Insurance & Financing

I keep telling myself just sit back and let the professionals do their job and be patient, boy is that easier said than done, I find myself thinking about it almost 24/7. I think while I was meeting with my dietitian for the past 16 months I wasn't no where near anxious and so ready, now that I have finished that and the referral coordinator is submitting my paper work I am so inpatient now. I really need to find peace and just relax. I sure hope I don't have a long wait, I hope the coordinator has submitted it. Alright gonna try my best to just forget about it and find something else to focus on, because stressing over it won't make me hear anything any quicker.

I just received the phone call from insurance and I've been denied. I have anthem BCBS, a bmi of 35.8 with moderate sleep apnea. I've been told my surgeon is going to do a peer to peer with the insurance company but wondered if I have any chance whatsoever of being approved. I wish I'd been told initially to forget it but now I've jumped through all the hoops only to receive this devastating phone call. All pre-op testing was completed, all pre-op appointments are scheduled, surgery is scheduled for 3 weeks from today, protein powder is purchased. Any input or advice is welcome. So very disappointed.

I currently have UHC Community Plan of Ohio and I am having trouble figuring out what the requirements are. I have called the insurance company several times myself and all I can be told is medically necessary and that I have to do the 6 month diet. My PCP and Surgeons office called and thats all they were told, medically necessary, and a 6month diet. I have been going to a weight loss program since July and I have completed all of the requirements on their end and the surgeons end. I just have to meet a few more times with the dietitian and nut and pcp to complete my 6 months. My last weigh in is in December. After that, they will submit an approval for the surgeon. …

What a strange pickle I'm in! My surgeon warned me that if I lose too much between now and my projected sleeve date in December (still waiting for approval letter to set the date), I will drop below the minimum BMI required by my insurance. Has anyone here been qualified at first weigh in and later denied for losing too much?

I have my last visit for my 6 months of weigh in/ diet documentation on December 16th, I'm so excited. Afterward my surgeon office will schedule my 4 hour pre-op class then they will submit authorization request to my insurance. I was wondering once the auth was submitted to your insurance how long did it take for any of you all to get a surgery date? I was really hoping for surgery in December but it sounds like it may take a little longer. Thanks

I need HELP I have bcbs of tx through my employer and was told there is an exclusion for weightloss surgery. I actually found a doctor that does surgery for people who have a hiatal hernia and the out of pocket is not very expensive but the coordinator tells me my insurance does not cover hernia repair either. I refuse to give up just looking for some advice is there a way around this?

Is there a site where I can go and check my Medicare to see if they have approved my surgery, or is that something you have to wait and here it from either a referral coordinator or the surgeons office? If anyone know please fill me in, I wanna see if they have a site where you can view their decision when they make one

I'm in pre-op stages and hope to have surgery in late October/early November possibly. I'm on my husband's insurance plan (Blue Chip/MA), which is much better/cheaper than my own company's insurance. However, he'd really like to change jobs early next year. After the surgery is done and insurance has paid for the bulk of it, I can't really see this being a problem. Obviously I'll have to see if my surgeon is on the new plan, but just from a surgery coverage perspective, anyone see any problems with changing after it's all done?

I am extremely upset. I got denied. I got the call from the insurance coordinator this afternoon. I asked her what we do from here. She said she is going to talk to my case manager and surgeon and see what they want to do and see what my potions are and she will call me. I'm so mad. She said that basically family history doesn't matter (as far as insurance is concerned) and that my pcos doesn't qualify me either. Ugh I'm so frustrated!! AND to top it all off, I'm only 20 lbs away from a bmi of 40. I'm definitely appealing because I can't afford this if insurance doesn't pay. I am completely devastated. I really don't know what I'll do if I can't have the surgery. Advice o…

My PCP wrote a letter of med nec and has prediabeties as the comorb... Has anyone had ins approve with just this? I dont have anything else as comorb, and BMI roughly 36-37. I only have 2 more weigh ins, every other test was completed and passed. I just dont want to get to the end and them deny because its not full blown diabeties yet.

For sleeve gastric?

