Insurance & Financing

Today was the big day for me! My bariatric patient advocate submitted all my documents to my insurance company. She said it should take 2 weeks to hear back. Fingers crossed I get approved!!!!

Oh, this is a rant. I should be so thankful, but in the moment it was unexpected and terrifying. Looking back on it now... No big deal. Approved and ready to go!

I weigh 10 more pds in my last visit then I did on my first visit. Will my insurance still approve it?

Wondering if anyone else has had problems with them like I have getting my disability approved. I was approved 1st 2 weeks but it's taking an act of Congress to get the next 2 weeks approved.

. Did anyone have Medicaid and not have to pay anything out of pocket? I am in NJ and i found a Dr. The office said they work with all insurances.Which is good news and bad news for me. Now I seen this Dr 9 yrs ago for bypass i never went through with it because they wanted $2,000 upfront because other Dr didn't take medicaid. I really need this so I can be here for my son he will be 1 in July. I can't afford to pay out of pocket. Did this happen to anyone? Was there away around it? Did they just accept whatever your insurance paid? I am just praying everyday I am not denied for any reason I am 27 and do not want a knee replacement this year on in life.. i can barely walk…

I've been searching this forum for medical financing sites. I have insurance, but might need a little help with my co pay for out patient surgery and with my deductible. Any suggestions would really be appreciated. Thanks.

Anyone have the Medicaid, United healthcare community plan in New Jersey? Just wondering if they cover the sleeve surgery! Also and did you have to do a supervised diet?

Hello new to the site. And have many questions. I finished my last 6 month appointment Friday June 5, 2015 my paper work was submitted Monday June 8, 2015. 32y 5'3 @ 247lbs I'm wondering if anyone who has Cigna TN could tell me how long it took them to get an approval back and how long did it take to get a date after meeting with surgeon? (I can't have appointment with him until after approval.) what are some of the thing you have to do after meet with the surgeon before surgary Also if you have Amarichoice (tenncare) as a secondary did they approve?

I started this process on Aug of last year calling my insurance and emailing to see if Bariatric surgery was covered. We even re-checked after Jan 1st to make sure coverage had not changed. They said it was if certain condition ect.. I did their 6 month structured diet etc... My surgeon verified my coverage, I have it in writing from them. I just finished all my testing and requirements and I could visualize getting a date. Now when I went to find out why they denied my paying on my psych visit they say morbid obesity is an exclusion entirely ! Nothing is covered. They are really sorry that no one figured it out until now. They will pay for all the bills up to now for th…

I was so excited last night when I was able to attend my Weight Loss Surgery seminar. I loved the staff I was able to meet from the practice and I found out that with a BMI over 50 that BCBS waives the 6 month mandatory supervised dieting. Both were great pieces of information. Today I called my insurance company to begin asking several questions from the surgeon's office that I needed to have done by the time of my 1st appointment. The end result was finding out that I don't have a $6600 individual out of pocket maximum to pay, but instead I have a $13,200 out of pocket expense maximum I could potentially face because I have a family plan through my employer. I have a …

I have Insurance that is covering my surgery on June 23 and my husband would like to have gastric sleeve done also. He has state employee insurance which doesn't cover lots of things including this surgery. Has anyone moved their spouse to their employers insurance in order to get them approved too, of course I will do during our open enrollment coming up? If so did you have any problems and how long did you keep them on your insurance. He has to move back on his at some point to be eligible for his employer retirement health insurance

I have Cigna. They require 3 months nutrition visits and psych evaluation. I plan to do those things anyway as I think they are important for success. Have already had Upper GI (discovered sliding hiatal hernia) and had Stress EKG today. My dr requires sleep study. She says 80% - 90% of her patients have sleep apnea and she is not comfortable doing surgery unless we are either told we don't have sleep apnea or treat the apnea with CPAP. My sleep study had been scheduled for tonight; however, insurance won't approve the sleep study. They said the clinic records did not show sufficient excessive daytime sleepiness that might indicate sleep apnea. I am sure dr. is go…

I am currently in the 6 month process of physician led weight loss program, when I went to my weight loss seminar I was told by my doctor that if I lost more than 30 pounds that I could possibly be denied by my insurance. My ob/gyn is doing my weight loss management and she prescribed me phentermine and Glucophage. I know that I can lose weight taking these medications I have in the past but as always I pack the pounds back on and then some. I am scared that if I lose more than 30 pounds that insurance will deny me and I will be back at square one. I was wondering if anyone else with BCBS AL has had this issue and could share your own experience with this. I have PCOS so …

