Insurance & Financing

I am just curious how long it took for them to approve you for your surgery?

Hello all any information would be GREATLY appreciated, so ive just started my Journey I had one consultation the Dr. was somewhat informative but they keep telling me I have to have medical records for the past 5 years I know it sounds terrible but i have none besides possibly from 2 years ago when I went to the emergency room I have BCBS of NC and wanted to know if that would be a big problem on getting approved. Ive struggled with weight problems since i was 15 ive tried herbalife,Hcg,Diet Center,etc and nothing has worked for me I just manage to keep going up, but after finding out about the medical records I am starting to feel very hopeless any feedback would be a…

I had a consult today with a different surgeon. They had two different recommendations for the procedure. One the anchor cut and the other a standard TT. She said she will pull down the skin tight and repair the muscle. She said I have a good hip curve already so the anchor cut wouldn't be needed. The other said with extra skin above my BB, an anchor cut will give a tighter waist. Anyone had a similar situation? Any thoughts would be appreciated.

Hi everyone, so tricare released its new benefits today does anyone know if tge gastric sleeve is listed yet? Medicare will cover it, not sure why Tricare wouldn't?

In tacoma washington. My insurance is tricare. I want to get the vsg at MADIGAN not outside a military facility. And I just want to know if anyone has gotten the sleeve through Madigan and all the details. Please. Desperate.

i currently have NALC /cigna federal and i dont believe they cover it i know im early only 8days post opp but i would like 2 know what federal insurance would cover and the process so i can switch for when it is time ... thanks i say federal because i work for the government want 2 know my options... I would love to have skin removal and Breast aug after please any info you can give on your experience in getting your insurance to pay and the process would be wonderful and who you suggest i select as a federal option to get what I want done when it is time.

i currently have NALC /cigna federal and i dont believe they cover it i know im early only 8days post opp but i would like 2 know what federal insurance would cover and the process so i can switch for when it is time ... thanks i say federal because i work for the government want 2 know my options... I would love to have skin removal and Breast aug after please any info you can give on your experience in getting your insurance to pay and the process would be wonderful and who you suggest i select as a federal option to get what I want done when it is time.

I wanted to wish everyone a Happy New Years! For those who got approvals/surgery in 2014 Congrats! For those still working on it like myself keep pushing on! Here's to 2015 giving us the answers we're looking for after months of hard work!

I had my first PCP Appointment this week..She told me that I need to write a letter to my insurance company explaining every detail of why I need this surgery. Then she said I give it to her for my dr office to help me get approval from insurance while they look for a bariatric surgeon for me since there isn't one in the network. Meanwhile She ordered for me to get my labs done so we are ahead of the game..I have Aetna and I'm located in California. Did anyone else have an experience like this?? Any advice is appreciated. All I know is I'm great at writing and this is going to be the best damn letter I've ever written. ????

incurrently have NALC /cigna federal and i dont believe they cover it i know im early only 8days post opp but i would like 2 know what federal insurance would cover and the process so i can switch for when it is time ... thanks i say federal because i work for the government want 2 know my options...

So due to my current health insurance denying me because there wasn't an medical clearance letter included in my insurance packet and my insurance is changing to tufts on January 1 I was wondering if anyone had experience with tufts health plan ?

Just curious....has anyone had any success having skin removal surgery approved by insurance for stomach or arms? I have highmark bc/bs and have been working with my PCP to document skin problems related to the excess skin. So far I have 3 visits worth of documentation. I'm wondering when I should submit it to insurance and if anyone has had any success in doing this?

I've inquired into WLS with my insurance BCBS federal plan. I was directed to the page in the benefits booklet, which says either BMI 40 or above OR BMI 35 with comorbidity but doesn't list which comorbidities are accepted. I think diabetes is pretty universal but I am only pre-diabetic. But, I have high blood pressure which is currently controlled with medication. My BMI is 39.7 so I'm pretty close anyway, but I'm wondering if I'll get denied since the hypertension is under control. I was diagnosed with GERD years ago but my last upper GI 2 yrs ago saw no evidence of it and I was not on meds at the time (but was doing Atkins so was not eating most of the usual trigg…

