Insurance & Financing

I just got a call from the doctors office. They said my insurance won't pay for the surgery because I don't have diabetes. Now I don't know what to do. My primary doctor told me that there is no way I can lose the weight without surgery. I can't afford to pay for it as I am unemployed and my husband is the only one with an income. I am so defeated and depressed. I don't know what I'm going to do. I just want to crawl in a hole and hide.

I had my psych eval on Monday and without realizing that she was asking these questions for a reason. She asked if I get lower back pain? And joint pain and how I am with stairs? Well...stupid me, I Dont get back pain and I Dont really get winded on stairs. And its hard to determine if all my joint pain is from my rheumatoid arthritis or the weight on top of it. I did tell her that I can't squat though! I realized now that she was kinda helping me out saying...well, you prob would be a little better w/o the extra weight and so on. So...I'm wondering if she's going to put in the report that I can still do that stuff and the insurance will see it and deny it?!?!

I got a call from my surgeons office saying they submitted all my paperwork and the ins company said I was terminated from my plan. I was livid! I work for a non profit in NH that has multiple facilities, I recently transferred to a new facility and there was an " error" swapping over my ins info to the new place. It's all taken care of now. But, I truly wanted to lose my cool on someone because I JUST had my last appointment 3 days prior lol I just needed to vent Thank you-

Does anyone have this insurance through an employer? If so, how did the aurhorization process go? Are they difficult to get approved for surgery by?

I am so excited! My surgery is approved!!!!!!! Now I just wait to get a date from the surgeon. Doing my happy dance!

HELP!! I've had to cancel my December cruise plans because I got a December 8th surgery date. Now I need to have my surgeon write a letter to the travel insurance company explaining why this surgery is medically necessary and why the surgery has to be done on this date, in order for me to get the remainder of my travel fees refunded (cruise line will refund half and travel insurance company will reimburse other half for "covered event.") Does anyone have such a letter they could share with me, please? My surgeon's nurse told me to let her know what the letter had to say and she would take care of it. I'm not sure just how much information needs to be included in the l…

So the doctor told me to give the staff the name n number of the bariatric surgeon so I need but than they told me they need the doctors IPN# and diagnostic code.. huh? Why does my pcp need that from the doctor I'm trying to get a referral to

I am so excited, received my approval for Lap-Band Procedure in less than one week!!!! Recently changed employers, so I have brand new insurance. This is my first experience with BCBS TX. Submitted request on Oct. 3, 2014, pre-determination completed and approval received on Oct 8, 2014. I'm amazed! I'm going through True Results in Houston, TX. Started the process on Sept. 17 (which was my 38th Birthday). I won't lie, I stayed on top of everyone involved, making contact with at least one party everyday, by email or phone. (Probably got on there nerves, LOL) It worked. The patient liaison said that she has never seen anyone get approval so quickly. The process so far…

Does anyone know another company that covers protein shakes besides ensure shakes? Need to know ASAP !!! Thanks in advance

My file was sent to United Health Care on Tuesday for my final approval and I have such a nervous, excited, stressed feeling! I absolutely have no feelings of apprehension as I know this is the best thing I can do for myself, however, I am very nervous and excited, all at the same time. I am so looking forward to the new year, new me and getting my life back. In preparation for my new lifestyle, I've institute the changes I can commit to. I've started going to my spinning classes three times a week again, which I used to do all the time before I gained all this weight. And, I did my first yoga class on Saturday. Let me just say, Yoga is not for the larger version …

My husband's insurance plan will not cover any bariatric surgery, even with co-morbities, so I am doing a cash pay VSG. Does anyone have experience with insurance covering complications AFTER surgery, hospital stay, post op office visits, etc? I mean, can insurance deny ANYTHING related to the surgery or just the surgery itself? I assume prescriptions will be covered so that's a plus at least.

I am looking for anyone who had their sleeve done at the Bariatric Center of Kansas City on 2nd floor. Can you tell me what you had to pay for the "facility Charge" and also the surgeon fee. I have Dr. Hoehn. Trying to figure all my up front charges. I have to pay 500 up front for my EGD, I have a 2000 dollar deductible with a total max out of pocket of 6000. can anyone help me understand how all this works, I am so confused. Thanks.

