Insurance & Financing

Any help I can get would be appreciated. I feel like I've hit a dead end, so if you know of any options I haven't thought of, please let me know! So, here's my issue... A little over a year ago, I decided to look into bariatric surgery. My husband knew people he worked with that did it and had great success, so we assumed (since our insurance is through his work) that it would be covered. I researched, got over the emotions of whether or not I should do it, started a program, then found out our insurance no longer covered the surgery. Then I learned of a good surgeon that took cash patients that a family member recommended. I was ready to start the program, get finan…

I have to see my dietitian on Friday which my insurance those not cover the visit under my surgeon but I found a dietitian that my insurance cover outside of the hospital where am having my surgery .i guess I need to ask should I pay the extra and do everything under my surgeon or does it not matter what dietitian I see ?please help me !

I called to check if my chart was still in medical review. I passed medical review and my packet was sent to the insurance company. I hope the insurance company doesn't take forever. I have UHC Choice Plus. I am excited, but scared that I am going to be denied.

can I have this one deleted?

As of 1st of July gastric banding is only covered if you are on the highest hospital cover for 12 months. Getting mine just before so I'm lucky.

Hello. I am new to all of this and I just did my seminar and want to start the process in having surgery. I have read that BCBS of Georgia PPO doesn't approve the sleeve surgery. Has anyone with the this insurance plan had a problem with getting approved for the sleeve? My bmi is over 40 btw.

It has been a long journey....approval for removal of my lap band was done December 13, 2013. They originally denied the revision to RNY. But after many months, dropped ball, etc..a peer to peer review was scheduled week before last. The day after my doc called and rescheduled my appointment because of unforeseen circumstances he was going to be off a week. I had put in my mind the review wouldn't happen until this week when he returned, but today I got the letter from my insurance company!!! Bless his heart, he must have spoken to them before he left. And I don't have to go thru the appeal process. Peer to Peer review process worked. Thanks to this site for all th…

Found out today that my specific group within united health care choice plus excludes bariatric surgery. Fabulous. So we are going to try and appeal it but overall plan on being private pay. Anyone know round about what the cost range is for sleeves?

Geez, I've just started thinking about WLS and just got insurance and the runaround has already started. I called the 3 bariatric centers in the closest city to me so I could attend a seminar and none of them accept my insurance. One accepts Blue Shield PPO, one Blue Cross, but no HMOs. I'm guessing I'll have to go to LA or Fresno. What if there are no providers around that accept BS HMO?? How can they cover it if there is not a provider?? I called BS and they said I am not covered UNLESS medically necessary....HA, DUH. It's like she's been trained to discourage it from the start. The way she said it. Anyway, when I asked her who they use she told me I have to be app…

I just in turned all of my insurance requirements to medicaid (mo care) .. How long did it take Medicaid to approve or deny your surgery??? Or any insurance for that matter???

I have BCBS of Texas TRS (I am a teacher) and i just started the whole WLS process. I haven't even had my first consultation yet. Can anyone answer any of my questions please? 1. Does BCBS Texas TRS even cover WLS? A teacher that I work with had hers covered through them so it should be the same right? 2. What was the process like? What steps did you have to take to get them cover it? What did BCBS require of you before they approved the surgery? 3. How long did it take to get approval? From initial visit with surgeon to getting your approval? Sorry for so many questions...I am terrified to get my hopes up and get rejected. Any advice would be greatly appreciated…

Hi everyone....I'm new here and have a question. I finally decided to do gastric sleeve back in January. Began getting my ducks in a row by seeing primary doc, nutritionist, and psych eval. (Like GI surgeon recommended at my initial visit back in 2013 --- I had waited a bit because I wasn't sure if I wanted sleeve or not). Early march I see GI surgeon again, sends me for endo. Unfortunately, my primary had only four years of documented weights. Per surgeon I needed five. So from various mds and offices, I finally tracked down 5 years worth of documented weights. Sent those records off to surgeon this week. Got an email tonight saying that she won't apply to insurance co…

This past week a number of claims showed up on my insurance account for pre-op visits and testing. We all know these things are necessary for approval. But it dawned on me today that if insurance hadn't approved my surgery, I would be stuck with $4,000 in medical bills (counting only those that were initially denied) for appointments leading up to insurance submission. Thankfully approval was a simple process with my generous insurer, but I don't want anyone left with loads of debt just because their insurer is nit-pickingly particular. If you are contemplating surgery and plan to use insurance, PLEASE check your coverage and pre-certification requirements carefully bef…

Does anyone have any experience with this insurance?

