Insurance & Financing

So far, my insurance has only required 3 things: - Past attempts at weight loss (which I gave them weight watchers history, and prescriptions for adipex) - Psych evaluation (which I did online) - Meeting with nutritionist (I did in office yesterday) My doctor's office called today and let me know that once the insurance worker is back in the office tomorrow, she will be submitting to insurance!! Of course they gave me the "It usually takes around two weeks to hear back", but I have seen as little as 3 to 4 business days, so I am hoping for the best! Hoping I will be able to start my journey soon!

Hi there everyone. Newbie here. I am going thru this fun process. I am waiting to get insurance approval. I know they will approve since the bypass is covered. However, I was wondering if anyone else has this insurance (Medicaid). If so how long did it take to get your official approval so you get your surgery date. Thanks in advance.

My husband and I are both having the sleeve done, pending insurance approval We are looking at sometime in April. We are in the final stages of appointments required by insurance now. My question is what insurance doesn’t pay (our case 20%) do we pay before or after surgery? Just trying to prepare myself.

I'm an employee of the University Hospitals Health system in Cleveland, Ohio. I have been told our insurance now covers a significant part of the surgery but have not been given a direct quote. Are there any other UH employees with the Traditional insurance and have had surgery? Should I make an attempt to call the insurance to get a jump on potential Insurance concerns? Geraldo67

I am financing due to being 38.5 bmi. The advantage is that I can be scheduled two weeks after meeting the surgeon! I believe the lapband is best for me. Anyone else financing?

My surgery date is set, for this I am excited! I already know that insurance will deny the pre approval but my surgeon and dietitian are confident they can get it approved on appeal. I have a hiatal hernia, due to my weight this is the only surgery recommended due to high rate of failure for the other options. Premera considers this treatment "investigational" which will result in the initial denial I am expecting. My surgery is scheduled in May (my surgeon is popular ), they are putting in the pre approval now. Does anyone have an idea as to how long I can expect the denial and appeal to take?

After starting the process almost 3 years ago and then bailing due to husband's sudden health issue I find myself here again. I'm back to considering the VSG. My insurance covers it (Aetna) but I'm reading stories of people being denied because their weight history has an occurrence of a BMI under 35 in the past 24 months That would be August 2018 for me After putting off surgery my Dr. put me on Vyvanse. It worked for a while and at one weigh in my BMI reported at 34.8. Problem is, I self-reported my height all of these years and I'm actually an inch shorter than I thought I was, I guess that's water under the bridge. If I had let the Dr. measure me I ne…

When my husband and I moved here, we didn’t have jobs so I applied for Medicaid for us while we were looking. And we got approved. I found out a couple of months later that Staywell/WellCare might possibly cover bariatric surgery so I gave it a chance. In 4 months I was completely approved and operated on yesterday. Woohoo! Let me know if you have any questions. I’ll try to help as much as I can!

My insurance requires a minimum of 6 consecutive months of physical or non physical weight loss program. See excerpt from my instance policy below. Does anyone know if I could use My Fitness Pal to show 6+ mo the of weight loss? I have 6 consecutive months from about a year ago and lost about 20 pounds but have gained it back. I am 5’2 BMI 40. I would like to do the surgery in early July but just started with my practice on February 3 and that puts 6 months at aug 3. I have a major work event in September and the timing doesn’t allow for surgery before the event. If I cannot do surgery in July I will have to wait till early October. :( The document must include th…

Has anyone had experience with BCBS MI / BCBS of Michigan? Curious to know about approval period. Thanks.

Hello, My surgery is scheduled for jan 2020. I submitted if i am approved before my deductible reset will it count. Will i have to pay my deductible before i can have surgery? My deductible and OOP is $6700 i have $1034 left to pay before it is met but all of that will reset the new year im So Confused please help ??‍♀️

I was able to get through the 1st stage. I've spoken to the clinic in Portland. OWL. They told me they are just now processing the paperwork and we will get the ball rolling soon on making appointments for the second stage. I completed the online seminar and filled out the application PDF. My Dietician MD sent out the referral and she, the weight loss clinic, and Molina have all said that the first stage is complete. I was given CPT codes by the clinic for bypass and the sleeve. Molina confirmed that they will cover both if I meet the requirements. I was told that I may be able to do a sleep study at home and mail it back in. So that is definitely one less worr…

So finally after 3 years of fighting with my past insurance I am approved! I used to have BCBS IL and switched to IL Health Alliance through my employer. They approved me within a few hours! BCBS IL denied me three times and after peer to peer they still didn't approve because they said GERD was not enough to do a revision. Surgery is in three weeks!

