Insurance & Financing

Prior to attending the classes at my clinic, I checked with United Health and was told that my coverage included bariatric surgery for someone like me (39 BMI) that has co-morbidities. I thought I was home-free. I have a well-documented history of obesity, high blood pressure, elevated cholesterol and sleep apnea. I went ahead and took the classes and then my surgeon's office applied for insurance pre-approval and I was flat-out denied. They said my co-morbidities are well-controlled by medication so there was no reason for the surgery. WTH???? My surgeon has requested a peer-to-peer review but I'm wondering if there's is any chance of getting an approval now. …

A little nervous after signing my surgical consents today... Not because of the disclosures, but because the nurse navigator basically told me... The insurance may not approve because I had a gain. I was 303 at the start and am now 311... They are sending off for approval.... :-/ wondering if anyone with Aetna better health or medical assistance can ease my mind any... Surgery should be two weeks from tomorrow.

I got approved by Wellcare of GA! I'm having my surgery at gwinnett medical hospital in duluth, GA. The lady I spoke with said that I would probably have $730-$750 out of pocket costs for the nutrition visit, psychological exam, & the 2 week pre-op liquid diet and pills. Is there any way I can go to my own nutritionist and psychologist to that takes my insurance that way I dnt have to pay for it. Or can I go to the health department for a nutritionist visit? Anyone experience the sleeve surgery with Wellcare of GA? TIA

I have been trying and trying to get information from my insurance company. I was able to find out that they cover bariatric surgery but after reading so many posts on here and other places about problems that come up I would feel much better if I could get a copy of the policy in writing. I called the number on my insurance card - that lady couldn't help me at all so she gave me a number of someone else to call who couldn't help either....but guess what? She also had a phone number of someone else to call who might be able to help me....I think I went through this process 5 or 6 times before losing patience and giving up for the day. Why does no one have any infor…

I'm so upset! My BMI is 38.86 & BCBS Fed (standard) did not approve me because my co-morbidities are not "major". WTH! I have GERD & major depression & MILD sleep apnea, & joint pain but I guess I need to have DIABETES, HTN, and/or SEVERE apnea. Ugh. I've crying all morning so now I'm ready to get down to business. Let me also mention that my surgeon's office was not at all helpful. I said, "so do I need to gain X amount of weight to get approved " All she said was "couldn't hurt to try but I didn't tell you that". Should I pursue this, or should I just start all over again with another surgeon? I'm spittin' nails! Has anyone ever gotten app…

Hello all. I'm just wondering if folks can give me an idea of how much they paid out of pocket, if they had out of pocket maximums with Cigna OAP. My date is scheduled but now I'm waiting for my surgeon's office to call and tell me how much the surgery will cost me out of pocket. I know everyone is different, but I gave met my yearly deductible just not my out of pocket maximum. Any info would help me. Thanks.

Well I'm a 40 year old male. 5'8 294. I have a bmi of 43. I suffer from high blpod pressure high cholesterol and sleep apnea and joint pain. Myndoctpr tolsd me that my sugar was up last visit. He recommended that I look into bariatrics. So I did. I am a candidate for the sleeve, my problem is that BCBSKC well at least the plan that my job has doesn't cover it. Wow go figure. What can person do to catch a break. I am open to any suggestions you may have.

I have been researching self-pay in Mexico since my denial last week. My BMI is almost 39. Before I commit to a surgeon there, I wanted to see if Lindstrom advocacy might be able to get me an appeal. They were VERY helpful & told me upfront that they couldn't help because my co-morbidities were not life-threatening according to insurance and medical circles. (my co-morbs are GERD, depression, and arthritis) Since my BMI is close to 40, they recommended I gain weight (about 8 pounds) She said once a person hits BMI 40, insurance would be wrong not to approve WLS. Has anyone out there been denied with BMI just under 40, then gained weight to reach 40 and…

I just completed my eco and cardio, my EDG is July 10, I asked the nurse today how long will it take...her response was, after you complete your EDG we submit your paperwork and it will take 30 days before approval (if any) and scheduling surgery. I said ok didn't realize it would take 30 days, she said by law for revision that's the time frame

