Insurance & Financing

Soooo just got a call from my surgeon and he said medicaid wants 2more months of nutrition counseling to make 6 months so no July surgery for me now I have to wait until August..kinda bummed but I know everything happens for a reason..but I was just wrapping my thought and training myself to do right and be prepared for surgery...so I'm guessing it's gods way of saying ENJOY YOUR SUMMER!!! And wait a month..but at least I know it's approved...anyone else experience this

Have been tested and going through nutrition classes My job just changed insurance and now I am not covered at all Any words of wisdom

My friend is going through the process, she just started. The thing is, she didn't have health issuance until recently. She can prove she has been over weight for 5+ years, that's she's tried to diet ECT...but she doesn't have 5 years of weigh-ins. Anyone know what will happen in this situation?

My information went to insurance on Thursday afternoon, I called today to follow up and was advised I was approved. Confirmed with my surgeon's office now I'm just waiting for a call from my surgeon's nurse to schedule my official date. Whooohoo

It took just over two months from the initial consultation to insurance approval. Here's their policy: http://www.anthem.com/medicalpolicies/policies/mp_pw_a053317.htm Surgery will be in a couple weeks!

Wow a week and a day and I'm approved for my revision! I had the sleeve done on 12/16/12 and I'm going for bypass on 8/18/14, due to gerd and a stretched sleeve. My weight lose was around 40 lbs with the sleeve and I've actually gained 15 of it. I started off at 239 post op, current weight 206, lowest weight since sleeve 189 (for about a day).

I've been denied by BCBS of NC and I sent an appeal letter on the 23rd of June. Not sure if I should get my hopes up or is it over for me?

Has anyone had approval from our insurance to pay for our protein shakes and liquid vitamins ?

So after 6 months of tests and appts I was called by the nurse at my surgeons office to tell me that my surgery was denied. I am HEARTBROKEN. ???? I have been though so much this year. As I started this journey, one month in, my 37 year old husband had a heart attack. Which then required a triple bypass because of 3 blockages. We made it through 20 days in the hospital, 6 days in the cardiac ICU. We both quit smoking, and I was determined to keep going forward with this. I kept my appts and tests even with him in the hospital. Just so I could have this done and we can BOTH start our new lives together. Because when he was in the hospital I could barely BREATH l…

Has anyone received financing through Medical Financing? I am just curious what kind of rates and terms they offer. Thanks!

I just found out yesterday that my insurance has no bariatric benefits. I have my initial consult today. Anyone go through financing or trying to find a different insurance? I'm bummed. SmileyLG

Has anyone's insurance stated that WLS is excluded and got approved for surgery? I need help. Thanks.

I have bc/bs federal. My paperwork was submitted as outpatient. When I found out about this, I called the dr's office and was told bc/bs will not approve sleeve surgery for inpatient???? The dr's office told me they submit the request as outpatient and then after the surgery is done, they request approval for two nights stay. I was told it will be just fine, don't worry. That just didn't sound right so I called bc/bs and was told they approve the procedure based on what the dr says is medically necessary. If the approval is stated as outpatient, you are responsible for 15%. If the dr requests two nights for observation after the surgery, you are still responsible for 15% …

I just attended my 3rd nutritional seminar. One woman just heard that she was not approved because her 6 months of nutrition seminars/weight loss were not "supervised by a physician." It was run by a dietician. The bariatric surgeon and coordinator are discussing this with the insurance company and hope to work it out. Just wanted to give everyone a heads up to check on their coverage.

My insurance has several requirements including a psych eval,6 months supervised diet/exercise. My surgeon also has ordered tests a test that has not been covered - the one where you swallow barium and the pop rocks to make your stomach poof up. BCBS has denied the charges for these services. Any advice?