I am wondering if anyone has used their FSA visa card for surgery in Mexico and if they had issues?

Please I need a Little guidance... I’m currently in the process of trying to get VsG.. Any information on Medicaid approval process will be greatly appreciated ??

I'm new to this whole process, where do I start? How do I find hospitals of excellence that are required? What is a medically supervised weight loss program? Can I do it with my PCP or do I need to go to an official center? I'm so confused!

I just received a $76K (not including anesthesia) bill from the hospital. My insurance has a 10K max lifetime coverage and this was the balance. It was an uncomplicated removal of lap band and RNY. 1 night in-network hospital stay. Does this seem high?

I completed all my requirements on 11/4. The patient coordinator said that she will upload it all to my chart for the team to approve it to be sent to my insurance. How long did it take your team to approve your chart to be sent to your insurance? The representative for my surgeons office said a few weeks.

Can anyone shed light on how much their surgery was? I have blue shield gold h m o 500/35 and was told they cover the doctor's fees but I am responsible for 20% of the hospital stay. Can anyone share how much they paid for surgery or give me any insight on how much $$$ I should prepare? Thanks!!

Good morning! New here just starting the process of getting approved by Cigna on a OA plan in Georgia for the Gastric Sleeve. I have been working with a Nutritionist and exercise coach since November. However I missed an appointment in December because I came down with Pneumonia. My surgeon's office says that CIgna requires 6 months of nutrition and exercise for pre approval. However when I called Cigna they told me once they did require 6 months then the next time I talked to them they said they didn't. They seemed VERY confused on what is and is not required. Is there anyone in GA with Cigna that has been through this process? Do you know if the 6 months is requi…

I’m starting my Weightloss surgery journey, I’m literally at the beginning I’m talking seminar beginning. I have questions about the requirements for Humana gold plus is the also the plan I have. I’m covered through a Medicare Advantage plan and aside from the program fee and the dieticians visits I’m supposed to have $0 everything? Does anyone else have this plan who has had surgery?

I have feeling of accomplishment and relief. I completed the Medicare criteria for my revision surgery this week. It has been a journey, stressful at times. In 2005, when I was preparing for my Lap Band surgery, I worked through all the pre- op requirements at the Bariatric Dept. Back then it was my PCP who gave me the biggest grief, as he was not a proponent of weight loss surgery of any kind. This time it was much different. The psychiatric evaluation and initial nutritional assessment I had done at the surgeon's hospital. But, since I live about 2 hours including a ferry ride from the hospital, I decided to do the Medically Managed Weight Loss Program with my lo…

So, my surgery was pre-approved. I had surgery on the day I was pre-approved for by the doc and at the hospital that was submitted for pre-approval. Hospital was paid. Doc was paid. A third doc was paid... it appears to be lab related, but I have no clue who it is. I can see all of this on the BCBS website. Today I get a letter stating that they (BCBS) have requested medical records from the doc listed below (but no doc is listed below). They state that it is to do a medical review of a service provided the same day as my surgery. They want all H&P documenting prior treatment and results and co-morbid conditions, current lab reports, height weight & BMI, copy of p…

Hey all, I was just wondering if there was anyone here who has dealt with Aetna and been approved on an appeal? I just found out this week that Aetna denied my surgery because the plan my company has doesn’t cover bariatric surgery. I am appealing but was wondering if anyone has ever had success with an appeal through Aetna?

I have my first consultation on January 2nd. I have spoken to my insurance company and they said there is no required diet period before I can be scheduled. They only requirement my insurance has is a BMI of over 35, 1 visit with a shrink, a visit with a nutritionist. My doctor is telling me I have to do a 6 month diet plan with his nutritionist that my insurance will not cover because they only cover 3 visits a year. Is this standard or do I need to look for a different DR. I feel like the doctors office is just trying to milk the insurance company. I have Blue Cross IBX.