So excited I got my approval for the sleeve after about 2 weeks of waiting. My surgery date is April 8th. I was wondering if anyone else has been approved by them recently and how much over all out of pocket expense you had?

I am so nervous! Submitted paperwork to bcbs of il on april 1st and they got all 47 pages of it. So nervous that they will deny me how long does it normally take for them to reach a verdict?

I have finally finished my 6 months of requirements and everything was sent to m insurance on Friday. I have Highmark BCBS and I am so nervous they will deny me for some reason. Say prayers for me!

My request was just sent Thursday 3/20/2014. The gave a "dummy date" of April 22nd. The doctors office said I should expect to wait four weeks for approval. It sounds like no one has had to wait that long. I wonder if I still have to wait until April 22nd if I get approved this week.

I started this process with a surgeon who doesn't participate in my new insurance. Is it ok to use the same nut, psych, GI, EKG, PFT? I've given my new surgeon these records already, and they will review them. Anyone with the same issue? I'd hate to go thru all that again!!!

Hey all...my packet was submitted Friday 12/7 and I was just curious as to how long does it take to get approved? How was your approval/denial process for verizon/verizon wireless covered by anthem blue cross and blue shield.

I am currently 35 and at bmi 33 and currently have 3 comorbidities. Anyone in similar situation that was able to get coverage for your procedure?

Just got Nevada Medicaid in Jan so far I have a PCP Rheumatologist.. Orthopedist..Physiatrist... and Nutritionist saying I should get lapband surgery but I was told by the nutritionist that my insurance provider (Health Plan of Nevada) that it would take 3 years.....anyone know anything about this timeline????

So I am going to be receiving benefits through California Health and Wellness Medi-Cal and I know tat they cover bariatric surgery I was just wondering if anyone has had surgery or is already in the process of getting surgery and also has CA health and wellness....If so, was it difficult to get approval? also did you get an ok choice of surgeons?? hope to hear from someone who has this same insurance thanks

Long story short...denied for revision from band to rny in December 2013. Insurance girl at Doc's office said we needed to re-do classes, psych eval, etc. Did this and got approval letter from NUT, Psych Dr, and Doc 2/7/13. Insurance girl didn't send in new clinical info to insurance until 2/26...after 10 business days I called Anthem and they said they had no new request on file. Called Doc office, insurance girl called me back and assured me they had everything. Still no word as of today...so I called Anthem again: a supervisor finally got on the phone and said there is no case pending. New clinical info doesn't do anything. the original request was denied -not m…

I was wondering about appeals. I have not yet started the process, so this is me just thinking of all the avenues and I am dedicated in getting this this year soon as I am done with not being able to enjoy life how I want to (that is for another post). But I just switched to my husband's insurance that does cover gastric surgery. The plan says you must try other avenues for a year. On that note, while I was on my own insurance plan that did not cover it I have been under a doctors care for weight loss and diabetes. Do you think I can appeal under the notion that I am under a doctors'a care for a year because of obesity? Otherwise I would wait a whole other year with…

I'm hearing that Kaiser is great when it comes to Bariatric Surgery. I hear that when we complete the mandatory 6 monthly appointments we will pretty much have met all requirements and won't be denied but they just may add additional appointments before they put your case up for approval. I have Kaiser Mid-Atlantic and I wonder how long after you submit paperwork will you get a response. Once you get the response, how long before you get a date??

