Insurance & Financing

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

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

I'm so disappointed right now. I had my consult appointment scheduled for Friday and today the insurance/billing person called me to discuss my insurance with me and what would be due at the consultation. I was expecting it to be $100 because that's what my co-worker (same employer, insurance and surgeon) had to pay for each of her co-pays since the surgery center is at the hospital. So it came as a huge surprise to me when the last said i would be responsible for $508 on Friday! She said I need to meet my entire deductible for the year that day. I asked why, when I had no assurance I would be approved for surgery would I pay my entire deductible at a consultation and she…

I got approved today. Very excited! I have BCBS Federal. Now just waiting for surgery date.

Hey, I have been deciding on having surgery for a while now. I just switched from thinking about having the band to having the sleeve done. Now that I made up my mind, I am scheduled to meet with a surgeon next month. I know that I have to do the 3 month diet before I get approved. I am wondering if I can use Weight Watchers. I don't have a nutritionist in my area that is covered and my surgeon is out of state so I can't use theirs. I am hoping to have everything done and ready for a surgery date in April. Any advice on the Aetna process would be great. Thanks!

has anybody been working with iowa bcbs i was curious to find out what there requirements are i am going in for first appointment next monday and its driving me crazy not knowing

Hey all! I'm super new and I am going through the approval process with my surgeons office and I have a quick question about my insurance. I have BCBS of Illinois, and i'm getting conficting information from them about whether the 6 month medically supervised diet is required before my surgery or not. I call them and the people on the phone at BCBS tell me YES I have to do the 6 month diet before they will consider approving me but I talked to billing in my surgeons office and she tells me NO I need to get it in writting that its a requirement and accord to the latest policy information regarding bariatric surgery for BCBS of ILL it is NOT a requirement. So my questio…

Anyone with humana? If so how long they took to approve surgery. Done with all requirements waiting for doctor office to submit.

Anyone with united health care that has been approved can you let me know what plan you are on?? My insurance rep through work is trying to tell me there are no plans that cover it!!!! THANK YOU IN ADVANCE

If so how long was the wait? Was it a hassle getting them to pay Any other info is helpful newbie here Thanks :-)

Ok I gained 3 lbs on my last nutrition appointment an I going to be denied?

Hey all! I am new here and am just getting started on this journey. I have been the a seminar and have my first appointment withe the surgeon and next Friday. I'm looking for advice and info regarding one of the requirements of my insurance company, Aetna. They require a 2 year history of a BMI over 40. I have had a BMI over 40 for well over 2 years now. It currently is something like 48.6. My issue is, after my son was born in 2009, I didn't see a doctor until early 2013. My PCP moved to another practice and I couldn't get in to see her for a few years and I just wasn't sick at all so no need for an urgent care or anything. So I don't have a medically documented histor…

Has anyone been turned down with that reason? I have BCBS OF AL. I had to have lap band removed due to erosion & making a hole in my stomach. Already even approved by surgeon for sleeve. So I'm gonna have to appeal initial reply of denial due to one WLS per lifetime. This is medically necessary due to BMI, uncontrolled diabetes. I'm anxious to hear any similar stories: success or otherwise.....

Paperwork was sent in to my insurance 1/15. Called my insurance today just for the heck of it. They were great she told me to call back on Friday 1/24 we should have an answer for you. Very excited!!!

I went for my first consult in mid January and after looking over my insurance policy I found that I could go with the 3 month dietary plan rather than 6 months. I don't know what I expected but I assume it wouldn't be submitted to insurance until closer to the 3 month mark. I've done everything the insurance requires and almost everything the surgeon requires. All that's left is a sleep study and the classes they require leading up to your surgery date. So I guess my question is, how long does it typically take to hear back from insurance and then if approved do I still have to wait until the 3 month mark? I'm so confused!

So my work changed from Blue Cross Blue Shield of IL to Blue Cross Blue Shield of Alabama, they told me (and I have an email) that it was not excluded from the new insurance. My husband who got the surgery a year (2013) after me (2012) went for a fill under the new insurance, not covered!!...They DID exclude it from the policy. So my question is (1) since the company's policy covered me for the surgery in IL, could they not have a case by case exceptance for us now that we have follow-ups to go (2) since they told me in writing one thing and now it's different do I have a leg to stand on to try and fight for them to cover it, since they already paid for the major part?? …

I am just wanting to see what anyone's experience was with Highmark BCBS? I am almost done with my 6 months of classes, I've done my psych eval and sleep study. Is approval long and hard with them?

