Insurance & Financing

Does anyone know if State MD Medicaid covers this procedure? MCO is Amerigroup!

Do all doctors charge a fee above what the insurance company pays? The doctor that I am having so much problem with charges 1500.00 above what insurance pays. Any info would be appreciated.

I have appealed my insurance 3 times and have been denied all 3. My Doc. has done a peer to peer and now it is in the hands of a 3rd party. My question is...If I go ahead with the surgery and self pay and in the end insurance ends up coming through for me. Do I just get reimbursed? Not sure how that works.

So my appeal was submitted and we are waiting to hear back. They have 30 days to respond and we're on day 20-25. I was wondering if anyone has been through an appeal had to wait that long and still get a yes or is this a bad sign that they are dragging it out? Any personal experience shares would be appreciated!

I am in a contest to win free gastric sleeve but i am loosing. bad. If I loose I will probably do self pay as it is excluded from my insurance. My hubby is against Mexico; I on the other hand wouldn't mind. Where have you guys found the cheapest place to get the sleeve done? Thanks in advance If you wamt to vote for me on facebook the link is: https://apps.facebook.com/575480265829438 takes about three clicks

This may be a dumb question, but if you opt to pay for your surgery yourself, do most places require you to pay the entire amount up front before they'll perform the surgery? I have Anthem BCBS, they give me a hard time approving my birth control (ridiculous) so I feel like they are going to reject me for this surgery no matter how many hoops I jump through. I'm trying to figure out plan B just in case. Any advice is greatly appreciated!

Good morning everyone, I have just begun looking into the whole insurance bit and went to the initial orientation. However, my BMI is currently right at 40 and they made it very at the orientation that patients below 40 must have a pre-exciting condition to qualify. What happens if I lose weight and did below 40 during the 6 months of food logging and weight management that required by the insurance? Has any one been denied for this reason?

I'm just following up with my experiences so far with Georgetown Bariatrics Dr. Weiss, VSG and Kentucky Passport for anyone interested. I went for the all day appointments 8am-4pm with the psych evaluation, dietician, general physical exam and insurance coordinator. It was a long day but I still prefer this to making several trips and several different appointments, it was a pretty well oiled machine, it was a group visit of myself and about 5 other women, lunch was ordered for us if we wanted $6 and I thought it was very tasty. Paperwork paperwork paperwork, psych eval was pretty straight forward I wasn't sure what to expect but it was basically to make sure you don't ha…

I am 25 years old and have been overweight my entire life. I was in and out of the doctor for my whole life (asthma, pre-diabetes, PCOS, allergies, sleep apnea) up until the age of 19 when my insurance dropped me from my Mom's plan. I didn't get insurance again until last year when I was 24 and still haven't been back to a regular doctor (I was scared to go since it had been so long), I've only been to my gynecologist who is sending my referral to Baptist health for a gastric sleeve surgery and she is really pushing for me to get it. I'm worried since there is a 5-6 year gap of literally no doctor visits that Anthem BCBS is not going to approve me for surgery for lack o…

I received a call this morning from a nurse with my insurance company. She asked a lot if questions and wanted to let me know that she was here to help. I have to admit, i felt uneasy about speaking to someone I've never met about my health information. Has anyone else experienced this with the insurance company? I just received my approval yesterday by the way.

Empire BC/BS covered my gastric sleeve, minus $250 in-patient co-pay. I had surgery on 06 Mar 15 at HMC-Pasack Valley and it was performed by Dr. Amit Triveti from Lap-Associates in Paramus, NJ.

Has anyone had to appeal with Federal BCBS? Outcome? How long does it take to get an answer after appealing? Thanks~

Okay so I have all my authorizations set and ready to go. My surgeons office sends me an email saying at my pre-op apt. I have to pay $900 which breaks down to $350 education fee and $550 surgery deposit. I email her back and say I shouldn't have to pay anything I am covered 100% she says that most insurances won't cover the education fee ect. I call my insurance and they give me this line about it "should" be covered. I don't want to go to my apt and have to argue with them ???? anyone deal with this before?

