Insurance & Financing

I participated in a webinar last night and decided to go with that Dr. He was very informative. I've gone to others before, but just kept putting it off. I really wished I had done this last year, but I kept telling myself that I didn't want to wait 6 months and I figured I could get the weight off during that time. Well I haven't made any progress on my own so now and its been a year so now it's on. No more procrastinating...its time to put my foot to the metal and complete the requirements. I'm a very impatient person. I have AETNA and they have a 3 month or 6 month program. I want to see if I qualify for the 3 month program...not sure of the difference. Just m…

Did BCBS pay for any if your pre-op tests? They declined all of mine which has cost me $6000.

I have standard Federal Blue Cross Blue Shield in Arkansas. I have met all my requirements, have BMI of 42 with co-morbities of obstructive sleep apnea and high blood pressure. Have completed all my prerequisites except I have one more weigh in on Oct. 11 to complete the required supervised weight loss. Have pre-op appointment on Sept. 30 and gastric bypass scheduled for Oct. 20. Here's my question... the insurance says must have "diagnosis of morbid obesity for a period of two years prior to surgery." The year 2013 is not a problem but I don't know if they will count 2014 since the year is not finished out. If I can have my surgery before the end of the year it will not …

I am so excited and nervous at the same time. My surgery is set for October 7th! Yay!!! I am ready for for my new beginning. Any tips on vitamins and hair loss? I am very worried about the hair loss and how bad it will be.

I'm going to have to switch insurance companies before 1/1/14 and I'm leaning towards Amerihealth. I know that they cover bariatric surgery, but does anyone know what the full list of requirements are before submitting for approval? Thanks in advance!

Hello all. I have an Aetna plan which does allow for the Bariatric Surgery. I completed all of my requirements including my 4th Nutritionist visit this past Monday 8/25. Needless to say, I was overjoyed because my paperwork was about to be submitted any day now. Much to my dismay, the insurance coordinator at the Bariatric surgery office called me to tell me he was missing the paperwork from my Physican which shows that I was seeing him in conjunction with my nutritionist visits from (May 2014-Aug 2014). I told him that I was not aware that this was needed. He said it was on my Pre-Determination Checklist and we discused it back in April. I referred back to the checkli…

It took a little over three months from start to finish. I had to wait to see their dietitian so I paid extra and went to the dietitian and phyco eval at my dr center. Total my out of pocket costs were only 300

So I reached my lifetime maximum for my sleeve procedure about 1/2 way through last year. I'm scheduled for my 1 year follow up and at this point neither the appointment nor the labs will be covered. Basically no follow up care will be covered ever again according to BCBS of KC. Seriously? I'm thinking about cancelling my 1 year follow up entirely. My Dr. is no longer with the practice, so I have no idea who I'll see, I was checked 6 months ago and labs were perfect, I continue to take my supplements as directed. I'm in my goal range and maintaining nicely. Thinking this can wait for my yearly physical in 6 months with my regular doc when the labs and the appointment …

Has anyone used Medicare for WLS? If so, what were the requirements? I have Medicare with BCBS Federal as a secondary. I was told I need to take a 3mth medicare weightloss class through my surgeons office. Is anyone else familar with this class?

Has anyone ever used vocational rehabilitation to pay for surgery. I am self pay and unable to get financing and my bariatric center suggested this program to look into. I am already employed and nervous I will say the wrong thing when I call as this is my last hope and will be devastated if I can't get help. Hoping someone can give me some info.

does health first ny require a 6 month supervised diet im trying to find out but i cant find any information on it

I was approved for surgery and have to go see my surgeon on Oct. 23rd for a following up and start my 2 week liquid diet. I'm so happy but feeling nervous and wondering what's ahead. Any advice? I'm only 5 pounds away from my weight goal. I'm feeling so many different emotions right now. Someone please share their experience.

Hi, I hope you can help me choose an insurance plan that will allow me to undergo LapBand surgery without requiring a 6 month waiting period. Luckily, I run my own small business (very small business, actually, with one employee) and I have the freedom to choose most insurance plans (either a business group plan or individual, depending on which will net me the best coverage). I haven't selected my 2014 coverage yet because I have spent the last 2 months researching WLS options, surgeons, and financing and was afraid of locking myself into the wrong plan. None of the insurance agents I contacted were helpful. The most they could tell me was to contact the prov…