I have primary coverage through Cigna, with Medicare as my secondary (on disability). I originally was going to have to go through all of the insurance criteria, but because I need to have a previous nissen fundoplication for a hiatal hernia repaired, my doctor was going to be able to do both at once and consider it a revision, bypassing all the insurance requirements. I got my surgery date set at June 30. I did my 2 week pre-op diet, my mom bought a plane ticket to come help with the kids, husband took off work, yada yada yada. Then, last WEDNESDAY, just a few days before my surgery, the surgeon's office called to tell me the surgery center canceled my procedure because …

Hello all I sent my paper work in on June 20 to insurance and was approved July 1..Received information from insurance company tonight will call my Dr office this morning for a date.

Submitted paperwork this morning and got the call that they approved already just a min ago! Its getting real ! Now have to wait for the surgery schedule dept to call and give me a date for pre-admin testing and physical and informational and surgery seminar. I can't believe its been less than a month and I'm approved! Now just to get the date!!!!!! I'm excited/scared!!!!

Hi All, I'm currently enrolled in Kaiser's mid atlantic program. I currently have the select plan and I would like to get my surgery done at Johns Hopkins. I'm in month 5 of this 6 month process. I would like to know if any of you who have Kaiser went to Johns Hopkins for their surgery? Thanks!

Good morning all! I have recently started the process to go through WLS. However, I have two insurances. Aetna and MD medical insurance (Medicaid). So with Aetna I can possibly get approval within 4 months. But with Medicaid it takes 7. My surgeons coordinator recommended that I drop the Medicaid. Because their process takes longer, but I don't want the financial burden that I would incur as a result of dropping the secondary. Why would you do? Also, if anyone has had this issue what guidelines did you follow? The primary or secondary. I really don't want to wait until winter to do the surgery. Any suggestions would be appreciated!

Would have been sooner but I had to get more weight history. They really mean 24 months, my first paperwork was off by 24 days. Also FYI they accepted my 1 week check up weight after giving birth. I also was also calling Aetna and my surgeons office everyday. It paid off!

Had my last dietary appointment this past Monday. Now they are reviewing to make sure they have everything and then will submit to insurance for pre authorization. I have zero patience when it comes to things like this! The office told me can take 3-4 weeks to hear back. Oye! What has everyone's experience been with this? My surgeon is also booked 2 months out, so looking at a September or so surgery date. A little background on me... I had the lap and placed November 2007. Lost 80 pounds but have struggled the entire time with finding a good fill amount. I am so tired of throwing up and basically cheating with food because the greasy/condiment filled food goes…

I had my first appointment on June 9, I was told by my Dr office that my insurance only required the phys evaluation and the nutrition evaluation which I did both on June 16. I was thinking that because all my insurance required were the two evaluations that my paperwork would be submitted, BUT today after speaking with BCBSIL, they haven't received any paperwork so I called my Dr office who then tell me that I have to complete my cardiac and EGD (July 10) before they proceed to my insurance. So I guess I am confused, is it my Dr office (who gave me the forms stating that my insurance only required the two), or do BCBSIL also require all to be done before approving?

Hello everyone! I have started my path to bariactric surgery at BELLEVUE HOSPITAL in NYC. I attended the seminar, saw the surgeon which gave me the green light due to my BMI (5´1 - 220 pounds = 41), I choose the sleeve gastric, had EKG, X rays and Esophagram done today but found out I´m not alound to go thru self pay (as over 5 friends of mine did) before applying for health insurance - and they told me to choose Fidelis or MetroPlus because this 2 won´t make you weight in for months before surgery to make sure you can´t lose weight any other way.. I´m so lost , wanted to know if anyone else has MetroPlus and how is their approval process. All my friends have used th…

BCBS if Alabama... Anyone have positive or negative experience to share???? Waiting....stressing...

