Insurance & Financing

I saw my dr yesterday and started my 6 month dr supervised diet. This is required by my insurance. I have my bariatric seminar on 7/22. Does anyone know which weight insurance uses? Is it the first weigh in with PCP or first weight with Bariatric center?

I'm trying to figure out the requirements to have VLG (I think that's the abbreviation?) covered by Medicare. Anyone familiar? Thanks!

Hi! I could use a little insight on Cigna. My insurance requires 3 months of a medically-supervised diet. I saw a clinical dietician on 6/16, and she worked out a diet for me. We spoke briefly about the gastric sleeve but I was in the the thinking stage. By early July, I'd decided to go for it so when I saw my PCP on 7/17, we moved forward with the insurance requirement. My PCP is at the same hospital I'll be getting the surgery, so it makes sense to continue under her supervision. Easier with records and appointments, especially. The dietician is at a hospital in the other side of town (where I see my rheumatologist). We have scheduled follow-up appointments for 8/15 an…

As anyone had there paper work submitted to their insurance around the august 1 and received and answer yet ??

Hi! I spoke with my insurance and they say they cover my surgery with a pre authorization and psyc as well but do not cover nutrition? I'm not sure if I was speaking the correct lingo but has this happened to anyone before? My scheduler had said to ask them if the require 3 months or 6 months and they said we cover the survey with authorization but not nutrition. Confused? Help please if you know

Hi. I just checked the BCBSNC MEDICAL POLICY UPDATES for JULY 15, 2014. This is what it said.... Requirement that patient be an active participant in non-surgical weight reduction program for at least 6 months prior to surgery removed. I am sooo excited about this. I have met my deductibles and was going to be pushing it to get my surgery in before December this year.

I'm pretty sure it is, and my blood work came back positive for it. Anyone know for sure. I have aetna Thanks in advance

My surgeons office called for a pre cert today and was told to wait until the nurse calls them back before they submit my file for approval. They said they have no estimated time for how long it will take for us to hear back about whether I am approved or not. Anyone have any info?

Ones anyone have empire plan insurance thru New York State??? I called them today and was told that per them I don't need a 6 month diet or to lose 5% this seems to good to be true!! I know my Dr will still Probley require a weight lose program which is okay! I was just wondering if anyone had the same insurance?!! I'm just beginning the stages and am having my first Appointment sept 8th!!

I am currently on my last month seeing my nutritionist for the 3 month program required by Aetna for WLS. So far all together I have gained 4lbs over the two months I have been seeing her and have yet to lose any.( I started at 391.6 my last WI was 395.6). I explained to my nutritionist that I was experiencing Water retention thus the reason for my weight gain. I struggle with PCOS which I've learned also makes it hard for me to lose weight. Last week I also found out that I may have ovarian cancer which my GYNO says is due to my size. I am currently 26 and on my parents medical plan which will end for me in 2015 so this is my last shot. If I don't get this surgery this y…

I like most, I have the supervised weight management requirement (3 months) with insurance. I originally made an appointment with the dietician my surgeon's office deals with but think they are just going to charge 2x the amount my regular pc would. It says I need monthly documentation of weight, current dietary program and physical activity- by either a licensed physician or registered dietician. Has anyone else just gone through their regular doctor for that piece? I need to get a letter of medical necessity from her anyway- but I'm nervous about somehow messing it up and having to start over again.

Hi All, I work for Verizon Wireless, and have Anthem Blue Cross Blue Shield (BcBs). My initial consultation was 12/23/13, I was able to see all the specialist and get approval by 1/14/14. The paper work was submitted to my insurance on 1/23/14... I am bitting nails (not literally) waiting to hear back!!!! I am scheduled for RnY gastric bypass on 2/26/14. I am so anxious, nervous, and excited, but my initial worries are the insurance approval. Has anyone ran into problems with Anthem?? Help!!! LOL

Hi all. Just venting. I finally chose my surgeon after consulting with a few different choices. I am confused because they told me that my insurance requires a 6 month supervised diet while the other 2 offices I visited both said it is only a 3 month diet. (I have GHI) Now I am going to have to call my insurance company to find out which it is. I am hoping for 3 months but if 6 is necessary I will do what I need to do. Did anybody else have a similar experience?