Hi, So I finished my 3 month pre op. The dr office called me today and said that most likely my insurance will not cover the surgery since I had gained 17pds.. I am devastated!! I explained to them that I had been taking Phentermine for over 3 years and as soon as I stopped taking it I have gained like crazy!!! I feel like I have changed my eating habits.. At times I feel like I was starving yet I still gained??? I am frustrated at this point. I was suppose to have surgery next Friday September 26. But the lady at the doctors office said she is most positive that my insurance will deny it. Has anyone had this problem where they gained weight while at pre-op and what di…

I have been searching and searching for info from others who used UHC and never really found the answer. Now that I received an answer from UHC thought I'd share. The situation: Lap Band self pay in 2007. It was a fail and caused many issues (sliming, puking daily, no weight loss). BCBS paid for removal in 2012. JPM requires the 6 month diet plan. I do not have this documented as I was working w/ a trainer (doesn't count). IF UHC would approve as a revision instead of a new WLS all pre-op requirements would be waived. I do have sleep apnea as well. Met with surgeon begin of Sept. Insurance submitted by 09/12 and APPROVAL received today 09/24!!! Drop the confetti peopl…

Ok so my surgeons office has a reputation of not getting things submitted to insurance for approval in a timely manner. Does the surgeons office have to submit it? Can I submit my own request? I have BCBS of KC

My sleeve surgery was scheduled for today, Wednesday, September 10th. I started my process three months ago. Met with the doctor, went through all the necessary paperwork and doctor visits, etc. Everything had been cleared and ready to go, or so I thought. I received a phone call from my doctor on Monday telling me that my insurance does not cover the surgery! MONDAY! Two days before I was scheduled to go in the hospital!! Needless to say I am absolutely devastated and depressed! The reason they are giving is that I have no health problems other than my excessive BMI. Even if this is their policy, the fact that my doctor is just now running my insurance through…

I've been reading a lot of comments saying that hope your employer purchased a waiver. What is this waiver for? What is it?

My insurance approval letter (BCBS) came in saying that I was approved for surgery and then there was a date in a right hand column beside it that says 9/22/2014-9/23/2014. What is this date for? My pre-op appt is on the 23rd, but my surgery date is 9/27. Does this need to be addressed?

Please be advised that review determinations can differ dependent upon the type of service rendered and the condition of the patient. It appears that your review was partially approved on 09/15/2014. Authorization number A00781536 states the review was approved for the Gastrectomy, but not approved for the EGD to be done at the same time. The Provider was notified

Yes, that is correct~ I have a $1000 "Co-Pay"! NOT "deductible" that is separate. NO, it does not go towards my maximum out of pocket either. I have been saving our Flex benefit card to use on this. However, that stinks also since we have only been able to contribute $2500 a year towards Medical Flex benefits last year and this year, compared to $5000 previously. Even at that we would run out by the end of July. I'm just curious if any of you have anything similar?

Has anyone gained weight from depo while on supervised diet?? I follow a strict nutrition plan, ecercise etc but keep gaining a lb or two a month. The nutritionist and dr both agree its from the depo. Im no longer going to get the depo shot. Im just scared ive gone through everything to get denied because of this.

I'm new to this my doctor told me I'd benefit from gastric bypass surgery being that my BMI is 57.6 347 pounds , I went ahead and called my current insurance company to see if I could get it done they said bit needed to be authorized. Now the office that I found was in Clifton no , so I called to change insurance from united health care to amerigroup has any thing similar happened to any one else please let me know currently I am waiting for my new insurance cards but with them I now have to change doctors because my doctor doesn't take amerigroup any help would be appreciated thanks

I was approved through medicare I was contacted by the patient coordinator I just wanted to know do they scheduled all the appoints for me or do I have to do them on my own this is new to me im confused and anxious at the same time I just cant believe that they answered back so quick

It has been recommended to me and I keep hearing this pop up that if my Dr. does a scope prior to surgery and finds a Hiatal Hernia that I may receive some assistance with insurance. Just curious if this has happened to anyone out there. I have Blue Cross and there is a specific exclusion in my plan for bariatric surgery. I had a surgeon tell me he has seen some patients save up to $4,000 after discovering a hiatal hernia. TIA

Hello I am wanting to know if I am wasting my time and hoping for nothing....Do any of you know if Medi-cal will approve the sleeve procedure? Does medi-cal even cover any wls?? thank you for your help.....

Does anyone know if Cigna requires 3 or 6 months of diet before approving? My insurance says 3 months, but my doctors say 6 months?? So, so confused!

