Insurance & Financing

My insurance has an exclusion policy so there goes that option. Financing would be needed. Does anyone know of a company that finances wls for people with poor credit?

I have finished all the prerequisites for the bariatric program and I have my date of March 13th for surgery. My last appointment was this past Friday where they wrote me out scripts for pain meds and a couple other meds to have filled before the surgery. My question is, my surgery is 2 weeks away, I start my preop liquid diet the 28th and my surgeon hasn't submitted to bcbsil for final approval yet! Does anyone out there have bcbsil that was approved so close to surgery? I called the office today and they told me it would be submitted this week. Im just so nervous with my luck that something will happen and Ill get denied or my surgery will get pushed back because the ap…

I just had my surgery Thursday. I get my claims set to me online. I was self pay but since I had a hiatal hernia repaired at the same time, I only paid $5,500 out of pocket. It looks like True Results billed aetna $17,500 for the EGD and $29,000 for the hernia repair! I don't know what to do but I can't be responsible for them battling it out, right? I paid my portion as agreed upon. I'm assuming if I owed more, TR would have billed me before the procedure? Anyone had this situation?

Surgeon wont operate until I have sleep study. Insurance won't authorize sleep study without pre-cert, which has to come from pulmonary doc, not surgeon. Seriously? So annoying to have to jump through so many hoops.

I'm changing jobs and can't find any info about this. Is anyone informed if Carefirst open access HMO will cover adjustments ? I'm a year out and still in the losing phase so I may need some future adjustments although I've been green since november 2013. Thanks. Nervous enough changing jobs and I dont want anyone at my new job to know about my surgery. Thanks!!

This is so stressful. My surgeon's office is submitting my stuff to insurance today. The thing is, Aetna requires a BMI of 40 for 24 months to prove a history of obesity. I have weights from June 2012, and all of 2013, obviously 2014, and one weight from a gallbladder surgery in January of 2011 which was when I was having gallbladder attacks and not eating--- putting me at 38.8 BMI (7/8 pounds away from 40). This is from 3 years ago, so i don't know why they need it but my surgeon's office wants to include it. I'm really freaking out and I don't know if they will approve me or not. Anyone have this issue and get approval?

Question? Has anyone run into the situation where the insurance company says you're approved but the doctor's office says they haven't heard anything yet? I recently completed my 6 month supervised weight management and faxed info over to my doctors office. The doctor told me they would submit last Friday but they submitted on Thursday, March 6th. Out of curiosity I called the insurance company to make sure the doctor had submitted and was told I was approved for 2 nights, April 14 & 15. I called the doctors office yesterday to find out what else I needed to do and was told still no word yet and that it was just submitted and I should wait. Does it take a while for …

Haven't gotten the Gastric Sleeve surgery yet, I'm waiting on the approval... If I get denied I don't know what I'll do! Did anyone do a payment plan?

I have been approved by bsca for march 26th. I cant wait to start my journey.

Yay im so excited. I got the call from surgeon today after 1 week I am approved I see surgeon Monday 3/17/14 to schedule. I have a ton of feelings right now. Nervous, anxious, excited...

Just finished my 6 month class, psych eval and already have done done the sleep test and endoscopy. The coordinator says the psych eval report is all they need before they submit for approval. I read on Aetna site they need 2 year bmi history from doc? My coordinator has not once mentioned this?

I haven't submitted to the insurance yet. However, I did have a minor back surgery recently which covered my deductible and out of pocket maximum. I shouldn't have to pay anything to the surgeon or hospital for my RNY if I get approved. Don't see why I wouldn't get approved, I have a whole host of co-morbidities and my bmi is 45.

I'm curious if anyone hasn't qualified because their BMI was a few "points" or pounds off, if they waited a but gained a few pounds and had a new consult? And how long you waited ? I was at a BMI of 40 as orientation and somehow before my consult I lost 4 lbs ( totally wasn't trying) and now my BMI is under 40. I'm seriously talking the difference of 4 lbs on qualifies me. So frustrating!!! I'm being tested for possible sleep apnea . If I have it I'm good to go if i don't I'm out of luck! Insurance sucks sometimes.

I can't believe that by next week I should have an answer from the insurance. It's crazy to think that if I'm approved I'll be sleeved in the next few weeks. The dr has agreed to help me get surgery before March 31st because on April 1 my insurance changes. Please send good vibes my way. I really don't want to go through this process with another insurance company if I'm denied.

Does anyone have an idea how medi pass works or what they require to approve u?

HAS ANYONE USED THEM TO FINANCE PART OF THEIR SURGERY? CAN YOU TELL ME ABOUT THEM.. ARE THEY LEGIT.. PRICES.. INTEREST RATES?

