Insurance & Financing

I just had my first appointment with my surgeon yesterday. According to Avmed requirements, once I complete the six months of visits, I should be approved. My BMI is 44.1, Avmed requires it to be over 40 if you don't have any comorbidities. I was wondering if any one has had any problems being approved. One of the ladies in the office told me she recently had someone denied even though their BMI was 41. I'm not sure if it was a different insurance company or Avmed.

I appologize in advance if this question has been asked before (or several times) but my WLS seminar is scheduled in Georgetown Ky and the only info they were able to tell me in advance is that they DO accept my passport medicaid insurance but she wasn't sure what they require as far as a supervised diet or any other requirements. Does anyone have any info on this? Thanks in advance.

Anybody in Jersey used a Dr. Kristopher Kollar?

Does anyone else have Blue Cross/Blue Shield Oklahoma? How long does it take for approval? Its been a week, should I call them? I am penciled in for March 19th and approved for being off work. I work at the hospital, so the staff is holding a spot for me. But if I don't get the 19th, I won't have another chance till the end of the year. I work in Catch Lab and there is never a good time to request off but we are loosing some staff, and I was told this was basically my only shot. What do y'all think? Please pray for me.

I had my second appointment with bariatric center today. This was the appointment were they go over my insurance requirements. I have United Health Care and they require 6 months of check ins with the dietician and doctor before approval. The lady from the clinic who was going over my insurance told me that if at any point during this 6 months I fall below the BMI qualifications, insurance will immediately deny me. Is this true? I thought they just wanted to see that you were putting forth the effort for 6 months but would still approve you if your surgeon approves you. My BMI is .3 away from the qualifying number. This seems very trivial but I suppose that's how the insu…

Does anyone have independent health? What were the requirements? Thank you in advance!

I am self pay and cannot go through with this if I don't have some sort of coverage for post surgical complications. I've heard Blis insurance does this. Any information you can share?

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Hello all. I am self paying my sleeve surgery. The price I was quoted covers follow up visits, but if there are complications they are not included in self pay price. Does anyone know if health insurance would cover those costs when the original surgery did not go through them?

Next week I meet with my PCP to ask her about getting the sleeve. I'm so nervous she will say no, or judge, or that all my referrals with take a million years to go through and then of course the nerves of waiting to be approved. For now I'm just a nervous wreck about the PCP saying no. Vent over

I haven't even seen my PCP yet to discuss WLS but I wanted to call the insurance so I so my homework. They told me they have no requirements or clearances listed under this surgery. All I needed was to discuss this with my PCP and if she agreed she would submit paperwork to insurance. This doesn't sound correct at all. No 6 month diet? No psych evaluation? Then I thought... Would my PCP require this and not insurance? What do you guys think? Btw I have healthfirst NY

I am currently working towards the goal of being approved for surgery I have to do a six month weight loss program through my doctor and am currently 2 month away from being done with that I have my EGD next week and my counseling appointment in two weeks everything is coming together so fast but I have to pay 5000 dollars out of pocket for my co-pay and was wondering if there were any programs who help people with that cost or somethings that you guys have done to get that paid

The insurance coordinator where im trying to get my sleeve said she "heard" anthem is now requiring a 6 month diet attempt. Can anyone confirm this? Sort of off topic, but I see people often mentioning co-morbidities on here. Is that a deal breaker for surgery? What constitutes a co-morbidity?

I'm going to the seminar on Tuesday and am excited to get the process started. My regular doctor told me he had a patient that was approved from medi-cal no problem. I was wondering if anyone had experience with medi-cal insurance for the sleeve? Did they require 6 month supervised diet, co-pay, etc? Any help appreciated, I'm so anxious to move ahead with this lol

Has anyone gone through Badger Care and if so how long was the approval process?

My insurance has assigned me a case worker "advocate". I have my first phone interview tomorrow. I already know I meet all the requirements on paper except a recent 6 month Dr supervised diet. It makes me wonder if there are the "right" things to say in this meeting and any taboo things to say. I did have recent 4 months with WW before I gave up (again) - it sure would be great if I could use that plus a dr recommendation to count for the 6 month diet requirement. Advise anyone?

Does anyone know if the self pay rate with True Results includes the anesthesiologist?

Hi Anyone have this insurance? If so how was your experience? Thanks!

I have spent 6 months of monthly doctor visits, had blood drawn for labs, gathered paperwork documenting 3 years of weights, and completed sleep study. I have a BMI of 45, I have high blood pressure and high cholesterol. I meet all my insurance company's requirements to qualify for surgery. My surgeon's office submitted to BCBS and they came back requesting all the documents for review. Surgeons office said it will take another 4 weeks before an approval or denial. Seriously?? Good grief!

Has anyone had assurant health insurance for their bariatric surgery? I'm just wondering how long it took to get an answer if you had this insurance and was it pretty easy to get an approval?