I just got back from my first visit/consultation with the surgeon. Soooooooo much information, but I'm more relieved after each step of this process is done. Step 1 - meet with PCP and get referral Step 2 - consultation with bariatric surgeon I can't wait until that list of completed steps gets longer. For anyone else just getting started, here is what my first visit was like. Filled out paperwork (does it ever freaking end?!) with medical history, symptoms, diseases, etc. Then the nurse took my BP (which was high, since I was nervous for some reason. It's usually not high at all.) Then an associate member of the bariatric staff came in with a deeper dive int…

High all!! I'm looking for anyone with any experiences with Health Net through Medi-Cal or just Health Net in general?? I am in the process of trying to get approved for the sleeve but I would really love to gain some more insight on what Health Net's specific requirements are as I am trying really hard to get approved on the first try. I'm sure I fit the criteria-265 lbs, bmi of 46, high cholesterol and triglycerides,early on set of diabetes and possible sleep apnea. The one big thing is,I have been overweight since 10 and dieting on and off since 13 BUT I have never been on a medically supervised diet until now!! And while I know that I am telling the truth about trying…

does anyone know the policy and procedure to have approval to receive the sleeve surgery through Medi-Cal with the health net ?

Is being eligible for the service of gastric sleeve, the same as being approved? I got a call from my surgeon's office letting me know I was approved for surgery, and now just need to complete their requirements (pulmonlogist visit) before I can get a date. I recieved a letter copied to me, that my surgeon recieved from the insurance company saying I was eligible for the services. Was just focused on that word "approved" so was wondering if that meant the same thing! ha ha.

I just got denied because they are not accepting my BMI of 37 with my illnesses because they don't fall into their list of approved comorbits. I have fibromyalgia, osteoarthritis, Sjogren's Syndrome, Relapsing Polychondritis, gastroparesis, and degenerative disk disease. But because I don't have high blood pressure or diabetes, I'm not "sick" enough. My doctor is going to do a peer to peer. I'm just wondering if there's ANY chance of getting approved?

So my insurance bcbs federal, says I need to show 2 weight loss steps that were medically supervised with in a year of surgery. Help !!! What qualifies, I did phentermine but that was 15 months ago and only lost 4 lbs

Anyone that has Aetna, does the Medical Director review the pre cert prior to approval or if they are going to deny you ? Ive heard that the only reason they send it to the Medical Director is because they are going to deny you ? Can anyone give feedback.....

Anyone in Florida?

After thinking about it long and hard, I finally started my journey for revision from band to sleeve in June. I finished all my requirements which was a nutritionist and nut evaluation in July and after getting clearance from various Dr's about my results of blood, eco, fitness and EGD my paperwork was finally submitted to BCBSIL by my Dr office in August. I did have to constantly check the status with my Dr office and BCBS to make sure all was submitted and received, good thing to do because once BCBS received my paperwork, I was approved but it took days for the letter to get generated by the predetermination dept. I was told that it only takes 1 day for the letter to …

I am new to this app. I am married to an active duty Army soldier. We are stationed at Ft Stewart GA. I was approved for the sleeve on post however the surgeons are deploying in May and do not have anymore slots until after we pcs in Oct. Problem is we don't know where that will be yet lol. I was wondering if I could get a referral for off post in Savannah and have our insurance cover it for the sleeve? I've gone through all of the steps to have it. Even the EKG that can be done again on post for free if need be. I don't know who to turn to. I really want to have this done before my husband leaves for Recruiter school in July 2014. Any help is greatly appreciated.

Hello all, I want to get this surgery and don't have insurance yet. I want the zero waiting period, the zero months supervised diet before the surgery. Does anyone have a personal (not through your employer) plan that requires no diet? If so, can you please tell me the specific name of your plan and the three letter alpha prefix at the beginning of your member id? Thanks in advance for your help!!!

My insurance (AHCCCS - Mercy Care) requires BMI of 35+ with 1 comorbidity. My BMI is over 36, but I am unsure if I have any comorbidities. My PCP just had me do a ton of blood work yesterday (liver, kidneys, diabeties checks, WBC check, etc etc etc). This surgeons office has a list of comorbidities.. Which, according to that particular list I have about 3 or 4 of them (anxiety, depression, back pain, migranes, headaches etc). Has anyone been approved with issues other than the typical sleep apnea, diabeties, high blood pressure, etc??? (regardless of ins co) I have read a lot about the NO weight gain thing. I have been seeing a nutritionist, eating right, exercising…

Hello All, I am nervous nelly right now but wanted to share my good news. I have completed my 6th months program. My papers were submitted on Jan 15th. Nut stated it would take two weeks to get a decision and sure enough I received the approval on Jan 29th. I am now scheduled for a consult with surgeon on Feb 13th with Dr. Liao at GBMC. This process just got real! Hoping all goes well.

