Insurance & Financing

This may best be catagorized under gripe threads, but essentially there are a lot of us who have exclusions on our health plans that will not cover anthing related to obesity, EVEN THOUGH it is recoginzed by the A.M.A. as a disease. The fact I find that unethical and absolutely messed up behind belief makes no difference, however, and it is what it is. I casually mentioned I was drinking Slim Fast at a doctor appointment for an injury to my foot, and this detail made its way into my chart. I got a denial from my insurance and had to pay the entire cost of the visit out of pocket. *insert expetives As such, my wife and I had to clean out our 401K and take a huge loan…

Hi....does anyone have Emblem health? Any insight to their process and approval rate would be great!

Just spoke with my insurance company and they have my application. It was submitted on 5/5/14. She said that it is now in the approval phase and it could take up to 6 weeks, but could be as little as one week. They only require 3 things...approval from surgeon, visit nutritionist, and therapist evaluation...I have done all 3 so i should be approved right? How many have dealt with this insurance and how long did it take to hear back with an answer? Thanks!

At my consultation appt my BMI was 40.05. Now I have to do a 6 month diet to get approved. My question is will I get denied if my BMI drops below 40 prior to surgery?? My coordinator assures me that the starting weight is the only one that matters but I'm not sold. I don't have any comorbidities and my insurance is BCBS.

I have been thinking about the gastric sleeve for awhile now and i began going to a surgical center in northern Kentucky. At first I was told I had to wait six months but now I'm being told I don't. The only issue with that is my center I'm currently with does not accept my new insurance so I feel like I'm starting over in a way. I'm not sure what to do.

My paperwork was officially submitted to Aetna yesterday, so while I am twiddling my thumbs waiting to hear something (an approval, HOPE-HOPE-HOPE!), please share your Aetna experience! How long did it take for you to get an answer once your paperwork was submitted? Has anyone with a high BMI and co-morbidities been denied? If so, why? Do your ears hang low, do they wobble to and fro? <g>

Hi, I have had two 6 month physician supervised diets within the last year and half. In each of them, I weight in like every 6 weeks or so. Do you HAVE to have 6 monthly weigh ins to get approved by medicaid (WV) or will that be enough with strong support letters from the physicians?

Today everything was sent into my insurance. I have BCBS Michigan. I'm nervous but have been told there's no need to worry! I guess I'm just nervous because I'm only 19. I am 5'8 and 368lbs though. If approved (fingers crossed) I can't wait to get a date! I am so excited and ready like nothing before. My insurance only required a psychological evaluation and medical clearance from my primary health care physician. That's not that much stuff at all. I don't know if that's a good thing or a bad thing lol This is my first post on here and I would love to make some pals! I have too much excitement and anticipation to keep it to myself. How long do you think it would take to g…

I had my psych evaluation yesterday and am alittle bummed. He wants to meet back with me in a few weeks after I keep a food journal. He wants me to document what I eat and jot down my thoughts about it. I agree that this will definitely help me be more successful after surgery, but I'm let down that it's going to take me even longer to get my information to UHC for approval. Now I'm nervous that he sees something that's making him not want to sign off on me to get the surgery. Did anyone else have to see the psychologist multiple times for approval?

I have officially completed all my requirements! But--- my NUT told me at yesterday's final meeting that there have been some major insurance changes that are just now being enforced and they are having problems getting approvals. Seems like my insurance company is one of them. I'm so nervous that despite me and the bariatric team calling my company in March and getting info that this is covered, that I will now be denied. I've mentally accepted that I cannot do this without help/a tool, and if I get denied due to these recent changes, I'll be devastated. I know there's not much anyone can say or do, but I needed to vent. Thanks.

I've been trying to save up for my out of pocket expenses... I know that the max out of pocket that i can be charged is $2500. Now, who will charge first? Is the deductible paid to the hospital? Do I have to pay anything else before I can have surgery?

My paperwork was submitted today to my insurance company. I have Affinity Health Plan Medicaid. I am hoping for a speedy approval. I have a BMI of 47 and high cholesterol along with joint pain and I am hoping to hear back soon. Wish me luck everyone!

