this happened to anyone. It shows my 10,400 paid. It doesn't even have services just inpatient. I did not have any complications and only spe…

I have Highmark BS in Pennsylvania and was wondering if anyone could share their approval experience. I am currently around a 41 BMI. I am in month 5 of my visits and basically I have gone up and down by 1/2 lb. each month. Right now I am about 1/2 lb. down from my original weight. I have an extremely difficult time losing weight, which is why I haven chosen to go down this path. I am terrified that I will be denie

Called my insurance ( after reading a BUNCH of forums on here ) and of course she read the manual to me like a zombie. I was told I had to complete a 12 month nutrional program . I have read in these forums that is not the case. All I have to do is go to my PCP, get a referral, medical clearance, psych eval, blood work, see a nutritionist, meet my dr/surgeon, process my claim and schedule a surgery date. What was your experience ? Also, she told me all surgeons are south jersey ( I'm central) any advice, tips, anything is helpful ! Thank you !

Has anyone gotten the sleeve through this insurance RECENTLY? Over the phone, I was told a 12 month nutritional program but I've searched a million forums on here, and no one was required to do that ! Also, I haven't been insured for 7+ years, so no other doctors have my weight history /: TYIA !

While I wait to hear back from my surgeons office... How is using an out of network surgery center with an in network doctor dramatically less than in network for both? I have UHC.

Just got off the phone with my insurance and found out I was approved!!! I called to check. It was submitted on the 5th and approval letter went out on the 7th!! So excited!!!

Looking for a reasonable US self pay option that specifically caters to out-of-towners (am also researching the Mexico option). Thanks!

Any one have Kentucky blue cross and blue shield Medicaid plan? I have several questions and need help! Please and thank you!!

I just got a letter in the mail that states i have to pay $1,602.26 for my appointment aug 12. I am wondering how much others paid and if there is a way to reduce this. T