Insurance & Financing

Back last summery insurance denied my Lap revision because there was an exclusion on Bariatric surgery. So friggin nice of them since my band was making me throw up unfilled. Totally frustrated my doc's insurance gal told me a great suggestion. Opt out if my employer's insurance plan and buy an individual plan on my own like Blue Cross who covers weight loss surgeries. I did it and with the new non pre existing clause they couldn't say no due to my prior Lap Band. Jan 1 my new insurance plan was effective and on Jan 14th my revision was approved. Feb 10th is my big day!!! I would have never thought about totally thinking outside of the box with playing this insurance tric…

Hi all. I am wondering about the drug test requirement under the Federal BCBS plan. Did you just have your pcp order it?

is there anybody that lives in Pennsylvania that has Keystone health plan East that has had the sleeve or the bypass I was denied because they said they do not do the surgery when I know there has been people that have had this surgery that have this coverage I just need to know who did the surgery so maybe I can get help

I have a HSA acct with bc/bs texas. They have a very high deductible 2500 ahh!!!! I just don't see why the hospital wants their % upfront as well with my deductible. My co insurance is 10400$ before bcbs pays 100%. I highly doubt the hospital will reimburse me back my money that they charged me up front. My facility fee is 90-10% Needing to vent Thanks

*tapping fingers on table* I'm waiting [patiently?] for my insurance approval. (BCBS Federal). I submitted my paperwork ystdy. Every time my phone rings I jump!! This is where head hunger starts to play head games!!

Have anyone every use this company if so I would like to know what is your thought on the company?

I just called my insurance company (today is monday) gave them my Reference number for my Pre-authorization. I was told that the Pre-authorization was approved and a letter was sent out last Thursday. I phoned the hospital to make my pre-payment and they told me that as of last Friday afternoon the final approval had not been given yet so I'm still waiting on approval? Anyone have this happen or is anyone familiar with the approval process that can let me know how it works...cause I'm confused.

A week ago today my surgeon's office submitted my paperwork to UHC for pre-certification. I called my insurance today to see if they received it and they not only received it, but they have approved me for surgery. Now I have to wait for my surgeon's office to open for the day and call them to get a surgery date. I can't believe that this is really going to happen. I am so excited that I am shaking. I can't wait to start my new, healthy life. I just knew it was going to be a great day today, my grandson turned 18. Now if we would just get an offer on our house the day would be complete.

Hello! I have been researching my insurance coverage of bariatric surgery and Cigna will only cover the procedure at one of their (Cigna's) designated Center of Excellence for Bariatric surgery. I found the closest one which is about 2.5 hours each way. I contacted them and I have to have all appointments with their clinic as far as dietician, psych, etc for a total of 5-7 visits prior to surgery plus the post surgical appointments. I just have to say that sucks big time! I have chronic back pain from an injury over 10 years ago when I was in my early 20's and now also have nerve roots impinged. Driving is sheer torture over 20 minutes, and the hubby cannot take that many…

My insurance has a bariatric surgery exclusion.... Makes me so mad because I called them on 1/3/14 to make sure I had the benefit and they said yes. Then; the bariatric coordinator called and said that I have an exclusion.... So I guess I'm switching to self pay Really makes me mad. I also called cigna today to double check and sure enough the lady said that it is excluded.

Good evening everyone! First, thank you for taking a second to read this, and thank you extra special for answering. I am a canidate for Gastric Sleeve here in Texas. I am currently under Amerigroup Texas Medicaid Star program, and I have a few questions for others who are familiar with how this works. 1) What pre-qualifiers did you need to be approved? 2) Were you able to use your PCP as a Dietician, or is a Dietician a necessary route in conjunction as your PCP? 3) What all was necessary for you to do in order to be approved? Currently I am 5'0" and weigh 238.7 lbs. Medicines helped me a lot to get to this high number, and it's something that I have been fig…

Soooo I called my insurance company and they said the procedure is covered. I said great! Can u tell me a surgeon that takes my insurance? The girl from the insurance company says " I have a list from 2010 you can call and ask doctors if they accept us". ....... I thought insurance companies kept this information handy?!?! The list of requirements she gave me as also from 2010, but she said the sleeve is covered....