She submitted the paperwork to the insurance two weeks ago. I had no idea she had done this I had not even spoken to her once about it. I just finished going through all the visits and preps and stuff. So surprise I get a letter from Cigna saying they need more information last Thursday They need the notes on the 3 months visit with nutritionist and pcp letter. I picked up pcp letter Monday and scanned and sent it over to her. That was the 21st. Mind you 3 months of NUT visits were conducted in her office. She didn't send with original request She says she would send over letter from pcp on Monday. Ok. On track now. So yesterday I open the mail and there …

I have BCBSNC I have met my $2000 out of pocket maximum and now the bills are starting to come in. Will I have to pay all of these bills before they will do my surgery or how does that work?

Hey guys I'm doing my 6 month supervised. I'm going to month 5 appointment tomorrow. I heard that if you gain any at all they will deny you. I started at 403 I'm now 377. But month 3 I gained like 6 pounds but lost it. What do you guys think

THE BILL ARRIVED Sooooooo, I received my medical bill for the surgery, lab tests, and everything else. WOW. Luckily we have very good insurance!! I have Mutual Heath Services in Ohio. I strategically had the surgery before the calendar year ended because I knew most my deductible and co-pays had been paid already. I was seeing my PCP almost every month for some sort of medical issue from the morbid obesity. Last year I went to the doctor more than the last 10 years combined. That was one of the factors that led me to the WLS, I was physically falling apart FAST. Back to the BILL, here is how it broke down of who paid how much: TOTAL CHARGE: $51,847.27 PP…

So the insurance rep from my surgeons office called me last week to let me know all of paperwork has been submitted to my insurance. She said they got a precert date &could have it done as early as June 16. However, they need to wait for authorization in order to make sure they will get paid. I called my insurance twice and was told they don't have any record of my dr sending anything. Today when I was told that my policy doesn't require pre authorization. The ins rep gave me her extension and said to have my dr's office call. Also to find out where they sent the paperwork. She asked if the dr was withholding services for a procedure that doesn't require pr…

A childhood friend of mines told me that some insurance (even medicaid) will pay for some plastics. Even Lipo. Is this true? Have anyone ever heard of this?

I've decided if my insurance won't cover me I'm going to self pay. I don't think I'll meet the co-morbidity requirements. But who knows. I'll try that route first and have package submitted to insurance after final tests Thursday. If it is rejected though I don't want to spend months trying to get it approved. I really want to have this done and soon. It's a relief to know it's only a matter of time now.

Was anyone else charged administrative fees. I feel like I am paying to have my appt's set for me or to fund the doctors they work with. I would like to use my own doctors that I choose. Is it possible to get all of you testing done outside the program?

My claim for vsg has been submitted to BCBS Federal! I've been really confident telling myself that my surgeon wouldn't have me going through all of these evaluations if he didn't think I had a good chance at being approved, but now I'm second guessing myself and worried I've been over confident!! I've heard that BCBS Federal can have a quick turn around time so I'm really hoping by Wednesday I will know. I really want the week of May 12th for my surgery. Panic setting in....I just want to know!!!!!

Hello! I went to my surgeon yesterday to get the results of the GI... he said the band and my esophagus look fine, therefore it will be hard getting the medical group to approve my revision to sleeve. I haven't been successful with the band I have pain on the port, nausea, food gets stuck, horrible GERD and constant burping. IDK what to do... I really wan to have the sleeve done....Dr also mentioned that only 10% are successful with the band, he thinks it just doesn't work for me. the insurance coordinator said she would like me to go to the nutrisionist first but it's not covered thru the insurance, therefore I have to pay out of pocket. I just don't want to pay fees a…

After waiting nearly three weeks for my surgeon's office to submit my info to insurance, the day has come. My info was submitted to insurance today. Now I get the satisfaction of knowing how stressful waiting on the insurance company to do there job is. With my list of comorbidities, I don't see how I could be denied, but I am sure it happens. I hope everyone else has a stress free wait and I hope we all get approved!!!

Does anyone have Carefirst? I was approved on the first try. They said I have to wait 6 months I need to see a nutritianist once a month. I was wondering since I have tried so things to lose weight ie: weight watchers 5x personal trainer, gym, nutri system, to name a few. I'd like to know if they can take that into covciderTion?