Ok im freaking out right now!! I got all my bills (or so i thought) after surgery and the total of what i owed was $350. I have the wonderful Federal BCBS basic insurance that pays 100% for participating providers. Then just today i got a bill for the assistant surgeon and I have to pay $2500!!!! Because he's a NON-participating provider. Well i specifically asked the surgeons office if he was a BCBS participating provider beforehand and was told yes he was. What do i do now??

Yesterday I was called by the suergon office and they informed me that I need to pay 640.00 before my procedure to the doctor. Addiction to that I may need to pay the hopsital. Did anyone had to pay a large amount of money before your procedure? I wasn't expecting to lay anything before the procedure just after. I have Blue Cross Blue shield. Any information will be appreciated.

I so frustrated!! Paper work sent Monday called insurance Tuesday not in system. Called Wednesday it was pending. Called today...denied! But the insurance gal said I was denied Monday! How can it be pending after it was denied? She said didn't your dr. Call you with the reason why it wasn't medical necessary ? Of course I said no. Called my dr and of course they were closed! Why oh why can't it work put?

Hello, everyone In all my reading on here, I can't quite put my finger on one thing, and I'm sure each person's insurance works differently, however - who actually gathers and submits the information for this surgery request to the insurance company? Is it the bariatric team performing your surgery? Or do (did) you do it yourself? My first appt. (consultation) with the bariatric surgeon is two weeks from today, but in making the appointment, the nurse who answered the phone said that my insurance is one of the easiest to deal with, so that made me think she is familiar with the entire submission process and obtaining of approval. So I got to wondering if they will…

My insurance requires that I do a 6 month medical weight loss plan first. My first appointment is this monday. I was wondering if anyone else has gone through this and if after the 6 months they do the surgery even if there is weight loss? If so then why do they recommend you do the 6 months first?

Did anyone who has Cigna gain weight while they were seeing the nutritionist and waiting for incurance approval? I had my first nutrition apt at the beginning of November and my last one will be in February and my weight has fluctuated the entire time (up and down). My BMI is 43 and my coordinator or counselor has not said anything to me about the weight gain and if this would be a factor in my insurance approval. I look up Cigna's policy and I don't see where it says anything about this. Anyone else have this situation and can let me know what their outcome was? Thanks!!!

I see lots of different insurances but no one with Health Net.... anyone ??? I'm so nervous. I thought my insurance approved my procedure hence the 6 month process. what I'm hearing is I'm doing this process in hopes that insurance will approve?? Guess I need to check in with doc.

Dr Cost $1,157 Hospital(after Insurance) $2,246 Anesthesia(not sure they really didn't want to answer any questions) $1280 1st hour, $450 ever hour after I had seen a few people with GEHA who had only paid $2000-$2500 so to be figuring these costs is kinda catching me off guard.

Does anyone know the requirements for surgery? I called BCBS and the rep said i needed to speak with a prior authorization nurse and my MDs office needs to send them some info. I advised the rep that i haven't even discussed this with my doctor yet. I wanted to know what the requirements were first. I don't want to go through all of that if I would be denied. So after that long phone call i still dont know the requirements.

Does it pay for revision surgery to RNY

Does anyone know if you can use an HSA account for surgery in Mexico? It works just like a regular bank account. We have a credit card and a checks in order to access the money in the account. As far as I know, we can use it for any medical bills. However, I am not positive about using it for international surgery. I intend to contact our tax guy this week, but I thought some of you may know. Thanks!

I have been waiting for quite sometime for surgery approval. Anyone with the same insurance experiencing the same? Thank you!

I was just wondering if anyone else has Medicare. My doctor's office has said they don't have to submit for preapproval, Medicare will automatically pay for it. I am kind of nervous about that. Anyone else???

