Insurance & Financing

Hello, Can anyone help on the process of Virginia Premier /Kaiser Medicaid? Some back story: I was furloughed in March and lost health insurance in June. I was a Kaiser member in 2018 before my employer changed health care option and I stopped my Gastric Sleeve process in 2019. Now after Covid I am on medicaid and saw that Norther Virginia offers Kaiser to medicaid patients. Has any gone through this process with medicaid? Can I just pick up where I left off with Kaiser?

Can anyone help me figure out what this means? They said that bariatrics are included with our new insurance but this makes no sense to me. I’ve called insurance and all they did was read it to me and can’t explain it any further. I have calls into places to meet with surgeons but don’t want to get my hopes up if this isn’t going to happen. Thanks in advance.

Anyone with Medicare? How is/was the approval process and coverage for the surgery? I have BCBS thru my husband's employer, and the coverage and benefits are excellent, but I'm wondering if the coverage requirements for the gastric sleeve surgery might be better with Medicare coverage so I don't have to wait so long. I can get my coverage back because I'm entitled to it with my SSDI, so I would just like to check my options. I only have part A right now, but I can get the other benefits back as well.

Hello I’m at the last leg of my program and everything has been submitted and I am now waiting on an approval. The hospital submitted my paperwork last Tuesday and I’m just wondering how long should I wait to get an answer. Me being impatient I called the insurance company yesterday just to confirm my paperwork got submitted and it did. First the guy said I was approved and I have a date of 1/11 then at the end of the call he said it’s still pending. I was like wait you just said it was approved. So now I am confused. I really hope I get an approval soon.

Hello, I am in the process of starting my journey. I have my first meeting with the surgeon on Sept. 26. I have Aetna POS I am really nervous that they are going to deny me. Can anyone who has gotten approved by aetna tell me in detail what they did?

Hello! My husbands insurance finally added bariatric surgery onto the insurance plan. His work is based in MA so though we are in NC, we have BCBS OF MA. Does anyone know how long of a period I have to go on a weight loss program before I can get approved for gastric bypass? 3 months? 6? The insurance doesn’t start until Jan. 1st or I’d call them and get all the info I could. Thanks in advance!

Just wondering if anyone had any experience with getting an approval through FEP Blue. I have finished all of the requirements and my surgeons office is going to submit the request and curious as to what the turn around time is for the approval. Thanks!

I have just started the process. I was trying to get my surgery done at a mil base, but COVID quashed that. I am switching to the civilian side. I have my seminar scheduled for Dec, but I would like to get as much done before then as possible. Who needs to write for the cardiac check up? Is this something I should be talking with my PCM about, or does the gastro do that? My pcm isn't very reliable he referred me to someone who hasn't practiced here for 2 years. Any helpful hints would be very appreciated. Tess

Hello, I'm a newbie here and I'm currently awaiting a decision from Aetna for gastric bypass. My prior authorization was sent and received on 11/6/20. I called on Thursday morning out of curiosity to see if they had gotten it and they had. They said it can take up to 14 business days and most of the time it will take that time. From what I've been reading a lot of people seem to get their decision back pretty quickly. I'm getting nervous that they will deny it and that I'll have to fight with insurance. I can't think of a reason they would deny it as I met all the requirements, my BMI is 62.3, I have severe sleep apnea, high cholesterol, PCOS, arthritis, and insulin …

I called Optum and they said I don't have to pay anything. Is that true?

Does anyone has to pay something after the insurance approved the surgery???

Hi guys, So I have completed all of my requirements for surgery and had my decision appointment October 22nd. That day they were submitting my paperwork and gave me a surgery date of the second week of December. So I call my insurance a week later to see if they received it and if I was approved and turns out my paperwork hasn't even been submitted. So I call my surgeons office and they said they're waiting on psych to send them her part and then they could send it in. Mind you I had my psych appointment in September and she said I was fit for it and would submit her part. I wait another week and make the calls to see where I'm at, once again everyone is waiting on …

only took 11 business days from submission to get approved

I just took an exhausting and horrid psychological test! Has anyone else had to do that??

I am in the process of pre-op for Gastric Bypass in December. I have purchased the multi vitamin and calcium chews in advance but am in the process of open enrollment at my job. One thing I need to determine is my medical expenses for the upcoming year. I was wondering if anyone paid for their vitamins through their FSA account?

I’m nervous about going through the process and getting denied by insurance.

I switched to Aetna starting 9/1/20 since I was denied by IBX (after they said it would be covered). I got the call this morning that I am approved already! My surgeons office submitted the paperwork on Friday. I did Optifast for the dietician appointments so I could get the 12 appointments in 3 months instead of 6 months. My surgery date is October 14! 7 months later than expected but finally happening!