Can anyone give me self pay prices in the Cincinnati Ohio area or within a 4-5 hour drive? Financing my sleeve is gonna be tough so I am trying to find a good price.

This is my first post on this forum. I just got off the phone with UHC in regards to having Vertical Sleeve. I was approved 8 days after the surgeon's office submitted the paperwork. My insurance requirements 6 month physicians supervised diet. A visit with a bariatric psychologist My surgeon also required the following sleep study A pre-op visit a bariatric dietitian along with a commitment for post-op follow ups Attend a support group meeting. My insurance is a self funded large employer plan administered by UHC . The plan title is Choice Plus PPO.

I have thought a lot about having a weight loss surgery and attended a seminar and now have an appt for consultation with a surgeon. When I spoke with the office they said they accept my insurance (I have United Healthcare choice plus). I called my insurance company today to see if my employer has added that as an option and they told me that gastric bypass and lap band surgeries are "excluded." It seemed like they only offered a physician assited diet but no actual surgery. Now I am discouraged and wonder if it is even worth going to have my consult now. Is it affordable to do payment plans on my own? Does anyone know the approx monthly payment on average for doing a sel…

So I finally asked my Dr. for support in getting sleeved and she is behind it 100%. I am awaiting a packet from my insurance co (aetna) on what the process is etc. So how long typically is the process? The patient coordinator said that my first step would be to go to a seminar at the place I would be getting sleeved. Then there are all these requirements - counseling, tests, nutrition guidance, Dr. visits, etc. I guess there is usually a 3 month program or a 6 month program before you can get the sleeve. So are all of these requirements BEFORE you get approved? Or do you get approved to do these requirments and if you complete them, you get the surgery? Does insuran…

Hello guys for those with Aetna if you were denied was it because of recent weight gain.. I did my last weigh in and I told them its the time of the month and also going through other things I put on couple of lbs I wanted to scream..but I hope I don't get denied I will prob be devasted...thanks for any help!

My job sure knows how to turn a smile upside down...Smh. So I find out from them, the day I get my approval that as of April 1, I will switch from a Kaiser Select plan to a Kaiser Signature plan. Which means for me that instead of going to any surgeon out of the 8 and any hospital out of the 4, now I have only 1 option for a hospital and 2 options for a surgeon. I've researched my surgeon and patients of my surgeon for over 7 months now and my approval came before the switch so why can't I proceed with the plans I gave on my referral request. I want this doctor and this hospital because I feel comfortable there and its literally minutes from my house. I don't drive but…

I just spoke with my caseworker at the surgeon's office, and my documentation is definitely getting submitted to my insurance today. She was actually working on it when I called. For those of you with AMERIHEALTH as your insurance provider, how long was the wait {days/weeks} to get your approval?

Has anyone tried and got financed with any companys for sleeve surgery? Im worried about putting in a application to several companies because I dont want to lower my credit score. Im currently at a 638 on credit karma. Has anyone out there been financed with a score that low? and if so what company

Note: I am extraordinarily grateful to have health insurance and understand there are many whose plans don't cover bariatric surgery. This post is simply a reflection of my current feelings and frustrations regarding unmet expectations -- expectations I thought were completely reasonable. On December 1, 2013, I was finally able to select a Blue Cross Blue Shield plan in Illinois through healthcare.gov. It was such a relief to finally be able to get medical care without sky-high out-of-pocket expenses. But BCBSIL messed up my application processing. First, they cancelled my medical insurance when my dental application came in and had to reinstate the coverage (thankful…

I have Oxford/United Healthcare insurance. I just finished my six months of requirements to qualify for surgery. I went through all of the consultations with Cardiologist, Nutritionist, Psychologist, Pulmonologist, sleep Specialist, etc. I attended two WLS support group meetings (which I found very helpful and positive), and I had my last weigh-in with my PCP today. I put in a call to my surgeon's coordinator and am waiting to hear back from her. I am assuming that the next step is for her to submit my paperwork to the insurance company for approval. Does anyone know approximately how long that process takes? TIA

Before I really get into the process of approval, I've been working with my mother (who has had gastric bypass) to figure out if my conditions are considered weight related. Specifically back problems, and the risks of being obese with my malformed heart. I don't have high blood pressure (it's abnormally low due to my heart), or many of the other weight related issues commonly listed. In your guys' experience, will the back problems and the risk with my heart be enough?