I've been working on my prerequisites for my Sleeve for almost a year and have been fighting to get it authorized for the past 3 months. I thought I fulfilled all my requirements but after 2 1/2 weeks of waiting for my insurance company to approve/deny they called me this morning. They cannot approve without medical records from my PCP for a 6 month period showing at least 3 visits with weights where I haven't gained - not even a single pound! But... the 6 month Dr supervised diet period does not count! I don't go to my PCP that often. I try not to. I thought that's what they wanted you to do! I've already submitted records from 2012-2013 like requested. I'm livid and fre…

I have 3 months of my 6 months requirement down but now my insurance is changing. What will happen?

I just found that my insurance paid for my nutritional consult. Is this a good sign that I have a good chance of being approved for surgery?

I have completed my 6 months of supervised diet and exercise this month. I had a sleep study early April and was just informed the results show I have mild sleep apnea--not enough to typically qualify for CPAP, but hopefully enough that my insurance considers it a comorbidity! My insurance requires a BMI of 40+ without comorbidities and 35+ with. I am sitting at 39.9, and have no comorbidities (before these results). My insurance lists sleep apnea as one of the qualifying comorbidities. I am hoping to submit to insurance within the next week and that this will help me get approved quickly!!!

My surgeons office will be submitting pre auth to my insurance anthem blue cross of California PPO tomorrow with a bmi of 36 sleep apnea and high cholesterol. I really hope I get approved

I was approved with UHC, received letter (copy of what was sent to doctors office) stating approval for band removal and gastric sleeve to be performed- great news!!! The second half of the letter states that if patient has maxed visits or dollar the patient would be responsible for balance unless stated other wise with plan. I am almost to my out of pocket max for the year so was curios if anyone else has had this letter or is it really just a form letter covering all patients? Will be calling Monday to confirm.

I am just starting the process of attempting to have the Sleeve surgery approved. I have United HC which requires " Documentation of a motivated attempt of weight loss through a structured diet program, prior to bariatric surgery, which includes physician or other health care provider notes and/or diet or weight loss logs from a structured weight loss program for a minimum of 6 months." I have been seeing an Endocrinology for 3 years for low testosterone and weight related pituitary issues. Every 3 month I go into the office for blood work, vitals, and weight loss discussions. Has anyone used their Endocrinologist for the documented weight loss program? It seems…

I am seriously not a patient person. I want my answer yesterday, ya' hear me?? I have BCBS Federal, and I've been reading that they are pretty quick about their decisions. Soooooo, I have been doing what I do best, and calling these poor people everyday since I completed my required visits on Monday (5/18). Tuesday (5/19), BCBS still hadn't received my package from the surgeon's office, so you guessed it, I emailed my patient advocate there. I know I'm super annoying to these people, but my surgeon is going outta town the second weekend of June and not coming back till the end of June, and I want to do this BEFORE he goes. I am crawling outta my skin waiting. I cal…

How long did it take to get approved by this insurance? Im from NY and Also have MEDICAID.

I am currently with Amerigroup/Medicaid i was suppose to get sleeved July 2nd, but i found out a week before surgery that the Doctor does not accept my insurance, smh. They told me there was a mix-up in the paper work. Mind you, I've been going to him for month and discussed everything from thick to thin concerning the whole entire surgery process pre and post. Now i'm stuck looking for a Doctor who accepts my insurance in the NYC area. If you of any doctors that accept it please feel free to help me out.

Need help - Looking for Lap Band Procedure in Northeast that is affordable. Does anyone have a recommendation for overall procedure under 12K? Thenewlisa

Last year at this time I posted this Blog about why June is such an important month for patients seeking surgery. http://bit.ly/1SUlolN I thought it was worth bringing to folks' attention. Here's a snippet: "By waiting you are RISKING that you might be one of the unfortunate ones whose failure to plan well in June caused them terrible Gloom at the end of the year, even though they thought – and their bariatric program thought – jumping the silly hoops and playing by the insurance plan’s rules was the right thing to do. So if your bariatric program is talking about having you wait and jump through more hoops show them this post and get them to re-think that plan. It …