Okay so I called today to make sure the person handling my case faxed over whatever they claim to be missing. The insurance told me they received it and that my case is pending and it can take up to 14 days my things were originally send on the 8th of sept so hopefully soon or on the 24th of sept I'll hear some news the waiting game is so annoying but nothing worth having comes easy in life I started my journey this year and I'm staying positive

Ok so i am over weight majorly actually clinically obese:/ And i want to get the lap band surgery. When i turned 18 last march i looked into it deeply, In order for my medica to pay for it i had to go on a 6 month supervised diet etc so i did now i go for my appointment for a EGD this Wednesday. So basically im out of the woods and i know the surgeon will do the surgery. BUT i still don't know if my medica will pay for it, i wont know until i do all the tests i have to do first. I read they will accept if it will help my medical problems etc. I also read that if you have sleep apnea they will accept because of that. Well heres a list of medical problems i have and meds th…

I'm crying tears of joy! I was originally set to be sleeved on Oct of 2013, but because I had started a new position it didn't happen. I will admit I was angry with myself for not going through the first time since it would have been self pay. Six months after starting my position my coworker informed me that our insurance covered the procedure, and that's what started my six month weight loss supervised journey. In a way I feel like I have been given a second chance. I'm ready to take that journey and rediscover myself

Sorry for the length! Hello everyone. I'm a newbie, this being my first post, but have been lurking here for a few months. I truly appreciate all the invaluable information you have provided to people like me who are just now entering into the whole process. I thought I'd share with you what I learned yesterday when I went to my first Kaiser Permanente Options Program orientation, as far as the hoops you can expect to jump through towards obtaining insurance approval in my area of the world. I am in the North County area of Southern CA, about an hour from San Diego. My first step after confirming that my KP insurance plan covered bariatric surgery was making an ap…

Okay, I'm not insurance Savvy. I thought Blue Cross was Blue Cross but the surgeons office said I have Blue Shield of CA. Does anyone know where I can find their requirements? I apologize if this has been asked before. I called and said I was approved but forgot to ask what my requirements would be.

Got an email yesterday afternoon from surgeons office. They submitted paperwork on Thursday and the insurance company called yesterday and approved me! Surgery September 24th!!

I am in the beginning phase of my surgery I have done the seminar and spoke with the patient coordinator. I have Cigna insurance and would like to get my surgery real soon hopefully by the end of the year.. what wording is needed to get the help i need for approval..

Hi, this is my first post:) My employer is a health insurance company that started covering vsg for employees only. Upon completion of a 6 month nutrition program participants can get the surgery covered. I finally decided to join the program and to my surprise there is a waiting list of over 150 people now. The program will only allow 10 people to join per month so i could potentially be waiting a year or longer to even start the program. Locally vsg would cost me $15K selfpay. My husbands insurance is Anthem BCBS (of which i am not covered). Tomorrow i will call and see if bariatric is covered. Open enrollment is soon so if so i will get coverage depending on if i…

My drs office told me today that I have to finish paying my deductible, AND pay the up front drs charge. This vill be over $4,000 for me. This has to be paid before my surgery. Is this a common thing?

My husband and I have just recently gotten married. I am currently on Tricare Standard because of being out of network for North/South etc, and I am still living at home until the end of the year and not currently with my husband. I meet all requirements in BMI and have PCOS. Does anyone know if I should run into any problems being only through Tricare Standard for the roux en y surgery? Thanks

BCBSAL is my insurance and it covers 80% of the surgery, surgeon, tests and hospital. Quilifiers are the usual, High BMI, serious health relates issues and 6 month medical supervised diet - which I am on my second month... I can't wait! I am a single mom and naturally I am trying to plan as well as possible the costs of my surgery. I know hwo much my surgeon will cost, but I can't seem to find out the cost of the hospital, at Mobile Infirmiry. Anyone here has any idea of how much does Mobile Infirmiry average cost is for about a 48 hour stay/surgery? Naturally, I know it could be between 15,000 and 30,000 and it depends on how you do, if there are complications... Just…

I just started this whole process (2 months in) and my insurance requires 6 months of weigh-inns before I can get the band. My question is during these 6 months does the insurance look for weight loss or it doesn't matter it's just checking your weight? (Don't know if this is a stupid questions but thanks for any help

So I just got the news that CIGNA is denying my WLS due to a pre-existing condition. I am not aware of having any pre-existing conditions unless they count being obese. The surgeon and program I am going through checked to make sure I was covered before I started the 3 month diet and appointments with NUT/ect and cigna didn't say anything about a pre existing condition then. I am confused and upset. It feels like medical insurance will do anything to not cover what they say they will cover. The doctors office is trying to get more information for me to see if we can fight it. I am pretty frustrated right now. Anyone else have this issue?