Has anyone ever gotten approved for WLS without having a primary care physician ? I am currently in between PCP's my last did not support WLS and now I'm looking for a new one, it seems like the WLS institute is really pushing me to get a PCP to write a letter for me, but I already has medical proof and a registered dietitian who I did the 6months diet with for insurance purposes. Please let me know your experience... Thanks

I started this journey back in September. I called UHC's bariatric resources back in September and registered for the program. I followed all the rules and started going to meetings at the Bariartics center I had to go to. I called back January and was told that that center wasn't the right one and that I was totally crazy. I couldn't have been told that. I called my HR group and found out that the rules had changed I had to go to a different center--so I got all my paperwork together and went to the new place. If bariatric resources had told me that I would have been OK--but they told me I was crazy--I couldn't have been told that. All of January I called them…

Had my office visit today with my surgeon and scheduling my EGD, frontera and evaluation. I was told today that my deductible is met, does this mean I will still have out of pocket costs with BCBS, has anyone had to pay both out of pocket and meet deductible? I asked if I was going to talk to someone about costs so I can prepare and I was told it wasn't necessary, so I guess I am confused because my insurance company told me I had 80/20 and I am responsible for 20%, but was told different today by the insurance coordinator.

Hi everyone! For those that have UHC, I was wondering how fast you were approved once your info was submitted? My packet is going to be submitted soon, so curious. Thanks!!

I feel like my insurance company is setting me up to NOT qualify. I have short lived success with losing weight. I lose and gain the same 20 lbs. I need an extra tool to help me continue to lose weight. Under the Insurance guidelines Before I can even talk to my doctor for the referral I have to participate in the Insurance Weight Management Program for 6 months. They pay for Weight Watchers for that 6 months. The catch is in order to stay in the program you need to lose 5% in the first 3 months in order to stay in it for the second 3 months. The papers say you need to have 100% compliance in the program. It doesn't say that you have to lose another 5% in that second 3 mo…

we have united healthcare insurance, if we go to a center of excellence, it pays 100%- yay- but I have a question about the guidelines- like most insurance companies, they require a 6 month physician supervised diet. I've seen my OB/gym (as my primary dr) for the past 7 years. He filled out the supervision form inputting the last 6 appointments I've had with him (non-consecutive, but all in the past 2 years)- he stated that we discussed weight issues/exercise. Do you think this will be enough to satisfy that 6 month requirement or do you think I'll need to start the 6 month process all over again? I'm meeting with the surgeon tomorrow, so my paperwork hasn't been se…

UHC has a 6 month diet and exercise requirement that must be supervised by a physician. I have already been doing weight watchers over 3 months now and working out, but today was my first doctor visit. Does anyone know if I can use the last 3 months towards my 6 months? I really had hopes I could schedule my surgery in 3 months.

Hello all, I was just wondering if any of you paid your out of pocket expense on the day of surgery? I had my pre-admission testing done last week and they didn't ask me for any payments. Surgery is tomorrow and they told me to leave jewelry, money and things at home. Kind of confused! N Any answer is much appreciated.

We just got a bill from the anesthesiologists that my claim was denied. We have Aetna and used one of their "Center's of Excellence" and my surgery was approved with no problem. The exact same anesthesiologist did my endoscopy and it was covered. What should I do now? It's a rather big bill that we were NOT expecting.

Just called my surgeons office and they told me they sent my paperwork to my insurance company Wednesday. I hope it gets approved, but do have my doubts. I have UHC Choice plus and they require BMI 40 or above, psych eval., and 5 years of being obese. I have the first 2 requirements with no problem. The third requirement is might be a problem. As with most overweight people my weight has been up and down through the years. I lost over 100 lbs between 2005 and 2006 and my BMI was in normal range. I started to gain back my weight and was once again obese in 2011. That only gives my 4 years. Back in 1993 I lost over 100 lbs and by 1995 was once again obese. I inclu…

Upon attending seminar a number of times was told by DR. the cost for fills would be your co-pay. If you had insurance all you would have to pay would be the CO-PAY. Quick synopsis: Lap Band surgery 6/10/13. after surgery all fills were done by nurse at participating weight loss center operated by hospital at a cost of $150 each fill/or unfill. As of 5/1/14 they are closing that facility and now I am required to go to the Dr's office that preformed the surgery and the Dr. will do the fills at a cost of $400.00 for each fill or unfill. Yes, I have insurance but the deductable and the major medical must be meet prior to any insurance paying as it is now filled with …

I have been thinking about surgery for years but always felt it was soooo expensive and my weight wasn't THAT bad. After a lifetime of obesity this year it got THAT bad. I decided that this was the year to make a change. I will end my 6 months supervised diet in October. My BMI is 39.5 to 40.2 usually. Each calendar year between copays and deductables, I have to pay 8000.00 out of pocket at which point my insurance covers 100%. For the first time ever, I will be about at 100% by August. I can not come up with 8000.00 again next year if they successfully put me off until 2015. Has anyone had experience with this situation.Now that I am determined to have WLS the w…

I have horizon nj health (Medicaid) and I was wondering how long did it take for approval and was it difficult. Any insight is appreciated

Has anyone had their procedure done here? Who was your surgeon and would you recommend them? Due to my insurance (BCBS) I have to use this facility. Thanks for any help you can give!