Did anyone with Federal BCBS take more than a week to hear back whether or not they were approved? I was told that my package was submitted for pre-certification on 10/3 and still have not heard back on if I was approved or not. Meanwhile, I was told by my Dr.'s office to start the two week pre-op diet on 9/30 and today has been two weeks of three shakes a day and one lean/green meal. Meanwhile, the Dr.'s office also told me it usually only takes a day or so for them to hear back. I'm hungry, anxious, and frustrated! I have a two year old, a full time job, and a need to know when to fly my Mom up, but everything is still up in the air and its driving me crazy

I am currently awaiting insurance approval... I have UMR United Healthcare Choice Plus. Does anyone else have this plan & how long did it take to get approval. Also when I called they told me that they had a surgery date of 11/7... this is the first I have heard of this date.. Does this mean that is when I will be having my surgery?

I'd like to call my insurance for an update to see if I've been approved. What information do I need?? I don't have to have a claim number, do I? My PCC sent out my paper work last week, and I'm getting anxious, so I'd like to call my insurance directly.

Has anyone used either in Mexico to help with expenses for the sleeve? I was exploring a Jan surgery in Mexico.

Hi all. New here! I've been lurking for a few days. I attended 2 different seminars recently to compare each Dr. Our insurance does have an exclusion on WLS so we are self pay. We have to have some up front and the rest the hospital will do a 5 year payment plan(which we will use some of our HSA to help cover cost). We are looking at 25-28k. The thought of spending that much money makes me cringe BUT it is my life, health, and I want to do it now while my kids are little! DH is on board with me but our only concern really is if 6 months after surgery something medical comes up and our insurance won't cover it because I had this surgery. Anyone have this issue?

I have ky WellCare and was wondering after the six months how long it takes them to approve

This was the easiest thing besides the fact that almost killed my nerves! But my surgery is officially November 10th!!

I filled out an application with OWLS and they said they aren't excepting OHP right now and want to refer me to legacy. I said ok, but I'm scared they won't except me. I have tried everything you can imagine to lose weight. I tried pills, drinks and sensa. I lost weight with sensa but when I stoppped it came right back. my BMI is between 52 and 53 so I believe that would approve me. I do have some minor to them health problems too. If OWLS said they didn't take my insurance does that mean I would have been approved if they did? I wish things were less complicated. Will I have to do the 3-6 month weight loss thing or wait for awhile before I can have surgery with my BMI so…

Woohoo!!! I am so excited to be a better, healthier version of myself. Don't give up or let anyone talk you out of what you want in life. I started the process last year and stopped due to some negative comments from people that supposedly cared about me. Never again!

if a second doc consulted, do they charge a fee for the consultation? has anybody on here changed doctors prior to surgery? thanks

This morning I got the call from BCBS that I've been approved for surgery!! It only took a week and a day to get approved. I can't believe this whole process from my first consultation to my surgery date is 2 months. Excited for 11/18/14..I'm ready!! ????

I called UHC to confirm if they had received my packet for the surgeon and the lady I talk to told me that they did and it was with the nurse department. She also told me that it look like the office sent in all the required clinical information and that approval only takes a week. I know that waiting is going to wreck my nerves but atleast I know it will not take 30 days like my insurance coordinator was telling me. My insurance plan has the 5 year weight history requirement but it doesnt have to be consecutive, that was the only requirement that is making me nervous since I didnt go to the doctor in 2011. But I am going to trust in the 7 years worth of documentation and…

I just got a call from my surgeons office seeing my surgeon will be out-of-state now on my surgery date November 6. I either have to pick a new surgeon or move my date to the 10th or 13th. To be honest the surgeons only met with me for like five minutes so far the appointments are really with everybody else in his staff. My thought is to keep my date. I'm just wondering if anyone has experience with the doctors and Kaiser South sac? If you can give me any input?

I have GHI and once your surgical coordinator sends all out your medical clearances from your PCP and all other requirements, GHI gives you a response in 5 business days. They are quick. Good luck.