I haven't been to my seminar yet, but already I am worrying about out of pocket expenses. I have medicare A&B and medicaid medicare, I know medicare pays 80% but I am not sure about medicaid medicare and if or what they will pay. From my understanding they are supposed to pay what medicare doesn't. I do not know how this works or if that is true. I live in Indiana, can anyone help me understand? I am so afraid I will not be able to afford this as my only income is SS. I am getting myself all worked up and have not even been approved yet, my goodness! Was anyone else as nervous as I am in the beginning of the process? Glojia

Vertical Sleeve Gastrectomy Insurance process | Denial | Sharing the journey with others and watch the video to see if there was an INSURANCE APPROVAL! Watch the video to learn more CLICK SUBSCRIBE to my channel & PLEASE leave a comment http://www.cindyvirden.com WATCH TO SEE WHAT HAPPENED ON MY YOUTUBE CHANNEL http://youtu.be/omdn8876qvY LOVE YA... CINDY

I have seen my family doctor who has encouraged me to have the sleeve done, however our insurance does not include Bariatric coverage. I feel it is important enough for my health that I will self pay and have a surgery date of August 4. Today we got word from his work stating we can appeal this and ask for coverage. Has anyone had success with this? Seems a little to good to be possible. Any information or experience you can share would be greatly appreciated. Thank you!

I have my surgery scheduled for August 20th however they are just sending my paperwork to the insurance company today. I would appreciate everyone's prayers that they approve this request in an accelerate manner. I am so nervous and will be more at ease once I receive the approval. Thanks!

Anyone else have Blue Shield of CA (PPO)? If so, was the process easy? Did you get denied? I've already had a sleep study and have apnea so I'm on CPAP. I've gone to see a nutritionist and had the psych evaluation. I'm currently doing the 6 month physician supervised diet (visit #5 is this month). Question on that - has anyone gained weight while on that diet and been denied because of it? I'm following all the guidelines that my physician is giving me, but I'm gaining weight. Makes me rather nervous about an approval!

So yesterday I was told that I had to pick a new medical group! & now I have to do a 6 month nutrition program! My original medical group only required 3 months! I am really bummed out but I prayed about it and I know my God makes no mistakes! Open enrollment is in January and I would be able to go back to my previous medical group.... However I don't want to waste any time! I am so confused as 2 what I should do! I really wanted to go through the surgeon that I met with and I do not want to re-do all of this over! I am so frustrated!

Has anyone ever got denied surgery from any of the Kaisers in southern california? and if so why did you get denied. The reason im asking is because im quite scared that they will not give me surgery because i am on week 10 of the options classes and have not lost any weight. My weight fluctuates, it goes up and down, but never past my first weigh in.. Back at week 4, I had an appointment with sarah turner an MD from the metabolic center and she told me if i didnt lose weight that the surgeons wont operate on me. I find this dissatisfying because throughout the whole options classes they did not tell anyone that they would have to lose a set amount of pounds such as a cer…

Hello! I will be losing my insurance in September, and will be on Medicaid temporarily. Unfortunately, this will be in month 4/6 of a supervised diet, and then surgery... I am hoping everything goes smoothly, and that I am approved. In the meantime, all I can do is keep going and prepare as best I can. My PCP and surgeon accept medicaid, but I am wondering if any of you who had wls with medicaid in Ohio are willing to share out of pocket costs? I had everything figured out, and now I am worried I won't be able to afford it. Thank you!

Ok, now I'm freaking out. I have been scheduled for surgery on August 13. One section of the Rex Hospital website says patients can have payment plans set up but another says that bariatric procedures are not eligible for installment plans. If I have to have my copay before surgery I'm really screwed. My surgeon fees will be paid off by July 29 and the rest of my out of pocket limit (BCBS NC state employee) is 2600 but I won't have that on hand by August 13. I've call every number I can find for Rex Hospital and Rex Bariatric Center and no one will answer. I've left messaged and emails for a couple days with no return call yet. I'm so afraid I've done all this work…

My request for surgery was sent to my insurance company today. I'm so nervous they're going to reject it. I don't know why I'm nervous because everything is in order, but I still have this impending feeling of doom. I really want the surgery so badly. I'm planning a cruise in October and I am hoping that my timing is good. I have Humana insurance and I was wondering if anyone else had experiences with them. I have Humana POS. it's a Medicare advantage program. I am in this all alone. I need the support of people like me who are going through the surgery. For now, I wait

They are cut and dry. BMI = or > 35 with 2 preexisting conditions or BMI = or > 45 is approved. If denied have doc resubmit.