Hello all I've read a lot of you all saying that you can check your claim status to see if your surgery is approved or not how would I do that? I have finished all my requirements for surgery but haven't heard anything from my bariatic coordinator

In the information given to me by the hospital I'm having my surgery through, it said that if your BMI is over 50 (mine is 59), Blue Cross Blue Shield of Michigan waives the six month dieting/wait period. Does anyone have experience with this? I'm getting BCBS of Michigan anyway, but I'm really hoping this wasn't misinformation. Thanks a bunch!

Does anyone have bcbsnc? I feel like this is the hardest insurance to have bc the 6 month wait is hard and I've done nothing but gain weight. My bmi is borderline and I'm nervous. Any advice would be helpful.

Hi all. I have Aetna insurance and they recently changed the verbiage in the weight loss surgery requirements from a 2 year history of Obesity, to a "presence of persistent obesity". One of the requirements I have through my work is to get annual health assessments and in turn, I get $500 off my insurance premium. So my question is, would my weights taken FOR Aetna at these health screenings be acceptable documentation of my weight? I feel like it's a silly question and surely they would, but I have never been through this process before so I can't be certain. Anyone know? I have my consultation with the surgeon on 1/7 and plan to call my insurance company in the near …

I am starting a new job on Monday and have to make a decision by then about which health insurance to pick, and I have narrowed it down to Kaiser or Anthem BC. I am hoping to have gastric sleeve surgery this summer. The Kaiser plan (after my employer contribution) will cost me $90/month but has a $6,500 out-of-pocket maximum, whereas the Anthem will cost me $190/month but only has a $3,000 out-of-pocket maximum. It looks like their coverage and requirements for the surgery are about the same but sometimes it's hard to know until the process is started. I can always choose a less expensive plan next year during the open enrollment after my surgery has (hopefully!) been com…

I live in orland, fl and was wondering Has anybody gone through the process with amerigroup? What are their guidelines and was it easy to get approved?

The national Obesity Foundation gives away 1 free bariatric surgery per month. I am in the running. Can you help me win? It would change my life the link is https://apps.facebook.com/575480265829438/ You would just need to click vote for a humanitarian and then vote for stephanie c. You win by getting most votes. Here is why I was nominated: Stephanie CummingsHurricane, UT Stephanie is a 20-something living in Southern Utah. She dedicates most of her time to school and work. In her free time, she volunteers at an animal shelter in her city where she helps clean the shelter and feed and walk the animals. Since high school, Stephanie has dedicated her time to other…

Does anyone know the requirements for NYC workers? I have Empire BCBS and I am having a hard time getting answers from them. My doctors appt is not until the end of April. Thanks

My husband and I's credit is not very good but we applied for a medical loan anyways to cover what my insurance can't or won't cover. I'm so nervous about hearing back from the loan company. I'm afraid that if this doesn't pan out it'll be my last chance at getting my surgery. I know its out of my hands right now but it doesn't make me any less nervous. Anyone out there with less than great credit get a medical loan?

I am only in the research stages of possibly trying to get the VSG in maybe the early months of 2016. Has one ever been approved with using Aetna Choice POS II? I think it is a PPO plan. Honestly, not sure. I have heard that most insurance companies will normally only cover the Gastric Bypass and the Lap Band and I have no interest in either of those procedures. I am only 4ft 10 and about 215 lbs with high blood pressure & a mild fatty liver. I am sure I am a candidate but I can't afford it being a single Mom of 3 with not so good credit.

If you have insurance, and your insurance won't cover bariatric surgery. Dr David Kim is doing a special for $4900. You have to go get checked for a Hiatal hernia which most all overweight people have. Then your General insurance pays for the test for that and the repair of it during WLS, and the bariatric cash price is 4900! Great deal!

My insurance does not cover any form of bariatric surgery. I am going to have to go the self pay route. I do not want to go out of the USA. Can anyone give me some institutions that provide medical loans? Anyone use any specific places or banks for theirs loans?

I am so disappointed I got a denial letter today and I had met all the criteria too. All the doctor visits, nutricionist visits, everything. They said it was denied because it is not medically necessary. I am on medication for blood pressure, diabetes and cholseterol. I have sleep apnea and use a machine. My bmi meets the criteria as well. I have asthma and 2 herniated disc in my lower back. I am going to appeal but any suggestions would be helpful....so disappointed...