I talked to the insurance company this morning, and I was advised that both my husband and I was both approved for surgery. We are so excited, now we have to wait to get a date. Hopefully, we can have surgery before 2015. I can't wait to join the loser bench with my husband. God is Great

I am cross posting this from the Lap band to VSG forum and here as well...hoping to find some answers! So, I've jumped through all the hoops for the last two years in order to qualify for revision surgery. First, i had Atena and for the life of me could never qualify. Then, I changed jobs and landed back with Anthem Keycard (the insurance I originally had when the band was placed in 2008). I went back to my surgeon (Dr. Schroder, Richmond, VA) and started the process again. Nutritional eval, psych eval, PCP approval. And, within 24 hours of the surgeon's office submitting the paperwork I was approved for a revision from Lap-band to VSG. I received a letter from An…

Approved!!! So happy I could jump up and down. She said I should know my date on this Friday....YIPPEE

Hi, I am going for my first appt to the surgeon, and i was just wondering if anyone else had cigna insurance and how easy or hard it was to prove that you had tried (the 3 months within 2 years) any advice is appreciated!

So as you can see by my post title I am absolutely beyond angry. After doing so well busting my butt to do m pre op diet, meeting all these goals. it turns out my company is being bought out, so I and my surgeon have to push hard and fast to get my surgery in before the end of the year due to change sin benefits for the new company taking over. Well we submitted just before thanksgiving. I have Tufts Cigna Carelink, its a joint insurance through both tufts and cigna. Well they decided to deny my surgery today. Why you may ask? well they said I don't have 3 months of continuous care . Which is bull because I do. And they have all the clinical notes of same showing it. …

I have had a really hard time during this 3 month weight loss program to lose any weight. I know some of it is my fault but not all. Has anyone been approved even though they gained weight during this phase? I'm really nervous and afraid this is going to hold me back! I already drink Protein shakes for Breakfast and lunch but then go home and eat a huge dinner. Help!!!

Well, there I was, thinking everything was moving along nicely towards a March 2015 surgery date. Then... BAM! My husband lost his job last week and thus our awesome health insurance ends December 31st. Since I left my job last year to be a homemaker, we are now in the market for private family health insurance plans in Virginia. Does anyone have recommendations for private insurance plans that cover bariatric surgery? I'm hoping this rather significant road-bump doesn't set me back more than 4 - 6 months. And obviously, my surgery has now moved down quite a bit on the priority list. Boo-hoo!!! Hope Everyone Had a Merry Christmas! Ginny

Has anyone had their surgery through Sparrow Bariatric and Weight Management Services in Lansing, MI without insurance? What sort of cost estimates did they give you and what did you think of the staff and docs? Thanks

Hi I am just starting this WL journey and I am already stressed about my insurance. I have Blue Cross Blue Shield Massachusetts and my BMI is 40 with no medical problems, which is the minimum necessary for them to approve my gastric sleeve surgery. The insurance person from my WL center does not want me to loose more than 5lbs as she is afraid if I loose too much the insurance will then say I am doing great on my own and do not need the surgery. She thinks I am in a tricky situation because if I do not loose it will count against me but if I loose too much it will also go against me. I was wondering if anyone out there has been or is in a similar situation and was the o…

So I have Illinois medicaid and am in the process of my 6 month physician supervised diet. I don't feel like my doctor is documenting my attempts at weight loss very well. She more or less writes weight loss of how ever much and then continue exercise and portion control. That's it. Will Illinois still approve me with this type of documentation?

Help has anyone been approved with aetna Bank of America ppo I'm very nervous after reading all of these comments about people being denied. I have my last 90 day diet app on October 16th.

Haven't been on here for a while so here is where I am at: WAITING! Everything has been finished and even called my insurance for any information they may have. Still pending is what was told. I had my information submitted about a week and a half ago. I have Buckeye Community and it is for Cleveland, Ohio area. Which brings me to wonder...why are there hardly any people here or on other bariatric forum sites from this area?! Anyhow, I am going to sit here patiently b/c beggars can't be choosers and I have waited this long anyhow. In addition...I am scared to death of the surgery! I am scared of my health problems as well, but the surgery scares me also. Does a…

I got all of my approvals pre-op, had surgery 3 weeks ago tomorrow, and last night my insurance company website updated my claim (just a few dollars short of $11,000) as DENIED. I've tried to call them 3 times today and sat on hold so long I had to hang up, because I'm at work and I've got a lot of meetings on Mondays. No idea what fresh hell is being perpetrated here, but my left eyelid is twitching.