I have Meritain insurance in AZ and am in month 5 of a 6 month supervised diet. My BMI was just over 40 (41.1) at the beginning of my weight loss, but now I'm at 39. I'm freaking out that if my BMI isn't about 40 they won't approve me. Although my surgeon doesn't require a sleep study, I requested one through my PCP due to my chronic snoring, because if I have sleep apnea my BMI only has to be 35 or above. My weight has fluctuated throughout the 6 months of supervised weight loss and last month I was up 5 lbs from the month before due to stopping phentermine, but still down 6 overall. To be honest I haven't been rigorous with my weight loss and exercise efforts because th…

30 y.o., 5'8", 230-240 (fluctuating weight) Weight and Weight-Loss Attempt History: Been overweight since I was 19. Went up to the 220s-230s for years. Pre-diabetic and fed up .. was able to get down to 180, but that was with an unsustainable schedule for myself: 1.5 hours workout in the morning followed by a 2 hour workout in the evening. Plus a calorie restriction. I was constantly exhausted, unsatisfied, and unhappy. Since, the weight has come back and I'm back to the 220s-240 range. I've tried yoga. I've had therapy. I've had trainers. I have had online trainers and nutritionists. I have had logs and trackers. I have been trained in mindful eating. I went to a stay …

I have two questions. One for those of you who have at surgery, after insurance what was your total out of pocket. Just trying to get an Idea on how much I will have to pay out of pocket after insurance pays? Second... What is Anthems requirements and are they hard to get approved?

I have scheduled to attend a weight loss seminar at a local hospital on May 18, 2015. Is this the first step to beginning the road to WLS? Should I have met with my primary physician before I do this? I currently have BCBS of Michigan through my small (less than 50 employees) employer. They will only cover 50% of the surgery as far as I know. When I called BSBS they didn't have anymore details than that to give me. My BMI is approximately 53. Anyone have any advise, suggestions, experiences to share, etc? I am just looking to figure out what to expect next, what kind of timeline I might be on before surgery were performed, etc. Perhaps someone here has some info. t…

I was hoping to know how the process was for gastric bypass. I called bcbsnc and the lady wasn't very helpful in answering the requirements I have to meet to get my surgery approved. I know I have to have a bmi of over 40 since I don't have for now any other problems. what I am not sure is do I need proof of last 2 years weight with my physician or meet with a dietician. All info will be greatly appreciated.

Hello Im hoping someone can answer some questions from me. I have upmc for you insurance. I am 275 lbs right now, my bmi is 42, I have no other health problems other than being overweight. Question is if I go under 40 bmi withen 6 months program am I then not able to get surgery? I am in PA and going through hope Bariatrics program, my pre surgical class is June 8th

Submitted to insurance 5/5 after 6 months supervised weight loss, sleep study, psych eval...aka the multitude of hoops insurance requires. Initially I was told approval should only take a few days, then 10-14 business days, and now most recently I was informed it takes 30-45 business days?!! What??! Every time I call my insurance company (Meritain Health--a division of Aetna) I get a different timeline, yet they all agree that it hasn't been approved yet. Anyone else have this experience. I'm so frustrated! I've been calling every few days, but it doesn't seem to be lighting a fire under anyone's butt to expedite this whole process.

Has anyone gone through Tufts health insurance for the by pass? I am told I might have problems get approval to go from the band to the RNY beause my BMI is on the borderline although I do have comorbidities.

For anyone who used Priority Health: how long did your approval take? I still have 2 months before my authorization request will be submitted, but one of the people in my surgeon's office said that Priority can take a little longer than some of the other insurances. Thanks for any input you may have!

Hello fellow bariatric surgery patients! I own a company that assists patients in appealing for denied surgical procedures and medications under health insurance benefits. Currently my company is competing in a competition sponsored by Chase bank. We are hoping to gain enough votes to move forward in hiring more nurses to expand more services to patients in all areas. If you could click on the link below or vote for Benefit Defender on the Chase Mission Main Street Grant website, I would appreciate the votes. If you have questions involving insurance denials you could message me here as well and I can attempt to provide you some insight that might be helpful in gaining he…

I have Aetna and called today and my level one appeal has been denied. I did the 3 month program and gained 9 pounds during the process and was initially denied because of that. I did and extra 3 months and lost 16 pounds and was down 3 pounds from my initial weight and I called them today and they have decided to uphold their initial denial. I am going to hire Lindstrom to do the second level appeal if I get denied again I will do the external review. If the external review is denied I'm planning on going to Mexico. I'm so upset I just want to cry but I won't give up.