I meet with my surgeon on Wednesday to prepare things to be sent to my insurance and book my surgery date. My insurance will be switching on April 1st so I have to HAVE the surgery and be out of the hospital by then. My surgical coordinator reassured me over the phone that it can be approved in 2 weeks but I feel like I read more and more stories about how that isn't happening for people. I have Oxford Health Insurance. Did any of you get approved within the first two weeks on your first attempt at approval?? I am so nervous!

Does anyone know if the hospital makes you pay up front or will they be able to bill you? I have the money to pay my portion of the surgery but I'm worried the hospital is going to ask for a bunch of money up front and I don't have it.

Hi, everyone, I'm new to this. I'm in need of some help. I have BCBS Illinois and was wondering who else has them. I been reading all the stories and it seem like they are a very rough insurance company. Someone please help me.

I have Blue Cross/blue shield of Fl. Blue Options. Can someone out there know if this insurance company will pay for VSG ???? I feel like I am on a merry go round, & can't stop

Has anyone after being denied had any success with a grievance against BCBS. I really want to do the surgery but they have denied me b'cause my blood pressure is under control with 2 meds.

Hi, I'm Izzie. And I'm 21. I'm searching for a surgeon to do my gastric sleeve surgery. Who accepts UnitedHealth care through (PAC), which will later merge with Medicaid. Jan1st. I have everything already finished. The psych exam, nutritionist, documented weight loss attempts dating back to 2011, and documented problems due to obesity. My bmi is 56.5. I'm class 3 obesity. My original surgeon just told me they won't accept my new insurance. I planned to get my surgery in January. But now I'm left w/o a surgeon. Please help!

I went to my first appointment yesterday. I have literally spent countless hours on the phone with insurance company seeing what my requirements are. They even emailed me a list of them. So I get thru with my appointment and I find out that the insurance people at the doctor's office do not believe my requirements. All I need is over 18, bmi over 40, bariatric center of excellence. I have UHC insurance so I have to go thru a company called Optum. I do not have to do their six months of nurse counseling sessions, like most people do. That is dependent on what your employer chooses. After spending most of the day yesterday on the phone with the insurance company they sen…

Hi I have been giving a order form for Blood work, Urinalysis, EKG etc............... Do I get these test done asap or should I wait until half way thru my 6 month waiting period Thank you any other info is also helpful to the newbie

Who is it that decides whether or not a person has to do the 6 month nutrition class? Is it the Surgeon or the Insurance company?

If so, did you guys have to pay out of pocket and was it hard to get approved? Just asking because I switched from Aetna it was said they didnt have so many requirments to meet. I'm have my first appointment with the doctor in Jan 2013 I'm hoping i could have my surgery at least by March. Has anyone used FEP BCBS? Thanks Nina

I'm just a few days into waiting on approval...curious if anyone on here has Aetna HCA and how fast you got your approval? if you weren't approved and would like to share that would be great....so nervous!!!

Has anyone experienced Aetna Ins requirements? What hoops to jump through?

Ok!! I am on the verge of a nervous breakdown!!! I got the "dreaded" call today that I have to wait until December 2014 to get banded. What the What! The insurance person called and said that as she was trying to finalize everything she learned that due to me being new to the policy (Dec 2013). That I have to wait a year. I did receive a certificate from my prior insurance company stating that it could be used to shorten this exclusion period. Has anyone had any experience with this. I had continuous prior coverage from 2008-2013.

Hello everyone I have a question I have my third visit on 2/23 and was previously told my doctor office that I had 3month supv diet and that the first visit counts... now after all that they call to tell me know that I would have to do another visit that the first visit didn't count...anyone know if the first visit counts this office seems not to know things...first the told me I needed 6 months of supervised visits then I called insur co and they told me 3 months so I called the dr office back and they said "Oh well that person misspoke it is 3 months" Now I am rethinking going through them since they seem like they don't know what they are doing..

I was denied. BCBS oklahoma said they have an exclusion policy on all bariatric surgerys:( Has anyone else run into this problem with bcbs oklahoma?

sorry if this is a repeat question, but i tried searching for answer. Has anyone gotten through the process of using UHC - Oxford Liberty Network and what kind of requirements did they need? i saw online the BMI requirement but nothing on monitored dieting and for how long. any info would be greatly appreciated.

I live in ga do anyone know how long it take wellcare ( Medicaid) to approve are denie your surgery.

I called my insurance company over a week ago and they told me I was approved for my surgery. So after a week and a half of calling the doctor's office to confirm they got the approval letter she tells me they never received anything. So she calls them and it turns out they pre approved me to submit the documents to see if I'm approved for my surgery. WTF! Seriously? They had to get authorization before even sending the paperwork. Now I have another 15 days of waiting. Not to mention when I told her I was approved she told me they were so backed up they were scheduling surgeries for April. I just needed to vent.

