Insurance & Financing

I have my last dietician visit next month and just wondering how long it takes once submitted to get an answer... Is there anything I can do to speed up the process? Call ahead of time?

Hi fellow sleeve patients I was wondering if anyone has Humana gold and called early to try and get approval for surgery. ? I am very anxious to do so but don't wanna jinx myself with the Drs office. I only have my nutrition and fitness class to go along w the endoscopy procedure then I can schedule surgery I believe. Any thoughts or recommendations would be greatly appreciated. Also If anyone knows the billing codes I need Thanks Will

Although I do not live in South Carolina, my husbands employer goes through them for insurance for his employees. I can't find anywhere that says bcbs of sc covers gastric sleeve. I know they will cover the band and gastric bypass because those two procedures are listed on their website when I log in. Now I'm worried sick. I don't want the lap band or gastric bypass. Does anyone here have bcbs of sc that can tell me whether or not they will cover the gastric sleeve?

I was denied today with BMI of 37.7 and was told my comorbidities were not extreme enough to approve surgery. The doctors office said the next thing to do was appeal the decision. Any advice on what or how to do this? Anyone ever get approval after appeal process?

I'm so depressed! Don't I deserve a 2nd chance? The removal of my band was approved but the bypass denied. So if I have the band removed, I'll gain a bunch of weight and then where will I be? I've already gained 11 pounds just since all of the Fluid was removed from the band. I am beside myself. I don't have the kind of money to self-pay. Should I fight this? I'm told I need 6 month weight loss documentation -- but the only thing I have are invoices from Nutrisystem where I tried them for 2 months approximately 6 months ago. Will that qualify? I just don't know what to do. Any advice?

I finished all the requirements to have my surgery submitted for approval yesterday! Yay! My question is purely for my entertainment unless someone else has the exact insurance as I do. (NC BCBS) How long did you have to wait for approval once it went to insurance?

I am still trying to find a high count Protein shake, Meal Replacement that I might like. I'm not a milk person and not fond of chocolate. I have two in mind Syntrax nectar and Bariatric fusion. Both have fruit flavors. I typically order from Amazon, but there is a sigh doctorsbestweightloss that seems good too. I'd love to get feedback. I've read horror stories of people losing haird etc. I have thick, thick hair, but I don't want to begin to lose it. Can we take chewable Vitamins? Or should we take liquid? Finally, I just phoned my case manager on insurance and asked about insurance coverage since this was what I need to have and she said she had never hear…

I have good insurance but there's a specific exclusion for weight-loss surgery. I've read about people having a hernia repair covered by insurance and paying the difference out-of-pocket to have weight-loss surgery done at the same time making the out-of-pocket costs significantly lower. *no it's not insurance fraud since there is a legitimate medical procedure that insurance is approving surgery for My question is how do I go about finding a doctor that's willing to do that? How do I get a doctor to even test for a hernia in the first place? Just call and ask?? I'm in Colorado and have only seen mention of this practice in Texas.

Anyone use Medicare for Gastric Sleeve? Did they pay for it? What was the process for getting it approved?

I am in Florida and have Coventry Summit Health Insurance. It is a Medicare Advantage Plan. I have researched and can't find any info on this insurance about WLS. My Dr's office has told me I need to do the 6 months supervised diet and a lot of the other tests and they will handle all the paper work for me. I am wondering what my Co-Pays would be as they haven't told me. Does anyone have this insurance and had the sleeve? What were your Co-Pays? Being on disability it is going to be difficult for me to save money but I need this surgery in order to regain my life and walk again.

Has anyone taken out secondary insurance when your own health plan won't cover the sleeve? If so, which one?

I work for the State of Washington. I have Uniform Medical through Regence. I will post my entire story in the other thread. I began my 6 month in October 2014, was referred to Weight Loss Center in March 2015. Meeting with surgeon, then dietician, exercise coach, surgeon again. Then my psych eval, and I received the letter of approval in July 2015. Not too bad. Does anyone have any experience with Molina Healthcare? My daughter has Molina and would like to get surgery too.

Hey guys, I keep getting conflicting answers on who I am supposed to be seeing for my "medically supervised weight loss program." My insurance is Federal BCBS, and they require 3 months of the supervised visits. Some people are saying I should be seeing a nutritionist for these appointments, while others are saying I should be seeing my PCP. I know I need a nutrition consult, as well as psych consult in addition to those. Can someone, anyone, please shed some light on this for me? I have called BCBS to clarify twice now, and it seems as if they are just reading from the handbook, and not giving me any clear answers. Thank you!