How long does it take for insurance to approve ?? I have Neighborhood HealthPlan by Masshealth. And also, last weigh in I was 215 Today I am 218 I have to go back for a weigh in tomorrow What do u think they'll decide ? Did anyone go into surgery without meeting the surgeons weight goaled ?

Does straight, plain old california Medi-cal cover fills? I don't have A plan, just plain old medi-cal, the little blue and white card

So all my paperwork has been submitted to insurance last Friday 2/13. I'm nervous bc I weighed 284 at the initial weigh -in and at my last appointment on Friday I weighed in at 293. I've worked so hard this entire time to try to get the weight back to the original 284 but it's been such a struggle, the lowest I've gotten is 290. I've cut out carbs, eaten high protein, and drank about 120 oz of water a day. I've also been working out every day but he weight won't budge. Will I get denied because of this? I've worked so hard and my doctors know it too.

I am going to my pcp on the 2 of march to get a letter for the gastric surgeon. Im worried because I dont know if she would approve it. I have health alliance hmo which does cover bariatric surgery.. I am 60 yrs old have a 38 bmi an diabetic type 2 (taking Insulin) Has anybody had their pcp refuse to recommend the surgery? also I have tried doctor supervised weightlos in the past including phentermine. do you think this would qualify or will I have to go thru another 6 months of supervised weight loss I know everybodys case is different but I am wondering if anybody encountered these situations and how they were dealt with. really feel that this is what I…

Both my health plans don't cover bariatric surgery. My state doesn't mandate bariatric coverage. As a result I am looking at going with Corvala at hospital angeles in Tijuana. If I have post op complications I believe my two health plans won't cover post op complications. Does anyone know of separate insurance policies I could buy that would cover post op elective surgery complications for vsg,

So I'm starting to worry about getting my appointments scheduled in a timely manner. I'm in the beginning stage of the process and told myself I was not got going to worry and just go with the flow...well...yeah right! I have Aetna and have a 3 month process to complete for insurance purposes. I'm sure we are all familiar with the process...well I'm worried because I've had my initial consultation which counts as month one visit/weigh in with the surgeon. That was on Jan. 20th. I was told I would be contacted by the navigator to schedule everything else. I decided since I had not heard anything yet, that I'd contact him myself. Well he claims has not gotten any "paper…

I had my last visit with my PCP today. Six months went by faster than I thought it would. I will be faxing everything to my surgeon on Monday and hold my breath for approval. I've done everything on the check list and can't imagine any denials. But I am nervous.

Has anyone given up on the insurance, self-paid, and then tried to get reimbursed after the fact? I have UHC HealthSelect and they want a year of nutrition. I don't have a year, my liver enzymes are going up all the time due to fatty liver. We are trying to appeal, but I am willing to self-pay to have the surgery done in December when I am off work for two weeks for the holidays and, also, that will be 6 months sooner for my liver. If I self-pay, I was wondering if I could send in a claim and see if they would pay me that way. Thanks in advance for all the help. There are a lot of smart people around here. Peace, Laura

Just got my denial letter today. I guess I'm not sick enough. I'm so upset. I've been weepy all day. :-( So- where do I go from here? I feel like mentally I was totally prepared to do this.... And now what? I can't go on like this.... I'm miserable and feel like my last resort was pulled out from under my feet. What do you do when your last resort is gone?

I forgot to tell you all I'm in Houma, La

As anyone used bcbs for insurance to cover your surgery? Is so, how long did it take for you to get your approval?

Hi there - I am half way through the 3 month process of nutritional counseling and appointments. I have a BMI of 37. My sleep study results came back negative for sleep apnea - which is a SHOCK. I have all of the symptoms of sleep apnea and snore so loudly my husband can't sleep in the same room unless he falls asleep first. No HBP or diabetes. I spoke with the insurance coordinator (who I have found is very knowledgeable and great) yesterday and asked her if I should even pursue this further. I don't want to spend $$ on the nutritional classes and psych eval if there is not chance to get approved. Every medical practice is a business - I'm concerned they might wa…

I have not openly talked to my doctor about this yet, mainly because in KY we have had 12 inches of snow dumped on us and its -9 degrees and eveything is a ploar ice land and we are in a state of emergancty so I cant really go anywhere but I was wanting to know if anyone else has medicaid and did you get approved for the gastric sleeve or better yet the duodenal switch? I am 6 foot 1 inch tall 24 yrs old. I have type 2 diabetes, asmah and high blood pressure I weigh 456lbs and have tried Phentermine with no success (it messed with my other meds and made me sick as a dog and I did not lose on it) I have tried diets out the ass and nothing seems to help and the more…

Does anyone know how NC Medicaid works to cover WLS? The only facility I can find to accept Medicaid is Wake Forest Baptist Medical. Do you know of any other places maybe closer to the Raleigh area? I'm about 30 minutes east of Raleigh. Also, how long does the process take to actually get an appointment set for surgery? I know it's a lot of questions. ..I'm sorry!