...And I just say "nothing" because if I tell them "insurance approval" they will wonder why? and what for? Well my anonymous internet friends, my Christmas gift came early and it looks like my insurance (after my call to them today) approved my surgery! I could cry right now! I am still waiting for my approval letter and for the surgery date and I know something could happen where insurance suddenly changes their mind but right now, I am just so happy! My fear of rejection was scaring me more than the surgery itself(reliving my college admissions all over again) and I just had to tell someone, because i've been keeping it hush hush until A.) Insurance approves or denie…

I have Arizona MercyCare (Mercy Care) AHCCCS Medicaid insurance. I have had Pseudotumor Cerebri (PTC) for three and a half years and I finally decided to look into weight loss surgery about 3 years after I was initially told to do it by my neurosurgeon to help the PTC. I started my 6 month physician monitored weight loss in March 2014. My weight fluctuated due to steroids and medications I was on for the PTC. Overall I lost 21 lbs, but one month I was up a few lbs. Because of that month, my surgeon's office said that was why I was denied the surgery. However, after speaking with the insurance appeals guy, he sent me what was sent to my surgeon's office: "Failed ph…

I have completed all of my requirements to have surgery and the surgeon's office submitted my paperwork on Monday, November 10. I just found out that the surgery was approved on November 17. So why have I nor my surgeon's office received an approval letter from BCBS? I have called them numerous times and am I told that they have 30 days to mail the letter. I am frustrated and angry. Any advise? Thanks, Jessica

I have surgery next Wednesday and had to pick up some prescriptions I will need after the surgery yesterday. Out of the three medicines (one for pain, one for nausea, and one for heartburn) I have been told that my insurance won't cover the Prevacid Solutabs. My doctor's office will try and get it covered, but if not they said they can change it to the regular prevacid to get it covered, I will just have to mix it in with something (not sure if it's a capsule or a tablet). But I'm just curious if anyone has ever gotten their insurance to actually pay for the solutabs instead? I Have Anthem BCBS through Commonwealth of Virginia.

Hello my name is Brittany and I was wondering has anybody dealt with Paramount Advantage. We have our last visit Wednesday to get approved. I was just wondering what were the requirements and after the paper work was sumbitted how long did the approval process take. Thanks for any answers

I am still pre-op. I meet with the surgeon in June. The office coordinator told me that EHP can be a pain to get approval. Anyone else have experience with them? I can't afford self pay so its approval from insurance or no go. Trying to stay positive but also not trying to get over excited. Any advice would be appreciated.

Hello everyone. I'm waiting on my insurance approval. Paperwork was submitted 1 day ago, so now the anxiety has kicked up a notch. It's been an interesting process and I plan on being active and sharing what I can.

I am scheduled for surgery Feb 4th and am self pay. I am interested in knowing how many people go this route ? I took out a loan to be able to pay for the surgery. My surgery could be covered by insurance but there are so many loopholes and a 6 month waiting period. With having to meet my deductible first, I decided it was worth the difference to get the surgery NOW and not wait. I may regret this once I start paying the loan back lol but this is the decision I made.

what do you guys think about the process from start to finish ...from first request to finally getting to have the surgery?? i've had people tell me they had everything approved within two weeks ,to some people telling me it takes 3 to 6 months to MAYBE be approved. I have just requested for the surgery from my PCP and she set me up with the nutritionist and said I would have to meet with the psychiatrist as well and it may be 3 to 6 months to actually be approved

My husband and I went to our last appt yesterday, and we are waiting for the insurance company to provide us with an answer. I am sure hoping that we can have surgery before the beginning of the year. I wish everyone the best of luck on their approvals . Happy Holidays

Hello, just emailed my patient navigator at my Dr.s office and she's submitting my request today to Aetna. She said 7-10 business days, maybe sooner. . Wish me luck!!!! Im praying that I'm approved!!!

I have bcbs fep standard plan. If anyone else had this insurance, how much did you pay out of pocket?