Hey guys I have bcbs nc (blue options) im starting to get set up for my appointments needed but was told for my psych & nutrition appt i would be called because I have to have money ready to pay! Can any1 tell me about how much you guys paid ..? Ive been wondering

just curious if anyone has used this company to get Protein shakes after surgery. I think it would be helpful.

Hi everyone, I spoke to the surgeon's insurance coordinator on Friday and she was getting all of my documentation ready for submittal to Aetna. Of course I have gotten myself worked up that I will be denied after reading all of the insurance horror stories! Really, the only thing I can see a problem with is that I don't believe I was on the Surgeon's pre-op plan for 90 days. I brought it up with the Patient Coordinator and she didn't think it was an issue so we will see. Surgery is tentatively scheduled for 7:30 am on March 24! I could use all the positive energy you can muster! thanks, Marsha State of Georgia Atlanta Metro area Surgeon: Dr. Dennis Smi…

My daughter has the chance to get free bariatric surgery and is up against three other people. This is through the national obesity foundation. Could you please help by voting for her and this life changing procedure. Vote for Stephanie C. https://www.facebook.com/NationalObesityFoundation/app_575480265829438 Click Link then click vote for humanitarian then click Vote for Stephanie C. I really do appreciate any help!

For anyone interested I'm posting my experiences with Ky Passport Insurance requirements and Georgetown Bariatrics: I have posted other info up to this point which can be read from my profile.....ok so I received a call from the insurance coordinator who is extremely nice and knowledgeable she scheduled me for an appointment on March 31st, this is an all day see everyone appointment from 8am- 4pm which I think is a brilliant idea dietician, surgeon, psych all done in one day psych evaluation is not covered by my insurance and is the only out of pocket cost at $250 that is due the day of this appointment they call you the day before to collect this fee. She says a packet …

I submitted all my paperwork yesterday about noon, and was told that I received my approval letter TODAY!!! Unbelievable! Hopefully 3 weeks until surgery!!!

Hello everyone. last week I found out that I received a denial due to not having the supporting documents demonstrating a structured nutrition program within 2 years preceding the submittal to insurance. I do have the documentation and just sent it to the surgeons office today to forward on to my insurance for an appeal. My concern is yet again the surgeons office. When I was informed of the denial, the administration nurse told me that I needed to have the program completed after the submission to my insurance. I have had issues with the administration part of the office since day 1 and followed up myself and found out that was incorrect. It has to be prior. I am a…

I've submitted my paperwork to the I surat e company on 2/27 I haven't recieved any word yet? I'm spooky flipping nervous. Do you think I should call the insurance company

I have highmark blue cross blue shield and they have denied my claim due 6 months being insufficient. Meaning my policy states 6 months supervised exercise to be tracked which I did. I've even loss 13 pounds because I was staying on track with going to the gym and eating healthy. Not sure if anyone one else had this issue with how to track the exercise requirement but I was told to just document it.

I wanted to share with you guys my approval experience. I was extremely pleased to receive approval in 2 days. My paperwork was sent to the insurance on Monday and I received the call on Wednesday. Woohoo!!!!!! I am now scheduled for surgery on April 22 and I am so excited. :-) Best of luck to all!!!!

I have it and things have changed a lot they cover almost everything for anyone wondering in ma

Hello. I am new here and praying to get the gastric sleeve surgery. I am a TUSD employee with Ameriben and they will begin to cover beg Sep 1 2014. I have read that they will not accept any one with hyprothyroidism. Does anyone here have that issue? I have not yet applied. I am afraid they will deny me. I was diagnosed while preg with my 6 yr old, and been on med since. Do you thing going off of it would be helpful to see if lab work before approval would come out normal? Will they request my med records with thyroid med previously being on there? Thank you Jaxwaqu.

I am going for all of my appointments in one day for a 5hr span. My BMi is just over 5o and I have BCN of michigan, It will waive the 6 month supervised diet due to BMI, How quickly does the process move after this?