I am looking into private healthcare companies that will cover bariatric surgery. I have found my surgeon, hospital, etc. I'm not looking to bargain hunt surgeons. I work at Dairy Queen part time, and am a full time college student. My employer does not offer any kind of insurance for employees, period. My parents are broke as a joke, so no help there. I am willing to pay the premiums that it takes for me to get surgery, but I don't want to take on a mound of debt this early in my life, and I DO NOT want to go to Mexico again, ever. Does anyone know of any individual health care plans/companies that will cover bariatric surgery? I am located in Oregon Thanks for …

My insurance (through my employer) is paying for my upcoming surgery. My sister really needs this too but she is a long time contractor and has always had to buy her own policy. She got one through the federal exchange when the new healthcare law was implemented. It's not a terrible policy but not great either, in spite of being very expensive. And it does not cover any WLS. Does anyone know of any surgeons or facilities that finance? What is the best source for financing? We are in Houston. Thanks, all.

So my surgeons office sent over docs last Tuesday. I called today to make sure they had everything and was told that the nurse made some notes in my file as of today. Hoping it gets approved by Friday so I can start my class and final pre-op appointment. Fingers crossed!

I just had my first appointment with my surgeon. Now I wait for approval from my insurance company. I'm so nervous.. How long does it take?? I'm ready to begin my new life!!!

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. Is this a common thing?

If any of you write a letter on your own behalf when submitting to insurance for approval or did you just let your surgeons office handle all that?

I have United Healthcare Choice Plus through Nestle and I am trying to have the surgery done asap. I have done everything I need to do, but the surgeons office keeps telling me that I am required to do a 6 month weight management before I can be approved. I have called UHC 4 times and asked specifically about that and they have told me I do not. Anyone else familiar with Nestlé's policy bulletin?

So I sent my appeal letter certified last week and they received it last Friday. Should I be calling them? Should I be giving it more time? I'm anxious to know if it will be appealed or not. Some people are telling me to call. Just didn't know if anyone out there has had any idea about being denied and appealing. Thanks!

Hi all. I'm currently on month 3 of my pre-op process. I have to be weight monthly to show the insurance company 6 months of weights (I have emblem HIP prime) my first weigh in I was 276, 2nd weigh in I was 281 and not somehow I've sky rocketed to 289. The surgeons office initially told me not to gain or lose more than about 7 pounds. I have basically almost doubled that. Has anyone been denied for weight gain during the 6 month process? I don't want to weigh in at 289 for august so I'm going to try and drop some weight but I don't think I'll be able to drop 8 pounds with only one week left in august. I started birth control again after 8 months of not being on it and I f…

I am following all the guidelines for gastric sleeve approval through BCBS of KC but I'm so afraid that something will happen and they will deny my surgery. Has anyone else went through BCBS of KC??

Hello everyone, I have BCBS IL HMO. Just recently changed my medical group for logistical purposes. I went to the doctor and we discussed WLS. She stated that she would be unable to put in the referral because I had not been a member of the medical group for one year. I know my health insurance covers this surgery, but she said she cannot make a referral for one year. Has anyone ever heard of this. Is this true for all medical groups? I can change, but would like to find a group that does not have such strict policy. I am currently with Presence Medical Group.

The morning of my surgery, the hospital bothered my husband for 3500 dollars while I was in middle of my surgery. How professional right? I called them to find out when they were going to bill the insurance. They told me they already did. Yeah they billed our old insurance company from last year. I don't even know how they got the info to send to that particular insurance company. Can we say morons?

Hello all. Just in case im denied by bcbs fed because i dont have history of bmi of 40 for two years im looking to go to Mexico. Question, where do you go for care after surgery?

Have Federal BC/BS, called this am for a status check on preop and was told no record of any request from my surgeon, I called the surgeon's office only to be told that they were told my paperwork needed to go to Florida BC/BS. The dr's office submitted on Tuesday, so now it's wait ...... Can't log onto Florida BS/BS site because my id starts with a R . Anybody have this problem? I don't even know if I'm making sense ..... I just wish I had a phone # to check status waiting is KILLING me!