I'm starting the process for surgery. I have United healthcare choice plus for railroad employees (BNSF to be specific). I'm wondering if anyone else has the same insurance and has been through the process. I've read so many different posts I'm not sure what to expect when I go for my consult. Some places I have read you need a 6 month doctor monitored weight loss and others have said you don’t need that. Just looking for some advice if anyone knows more about my type of insurance and bariatric surgery. Thanks!

I've been waiting a whole month now for approval. My doctors office will not return my call about the status of my surgery. I've tried calling about 12 times and have left messages each time. Should I call my insurance company? Should I speak to an office manager? It's really frustrating that they won't even return my phone call. I am so discouraged right now.

Paperwork submitted to UHC today. Doctors office told me they have 45 days to make a decision. Fingers crossed....

I have Cigna in TX and I went for my initial tests at the hospital outpatient pavilion.(Just getting started) and I was told that Cigna didn't cover any tests for obesity. Not even an A1C test. What? Anyone encounter this? Could someone have possibly coded something wrong? I need 3 blood tests and 2 chest xrays and an ekg. Blood alone is gonna cost almost $1000 if I have to pay myself. They charge a $200 facility fee too. Do you think my PCP could do the tests? He has a lab tech and xray equipment in office. I had to do an ekg and chest xrays 8 months ago when he discovered I was anemic. Or do I have to go to the other place? So bummed. My first dietician appt is …

Hello all, Has anyone been denied skin surgery by insurance, appealed and won? I have bcbsil, recently submitted to and denied panniculectomy. The doctor wants to appeal, what can I do?

Hello to all....I am in the process of the pre-approval 3 month appointments with BCBS Federal. I am using Bluepoint Surgery Group in Northern VA. Can anyone share your experience and tell me if there are any pointers in receiving approval? Were you turned down? Why and what did you do? Thanks so much!

I put in approval for both panni+abdominoplasty and a brachioplasty at the same time. The TT was approved and done, but the Brachioplasty was denied. They did the peer to peer review and I don't think anything came of it. I think at this point I have to write an appeal letter. Do you all have any recommendations or tips for getting appeals approved?

Hi all, I currently have a BMI of 41 and I'm 5'4" and no comorbidities. I have BCBS of IL and all my paper work was submitted yesterday. Now it's a matter of waiting but now I'm freaking out, what if they don't approve. Does anyone else have this insurance and has anyone had any issues with the approval?

Got off the phone today with a representative from United Health Care and apparently I have to have 6 months of supervised weight loss with a Doctor, Nutritionist or Registered Dietitian. While I am grateful for having insurance I am a little bummed out about having to wait 6 MORE months. I've been considering Lap Band for 5 years and now that I finally made a decision waiting 6 more months just seems like torture. Judging by the posts in this forum this is not that uncommon...I'm just feeling antsy and frustrated. First of all I have no record of the multiple attempts to lose weight since I was 12 years old! Second, My BMI is 41....So if I do lose weight in these 6 m…

I have Blue Cross as primary ins and Medicaid as secondary ins. I called Blue Cross yesterday and they only cover my surgery at 50%. Does anyone know if medicaid will pick up the remaining balance? Or how that works.....

I've been talking to a few providers and some of them offer partial inhouse financing for the operation with no credit check that brings the cost down to $3200 or so. Has anyone had any experience or success with this?

I wrote to my health plan to ask what the specific requirements were for bariatric surgery. This is the response I got. Hello Thank you for your email inquiry. Coverage for Bariatric Surgery for members age 18 and older is provided when authorized in advance by the Tufts Health Plan Pre-Certification Department. Coverage is for medically necessary surgery to treat morbid obesity when the member meets the Medical Necessity Guidelines submitted by the member's primary care physician or bariatric surgeon. Coverage is subject to the in-network deductible and any applicable co-insurance. I am PUMPED!!!! I know that I meet the medical necessity guidelines. I know the …

I had it and got approved with no problems. No monthly visits to PCP's or anything. Just wondering anyone else's experience.

I have been trying since last June to see a surgeon for bariatric surgery. Global health has continued to deny my request to meet the surgeon and all together denied the surgery request by my Primary Care DR. My primary care doc and his nurse were very helpful to get all paperwork sent in to Global Health with the request. I also had their requirements met with another support letter from my Endocrinologist. So now I am moving forward as a self pay patient. My appeal was even denied. I am starting to believe that Global Health states that they will pay for bariatric surgery just to get new members to sign up. Has anyone else had any luck with Global Health?? I wou…