Hello everyone I'm a self pay and would like any recommendations you all can give me on a surgeon and price. I also had surgery for uterine cancer last year so I need someone who's really good. Thanks

Sorry it's been awhile since my last update. I ended up having to start a six month doctor supervised weight loss program. The one I did two years ago didn't count. My surgeons office says I technically started my diet with their office in Jan, so I'm looking at July or August for surgery. This whole process has been a headache but I haven't lost faith. I ended going back to my PM and getting percripton Phenter something. It's been ok so far. It gives me insomnia; ( More time to exercise I guess;) Tomorrow I have another appointment with my nutritionist. I think I only have two visits left. I've thought about giving up so many times, but I haven't yet. I keep telli…

For anyone who has Passport Ins. in Kentucky I want to tell you what all I have learned... I went to the required seminar at Georgetown Community Hosp. on Monday 3-9-15 the surgeon Dr Derek Weiss was very informative and answered many of our questions, you can tell he not only enjoys his specialty but he's damn good at it and as a prospective patient that's a relief The insurance coordinator is extremely knowledgeable, she knew most of our insurance requirements right off the top of her head. Soooo for those who need to know: Kentucky Passport Insurance requirements are as follows: **I'm not an expert this is just my info received and my understanding of it all so far*…

I have aetna and I am totally panicking!! Everything is all done and getting submitted on the 21st. But I have no co-morbidities and a bmi of 37. I have pcos, pre-diabetes, high cholesterol. HELP!! Anyone in the same boat? Any suggestions?

My surgeon requires a colonoscopy prior to gastric surgery if you're over age 50. I had mine in January. While I was under, they also did an endoscopy and took a biopsy of my stomach. The colonoscopy is covered at zero copay to me, as it is one of the special screening procedures. I expected a small bill for the additional work for the endoscopy. The hospital bill came in the mail. My insurance paid around $1500, and they said my part was around $1600, which was a combination of deductible and copay. I called my insurance company and asked if the colonoscopy was indeed covered at 100%, and they said yes. So I said if I had only had the colonoscopy, my portion …

Unless I pay extra to keep what I have now. Please talk to me about your experience with UHC insurance and Gastric Bypass. My current insurance has a 6mo guided weight loss requirement and, according to my potential new surgeon, that will transfer over to them for UHC approval. But tell me your experiences? What do I need to know?

I just recently started a new... that I am very thankful for. Along with the job comes the new health insurance. I have several plans to choose from, but none of the cover bariatric surgery. I feel like I am being pinned into a corner and being forced to pay out of pocket (which I cant afford ouf of pocket). Any advice would be greatly appreciated.

So I am on my website for my insurance this morning checking my prescription prices and I notice a tab that says "authorizations". Curious I click it and lo and behold I find out that I have been approved for my surgery for March 30. On top of that it was not my surgeon's coordinator (who is still collecting documentation she said I needed) who got the approval it was my PCP'S office. Now he referred me back in January. So how long has this approval been sitting here? What really frustrates me is that I told this coordinator that I shouldn't need all this documentation and testing as my BMI had been greater than 40 for the last 2 years and I have Medicare, even though it …

Hello voyagers...Just wanted to get a glimpse of whats in store for me. My first seminar will be this Friday the 30th and i have healthfirst/medicaid so I wanted to hear from those that have the same insurance as me though im aware that everyones situation is different. My hospital of choice is Montefiore....Thanks.

Hey all, I'm new. Long story short I just got told by my would've been surgeon's office (Dr. Weiss at CBH) that as of January 1st 2014, KY Medicaid no longer covers bariatric surgery. I was so close to finally getting something done, but the very day my insurance went active was the very day they stopped covering what I needed it for in the first place. Oh well, that's life eh? I guess they'd rather spend that money on my future heart attack and stroke treatments. Anyway just thought I would stop by and pass along the information. I hadn't read about this anywhere else on the web, so I thought there might be others who need to know. Regards.

Anyone have any information with getting approved? My initial consult with surgeon is tomorrow. I have a BMI of 41 and am on medication for acid reflux. I know I will have to do the 6 month diet and it will be a while before I have to deal with approval/denial, but I can't stop thinking about it! Any insight(preferably good) would be greatly appreciated!