So frustrated! After calling True Results in Houston, I waited 2 agonizing days to hear back from them to find out if insurance would cover the procedure. DENIED! My boyfriends company has an exclusion for ANY type of bariatric surgery. Soo they asked if I have acid reflux or heartburn, which yes I've dealt with that for so long, it makes me miserable. The lady told me that there could be a way around it. If they checked me for a hiatal hernia, and if I have one, they could go in and repair it and put the lap band in at the same time. That would be a way to get insurance to cover part of it, I would just have to pay the $5500 for the band itself. I was told to come in for…

Does anyone else have CIGNA? I changed my surgery type from band to sleeve. I got a letter in the mail today that they're asking my surgeon for more info.....has anyone had this happen to them? Thanks

For those with Aetna .....How many weights did you actually have to submit prior to surgery..beyond the 6 months directly preceding surgery. I am concerned as I had a period of time ( one weigh in ) 16 months ago where I dipped below my required 40 bmi. ( it went to 38) Do I just have to submit one weigh in record from 2012 as an example? I am struggling to get these answers directly from Aetna. I do not want to go through the next 6 months and get everything done to find out one weigh in is going to disqualify me. I would rather wait three additional months to begin the 6 month pre-surgery requirements and know all my weights are qualifiers.

Hello. I have been to my seminar (requirement) and called my insurance to fill out necessary paper work for initial appointment with my surgeon in July. I have Amerigroup/Medicaid of NJ, anyone else? If so, how did your process go? Quickly? Did you have to lose weight prior to surgery with diet and excersize? Thanks.

I am having a hard time finding a surgeon in my area that accepts my insurance. I have United Health Care through Medicaid and I live in New Jersey, Essex county

I live in NC and have Medicaid. Does anyone know how hard it is to get approved? I think my BMI is 40, if I figured right (5'5" and about 240 lbs.). Any info would be appreciated! Thanks!

For those of you with Cigna, I'm wondering how you did the 90 day medically supervised weight management.

I am sooooooo excited! I can't believe it! The hospital called me today, and I got home and there was the letter from the insurance company! I'm still in shock.

Just wondering if anyone has BCBS Blue Choice insurance (not sure if it is strictly an Iowa plan or not)? If so, just wondering what kind of requirements they have. I have seen some people say varying things with BCBS as far as what "hoops" they have had to jump through. I'm just so anxious!! lol

I live in Iowa and have full coverage Wellmark insurance. My BMI is 39.5 with hypertension, GERD, and depression/anxiety for comorbidities. I have completed all the physician supervised diet stuff. I'm worried insurance is going to deny me for not having BMI of 40. Anyone have any experience with Wellmark's approval process?

Has anyone gotten surgery using medicaid/wellcare in Georgia? What Dr. did/will you use? I am having a hard time finding a Dr. in georgia that will accept medicaid. I am 25 297lbs, 5' 4.5", that puts my BMI at 50.2. I really want to get this done in the next few months. I have a 2 year old little girl that I want to be here for. Any info or advice will be GREATLY APPRECIATED!!! :wink::confused:

Is their anybody that live in Illinois are familiar with County Care? If so, how long was the process for surgery?

I am in the first month of my required 6 month pre surgery requirements. As typical I am required to obtain 2 year weight documentation. I am in the process of getting a case manager through Aetna but would like some others experiences. My current BMI is 46 but it has been much lower over the last two years. ( I was over 320 5 years ago and lost 135 pounds over 2 years. I started regaining slowly, lost 40 again and ultimately regained to 280.) I am wondering if having a lower BMI will hurt me? My only comorbidity is acid reflux. My main weight related medical issues are mobility related. Secondly I have only been with my current PCP one year. Prior to that I had n…

I have BCBS federal in NC and I have called them twice to find out what the Bmi requirements are for the sleeve. I just get told to look in my book which tells me nothing specific. Can anyone tell me what the sleeve BMI must be for the sleeve and how long it must have been that high. Thank you I am going nuts!

Hey all. I have been lurking around for several months now, but haven't posted. I could really use some feedback. Well, my heart is really set on getting sleeved. In addition to being obese, I have a Rheumatoid Arthritis and Fibromyalgia. I have already seen my primary doctor and gotten her approval and referral to an endocrinologist next week. However, when I called my insurance they said that my employer doesn't cover wls (I have Blue Cross Blue Shield of California). Has anyone gotten their sleeve approved after being denied? Not even sure if this is possible, but figured I'd ask. Thanks!