Hi all! I am a 24 year old female I am 5 foot 6 inches tall 235 lbs with no co morbidities my bmi is 37.9 and my first appointment to meet with the Gastric sleeve doctor (Dr.Attia) is May 20th... Can someone please tell me there is a possibility that I can have this surgery, or am I wasting my time?! also would I be eligible for something else worst case scenario such as the lap band?? How was the first appointment and how long does it take to find out whether you are approved? Sorry for all the questions !

I got approved for revision surgery from lap-band to sleeve. Paperwork submitted this past Friday, and dr.'s office called today! I'm approved!!!!! That was an instant approval!!!! Thank you Jesus!!!!!

Does anyone out there have humana gold plus HMO? I was wondering if I have to do the 6 month or 12 month pysch appts or do I just have to do the one ?

If your insurance has an exclusion does that mean they won't even consider it even with a letter from the doctor and proof of previous weight loss attempts?

Hi guys I have a long story to tell and I need support. In 2011 I was getting all my blood work done and checking into my hotel room the night before my surgery when they called and told me I was pregnant. So we turned around and headed home. Now here we are in 2014 and 2 kids later, and I'm ready to try it all again. This time money is harder to come by even though my husband received a promotion at work. Taking care of 2 girls is expensive. Who'd of thought it? Any way during my first pregnancy I developed gallstones and it's highly recommended they remove my gallbladder. To this day I still have. 1-2 attacks a month. Now here's the question has anyone been able to get …

Hey! So I haven't posted in a while (just rockin' my sleeve and enjoying life!), but I'm still working on my webpage which lists the self-pay prices for bariatric surgeons performing VSG. I want to help others to find a surgeon they can afford, if they're unlucky with insurance like I am! My website specializes in surgeons in the United States, since many folks are uncomfortable going abroad for surgery. If you paid out of pocket for your surgery or are thinking about it, please PM me with the name of your surgeon (or the one you're considering) and the self-pay price. I want to collect as many self-pay prices as I can to make the website comprehensive and useful for po…

Tomorrow is the last of my 6 pcp visits, and I'm really worried. My visits aren't consecutive-- which, my bariatric resource nurse says is fine, they can be non-consecutive and go back up to two years. I have six visits over the past 12 months, and I haven't lost any weight. In fact, I've gained weight from my first appointment 12 months ago. I gained 20lbs between May of 2013 and August of 2013, then kept my weight steady for the remainder of the visits. If you were me, would you go ahead and submit everything, or keep trying until you've lost weight?

I have been seeing my PCP since December 17th For weight management. He gave me a diet and exercise recommendation. My next visit was march 17. I was only down five pounds. I have been seeing him monthly since. Will this count as a diet plan or most I start over with a three month plan with the surgery center?

That's the only thing missing for the insurance. I do not seem to convince my previous or new doctor to write me the letter. What should I do? I do have a gap of 3 years where I didn't see any doctors due to not having insurance then. Please help!!

I was told last week that info had been sent to the insurance company. Come to find out that insurance coordinator was not even there last week. So I called them yesterday and was told it would be before the end of the week. I was fine with that I understand she was out all last week. I called today to check on it and was told it could be next week. So what is it this week, next week, maybe sometime in the near future? I am so ticked off right now. My expensive insurance is paying their salaries I expect to be treated with respect not like they are doing me a favor.

So Bariatric surgery is not covered on my insurance but with all my health issues my doctor seems to think my insurance will cover it.... Has anyone's insurance covered it even though it's not listed??

I'm just now starting the process in Colorado Springs. I got my referral today from my PCM. We are most likely moving in the next 2-3 months to Fort Rucker, AL. I'm curious if anyone else has moved during the process and if you can use your records from one location and apply them to the next to shorten the wait time up until surgery. I'm also wondering if anyone knows off hand if there is an MTF in Southern AL that performs the gastric sleeve and if not if they will allow someone to travel up to Fort Benning, GA to have the procedure done there. It seems the VSG is only covered by Tricare if done at an MTF. Thanks in advance!