Well i did my assessment today with the nurse. Gave me a whole bunch of scripts to have tests done and paperwork for my primary. Made all my appointments for next Wednesday. See surgeon august 4 and psych eval august 5. Cant see dietician till september 4. They will let me know if someone cancels. Also gave me a whole booklet with info in it. It was a lot to take in at one time. Moving forward. Yeah!

Ugh I am scheduled for surgery on the 29th and have been dealing with anthem since the 27th of March. Originally I was scheduled for the vsg all paperwork was submitted for that procedure. Well come to find out my policy is one of few that does not cover that procedure so I had to go another route. Lap band it will cover.BUT Dr's office had to resubmit everything for a new precert and being the Dr's office spoke with my insurance and all was good to go I am having to completely go thru the entire precert process again. Same nurse reviewing case nothing changed but codes and it's taking them forever to write the approval. Any of you had lap band with plication? If so ca…

If u are right at 40 bmi with no other problems do u have to make sure u stay at 40 bmi until your procedure is approved. No weight gain or loss????

Got no reply so good bye

Does anyone have Coventry? I have the pos sliver plan in delaware.

Would anyone have an example of an appeal letter that you wrote to your insurance company? My surgeon's office has been fighting with my insurance company and are filing an appeal and they suggested that I write a letter, too, and I'm not sure what I should write in it. This has been a very frustrating process for me and I think I need to give this my best shot. I am trying to get approval for VSG. You can e-mail me at cindys32@yahoo.com or leave a document here for me. Thank you so much!

I received a statement from my doc's office last week and was completely unprepared for what I saw. My insurance was billed for a VSG and Haetal Hernia repair to the tune of $120,000! Holy ****! When I had asked how much the procedure was going to cost previous to the surgery I was told it would be around $25,000 in total and "not to worry" insurance would pick up the tab. When I contacted the billing department I asked how they could justify this sort of charge the associate said that this was a major surgery and the charge was normal. She also went on to say that just because $120,000 was charged it didn't mean my insurance would pay that amount. I replied that accordin…

Hello, my name is Chanel and I am 24 I have blue shield of CA and was wondering if anyone knew if weight w***hers counted as 6 months supervised diet. Has anyone been approved using them? Thank you any feed back would help. I sent it in to insurance last week and am still waiting. But the weight w***hers has me scared. Please let me know. Thank you all.

I live in NC and have BCBS. I've been posting about how I'm on track for an October or November surgery, but I think a new change in insurance policy may have just worked to my advantage and enabled me to be able to have it much sooner. This is the quote I found under the revisions section of the Policy for Surgery for Morbid Obesity section of BCBS NC dated 7-15-2014: "Requirement that patient be an active participant in non-surgical weight reduction program for at least 6 months prior to surgery removed." How exciting is that. I started the process in March and am supposed to have 3 more monthly PCP visits, however, if this change completely removes the need for th…

Hi Im new here . I live in brooklyn ny and have HIP PRIME insurance through my job . I'm interesting in the vertical sleeve surgery . I still haven't met with my PCP . It's hard finding a surgeon who take my plan. Those anyone know of a good surgeon in NYC . :-)

My BMI is 37 and of course BCBS Federal (Virginia) requires 2 co-morbidities for approval under BMI 40. I've long suffered from& am treated for MDD (major depressive disorder). My other CM is GERD, and I have very mild sleep apnea. Has anyone out there with BMI<40 been approved with depression as a main co-morbidity? Most interested in answers from those insured by BCBS Federal. Thanks!

i have my seminar coming up with dr.neff in cherry hill i have have horizon nj health can anyone tell me how long it'll take the process anything helps. what will get me approved what to expect with dr.neff. Thanks!