Waiting on new approval from our new insurance at Aetna. Approved once then our insurance changed!!!

Starting from scratch with this company what do I need t look forward to??

I have Blue Cross Blueshield but I work for a Medstar company. I could have opted for Medstar insurance during open enrollment, but I wanted blue cross because I wanted to be able to go where ever I wanted for health care. I pay more monthly premium (almost double) and I have a bigger deductable and more out of pocket expenses, but I thought it would be worth it, so that I'm not limited to just Medstar facilities.... THEN when I started this, I was told by my insurance that I could still only go to a Medstar facility for my surgery. Even though I have blue Cross. Any medstar employees out there going through the same thing? Pre or post op? What have your experiences bee…

Anyone know if you can file for short term disability in California for the time your recovering from surgery? My husband is planning on getting bypass done in a few months but doesn't qualify for vacation or sick time.

Hi all! New here...I just called Member Services listed on my ID card, and they show nothing received by my surgical group. My contact there said it would go last Wednesday. Am I just bring impatient? Thanks to all! Ps I hope I posted this right! I've had a heck of a time figuring out how!

I am going to be self pay and I am finding so many companies that I am lost. I don;t know which ones are legitimate and which to be cautious in dealing with. Does anyone have any suggestions? I am still early in this process, will be attending the seminar on January 4th. Thanks

Does anybody have BCBS TN. I talked to my surgeons office manager and she seems to think that since my BMI is at 40 now that I don't need anymore co morbidities. But it's been about 38 for the last five yrs and they want documented weights

I haven't seen my doctor yet, my appointment is scheduled for Wednesday June 4, and I just got confirmation from my insurance that there are no restrictions for the revision from band to sleeve....I'm doing the happy dance right now and excited to hear what my Dr has say on Wednesday, I am hoping for a surgery date at my time of visit (keeping my fingers crossed)

New here and just submitted my paperwork to the insurance company.. Papers were submitted 5-5-2014 and I still havent heard anything back.. was wondering how long it took for everyone else!! Going a little crazy waiting!!!!!

Hello everyone! Been lurking for quite some time now and just got my approval for surgery! I am BEYOND excited! When the coordinator called me and told me I was approved I started shaking and crying..I just can't believe that what I've been working on for 6+ months is finally in motion! I know the road is long ahead of me, but I can't wait to begin this journey!! Insurance: Premera Blue Cross

Hello, I have BCBS Federal, Basic Plan. I am required to show "Evidence of attemed weight loss in the 1 year period prior to surgery have been ineffective". I asked my surgern about it and he said reciepts for gyms, or notes from family doctor would work. But I don't have either of those even though in the last year I have several attempts of losing weight on my own. I was thinking about doing a notarized letter for insurance with a list of attempted diets. Anywone try something like this or something different that worked?? Also how do I prove I have not smoked or been to rehab?? Thank you!!

My insurance has approved surgery however they won't pay for the nutrition consult or my original consult with the surgeon saying that no benefits are provided for services primarily for obesity. I know normally nutrition appointments and weight loss attempts are not covered under my plan but they do cover bariatric surgery and I need these 2 appointments in order to have surgery. Anyone ever have any luck getting these appointments paid for?

The surgeons office said it PH usually only takes 5 days to approve... that was about a week and a half ago, and i still havent heard anything... getting kind of anxious. Have the date set penciled in already... and requested the time off work. Praying I hear something soon.

I'm going through a center that does WLS with local Drs who also have their own practices. My insurance company recently denied my claim as I don't have co morbilities. I'm ready to self pay but center wants to keep pushing for coverage. I am getting really frustrated at this point. I'm wondering If there is a benefit to them if insurance pays rather than me paying? There must because I don't get it. I'm ready to go somewhere else.

BMI was under 40 so I was required to attend 7 consecutive weigh-ins which included visit with nutritionist. That was the best thing for me because she gave me a list of post-op changes and I slowly implemented them. Also had to see psychiatrist, cardiologist, primary physician and have colonoscopy. December 2012 orientation, November 2013 surgery.

Hi. I haven't got a final bill from my hospital yet and I was wondering if anyone can tell me what the out off pocket expense is that the insurance doesn't cover?