I'm at that very beginning of this process and I'm so confused. I spoke with my surgeon and they advised me that they would like me to call my insurance to get the specifics of my policy (I believe they do this as well, it's just a way for them to make us be aware of how our insurance works so we aren't surprised). Well, I called and I got one answer. It didn't seem right based on what I was seeing on here, so I called again...and then I got another answer. I spoke to someone in BRS, and they brought up the 6-month requirements that seem to no longer apply, but they are insisting they are (and sent me papers from 2017 to "prove' it). I reached out to my HR department aski…

Does anyone know what they mean when they said we have to submit the Bariatric Resource Services weight loss form or UHC with chart notes? I’m not sure what kind of notes? Can my doctor type up a letter in regards to the chart notes? Cause my chart notes said discuss weight lost and out in a low carb diet. And the other didn’t even mention my diet.

Will HIP cover gastric bypass? And what requirements if any do they have? Thanks

I am just curious---Did your insurance require a medially supervised diet of 3 months or 6 months? Which insurance do you have? TIA!

Hey there- I’m a lower BMI patient and do not meet my insurance criteria for coverage. Have decided to self pay at blossom Bariatrics. I have such fear over complications and my normal insurance not covering them bc they would be the result of an uncovered surgery. Does anyone know of any supplemental insurance coverage you can buy for this type of elective procedure?

Hi I'm new. My Dr wants to de a duodenal switch after I have had a failed sleeve done a year and a half ago. I was wondering if anyone has had medicare and tricare insurance and what was the out of pocket? I'm in WV if that matters.

Anyone have any experience with switching insurance during the process? I have IBX, went through the whole process and found out I was not covered when it came to surgery time. I am switching to Aetna, which starts Sept 1st. I am currently doing Optifast and meeting with a dietitian to hit the 12 dietitian meeting requirement. I have a few concerns... 1. When Aetna kicks in I will have all the requirements done (Aetnas requirements). Do you think they will make me do them again? 2. I could be below the 40 bmi by then, will they take my initial weight from last year when I started the process or my current weight. (I have no other health i…

First I got a denial letter from insurance. A few days later I got a second letter saying the denial had been reversed and surgery was authorized. I waited 7 weeks to hear from my doc who is 4 hours away. I finally called to say what the hell this is taking too long. They said they only had the denial, they did not receive the authorization. The admin assistant also said, oh yeah your paperwork has been on my desk I just didn't know what to do because I hadn't heard from our insurance specialist either. I had to scan and send her my authorization from Cigna. None of this sounds normal and it feels like they're giving me the run around for some reason. I would love…

I just got my paper work for my seminar next week... so i see I had to call my insurance BCBSTX , they tell me my plan doesn't cover it.... even with health issues, I have numerous weight related health issues eg) diabetes, hypertension etc . IM absolutely gutted. I don't no what else to do.?... i can't pay out of pocket. I guess this just isn't going to happen... Wishing each of you every success

This was so easy it’s almost unbelievable. My insurance literally has no requirements other than the BMI. Under 40 one co-morbidity over 40 you’re good. That’s it! No psych evaluation or 6 month diet. I was told by the insurance if I meet any of those requirements I’m automatically approved and I was! YAY!! Surgery date 7/1. ??????

I’m kind of worried I won’t get approved.I’ve been trying to get this surgery for two years.The only problem is that I’m underage. Two years ago I was accepted into a bariatric surgery program at a children’s hospital, but my insurance wouldn’t approve because it was in the next state over. (We were desperate because I had got diagnosed with high blood pressure)My mom and I were basically told to change my insurance to Horizon NJ Health because they have programs as well.We had to wait about a year for me to change it and get my card. Then, for me to be accepted into a program I had to be 15. I’m turning 16 in a few months. I’ve saw an endocrinologist,participated in a …

I was just denied by my health insurance medical director because my BMI is 38 and not 40. Plus I haven't had nutritional classes in the past few years. I took them when I had my original surgery 2013, I've left a message with the Lindstrom group to do a consult. Anyone used them recently and if so, how long was your process and if you don't mind sharing an approximate of how much you paid? Thank you!

I am new this? How long did you have to wait for approval from Tricare Prime? Everything was faxed in today around noon. I am hoping to still getschedualed for mid Aug. wishful thinking thanks for yiur coments

Hi, I am switching my insurance to Masshealth in September. I would like to know how long it takes the whole process throughout Masshealth. I will have my first appointment in August 20 but will be throughout my old insurance then I will change.

My BMI is just barely 40. It's like 40.3 or something like that. However, my BMI has been between 35 and 40 for at least 10 years, regardless of what I have tried and I've tried just about everything that seemed reasonable. I weighed at my PCP 2 weeks ago at 40.3. She referred me to bariatric surgeon and also gave me phentermine. I met with him by video conference today. I called my insurance today. They said BMI of 40 qualifies even with no comorbidities. I don't have any comorbidities. The phentermine works - I have a greatly reduced appetite. I've used it before and it works until I stop taking it. I know I have been eating less, so I'm worried my weight will drop and …

has anyone changed surgeons after getting insurance approval? if so, did the approval still hold or did you need to resubmit for preauthorization/approval?