I was approved for vsg surgery on the feb 25th. Then last week I was told that my surgery would be on the 29th because they missed the paper day deadline. Just listened to my voice mail and was told my insurance company wants a letter from my PC doctor that I'm healthy enough to have surgery. Then office assistant said that starting this year BCBS of GA is requiring a six month medically supervised diet. I'm so hurt! I've already started my pre op diet. I already got approved! Wtf! This sucks! I'm off to have a glass/bottle of wine.

I know this may have been asked and answered but I haven't seen it, So here we go, in the policy it states:The individual must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery. What does appraised by the physician mean? Just that he knows of your attempts or does it have to be documented? ​I go for my first visit with a surgeon next week and I just want to get as much info together to expedite the process. Thank you for your help Medical Policy.doc

I know every insurance company is different but.... I have severe osteoarthritis (pending total knee replacement) and high cholesterol. My sleep study is scheduled. I'm not sure if I have the co-morbidities required for a BMI of 35-39. I am working hard to adjust my eating, exercise... habits now. I was 271 at my first appointment with the PA. I am now 252. The PA cautioned me against going below a BMI of 40 prior to insurance approval. I'd hate to put brakes on my momentum. Without a diagnosis of sleep apnea, would my other two diagnoses qualify me for a BMI of 35-39 ?

I have bcbs of mississippi. I started my documented weight with my surgeon at 272. In December I weighed I at 258. Today I weighed in at 261. My doctor is submitting my information to bcbs of mississippi tbis week. I am worried that the 3 lb weight gain will cause a denial. Should I be worried? If I am approved how long will it take? Worried. ... VSG Ready

I have APWU and wanted to see who has been approved and what you have to submit to get approved? Thanks

Got the call today. Will get my surgery date next week. So excited????

I am so thrilled that I was finally financed for my sleeve! I am so excited and nervous for my journey. So many questions, yet I feel so well informed due to my lurker status on this forum.

Does anyone know if Cigna will deny you for net weight gain after the supervised visits with a dietician? I see a lot of threads on the topic of Aetna and weight gain, so I was just wondering.... Thanks.

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Hi everyone, I'm a newbie and this is my first post. Was just wondering if anybody on here has Aetna so-cal H. M. O. and if so could they share their stories on the journey to approval. I have my primary care physician on board, met with my NUT and she approved, had my psych evaluation and she approved, had my sleep study and was told I didn't need the cpap machine but when I hit REM sleep in the early morning hours, I stop breathing 8x's an hour and so my oxygen decreases during this time and to solve this issue I will need to lose weight. I am 36, 5'5 and weigh 225 (at my heaviest I was 245). I am pre-diabetic, and have high cholesterol (but not on meds at this …

If you had or are in the process of doing your 90 day medically supervised weight loss, how many appointments are/were you required to have with your dietician?

Hey guys, been lurking on the boards for a couple years and I'm looking for some info. Quick rundown... Banded 2010 with BCBS, required me to do NUT/psych, doctor letter, and information seminar. Lost 25lbs, got fills monthly for 2 years...nothing. Surgeon said I developed an "intolerance" to the band. Okay? So I got a complete unfill in 2012... fast forward 2 years later and I'm still having vomiting issues and things get "stuck" frequently, my BMI is over 40. Talked to my surgeon on Dec 1st about a revision, which he doesn't do, so I was referred to another surgeon. Have an appointment pending for new surgeon but in the mean time, I checked BCBS revision requi…

I was wondering if anyone in Ohio has this insurance and how long it took to get approved. I have done my 6 month of diet supervised visitations lost almost 60 pounds and I'm just waiting for my patient advocate to submit all the forms. Also did they pay for the Optifast before surgery? Thank you in advance, Melissa

Hello, has anyone had their surgery with Kaiser in the Inland Empire? If so, can you tell me what steps you took to get approved by Kaiser? Who your pcp was? I'm switching to Kaiser January 1st and want to make sure I find a new primary care physician who is pro weight loss surgery, and want to make sure I do all I can to get approved. Thank you!!

Hello my name is Eddy. If anybody has cigna healthcare what are requirements for pre op. I talk to them and they told that is cover and also I'm seeing a nutritionist and also seeing my lung doctors soon when I get my new card. Because I want to how much weight I need to lose before. I am already starting the paper for the surgeon

Hello, I was wondering if anyone knew of any Doctors in the Austin, Round Rock area that accept Superior Healthplan? It is medicaid but you have to be specific about what is on the card when asking around. I went to the Nix center in San Antonio, but would like to find something that is in my local area. I've already met the requirements, now I'm just wanting to find a Dr. that takes this plan. Thanks, Shanna