I'm posting this because I had trouble finding it on this site and saw that several other people were looking for something similar too. This has to be on your PCP's letterhead. Bring this with you to your appointment with your PCP for medical clearance (I even filled mine out myself!) [Date] Re: [patient’s name] Date of Birth: To whom it may concern: [Patient’s name] has been a patient of mine for [insert number] years. Patient is [insert height] tall and weighs [insert weight] pounds for a calculated BMI of [insert number]. This patient has been excessively overweight for the last [insert number of years] and will benefit from Bariatric surgery. The patien…

My insurance denied me, the barix Clinic said they hit a brick wall with my insurance, BCBS PA PPO. My husband said we will self pay, but the Clinic is $25,500. I live in NE PA and was wondering if anyone else is self pay and where they went that is cheaper. my husband said go to the clinic. his analagy is do you want a mechanic charging you 10.00 an hour that doesn't know what to do, or one that charges 100.00 that is awesome at what they do? please help. lead me in the right direction. thanks

Hi I'm looking for a loan so I can have the procedure My insurance won't cover it anymore Anyone help?

I apologize for starting a thread for this but when I first started poking around this site, I found an example letter for the patient to send to their insurance. I want to use it and now I cannot locate it. If someone has easy access to this, will you please share? TIA.

I finished my insurance requirements last Friday. Only took 2 weeks to complete consultation with surgeon, nutritionist visit, psyc consult, PCP visit with labs and upper GI. Everything should be faxed to my surgeon's office by tomorrow. I've heard my insurance (Anthem BCBS of CA) approves in 3 days. It's all I can think about!! I'm hoping to be approved by early next week. HURRY UP!!

A facebook friend shared this link, it was very helpful to me, if you have Aetna and am confused! http://www.aetna.com/cpb/medical/data/100_199/0157.html

I am waiting approval from insurance. I have United Healthcare. Anyone have Amy idea as to how long the process takes?

To laugh or cry?!! My docs office got pre-approval for surgery in-network. My insurance broker told me that my new health plan with Humana includes Bariatric Surgery. I went ahead with it and got Sleeved a month ago. Doc did not require anything up front and insurance was approved. Received Claims last week from Humana that all charges associated with this have been denied due to lack of coverage of Bariatric Services. Just wrote an appeal - ahem....long, detailed with pre approval code and my anger all displayed in letter. What gives? Could they really deny this?? I am infuriated and told them so. I should be recovering and focusing on my health but stress does not ev…

I'm waiting on final approval...but short on the cost of having the surgery ... does the surgeons office finance or do I need to go somewhere else?

Part of my pre-op requirement is to meet with an exercise physiologist. However, I am on a very tight budget. I am on disability due to kidney failure. The fee for the exercise physiologist is $125.00 for the first visit. Is there anyway I can get around paying this?

Hi everyone started my process. Today was my first NUT appt. I have to complete a 3 moth journey w/ dietitian. I am in the borderline BMI, 41.8. I am concerned; wonder ifI lose to much weight I will get disqualified for surgery. Then again I can not gain anymore either( is summertime). Any one with Cigna that can advice me? Thank you.

Hello all! I was also denied by Aetna for weight gain. I don't know where u all live, but I was given a lil tip from a friend on sending my appeal into Aetna... CONTACT YOU STATE REP AND UR STATE SENATOR!! I live in PA, I contacted and emailed Pennsylvania senator Stewart Greenleaf and emailed him my appeal letter on Monday night. Today I was received a call from his office stating that they received my request and sen. Greenleaf was writing a letter on my behalf to Aetna supporting my appeal AND sending it out today!! I sent my appeal letter in today too...sent by certified mail. I gave it to my 2 sisters, husband, one coworker, and my mother and everyone ended…

Hello.. I just had my nutritionist apt today and yesterday the visit with the surgeon. Should see the psych in the next couple of days. But, i'm having some insurance fears, as we found this: NHP covers bariatric surgery for: Medical necessity for bariatric surgery is established when all of the following criteria are met: Individuals who are at least 95% of predicted adult stature who are: 1. BMI greater than or equal to 40 (mine is 43) 3. Documented failure of attempts to sustain weight through less intensive, physician supervised methods, such as diet, exercise, behavior modification programs and pharmaceutical interventions ; (in which we …

Has anyone been successful using pictures if you dont have documentation from doctors office concerning your weight for the two years BCBS wants?