Finally I was approved I have to see my surgeon on Oct 23rd to go over things and start the 2 week liquid diet. I'm so happy and nervous but glad very excited I got approved! Does anyone know what happens next? Is the liquid diet hard? Do they provide the shakes?

I have medicare and UMR. I have not met all of my UmR deductible and will probably owe 1200 dollars. My question is this. I will see doc at his office prior to surgery. Do i pay rest of deductible to him? if so, when i get to hospital and dr office not posted the deductible payment, will hospital ask me to pay the remainder ? hmm, if that happens, then i've paid twice.anybody else have this problem? thanks

I was one of the people who knew it was covered but didn't check how much it was covered. Now I am waiting on my date but will have a whole in my pocket for months. Don't let this happen to you.

My surgeons office submitted all my paperwork a week ago today. Anthem bcbs said it is still pending. The rep said on the bright side they have my surgery date of 11/18/14 recorded. I don't see how that is the bright side, that's only a date pending insurance approval, without that there won't be a surgery. Trying not to get my hopes up, although my surgeons office said I meet the criteria, and also trying not to get discouraged. I know it can take up to 3 weeks but I have heard that anthem bcbs has such fast turnaround times. Maybe I'm just not one of the lucky ones to hear back so soon. ????????????????

Hey all, I am currently finishing up my last couple doctor appointments and am curious as to,how long my insurance will take to give approval once documentation is submitted. Can any one that has BCBS share how long their approval took? I am hoping to have my band in by Christmas, but I've been told BCBS takes 60,days.

After my coinsurance my bills going to be over $15,000. After all the struggle leading up to my surgery here in a month I will have a massive bill.

So, I have made the decision to go forward with the process to get the Gastric Sleeve... I called and registered for the next seminar at the best local hospital (in my experience) and was told to complete registration paperwork and send it back. I was also told to call insurance to find out what is covered for bariatric surgery. I called my insurance and after the phone call I broke down in tears. I was told that it is not included on my insurance plan and is in the "exclusions" because my employer chose not to include it. I logged on to the United Health Care website after I got home from a meeting tonight and cried over this exerpt under the "Exclusions" heading... T…

Hello all. I have been doing this process for longer than 6 months. Today is the day that they submitted to blue cross blue shield. She said that they are really quick with approvals. I hope that is the case for me. I was hoping for the end of october but I guess I'll wait longer lol. Any one has blue cross blue shield? How long did it take to get and answer? Also did you get approved right away?

Well after VEING approved 9 months ago insurance changed the day after then denied by new Insurance then did the three months with the dr. Nut. And excersise specialist.. I have been approved!!! Wow I am still in shock!!

My file was just submitted to the insurance company yesterday and the Dr. office called and I was approved!! December 2nd is my day!! I have an appt. for my endoscopy at the end of this month and one class and some labs and my pre-op physical in November and then my 2 week liquid diet starts Nov 18th and I am on my way to the losers bench! So excited!! I hope everyone else gets approved this fast, I am blown away!

So after getting denied by Aetna for a "net gain" during my husband heart attack and triple heart bypass, I appealed....and was denied again. I don't even know where to pick up and start now. I sent in all of his discharge paperwork so they knew I wasn't just making excuses. And I'm not. I know I messed up. I know I gained. I know how to now fix this. But I'm lost on moving on to my second appeal. I'm depressed, severely. I'm miserable. My husband is ready to kill me I think. I'm crying all the time and I just wanted this for myself so bad. I know I have to get over my "pity party" and start fighting but honestly I feel lost, alone and just really down. A…

Hi All, So I've gotten the ball rolling slightly... but I've already hit a slight speed bump. I've given my surgeon's office all my insurance info in order for them to verify that my insurance covers the surgery... and the coordinator calls me today saying that my insurance covers the procedure, and that the doctor/hospital is in Network, AND they're a center of excellence... However, she says since I have EPO I'm also a part of Pathway X Tiered? And my doctor doesn't have a contract with them? The coordinator told me sometimes they can work around it, so I'm just waiting for a call back from her. Slightly bummed out because if it turns out I can't get the procedure …

Hello after many months of preparations, dieting etc my surgeon submit papers for surgery request, insurance denied, I call insurance and they told me it's because it's missing clinical note, surgeon told me it's because my insurance doesn't cover gastric sleeve. Only lap bad and gastric bypass. I have military tricare west. Any person here has same problem? Should I do the bypass instead? I think sleeve is less invasive.