I'm interested in finding out about how people actually pay for their surgery. Anyone willing, would you please indicate the following: 1. Surgery type (RNY, Lap-Band, Revision, Sleeve, etc.) 2. Self-pay, "government" program (ie, Medicare, Medicaid) or private insurance 3. Amount billed (grand total, not itemized!) 4. Amount YOU personally paid 5. Geographic location (either region or state) 6. If you had insurance, did it cover bariatric services? I'm curious what percent self-pay versus those who have insurance & those with insurance, but no bariatric coverage. Thanks in advance for anyone willing to participate...I'll be happy to post the res…

In 2009, I had a lap band inserted, a procedure that was covered by my insurance carrier, Blue Care Network. Five years later, I've lost and maintained a loss of 40 pounds. Still significantly overweight, in December, I started steps to get my band revised to a sleeve. Prior to beginning in earnest, I contacted my insurance company (BCN) and was told that a revision wouldn't be covered because WLS was a once-in-a-lifetime benefit. I called back and spoke to someone else at the insurance company and was told that wasn't the case. So long as the procedure was deemed medically necessary by my surgeon, the insurance company would consider covering it. I called a third time; s…

Doctors office submitted my paperwork to insurance today. I know this wait is going to kill me! So I was just wondering, how long did you wait for approval from BCBS Federal (basic)? Did you call customer service for status updates? If so, how often?? Thank you!!

HI! so my suregeons office submitted everything to my insurance and I was waiting on "THE CALL" however a few days later my surgeons office called me and said that they did not know home depot had like a clause where I had to do a 3 month weight loss program . I had been to the nutritionist in feb and 2 days ago and im going in august then she said she would submit to insurance again. im nervous tho because they don't have recorded weights from 3 consecutive months ! but it didn't say it had to be consecutive. also my weight 2 days ago went up 3 lbs since FEB but the nutritionist said just to lose by my next weigh in and ill be okay. Im just nervous I have been waiting a…

Wondering if anyone else has been in my situation. I started my journey with a BMI of around 55. I've really bought into the plan my doctor gives us and have so far lowered my BMI to 51.99. My insurance has an exception to their 6 month medically supervised diet/waiting period for those with a BMI of 50 or over. I have one more appointment before we submit to insurance - in about 2.5 weeks. We will schedule my date then. Last month I lost 9lbs. If I were to lose another 11.6lbs, I would be under the 50 BMI. I've been so worried about losing too much and having to wait those extra months! I don't want to go off of plan and negate all of the hard work and effort I'…

I am in a position where I am ready to try to revise my lap band to a sleeve surgery. My current insurance will not cover a revision or removal unless "medically necessary", and apparently extreme side and shoulder pain along with damage to the nerves that control the diaphragm is not a "medically necessary" reason for removal I am looking for an insurance company in Oregon that will cover a revision surgery, or a sleeve surgery if I can pay to have the band removed myself. I've gotten to the point of desperation, even calling various surgery centers in Oregon and asking about which insurance companies they work with has gotten me nowhere (doctor/patient confidentiality…

Hello everyone, I am so nervous to lose more weight and for my BMI to drop under 40. I am just afraid of being denied by my insurance (United HealthCare - Choice Plus). My plans requires a six month diet plan and my doctor will be submitting my insurance paperwork until Oct 3rd-- which means I will probably lose some weight by then. I started at 257 and now I am at 227 (40 BMI). I am afraid to go below a BMI of 40. I am not sure what UH considers a comorbidity. I have PCOS, high cholesterol/triglycerides (Hyperlipidemia), pre-diabetic (AC1 sort of high), GERD, back/neck pains (deterioration on spine due to weight). I used to have sleep apnea, but since I had sinus s…

Hi everyone, I am going to see my surgeon in two weeks to send off approval. I am nervous because I do not know if my insurance will approve the surgery. Does anyone have United Healthcare choice plus through general Electric if so what are the requirements ? Did you have to the six month diet? Thanks.

Hi Everyone, I have BCBS NC and as of yesterday they have eliminated to 6 month diet requirement. That's right, NO TIME LINE!!! I had a really hard time getting details when I started this journey on what my plan required for approval but I finally did. I thought I'd share how you too can get your medical policy detailing the requirements if your searching through "mud" like I was. It's pretty simple (but takes us forever to think of it)..... Google "BCBS SA (state abbreviation) Corporate Medical Policy". This should take you to a page that list all the medical procedures covered by BCBS in your state that have approval requirements. In NC it's listed as "Surger…

Has anyone been approved by Regence BlueShield in Washington State? If you have how long did take for approval?