I currently have GEHA but when I go to the doctor they refer to it as Healthlink. I am in the 6 month physician documented diet which is mandated by the insurance company and I am getting disappointed with the process. Has anyone ever been approved with GEHA/ Healthlink? Also did you lose any weight during the 6 month diet requirement? Thanks in advance

Hi, everyone! I have a pretty nice plan with BCBS of NC (that I will lose 9/1/14 since the premium increase is so much due to obamacare). As of the middle of this month, BCBS dropped the 6-month supervised diet. My paperwork was submitted on 7/28/14 and I was approved for surgery today, 8/5/14. Not bad at all, especially since two of those days were the weekend! I have my results visit with my surgeon tomorrow morning. This is all happening lightening fast!

So my surgery was scheduled for 7/7. All 3 times that either me or the weight loss center talked to the insurance we asked if they needed to be a Blue Distinction Center and were told NO! Got a call today on the day I was supposed to start my pre-op diet and was told that they do have to be a Blue Distinction Center. So frustrated because now I have wasted 6 months and will have to start over with a whole new program. They would cover my surgery out of network but that put me at paying $4500 out of pocket vs about $500. On top of that I have already paid the psychologist, did my visits with the Nutritionist, went to the support group meetings etc. It's caused me to use 21…

Hi there.. I'm brand new here and just starting on my weight loss journey. I have my initial consult August 11th. I'm a little nervous about being deemed not a good candidate for surgery. The first reason being that I had a child in October. It may sound silly, but I don't know if there is a specific time that has to pass after childbirth (c section) before you can be considered. Also I'm scared that my history of extreme yoyo dieting will negatively affect me as a candidate. I've lost, and gained, 100-120 pounds about 4 times (I'm 34). I've gotten down into my 150's through starvation and extreme exercising but then over the next few years it comes back. I have Cigna ins…

Hi everyone! This is my first post. Currently I applied for GA Medicaid and got approved. I submitted my paperwork for Wellcare of GA and now I'm just waiting for card so I can go through and start whatever I need to do with the surgeons office. I would love to hear from someone who went through Wellcare of GA for the Sleeve surgery. I know I am just starting my but I don't know the processes and what Wellcare will require me to do so hearing from someones experience would be great! I'm 21 with a BMI of 46.3 I appreciate any feedback, thank you in advance!

In the past 7 years.. I have done the dukan diet, atkins, HCG diet, Optifast, medifast, nutrisystem and other misc diets. I have been losing and regaining the same 50 lbs, they just seem to creep up since I have never been able to sustain it. I am debating between financing and going self pay in Mexico (Dr. Ortiz) or going through the insurance process, which I fear will deny me, for my bmi i would need to have at least one co-morbidity of the following: Daily functional interference to the extent that performance is extensively curtailed.4 b. Documented circulatory insufficiency. c. Documented physical trauma secondary to obesity complications, which causes the membe…

I have Anthem Blue Cross and my medical group is Newport Medical Group. That is who they are billing. They only require BMI over 40, 2 co morbilities, psych evaluation, Dr talk and nutritionist visit. I got it all done in 1 day, except the psych eval. I have that next week. This is moving so fast for me. I hope after insurance approves me, it moves quick dr le port's office seems slooooooow. I would love to hear from anyone who went through or who is going through Dr leport's office in fountain valley, ca. Thanks!

Am just beginning the process next week. My dr mentioned that the process has changed from the extensive process it used to be to get approved. Anyone had sleeve surgery recently with Kaiser in Northern California? Could you tell me what your approval process and time line were?

Hi Folks, My husband has always been healthy (aside from weight) and never went to the doc...literally in the 8 years we have been together. He has two years of history but doesn't have the third. Surgery coordinator is saying draft up a letter to insurance to explain lack of medical documentation. Anyone have ideas, resources, examples? We are going to print off Facebook timestamped pictures to include as well. ANY help would be appreciated! Thanks, Sarah