Ok so I am working on getting insurance through my job. Its bcbs and covers wls. That being said I now have to submit a letter from my husband's previous job showing from when we first got coverage until it ended. Roughly 8 months. Before that we had medical through the state for roughly 1 to 1 1/2 yrs. Once I get this letter then I can apply for insurance through work because it will be a change in life event making me eligible for their insurance. So has anyone had to deal with something like this and then go through the wls process. From what I am learning they cannot deny me coverage and I don't think they can make an exclusion for example wait a year. I know that b…

I have a BMI of 40 I am jumping through all the hoops but I am so scared that my insurance will deny me. My doctors office saids I have a 95.5% chance of getting accepted. I did my pschy eval and nutrition eval both approved me. I have to go get the letter from my doctors office but she referred me for surgery so I know she will too. I am just so scared that because I dont have record of the weight loss program that will get denied. My doctors office saids my insurance doesnt require it. Has anyone experienced this ?

Ok so I know I really need to talk to my provider etc but I'm impatient. That being said I was wondering if talking about weightloss with my doctor and seeing a nutritionist once or twice through them would count towards efforts of weightloss if the doctor documented it. I am at a 54 BMI so don't need to worry about the co morbidity issues. Just trying to get ahead of the game. Thanks for any and all help. [ATTACH]42707[/ATTACH]

Have blue shield of California insurance and am wondering two things! I h ave a ppo . The two things are how much do you have to pay for gastric sleeve and do they cover a breast lift?!!!

I'm very ANNOYED. My initial consultation was on 01/28/14 and my surgeon's office still has not discussed financials.... what I'm paying...... what my insurance is paying..... When what needs to be paid..... NOTHING..... I called this morning and left a message

As my surgery date got closer the excitement was building rapidly but when I when I returned from lunch and received the email from my surgeon office that I was APPROVED......omg I LITTERALLY was jumping up and down and yelling THANK YOU JESUS!! This journey at times has been tedious but well worth it. Things became very real once I received the approval. I am so excited yet nervous but I know these are normal emotions.

So super discouraged I was denied by my insurance even though my bmi 52!!! Anyone with UHC what is your plan??

Is there ever any chance of getting insurance to pay, if it's an "employer exclusion"? I've heard of lots of appeals processes and whatnot... Does this apply? If it's an exclusion to our plan, is there just no hope?

So my BMI is 40 and my insurance supposedly cover the procedure at 100% if I get approved. Well my doctors office gave me a surgery date for 3.28.14. I am so frustrated because they still havent submitted my papework to the insurance. I have everything ready to go and I am so afraid that after I jump through all the hoops they will say no to me .

Everything was sent in to Cigna on December 24th! Christmas Eve and then just found out today that Cigna Approved it December 27th!! Wow I can't believe it got approved that fast! I'm so excited!!

Before I start I just want to say I know the purpose of this is to lose weight!! My frustration is that I just learned that Aetna has made a new requirement....from your first weight if you gain 1 lb you will be denied!!!! Seriously? This concerns me because I haven't had any of my education at this point I start next week but my 1st eval was 1/31 if I've gained 1 lb I will be denied?!? I have 12 weeks of classes to attend if I lose weight at every appointment but gained 1lb between 1/31 and 3/26 I'm going to be denied? Anybody know anything about this?

Hi everyone, I'm new to this app and have been reading everyone's posts and I am truly inspired. Yesterday I had my consultation with my doctor and he approved me for GBS and has sent the approval over to my insurance. I have cigna HMO. Does anyone have any experience with getting approved and also the steps? Any advice would be great. Thank you in advance.

We submitted 3/4 im so anxious now I hope they approve me!!!