I'm considering self-pay since my insurance has an exclusion on W LS . My main concern is postop complications and how/if they 'd be covered by insurance. I know that every plan differs, but what's the best way to find out if I'd be 100% on my own if there are complications or if my plan might cover say an ER visit for dehydration, antibiotics for an infection or surgery that becomes life-saving? Is there any tripe of supplemental insurance that I could purchase that might cover complications ? I'd love to hear any stories or information that anyone might have.

Okay this seems like a no-brainer, why not bill insurance for the hernia repair and charge the patient the difference in the cash price for the sleeve or other bariatric procedure. There is a place in Texas called Kim bariatric that will do this, but I am out of network. I have called several bariatric centers and they had no idea what to even think about what I was asking. Does anyone have any insight on this topic?

Ok in trying to find a way to help my sister get sleeved. She is a widow who has survived raising 3 beautiful girls and has always put them before her. Now that their older some with families of their own she has the Medi Cal Blue Cross through Obama Care. I read where they do cover the surgery but it needs to be medically necessary.....yadayada Has anyone else ever used Medi Cal coverage for this procedure in the fresno kings county area?

I didn't think I'd get approves so fast. I am bmi 40 and have no health issues. Just thought it wld be harder than this lol. After a half week of binge eating out of nervousness for the surgery (oddly enough didn't gain scale weight but I can tell my tummy grew some. I stopped weight training a few weeks ago cuz my schedule doesn't fit it in well anymore and I think I lost muscle at the same weight ratio as fat gain) Anyhow, finally calmed down with the stress eating (been a year since I did that! Was feeling like I'd never eat again lol) and I think I was pms eating too. I am all good now. Feeling much better about the surgery and less scared. I'm doing my pre op die…

So I have been reading on here a lot lately and read that with my insurance, if you have a BMI of 50 or more that they would waive the 6 month doctor supervised visits. My current BMI is 49.3! Not that I want to weigh anymore than I already do but is there a chance they will go ahead and waive it, or do the insurance companies stick to exactly 50 or more? I have Blue Cross Blue Shield of Michigan by the way. Thank you!

I have everything ready for the surgeon's office to submit to BCBS of IL. I am under a time crunch, because I am a teacher and really want to get this done this summer while I'm off. I am panicking thinking the paperwork is going to sit at the surgeon's office for awhile before they send it. And then they said it could be up to a month for the insurance to get back to them. So my questions are: 1. Anyone have BCBS of IL and how long did it take to get final approval and 2. Who can I call at the insurance company to check on the status and make sure the papers are there? Thanks in advance for any help!

Anyone been thru the NV Medicaid process for the sleeve? Any info would be appreciated.

Hi guys, Is anyone having issues with your doctor/insurance? I know there's a forum out there for this kind of stuff, but I'm an August Bypasser and I'm getting nervous since it's so close! My doctor scheduled me at an OUT OF NETWORK hospital. WHY? They gave me some story about "better pricing". If I go to an "in network" hospital, I will have more out of pocket. Why do I feel like my doctor has some kind of vested interest in the OONetwork hospital? My doctor also is requiring that I use a new pain pump called "On Q". That is an additional $250.00! I asked if I could just use the old fashion method of pushing the button for more pain meds and they said n…

I am sorry for the first topic. It needs editing. This is my first time and I do not know how to edit. MY question is does anyone have this insurance? If so,was it hard for approval? ?

tiGreetinDoes anyone have Health First Silver Leaf in New York. If so, have you been approved for the Gastric sleeve?

I am getting an endoscopy done next month to see what is wrong with my sleeve which will most likely need a revision. My current health insurance has no bariatric coverage. Is there any insurance that I could self pay for my revision? My other option is cash pay for this surgery. Thank you.

Hi, all! I have Federal BCBS insurance. My requirements for the sleeve are 3 months of supervised visits. I started my journey last year with the same insurance, so October 2014, and November 2014 are 2 of my supervised visits. I moved out of state to start another federal job, and my insurance didn't kick back in until now. Will my 2 other visits still count? I'd like to pick right back up where I left off, but I wasn't sure if I had to start my supervised visits over. Any advice is appreciated!

Hi everyone, I am being sleeved in about 4 weeks, and I am self-pay. I know complications aren't common with a sleeve, but still…if there are complications, they could very likely get extremely expensive. Does anyone know if there is any type of insurance package you can buy just in the unlikely event of complications? I have an e-mail in to my surgeon's office but am always looking for first-hand experiences if anyone knows of something. Thanks.