I have United Health mdipa through the federal Government in MD. I was wondering if anyone who has this medical has had surgery. If you have, how much of that surgery did you have to pay?

OMG! I am so anxious and stressed out, this has been a long journey, almost a year of research and then a cancelled surgery in Mexico. I just wanted to feel safe and have a Dr close by that I can turn to when necessary. Now almost another year later after diet and nutrition, tests and psych visits my paperwork was submitted to Cigna OA Plus for approval. This nail biting experience is worst than the process. Fingers crossed, toes crossed and prayers going up waiting for an approval. I need an approval. Can't sleep or focus, I just am so anxious and nervous!

I am so happy and so thankful!!!!! I got approved today, my surgery date is May 23rd. I thought my surgeon submitted paperwork last Wed but he didn't, I was disappointed with the delay. I find out that they submitted on Friday and it only took 48 hours for them to approve. I am soooooo HAPPY! Thanks to all that listened to my whining, I'm sure there will be more whining to come, but at least I will be doing it from the losers bench!!

The journey has been smooth until now. I get my insurance through my employer, professional benefit administrators (PBA). My medical insurance with them in through Cigna. Now I got pre approval and went through six months diet requirement. Doctor submitted insurance and today I get the call that sleeve was denied that I only and covered for gastric bypass. Now I have been dealing with the which one I want and decided for my lifestyles and my needs that sleeve will do much better. I don't want to give up even though insurance is saying there is no loop hole. If I appeal that could be another 30-90 days!!. Cigna approves sleeve but PBA (my actual insurance) does no…

hi all, newbie here. Been wanting to write this for awhile now. Completed all pre-op conditions for insurance, (psych eval, nut classes, blood work, etc.) and I put in a call to see when the coordinator will submit my file to insurance. My problem is this; I have bcbs of wny and the turn around time can be up to 3 weeks for an answer.... AND NOW the bariatric center tells me I also have to wait for the surgeons hospital (ecmc) to approve patients with bcbs (medicaid based) , because ecmc doesn't currently take my insurance..... Sooooo could you have told me this sooner? They have "a list" of approved patients with my same situation that I will be put on, if I'm app…

I got a link to this news story in email this morning and thought it might be beneficial for some of you who have been denied coverage. It gives some ideas about how to appeal and some surprising stats -- that over 50% of appeals win coverage. http://www.washingtonpost.com/national/health-science/patients-often-win-if-they-appeal-a-denied-health-claim/2014/04/14/ee4dd3e8-c40d-11e3-9ee7-02c1e10a03f0_story.html

My question is...I am paying cash for the surgery due to have insurance with strick exclusions. But now my doc wants me to have colonascopy, EGD. Will that throw flags to my insurance carrier and cause them to excluced payments for any sleeve related charges?

I am going to be a self paying sleeve patient. I am interested in finding an insurance policy to help cover any additional expenses that may incur if complications happened. I have heard of the Blis insurance but my surgeon is not part of their network and they are not accepting new providers until next calendar year. does anyone know of another insurance provider that covers this type of short term that policy? Thank you in advance -Paige

So I was notified today that I have a "tentative" surgery date of May 23. I qas told that insurance needed a prospective date but they haven't fully said "yes" to approval. Has this happened to anyone else? Also is it safe to say I'm pretty much approved?

Does anyone have Medicade with Health First how long it took u to get approved??

So all paperwork went to insurance Monday. When you guys think it okay to start calling? I have Cigna insurance. I am totally obsessing!!

I have GWH Cigna and in waiting now for Approval. Just wondering if anyone else has it what their approval time was?

Not sure if this will help anyone however I thought I would share how I got my surgery covered when it was excluded from my group policy through my work..... My group policy was a total wash. They said covergae was excluded and medical necessity or not, no coverage. So, when open enrollment thru my work began, I went through an outside insurance broker (you can't go through the Obamacare exchange if you are eligible for a group policy through an employeer or spouse's employeer but you CAN get your own individual policy) ...... I found a full "Individual Policy" thru another big name insurance provider, made sure that the policy I chose had bariatric surgery coverage an…

I got the call today that I was approved!! My paperwork was submitted Friday afternoon so it happened quickly!!!