I can't believe it, but my dr. office sent the paperwork to Cigna on May 14th, and I have a letter dated March 21 with the approval!! I just found out about it today, as I've been out of state since the 15th. Although my BMI went down to 37.4, I have severe sleep apnea so I have a feeling that helped in the decision. Surgery is next Thursday, June 5th!

Had my meeting with my surgeon on the 17th of april. Got my letter in the mail on april 27th supposed to have a surgery date by monday.

I am in the process of going from band to sleeve. My doctor’s office here in Houston told me they had to verify my insurance, two weeks later they did and now I have a doctor’s appointment with my surgeon June 4. I had the band back in 2005, I am filled to capacity and can still eat without feeling full or barfing, but what’s confusing to me is this; I thought you visit the surgeon first before they go to your insurance company. Can anyone please remind me of the process because I am lost?

I have Humana Medical Insurance and it would not cover my sleeve surgery, although they said it would cover my husband because he is the employee but not any family on his plan would be covered. That is the most ridiculous thing! I ended up having my surgery 4/2014 and financing over $13,000. I am diabetic and have heart disease in my family which would make sense to me that the insurance company would cover considering the possible health problems I could get. Anyone else had a problem like this with insurance?

OMG !! My bariatric center just submitted my preauthorization to BCBS NJ!!!! Please pray for me! Anyone with BCBS NJ? Please let me know how long did it take to get approval? Thanks all! sleeve30

I had my surgery done here in the United States in New England by a Center of Excellence Hospital, one of the best around. This is the facility that patients who have gone elsewhere and are now having complications get sent. Between pre-op visits, nutrition visits, cardiologist and psych appointments as well as a pre-op endoscopy, here are the costs: Total billed by all medical agencies: $43,200 Total covered by insurance company: $23,000 Personal out of pocket costs: $9,500 I have a high-deductible health plan, requiring me to pay full costs out of pocket until $4500 is reached. Interestingly, the cost of the surgery itself including surgeon, anesthesi…

I am looking at gastric bypass and have a dilemma. The Dr. office says do self pay, it will be cheaper. The insurance company says no use your insurance since we have allowable rates the Dr. and hospital must follow. My insurance company pays 50% up to $10K. Here is the problem.....I can't get a straight answer as to what my cost would be using insurance. The Dr. says they can do "everything" as self pay for $23,000. They had someone from the hospital quote me using the "estimated allowable" which is $36K is I use my insurance. How could it be more expensive to use insurance??? Ready to pull out my hair!!!

United healthcare waived all my nutritional visits said I didn't have to have them I just have to complete 8 coaching calls with United healthcare's health coach, anyone else have to do the coaching calls If so what do they consist of? So this will/should move up my surgery date according to my case manager at doctor's office and case manager with united healthcare.

You all are a WEALTH of information!! I thank God for this forum!! Having said that...now I'm wondering what will happen with my coverage?? Since I was laid off days after my surgery...how would this be covered or WILL it be covered - should my band need to be removed?? My insurance is still through Blue Cross Blue Shield but...with my new employer. Oy vey. Thanks for the information! Peace Always!! Mel

I've been reading about everyone's out of pocket cost for the in hospital stay after surgery. I have BCBS ppo of Mass, I have no idea how much everything is going to cost me. Does anyone else have BCBS of MA that can give me an idea of what their out of pocket cost was?, And was the hospital willing to do a payment plan?..I defiantly don't have $2,000 to put down!

Hi there, girls & boys! I have PERS Care, which is an excellent insurance program offered through my employer (State of California). It is through Anthem Blue Cross California. I actually work for the agency that administers health benefits to over 1.7 MILLION people in California & beyond. So, not only do I have lots of information about co-insurance/deductibles/Annual Max works, but after 5 years with my organization, I have learned so much about how all the plans are administered (Kaiser, Blue Shield, etc). If you are a State of California employee, or you work for one of the thousands of other public agencies contracted with the State for benefits, I …

So I have my initial appointment and blood work on the 17th. The office is sending me a form to fill out for my insurance and I'll give it right back to them. I've been trying to research on if they cover WLS. I meet UHCCP requirements (over 21, BMI over 40(I'm 41.6)) Does anyone else have this insurance? I know some UHC plans make you do a 6mo diet, but I've heard choice plus plan doesn't make you do that. Any advice?