So my abdominoplasty and panniculectomy was approved and covered by my Highmark BCBS insurance, but they denied my brachioplasty (arm lift). I've got tons of medical notes documenting PCP doctor's visits, medications tried for the breakdown and irritation of skin, limitation of movement, my PCP wrote a very convincing letter about why this was a medical necessity and I submitted my surgeon's pictures. I was pretty certain the appeal would be approved. But it wasn't. I was pretty upset. So I'm gearing up to do what the denial letter suggested, and that is to take it to a third level appeal, which would be an outside party evaluating the request. Has anyone had ANY …

I met with my surgeon today! Apparently since southern surgical is a bariatrics of distinction facility, they don't have to send my info. to insurance for approval or denial - I'm just automatically approved after they have all my tests and info. I wish they would have told me this before all the worry about getting denied lol. My surgery is set for November 12! I'm a teacher, so I will have the 12th off for veterans day, and a few days for thanksgiving, and the weekends to recover. That will give me 16 days. I hope this is enough time to recover. If I need more, I have extra sick days I can take. I just don't want to leave my students with a substitute for any longer tha…

Hello All! I signed up for the mandatory, yet free class through Southern Surgical in Greenville, NC to go through the process to get the VSG. What I am wondering is if anyone has been in my situation BMI and insurance wise, and if you can tell me what to expect of this process? I have a few comorbidities, but it wasn't enough to be prescribed medication for it (minus BC for severely missing periods). I have PCOS, pre-diabetic with an A1C of 5.7 in January. There is a family history on my mother's side of strokes and heart failure. Thank you for your time!

Hey everyone! I was approved for surgery and am shocked at how fast their decision was. Paper work turned in on a Friday and approval on Tuesday. I was expecting it take at least a couple of weeks. I have my surgery date on July 28th. I'm so happy!

I'm researching insurance policies and trying to decide on which one I should choose when the open enrollment period begins. I'm not very knowledgable about insurance and am feeling a bit overwhelmed wading through everything. I currently have Blue Shield and am very dissatisfied with their service in all regards. I'd be so appreciative of any advice anyone might have for me. Edit to Add - Never mind, the issue has been resolved.

Received my call today saying Cigna (great west) denied. I finished the 3 month weigh-ins and all my drs appointments. The coordinator told me they denied bc cigna requires 3 months that total 89 days and they sent my papers in too early. So now I have to go back in for another weigh in and they will send a second time. Anyone else have this happen? Should I be worried that they have to submit it again?? Thanks!

Hi. Dr.Dominguez in Covington La is the only physician I found thats currently accepting medicaid (Bayou Health). Please post any other La physicians you may know of. Thanks

Any RNYs that have BCBS Federal in Florida and used Dr. Jeffrey Lord at Sacred Heart in Pensacola? Just had a few ins questions. Thanks

I'm with BCBS of MA, PPO Elite plan, and it's been great. My total turn around for the approval/prep/surgery is a total of 45 days or so. I was approved 1 day after submission of the application. Very happy it's been this easy and quick. Of course I have all of the qualifiers (pre-hypertension, diabetes type II (borderline) and sleep apnea. So, going in for surgery this coming Wednesday! Can't wait!

I've been doing my research on vsg and even have my first surgeon apt next week. I just called my insurance to have them send a packet with official requirements (Anthem BCBS so I knew it was 6mo observed etc). Online my interactive insurance plan estimates the cost for various hospitals including what my out of pocket would be. When I called I was told online was mistaken and my employer's, plan does not Include ANY WLS. I'm devastated. I spoke with my vp (I'm in HR) and made a valid argument for getting WLS included for 2016 plan and he was on board with it. But at the end of the day it's about cost for the company, so I'm not holding my breathe that anything will c…

Hi! My name is Brittany and my husband Michael and I are doing the sleeve surgery together. We live up here in California, right along the border of Cali and Oregon. We've been going to Southern Oregon Bariatric center since we decided to do this surgery last November. Our first appointment was 3 days before Christmas on December 22nd and that got everything put into motion. Our insurance is going to pay 90/10. Today we went in for my husband to meet the surgeon as his surgery was looking like it was going to be early next month. BOY WERE WE WRONG. Upon preauthorized approval, we were told that Anthem no longer works with that specific center in Oregon and we can …

Okay I just got a $25k+ bill from my hospital today! WHAT???? I expected some copays but never this!!! The note at the bottom said "Your insurance has informed us that you have met your benefit max for this service and therefore has denied payment...etc." Original bill was over $41k surgery was January - I called in December SPECIFICALLY asking if this surgery was covered (January starts the new plan year, we kept the same insurance company but I just wanted to know if anything changed or if this was not covered) at no time was I told there was a maximum benefit amount. I would have certainly talked to my doctors office ahead of time if there was! I didn't even…