Anyone had/having their surgery at John Hopkins Sibley Memorial in DC using GEHA through United HealthCare?

Hey, new here and I’m just wondering if any Canadians are on this form? Specifically BC people. I’m just wondering if anyone has had MSP pay for weight loss surgery and how long it took? And I am also wondering if anyone has gone out of country for it?

What is the least invasive weightloss surgery covered by ca health and wellness. What were the steps needed

I called my insurance company IBC PPO back in August, they sent me a copy of the bariatric policy. BMI over 40, weight loss attemps, etc. This is for it to be covered under medically necessary. Is the what everyone else used or does everyone else have a bariatric rider? The surgeons office said I was denied because I do not have coverage. I had to call the insurance company 4 times before I found someone who referred me back to the policy I was sent in August. I am so confused. I have been on the phone all day! Curious if anyone else got the same run around. Fingers crossed I hear good news soon. Hoping I don't have to pay out of pocket.

HI! I would love to know if anybody has had success getting insurance coverage for WLS when your BMI is under 40 and you do NOT have high blood pressure, sleep apnea or high cholesterol. Do any other comorbidities work to get coverage? TIA!

Once I have my insurance approval, is that approval for the surgery or for that specific facility/ surgeon to do the surgery? Im wondering if you can change facilities after that or if you have to stick with them? If you change do you have to go back through the classes and visits?

I was wondering if anyone can share any information about their insurance having a maximum benefit for WLS and if they had additional out of pocket costs because of it. My insurance - United Healthcare (UHC) - has told me they will pay no more than $40,000 for me to have surgery with my original surgeon who is in network at a center of excellence. The surgeon's office pointed it out to me yesterday, and I asked if that was enough, and she said as long as I don't have complications I should be okay. I'm worried because I am having a hiatal hernia repair and rny. My last hernia repair was $44,000 but the hospital allowed insurance to pay $7,000. Won't that same prin…

So with kaiser in the inland empire area, when you get the referral to the options class, is that the approval that you will have the surgery? Or after going through the 12 weeks class can they still deny us? If so what reasons could they deny us?

Is anyone familiar with this insurance? I meet with the surgery coordinator and one of the drs in about 3 weeks to go over what exactly my insurance requires.

Hi. I have United Healthcare. My BMI is 37, a bit over the 35. I had to do a 6 month program prior to surgery. And today I finished the program but I gained 3 lbs from my starting weight. I was told to keep it steady and I really did. Will insurance deny me for 3lbs? :(

Just wondering how hard this is going to be with a BMI if just under 40. I’m at the very beginning of this process. I don’t have diabetes but I see a cardiologist for some issues, have had joint issues and planters fasciitis. Not sure if that would help with it being deemed medically necessary.

Has anyone with Tricare Prime (East) had any luck with getting their protein and vitamins covered by insurance? The website states they will cover medically necessary issues, but was curious to know if anyone has actually been able to get it. TIA

I am doing the self financing option but I have to find a loan that will overlook my poor credit. Any suggestions?

I have a question I'm trying to get the sleeve surgery done. I have medicaid and I'm having issues with finding out how long my cpap needs to be used for me to be cleared for surgery I don't know who to talk to.

Hello! I am 25 with a BMI of over 55. I originally tried to start this process 2 years ago, but my family was on BCBS and they wouldn't even admit to anyone that called (besides me and my mom) that they actually covered the surgery. We got on new insurance, but I was told I couldn't start the process again until we'd been on our United Healthcare plus plan for a year...but I also had to get the surgery before I aged out of my parent's plan at the end of January 2021. That year mark is April 30th... if you do the math, you see I have enough time to do the 6 month supervised weight loss, but only with maybe two months after to get the surgery done before I have no insurance…

I'm a natural worrier when it comes to things I can't control. I had my 2nd of the 6 weight loss doctors appointments required by my insurance for WLS surgery at the beginning of this month. I am scheduled for my next appointment on April 6th. I am getting very worried that the doctors office will end up closing due to coronavirus precautions and I'll miss my appointment for the month of April. If that happens, I'll be back to square one unless insurance allows some kind of waiver due to the circumstances. I know there is absolutely nothing I can do about it and that only time will tell, but I wish I could mute this inner voice of mine!

I'm expecting my vsg surgery to be performed within the next 6 weeks. At the same time I'm considering changing jobs, which means I would lose my current insurance and replace it with a new one. The job change would probably happen within the next few weeks. Assuming the new plan covers the surgery, does anyone know if I would have to start completely from scratch? I've been chasing this for almost a year now and would be devastated to have to start all over again, but at the same time this job opportunity would be tremendous for my career. Anyone have experience with this?