I am waiting for the papers are being submitted and waiting for approval so then I can have my psych eval, and meet with a surgeon. I declare the wait on the paper work and approval is torture, but what can we do, nothing but wait and be patient, although the patient part is not that easy, I wish I can remove it all from my mind until the answer comes in, that will be less stressful

Hello I have CareFirst BlueChoice which is out of MD. I am based in NC but have insurance through my employer who is out of MD. The insurance falls under the umbrella of BCBS. If you do have them, what was your success rate with an approval and the time frame? Thanks in advance.

I have KY Medicaid with my MCO being Anthem BCBS. I was required to do a 3 month diet as well as a few other things. The criteria they stated was 35+ and 1 or more comorbid OR 40+ with no co requirement. I fall into the second category. We completed all requirements and submitted the paperwork. They denied me! They stated a Medicaid change now requires all to have a co regardless of bmi which is not true. My doctors office contacted Medicaid directly to check on this and got confirmation nothing had changed. We are currently appealing. I'm so frustrated I could scream. Time seems to crawl by while I'm waiting.

Just curious... What are some common reasons people are denies WLS by their insurance carrier?

Has anyone switched doctors during this process? My current doctor messed up my appeal that they submitted on my behalf. With open enrollment I am switching insurance so I have another chance and want to switch doctors. Has anyone done this? I'm so frustrated with.

I have both Insurances Medicare and Medicaid, my paper work for a referral is just being done for a approval, then I was told have to have the psych eval. I've already met wit a dietitian for the past 16 months. So after meeting with the psych Dr. and if he clears me does the rest go kinda fast to get to the surgery point after that? Please I am open for all advice from the ones whom already made it pass my point...Thanks

I have Cigna and am looking to switch from the ban to the sleeve. Anyone else with Cigna have this done? I had Tufts when I originally got the band and I'm worried that Cigna will not approve. I'm going to meet with the surgeon today. I was banded in 2008 and lost 70 pounds but have gained most of it back. I've been experiencing on & off pain for the past year. I did the barium swallow test a year ago but it looked like the band was in place. I don't like it - don't like that 'stuck" feeling - I just want to feel full. I was doing great until the band was too tight and waited a year before having some saline removed. By then, I was back into oldbad habits.

Well yesterday, Monday October 20th, my surgery center sent all of my paperwork in!!!! I am nervous and excited at the same time. But the 'what if's' are cluttering up my brain. What if I did too well on my Dr supervised died and they say no? What if they say yes?.... Since I began this journey I have been extremely cautious in how excited I am towards where I could be in a year with the surgery so if I am one of the unlucky who get denied I won't be too upset, yet if they approve... Oh my goodness where could I be with my health in just a few short months!

I guess I'm not very well educated about health insurance. I've met my $1,000 deductible, my max out of pocket is $4,500. So I'm assuming ill need to come up with $3,500 before my surgery in 2.5 weeks!!! My dr. Office hasn't brought any of this up!!!

Does anyone know what will happen if you switch you insurance right before your surgery is scheduled? I was approved for surgery by my insurance company. They told me I was when I called a few days ago (but my doctor has not called to tell me yet.)They said that the surgery was approved for December 2-9. Unfortunately, because of the new healthcare laws we need to change our policy, although it will be still be with Carefirst Blue Cross Blue Shield. Our current policy ends the last day in November. Anyone know the answer?

May 2014 I attended a bariatric information meeting. Started the 6 month physician assisted weight loss requirement for insurance. Completed beginning of Oct. Paperwork submitted to Cigna 2 weeks ago. 1 week later found out I was temporarily denied because they are requesting a letter of medical necessity and medical clearance from my PCP. Informed my PCP who stated she would submit letter (all before my surgeons office had any idea I was denied). Surgeons office stated they would call me Monday (yesterday) with a status to the resubmission (assuming they receive pcp letter in a day or two). I've sent 3 follow up emails since last week and last one stated to please let me…

So I'm reading a lot about insurance not covering the total cost of surgery. My evidence of coverage only states $100 per admittance copay for inpatient. Does that mean that's all I'm going to have to pay? Or am I going to get stuck with thousands of dollars owed? No one has told me about any costs, and I'm already approved and scheduled!

For anyone that has Cigna insurance....... how long did it take to get approval???? I am on day two of waiting and just was wondering.