I have my diet #6 on the 18th, so I am FINALLY at the light at the end of the tunnel. From the beginning the surgery center told me my max oop would be $2,000, now I checked this morning on my Blue Shield on a claim and just so happen to see that my max oop would be $20,000 since they are considered out of network!!! I'm in a panic..I don't have $20,000 for this? I was going to use my flex spend account for the $2,000 as it was. Does this seem right? I just don't want to have this surgery and get a $20,000 bill that sends me into the poor house or bankrupt.

I am currently below 40 BMI, however, I have been gaining weight like crazy. My insurance denied me because I was below without two comorbidites despite the fact that I have GERD, high cholesterol, depression, and anxiety. I'm considering gaining weight then having another weigh in to submit to the insurance company. Has any one done this? If so, did it work? I know that this is probably a bad idea but I'm so close.

The bariatric clinic just sent off my paperwork on Monday. I am a little nervous, and can't wait to see if I'm approved. I'm gonna call my insurance Friday to check the status. Can't wait to get my journey started!!!! Fingers Crossed!

My BMI is currently 40 and has hovered around the 39.5 mark the last year. The previous 5 years, however, my BMI has been closer to 35-36. I have no comorbidities, but am being tested for sleep apnea in a few weeks. I have Highmark BS and they require a 2 year history of "severe obesity". Anyone else encountered this or have experience with how strict they are about the 2 year history?

Hello everybody...well, my doctor sent my referral off to the insurance company and they told me that i'm NOT a good candidate because my BMI is 38 and i need to be 40. is this normal insurance-speak and this is part of the game they play or am i just done? i really don't want to GAIN more weight to have this surgery, i'm already uncomfortable enough. i don't know if i keep having my doctor resubmit the application or just join weight watchers...again *sigh*. Any advice would be awesome. thank you.

I have BCBS of Al. I got denied one time (office said that was typical). Now we're gonna submit it again. I am trying to get the sleeve. Almost a year ago I had to have lap band removed in emergency surgery due to erosion & a hole in my stomach. My surgeon documented the removal was due to the band failing- not patient non-compliance. I loved the band! I had it for 6 years. I did NOT want to remove it although I know I had to. So I want to know success stories from people who used BCBS of Al.

Hi Folks, I have Coventry insurance and they pay all of the surgery except a $2500 copay. Has anyone else had something similar to this? Is this owed to your surgeon or your insurance and have you been able to set up a payment plan? I have flex spending to cover a good chunk but my husband is also getting the sleeve about a month after me in May (same insurance but we won't have flex to cover his copay). So, total we will owe $3500 in copays to someone....any info would be much appreicated! Thanks!

How long did it take for issuance to approve....I'm about to have things sent but would like to know how long and if the sleeve is covered...I have to go through a 6 month process for Medicaid and have done the seminar, head physician visit, dietician, preop class 1 of 3, and was approved by my health psychologist!!! And still waiting on financial assistance approval!!

I have united health care. I called to the the surgery requirements I was told a 6 moth dr visit w/in 2 years, psych eval, seminar, place of excellence, and so on. I've done everything they asked to a t. Today I got the date for my surgery a arch 24th but now they are asking for a 5 year weight history. The problem is that I didn't have health insurance for a couple of years so I only have 3 years of dr notes, I did do weight watchers in 2010 & 2011 but they didn't record on a computer & I cannot find my book! Anyone w the same issue?

My husband's employer has excluded WLS, so we will be going self-pay. (Mexico actually) What about complications down the road, if there are any? Dehydration, ulcer, stricture, leak?? If (God forbid) anything were to happen requiring ER or hospitalization, what are the chances of insurance covering anything related?

How long did you have to wait to get approved for wls with bcbs of al

I got approved for my Gastric Sleeve procedure by Blue Cross Blue Shield of Georgia in January. I called my insurance to confirm the details of my deductible and out of pocket amounts. I had an interesting conversation with the customer service agent. My individual deductible is $350 and my out of pocket maximum is $2890.00 ($350 of that amount is the deductible). My plan covers the Gastric Sleeve at 80% and I am responsible for 20%. My confusion is that the financial coordinator for my surgeon states I have to pay $2890.00 at the date of my surgical interview (happens about 3 days prior to surgery) but my insurance states that the procedure can happen after I pay the ded…

Has anyone used insurenutrition.com?? They specialize in getting your insurance to pay for your protein shakes. I just heard about it and wanted to know if anyone here has been approved.

tears of joy

In October when I met with my surgeon and began compiling the requirements for surgery, BCBS of NC did not require the 6 month weight loss history with a PCP. However, last Friday we FINALLY submitted the fulfilled requirements to insurance and on Tuesday we found out that I was not approved on the basis that I had not completed the requirements for full review.... And the requirement that I was missing was the 6 month weight loss record with my PCP. I also found out that the new requirement was effective IN OCTOBER... Which means it was updated shortly after my surgery center requested the requirements. I am so angry because had I known about the 6 month requirement, I …

I received the call today from the surgeons office that BCBS IL approved me. Weird thing is, I've not even completed by prerequisites. Almost there and feeling oh so excited.