Has anyone been approved using US Family Health Plan which is part of the John's Hopkins Medical System in connection with Tricare. I just looked at their requirements and they look very strict. Just wondering if anyone else has this insurance.

I have so many different feelings built up inside me I just want to cry. Cigna told me it was because of my bmi which is 37.5. But with Cigna it states they will approve based on a bmi between 35-39.9 with one comorbidity or more and I have high blood pressure as well as a heart condition. You would think they would want to help me. Right? Now they are saying my doctor needs to request a peer to peer review. Has anyone else experienced this and what is the normal outcome and length of time? Thank you all for being there and listening to me vent. I appreciate it.

Oye this is nerve racking. I was thinking it would take a few days to get BCBS's decision, but my surgeon's team told me it could take 4-6 weeks. SAY IT AIN'T SO!! Patience is a virtue? I was hoping I would be well on my way before school started in the fall. : (

Just got the call 5 minutes ago that insurance said "YES"! Forgive the exclamation points, but I'm so excited! I hope you all receive the same great news very soon.

After trying to accumulate all of the information and jump through all of the hoops since JANUARY, I learned today that Blue Shield of California denied my sleeve surgery as "not medically necessary." I have so many comorbidities that I have to ask, "what the [blank] does it take?" I have severe sleep apnea, fibromyalgia, lymphedema/cellulitis, depression, neuropathy, knee and foot pain, a BMI of 45, and I am post-stroke. I am dependent on a cane or walker. I was originally told (at my surgeon's office; they now say they didn't, but I took notes and so did the friend I brought with me) that although BSCA usually requires 6 months (or 2x 3 months) of a doctor-supervi…

Has anyone had surgery at Loma Linda? Does anyone here have UHC West for insurance? I called UHC and they told me that all I needed was a BMI over 40? Is this true? Please advise. I'm sure that the UHC question has been asked a million times but after thorough research I wasn't able to find the information that I was looking for? Is it according to my group plan? #ugh

Anyone have this insurance? If so how was your experience? I know they don't do the 6 month supervised diet, which I am thankful. Thanks

Okay, this is a pretty long story but I really need some guidance, and am having second thoughts about my second thoughts. My journey for the sleeve began in oct 2010, I made an appt to go to a seminar to an MD that was an hour away from my home, but he was rated a great Dr. and the hospital was a center of excellence. My husband and I went and decided to wait a bit and get some more information, I kind of felt as they were not really interested in "our" well being but just to make a $. Besides the surgeon wasn't there that night, we were told that he never takes a vacation and this was the week that he decided to go. So we waited and before I knew it it was april or so, …

Has anyone gotten approved with medicare insurance I have medicare and medicaid but was told medicare would be my primary! Just wondering how long it took to become approved using medicare? I have my first appointment with the surgeon this thursday I also need questions to ask him... any suggestions would be greatly appreciated sammy

I have bcbs federal. Any suggestions on how to have a better chance on getting approved?

I wanted to create this thread to help people understand what you need to do that have Aetna. I know every insurance policy is different, but with Aenta you generally do the same thing. I know when I started on my weight loss journey I was SO confused on EXACTLY what I needed. I was just approved this morning and I am beyond excited. This is what I did for the 90 day multi-disciplinary program - You need documents showing you have had a BMI of 40+ for the last two consecutive years (or a BMI 35+ with co-morbidities) I went to my PCP and asked for these records myself and faxed them to the surgeon's office. - You need to see a nutritionist once a month for three consec…

Hey ya'll! I am strongly considering a band to sleeve revision. I currently have United Healthcare with a bariatric surgery exclusion. So I will need to switch over to my husband's insurance (BCBSNC) during open enrollment in October. I am pretty sure that BCBS will require a 6 month physician supervised diet prior to approval, and I am wondering if I could/should start that through my surgeon's office prior to even getting on BCBS (i.e. would it count?) I know the costs of products wouldn't be covered if I did it before getting BCBS, but I am trying to get this surgery scheduled as soon as possible. A little bit more on me, if anyone wants to comment on this info a…