After reading quite a few topics here I realized that my sleeve is being handled a bit differently. First and foremost, a bit of background. I'm 48, 5'4 with a BMI of 35.3. I'm covered by Cigna. 10 weeks ago was my initial visit with Dr.Sadek, Director of Bariatric surgery at Robert Wood Johnson. It was my orientation. I walked out with a surgery date (7/31) and a list of the doctors that I need clearance for the procedure; a letter of medical necessity from my PCP, along with five years of weight management records, a clearance from a pulmonary dr, gastroenterology clearance, cardiologist ok, & of course a clearance from a nutritionist. Being on a smaller …

Seriously need help, so close to making this happen and being a better husband and father. Please read and help this 475 pound man find himself again!http://www.gofundme.com/y7yyta7y

After much research I emailed a bariatric surgeon I am interested in having do the sleeve procedure. He called me and we had a nice conversation, he told me a lot about himself which I already researched. Said I sound like a good candidate, Healthwise and all. So I said, you work with Federal Blue Cross blue shied. He said yes, but you should consider self pay. Now I'm pretty sure I meet all the requirements BMI 40 (occasional can drop to 39), have documented numerous doctor supervised weight loss programs on/off over the past five years,(two doctor supervised the past two years alone) as well as documented weight watchers, jenny craig, and others. I believ…

I have gained so much knowledge from this forum. My only remaining questions deal with insurance and financing. I have BCBS of Texas. We emailed them regarding a possible surgery for me and received a letter that said: For a member to be considered eligible for benefit coverage of bariatric surgery to treat morbid obesity, the member must meet the following two criteria: BMI equal or grade to 40 kg/meter OR BMI equal or greater than 35 with at last 2 comorbidities (listed below). AND Documentation from the requesting surgical program that *Growth is completed * Documentation from the surgeon attesting that the patient has been educated in and understands th…

How strict are they about the two year weight history? I don't have one and I am afraid that I will be denied.

I have my first appt with surgeon on Thurs. I have local government BCBS. They said our policy doesn't require the 2 years of weights or 6 month proof of attempted weight loss, but it only covers Surgical asst fee and anesthesia fee at 50%, so was just curious as to what my out of pocket cost would be.

Has anyone got WLS through Wellcare? If so can you share some details. I know I'll qualify, as my BMI is above 70 and Im under 40yo. What surgeon/hospital did you or going to use? I appreciate any insight.

I'm new here and just beginning to look into have the procedure. Just had my physical and Dr. suggested and gave me a Bariatric Dr. referral. I have no idea if my insurance will cover this. I was interested to see if others have the same insurance and were covered. Been trying to read as much as possible about the procedure and the wait time. Is it possible for a shorter wait period before approval?

I decided in May 2014 that this was what I needed to be a healthier person and to have have children (I have other underlying health problems that made me high risk, therefore was told I needed to lose weight). I made my appointment and went to the informational class. I was so excited and new to it all. I look back and think how silly I was to think this would be easy. At my appointment I was told my insurance (state of VA) would require a 12 month program but that the Dr would appeal and I could have other doctors appeal. I thought oh I got this. Nope denied. On with the 12 months. So starting in May (thankfully) I started getting the phone calls to start my program. No…

So my Surgeon's office submitted all "complete" documentation for VSG, only to get it kicked back from Cigna stating they need CPT codes, a surgeons letter and also a formal nutritional evaluation. So surgical coordinator submitted a "reconsideration" with all additional info. Then it got kicked back again because they wanted an in depth nutritional evaluation from an registered dietition. I completed that last week and surgeons office re-submitted. Now Cigna is saying they will not accept any more reconsiderations (I guess 1 is the limit) and now there is a peer to peer review scheduled for tomorrow afternoon. My surgery is scheduled for 6 days away!! It's bee…

The surgical coordinator at the WLS center told me last week Friday that she received a message from BCBS. She said once we get the denial notice we'll forge ahead with an appeal. But I'm totally disappointed and confused. And I've received no notice of denial to date. I've done everything per the guidelines for approval that Fed BCBS outlines. The surgical coordinator said the BCBS rep mentioned it had something to do with my 3 mos requirement in a medically supervised program but I turned in all the paperwork that shows I did one for four months within the last two years (which is what Fed BCBS says is a prerequisite). Has anyone else had this issue and how was a it res…

Finished all of my requirements and the surgeon's office submitted my request for approval to insurance yesterday! I hate this part. With no tasks to complete, no one monitoring me and no certainty about if this surgery will happen or not I feel a little lost. Any thoughts on this waiting game are appreciated. Anything that kept you motiviated? I would love to hear about how long it took to get a response from insurance. Jenn