They make it seem kinda grave, though. Its good for 6 months from now BUT if I back out I cannot request bariatric surgery of any kind for THREE YEARS. At that point, I would have to re-do all the requirements again. Phew! OK, good thing I'm not planning on backing out!

I have bcbs fep. Yesterday I got a bill from the anesthesiologist who did my EGD for over $900 bucks!!! Will I have to pay this before my actual surgery? I'm contacting the insurance to see why I'm paying so much out of pocket! Has this happened to anyone else?

Through my company's health insurance open enrollment, I have the opportunity to "buy-up" to a higher coverage plan for the next year. My surgery will likely be in late January or early February so the plan would be active by then. It seems like considering all of the associated costs it would be a better option. Both plans cover bariatric surgery, but the higher plan has a lower deductible and much lower coinsurance rates for surgery and hospital stays. I'm trying to determine if the increased monthly cost for the year will be worth the hospital and follow-up savings. Has anyone done this before? Was the decision to "buy-up" worth it in your opinion?

The director of my WLS office just called me to ask would I like to have my surgery done before or after Christmas . I couldn't believe it !!I had my last visit with my NUT for my supervised diet history on December 2nd . That was less then a week ago I thought the insurance clearance would take longer . I have Empire Plan BCBS of NY . I am so happy that I started to cry . It's been a long 6 months trying to get all the tests and clearances done . I can't wait to be in the other side of the losers bench !

Hi everyone. I was banded on 2/6/13 and am in the beginning phases of converting to the sleeve. I have Aetna and would like to find out if anyone has done this through Aetna and how the process went. Thanks! Jennifer

Hello All- I wanted to post this as a reminder and to be a positive story within so many insurance denials. I started my WLS journey in June 2014 with a seminar at the hospital where my eventual surgery will take place. At that seminar, I was provided a check list and a 10 page application to become a patient in the bariatric center. I went to my primary and asked for a letter of referral, a copy of a sleep study I had previously and wrote a letter myself describing why I thought surgery was the best option. I emailed all the info and my application to the center and received an appointment on August 6th to start the preliminary testing and pre-op diet required by …

I searched for MMSI when I was first researching WLS options. I wanted some information regarding their requirements and turnaround time, but I couldn't find anything. I've since been approved and want to share my experience. My particular plan covers 90% since my provider is in-network. There is no coverage for out-of-network. The requirements for coverage are to have a BMI over 40 or a BMI over 35 with one co morbidity, complete a psych evaluation, and attend behavior modification group. There was no supervised diet requirement. My paperwork was submitted by my doctor's office on July 31st, 2013. I received my approval on August 8th, 2013.

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, 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!!

I am on WV Medicaid, and started the process of getting my pre-surgery evaluations and diet started at the beginning of 2014. I finish my 12 month supervised weight loss in January. I am having my heart eval next week, my pulmonary eval next month, and my psych eval as soon as I can get it scheduled. I am also waiting for an appointment with my surgeon, Dr. Akkary. Does anyone here have any experience with WV Medicaid? I don't know what to expect re getting approved for the surgery. How long does it take to get approval? I have a BMI of over 60, type 2 diabetes, arthritis, and GERD, so proving comorbitites won't be a problem!

Hello everyone, I'm getting worried and I could use some advice. I attempted to begin the process to get the sleeve during the summer, but was told that my 2 year weight history did not show a BMI of 35 in 2011. About a month ago, a friend referred me to another surgeon who agreed to start the process. I've completed the Nutrition appt, sleep study, psych eval, stress test, and endoscopy all in the last 2 weeks! Whew! I have 2 more groups to go, one in November and the other in December. I'm so hoping that I can submit in January and get approved, but I'm so worried that my medical records will not reflect that I have a full 2 years of a 35BMI!!!! I have chronic high b…

My info was sent to the insurance company on sept 8th and I've been waiting. I decided to call today to see if I can get some info from the insurance company. They told me they're waiting for my case worker to send them 2 things that are missing and they need it before sept 16th by 12 noon. I called my case worker she said she got the info and to not worry that she will take care of it. I'm so scared to get denied and I hate the waiting game. Has everyone every experience this? How long do they usually take to approve?