I was hoping this would all get resolved and I wouldn't need to post about it but here we are. My surgeon and her team always had trouble with my insurance. They wouldn't respond to requests and they could never give me an idea of how much it would cost me. I got a pre-approval from insurance before surgery. After surgery my $130k bill got sent over to insurance and of course they denied it. They said they requested medical records from my provider but that request came through BCBS Oklahoma since I'm out of state from BCBS Arkansas. My provider said that request gets routed through the billing department and that they'd check to make sure they got the req…

Can anyone provide a phone number for Medicaid. I live in Atlanta and I've called so many numbers. All I'm getting are automated. I would like to speak to someone to see if my Medicaid covers bariatric surgery. I'd hate to get well into this and find it's not covered. Please help!!!!

So I finished all of the insurance pre-requisites and I had an appointment with my surgeon today. He says I am an excellent candidate for gastric bypass surgery based on all the consults I had- nutrition, psych. So my doc says he will fax in my paperwork to the insurance company wit a request for authorization. Once insurance approves, they will call me with a date. I know it’s different for everyone and with Thanksgiving coming up it may delay things... but how long did you have to wait before you got authorized? I have Blue Cross Blue Shield of Illinois.

My employer is now using Carrum Health and fortunately it will cover the surgery 100%. Does anyone have any experience with Carrum?

I will be So happy when all of this is over my Anxiety is so bad i am switching Insurance Jan 1st from BCN MI to Meridian so my deductible Can be Lower because right now Its $6700 and Going Up next year to $6850 Which Is Ridiculous So i Am switching. My surgery date is jan 28th and only thing I have Left to do is Keep my weight down and submit for Approval. Im Waiting on the surgeon office to call me tomorrow to tell me if i will have to start anything over when i switch insurance or will all my preop test and weight loss be good with the new insurance. All the requirements Are the same For Meridian except wit BCN if your BMI is High they waive the weight loss program, fo…

Getting started here in KS and have Anthem BC/BS-CA. Current BMI is 44- no co morbities. My question is- if during the Doctor monitored diet & exercise 6 month period, my weight dips under the qualifying 40 BMT; is it possible that I'll become disqualified? Just wondering... Thanks in advance for any input!

Anyone here with Texas BC/BS? I've scheduled my first consult for December and know they require 6 months with a nutrition program before surgery. I'm in school and want to get the surgery done over the summer ASAP so I won't be at risk of missing any of the fall semester. How has the timing been for everyone else on this insurance? Has anyone had any problems getting approved for the surgery right at the 6 month mark? Thanks!!!

My insurance approved me for a roux en y in only 3 days!! I am so happy! I have a pre-op class to take on 11/15 & 2 more on 12/5 and 12/12. They said they would give me my surgery date sometime between 12/5-12. I can't believe it. It still doesn't feel real!

My office recently submitted my paperwork to CIGNA for approval. I received a decision within a day but the claim was denied due to where I’d be having the surgery. Cigna stated the location where they wanted to perform the surgery as outpatient is not on the 2019 Bariatric Center of Excellence list. I checked and the surgery center is in fact on the list. I actually had my EGD performed there and they paid that claim. I called CIGNA and the rep stated that the ruling they gave is not accurate and outdated. The rep also stated that the case manager is reaching out to my office to rectify the issue. I am frustrated but trying to remain hopeful. Has anybody ever been…

Hi, so I'm new to this site, but I decided back in may I wanted to do wls, when I first talked to my insurance company about requirements I met all of them, so I picked a Dr. and got my consultation date. Then when I was speaking to them about something completely different I decided to ask about requirements again. Good thing I did because the first time I asked they failed to tell me I must do their bariatric program and get surgery at one of their hospitals of excellence. The only problem was there is not one in my state. However they reimburse me for travel expenses. It was just so frustrating because I was excited to begin with my consultation and everything. Now I f…

I had my surgical consultation today for revision, but on the off chance that it is not deemed medically necessary for revision, I do qualify for bariatric surgery in general, repeating all of the requirements as if it were a new procedure. My question is regarding Cigna coverage. Most plans require a monitored 3, 6 or 12 month diet/nutrition/weight loss management through PCP or somewhere similar. Cigna's policy says NOTHING about this, only that "a statement from a physician other than the surgeon, that the individual has failed previous attempts to achieve and maintain weight loss by medical management" - it gives no other requirements or indicators. I called Cigna tod…

Hello All, I work at Wells Fargo and have Anthem BCBS with them. I am in process to complete my 6 month diet requirement for surgery in the middle of December! My doctor said if they get my approval back within 5 business days they can get me in before year end. This makes a big difference in paying $1k then to $5k in January. Anyone who works with Wells with this insurance, I just want to know approval timeframe?