I am a child (19 years old) still covered by my active duty father's insurance (UHC Military West/Tri-care West) and I am covered to do the RNY surgery, but I absolutely have my heart set on the sleeve. I keep running into rumors and old posts about possible coverage, the latest of which is that it will be covered by January 10 of 2014, but I can't find anything supporting that rumor. Is there a way I can get it with my civilian doctor? (I also have my heart set on him, I will not go to another center to have it done). Is there a way I can get them to cover my specific case if there isn't a possibility for it to be approved anytime soon?

This sounds morbid or fraudulent but please hear me out. I've had the Lapband for almost 2 years and it has been nothing but problems. i cant wait to get this thing out of me! I've been busting my behind and have lost some weight but no im screwed. To get the lapband out, my insurance covers it, no question but i cant switch unless i again meet the same criteria as pre op. I dont have high blood pressure any longer, nor is my bmi over 40. i dont have a co morbidy. Im terrified that if i take the band out, i'll gain all the weight back. Is there a way i can "fake" a test to make it seem like i have either (per insurance) high blood pressure, sleep apnea, high cholester…

Hi I've had the lapband for two years now, after a year I have had nothing but problems with it I can no longer get fills because it makes me so nauseated and bad heartburn. I've lost 80 pounds and since about 8 months I've had no fluid in my band I've gained 10 pounds of that back so my doctor says it needs to come out so has any one have an approval from band to sleeve with Cigna? Plus I will have to wait 6 to 8 weeks to have the sleeve done because my doctor doesn't do the revision at the same time, any thoughts would be helpful.. thanks

Hi. Just starting my journey. My doctor referred me for weight loss surgery and I have decided on VGS. However my BMI is about 33.6 and BCBSNJ requires a BMI of 35 with comorbidities (which I believe I meet at least 2). Has anyone had luck getting approved with this insurance at this low of a BMI? Do I just try to gain the extra 12 or so pounds? One weight loss surgeons office I spoke with actually told me to put weights in my pockets to meet the weight/BMI minimum at my weigh in. I really believe the surgery is going to benefit me and I want to make it work. All input is greatly appreciated.

Does anyone in the NYC area know which insurance has the quickest approval for Lapband to sleeve revision. I recently lost my job so I don't know if I should continue coverage through COBRA or try Medicaid or something on the lines. Please help!!! Thank you in advance.

MY insurance only require 8 weeks if supervised diet which could be with weight watchers or with a doctor within 12 months. Anyone else had this requirement? Does it mean I need to see my doctor every week?

I am new and dealing with Medicare. I was in a bad car accident in 2009 and am unable to work or move around much. My depression after the accident did not help much. Now I have packed on 70lbs since then and still gaining. I am just under 35 bmi but have a lot issues from the weight. I know you are suppose to be 35 bmi to get approved but does anyone have any tips to making sure you get approved through medicare? Thanks Amanda

I GOT MY DENIAL LETTER TWO DAYS AFTER THE DOCTOR SUMMITTED 93 PAGES OF INFO .I'M GOING TO APPEAL BECAUSE I'M 5'4' 236PDS AND HAVE THYROID AND DIABEITES SO I SHOULD HAVE MET THE CRITERIA ANY IDEAS ON WHAT I SHOULD BUT IN MY LETTER. ANYBODY HAVE ANY GOOD RESULTS WITH THEIR APPEALS?:teeth_smile:

I let the nerves begin !

Hi, I was wondering if anyone had any success in getting the 6 month supervised diet period waived? The idea of waiting 6 months and then waiting for a date is excruciating but my concern is more than that. I do not know how long I will be at this job (and thereby my insurance coverage) and would love to move forward asap. Any thoughts? Thanks Laynie

I work for a garage door manufacturer here in Ohio. I want to say that this company really cares about it's employees and how thankful I am to be where I'm at. Not only do they opt in for the bariatric surgery, but there were no 6 month diets or red tape. I met with my surgeon, met with the NUT and met with the psychologist. Submitted to insurance and 7 days later I got my approval letter! I have no Co morbidities just a bmi over 50. If anyone out here works for Clopay and has questions... I'm your go to girl:) But I'm here for anyone that has questions I really want to be an advocate for bariatric surgery and take some of the hush hush away from the subject. So if the…

I started my journey in Oct 2013 and got all my pre-op things done, did 3 months of diet. Summited in January and was denied because they would not except the weight-ins I did for those 3 months. (didn't state diet and exercise and wasn't detailed enough for them) So I started all over again with a 3 month program with a special dr that does the nutrition for people gearing up for wls. It was resubmitted but my insurance called my surgeon and said they wanted to do a peer to peer. Than was done yesterday and the medical director said he would have his descision within a week....Im tried to stay positive but I am a nervous wreak!