Hello, I am in the process of started my visits and i am wanting to know what is deemed medically necesssary per title 19? I called the customer care and I was informed only my provider can request that information? If anyone can help me I would appreciate it??

I received my approval letter from Aetna in the mail today. It has an inpatient services date of Nov 5th on it. Is that the day my Dr. Office would have submitted for surgery? So far all the Dr. Office has told me after they were given verbal authorization is that the coordinator would call me to schedule a date........and I haven't heard from anyone since last week when they first told me I was approved. Anyone else get an approval letter with an inpatient date on it? If so, is it the same as your surgery date or is it just a random date the insurance company puts on the letter? (It would help if the surgeons office would return my calls but for whatever reason th…

Anyone had experience with Qualcare? I'm waiting to know if they are going to approve my revision from band to sleeve. Not sure if three trips to the emergency room will count since its been over several years.

I completely all of my pre-op insurance requirements today and the women at the doctors office said she was sending everything in around 330 today. Which means now we wait to hear back! Gosh the waiting may kill me- how's everyone else doing? Anyone in the same boat? Also how long did it take you to hear back from the insurance company?

I have UHC choice plus. For some reason, UHC will not give me my plan's requirements for WLS in writing, only over the phone. I have spoken to them many times, and they insist there is nothing they can send me. I just saw my surgeon for the first time and we are trying to set up a plan, and they seemed surprised that UHC would not put it in writing. Its important (among many other reasons) because I was told I don't have to have the required 6-month supervised diet. Has anyone had a similar experience? Any solutions?

Ok so I've met with my nutritionist once so far. I had gained 4 lbs when she weighed me from the time I met with the surgeon at 284 and she weighed me at 288. My question is will I automatically be denied from that initial weight gain? If I'm able to lose that weight by my next visit, which is on October 16, and continue to either lose or maintain that weight will I not be denied. I'm just getting really worried over that initial gain. I also think it's a bit ironic that the very thing we're getting surgery for could wind up denying us the surgery that would help alleviate that problem. Ugh, oh well, please if anyone has some info about Aetna and all this please respond! …

I have had medicaid for the past 4 years. Started the required 6 month supervised diet and exercise in April. I have jumped through every required hoop and completed every test except next months weigh in...and I just found out that I will no longer be covered by Medicaid starting Oct. 1st. I am just crushed. I don't even know where to turn next. Self pay for me would be $16, 800!

I was banded in 2012, had lost almost 75 lbs. at one point. I'm now at a total weight loss of 57 pounds. Ever since my surgery, I have never really done well with solids. I didn't wrooy about it at first cause I was losing but then, my weight plateaued and I gained a bit then plateaued again that I began to get concerned that about 90% of my diet is liquid. I got sick of Protein shakes so occasional ice cream shakes and sodas came into play (thus the weight gain). But, the main problem is...when I try to eat solids, even healthy solids, I am in the bathroom getting rid of it. Finally heard from the dr. that my body produces too much digestive mucous/juices too fast and …

I had my first consultation 9/18/14, did the blood work met with the nutritionist twice and my surgeons office submitted my paperwork today! Surgery is scheduled for 11/18/14. Anthem BCBS gave me my claim number to follow up with, let's hope I don't have to wait long for a "yes"!

I have Aetna and it took forever to get approved. Approval finally came through verbally and I received the letter yesterday. The approval letter is for a band when I am getting the sleeve. I initially wanted the band but changed my mind half way through the process. Does this mean I need to resubmit? I am BEYOND frustrated. At first the insurance package wasn't submitted in full and now I am approved for the wrong procedure? I dont want to point fingers but I am super organized and had everything in order. This is also not my coordinator's first time at the rodeo so I'm not sure what the deal is. Does anyones know if we are going to have to back to the approval drawing…

All my info was fax to my insurance company on 9/8/14. Does anyone know how long it takes to get a response? I feel so nervous and need some advice