So, I recently went to see Dr. Vadim Gritsus about getting the sleeve done. I currently have Horizon NJ Health through NJ Family Care (medicaid) but I'm being cut off at the end of the month because my income is now over the limit. NJ Family Care suggested purchasing insurance through the Marketplace. That being said, I'm wondering if anyone knows of an insurance plan offered through the marketplace that has a 3 month or less requirement process for bariatric surgery. I've considered quitting my job in order to keep the medicaid but its just too drastic and I'd rather do the right thing and purchase insurance (the insurance through my job doesn't cover bariatric surgery).…

Hi, I had my R and Y in 3/2014: I lost a lot of weight, however it’s been now tricking back... can figure out why! So my BMI is like 27.5 and realistically I need to get off 33 lbs My question? Will tricker pay for the endoscopic gastric revision? Does anyone know what it costs? And will tricker pay for any revisions? Thanks

Insurance approved me today. I am still waiting on the insurance coordinator to set a date though. She asked if I had a date in mind....I told her ASAP[emoji1]

Hi! I don't know if this has all ready been asked or answered but I'm new to the site. I'm looking to have the sleeve surgery done with my Medicare being my only insurance. I'm looking to find out what is the waiting time, what may be my out of pocket portion and what test does Medicare require? I'm in Georgia. Thank in advance

Hello. I'm new here. I am so grateful I jave found this forum. I have finished all of my requirements. Now I'm playing the waiting game for insurance approval....

I’m so excited that my surgery was approved. All I have left before scheduling my surgery is to take my pre op nutrition class. I’m almost to the Losers Bench. Lol

Newbie here with a question. I have Aetna and one of the requirements is 2 year documented weight history. I’m currently BMI of 40 without co-morbidities only high cholesterol. My 2 year history shows about 35 BMI. Could this be basis for denial?

Hey everyone , I'm new to this forum and I wanted to ask if anyone has FL Bluecare ***? I wanted to how many "hoops" my surgeon and I would have to jump through (so to speak) before getting approved... I have so many questions, and I think I have called to get information so many time that I know the breakdown of the benefits by heart lol I just want this surgery to work out... I have spent my whole life gaining, and losing, and gaining and just being obese... I am tired of feeling like this, I want to better myself and this is really my last option.

I was sleeved in 2014 and now I’m looking into getting a revision due to GERD and a Hiatal Hernia. Has anyone had Medicaid approve revision surgery??

As the title says it was approved. Now I just have to see the surgeon at the bariatric center I will be going to. I just have to jump through the hoops to get approval for the surgery. I just hope they use my starting weight for the approval. I'm teetering at a 41 BMI so if I have to lose too much I might not qualify. Anyone have any experience with that?

I am 29 with a BMI of 41 and have been considering WLS for a while. I have OHP (Oregon health plan) so I needed to get a referall to see a bariatric surgeon. I just had an annual check up with my PCP and mentioned WLS. She didn't seem super enthusiastic about the idea and after mentioning I'd like a referral twice finally took the info to do so. I mean I do meet the requirements for approval with a BMI over 40. I'm just hoping my referral gets approved soon. I hate waiting but at least I've got things started now. Lol anyone with experience dealing with OHP?

I have had the lap band for 10 years now and it wasn't until the last 3 years I started having issues with it. Now I am back over 240 and my doctor had to remove fluid because of my heartburn/gerd. I ended up with ulcers on my esophagus that are now cleared up. I have gotten almost all my clearances done in about 2 months and wondering if anyone has had UHC approve that quickly? My doctor is submitting to insurance this week. Everything I am reading says 6 months but its also all for initially getting one of the surgeries done not the revision.

Hello. I've recently just started looking into possibly getting approved for surgery after many failed attempts at numerous diets and such. Is anyone on here from Bend, OR and can give me any info on the bariatric program with Dr. Archer? Also I do have OHP (Oregon Health Plan) and was curious if anyone had any experience with them as far as getting approved. I have a BMI of 42 and hypertension, pre-diabetic, and just tired of my body not cooperating. Any insight is appreciated.