After bawling my eyes out last night (and a week and a half wait that felt like a month and a half) I finally got the courage up to get my husband to call Aetna (I'm such a wimpy chichensh#t). I was worrying after reading people getting disapproved for minor inconsistancies like height at the surgeons office (barefoot measuring) different from height at the pcp's office (they just ask) and other problems like 3 days short on supervised diet, not being over 40 bmi for 2 years, etc... I just knew I would not get approval. Hubby called for me this morning and I'm approved! Now I can start to prepare...buy the Protein, gas strips, etc. Yay! I'm jumping through the roof! …

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

I am so excited I just got the call from blue cross blue Sheild Federal that my request was approved and my letter will be mailed out. My doctor submitted the docs on 12/30/13 and I was approved 01/02/2014. I am scheduled to be sleeved on 01/14/2014. This has got to be my year.

After having to wait out a pre existing clause on my insurance.. a year actually.. I have finally completed everything and it was all submitted last Thursday... Anyone out there have BCBSTX and about how long it takes to hear back after submission?

For those of you who are choosing a surgeon based on costs alone....DON'T. FYI, there are some doctors (yes, even in the good ole US of A) who are "advertising" that they are endorsed by different associations....VERIFY, VERIFY, VERIFY. I called to verify one of the surgeons in Florida who advertises for "cheap" cost. (Do your research and figure out who, I'm not wasting time on this forum since it is obvious a big percentage of the "users" are coordinators or people trying to sell you a surgeon like a used car!) When I called the AMA, laproscopic association, bariatric surgeons association, the doctor was not even in their database....Hmmm.....In fact, the lapros…

Can any one please tell me what the going price for Gastric sleeve surgery is in the states??? I am self pay and I have heard 10 thousand to 25 thousand... I am having surgery in Florida for about 23 thousand. Is that about right or am I being HAD???? Help Help!

I feel like a giddy school girl! I was sleeved 11/2012 in Mexico as my husbands insurance didn't cover any form of bariatric care and he's watched as I've lost the weight and been successful. He's finally decided that he's ready to make his own sleeve journey! I'm so excited for him!! Luckily, his current insurance carrier now does cover bariatric surgery, so I've contacted their 'Bariatric resource center', they've set up a referral in their system, and they're supposed to be calling within 3-5 business days to get him enrolled in the program, and tell us what to expect. Does anyone already know? Does anyone have United through Raytheon? What services do they cove…

I am self-pay (my insurance excludes wls) I had decided on Dr Illan in Mexico, he has a great reputation and reasonable costs. BUT even though he is a good choice I can't help feel I should at least research costs of sleeve in the U.S. Please if you are self-pay and had your sleeve surgery in the U.S can you tell me costs etc ? Thank you !!

It's checked my mail and my approval letter was in it. February 26th is the day! Thanks for the encouragement!

I'm just starting this whole process. I've called my insurance company and they say I have to go thru 6 months supervised diet. They gave me a list of approved Dr.'s I can have the surgery with. My insurance covers up to 80% and I will have to pay the surgeons fees. do I just call one of the Dr.'s and set up an appointment with them? Would I just use their dietician for my supervised diet? What if I have a hernia or need my gallbladder removed, will the surgeons fees then be paid by insurance? Anyone have any luck with that or ideas? Thanks for any advise you can provide! Jodi

So excited to hear from doc office yesterday that my insurance no longer require 6 mnths, now it's only 4..surgery may be end of Feb or beginning of march..happy, excite and super nervous at the same time. I guess It normal and for the last 5 mnths I thought it would happen April/ May. .now it may be sooner..had this happened to anyone else? Where you end up having the procedure sooner than expected?

I'm required to give 2 years weight History from a doctor one from 2012 and one from 2013 I don't have anything from 2012 as I was new to the state and not going to the Dr for anything what do I do?

Has anyone else had to take these personality tests as a part of the psych evaluation? I had my appt. today and at the end of the session my Dr said I needed to fill out these two tests, return them and he would make his decision on my bypass surgery after he gets the scores back. I am a band to RNY revision, so I had the psych evaluation before that surgery in 2007 w/someone else and didn't have to go thru quite this much. Just wondering what it was like for others. thanks.

April my ins changes to medicare/BCBSCplus. I am 65 and want to have the sleeve done ASAP. How long do I have to wait and what was your experience as far as how fast did you lose? I have uncontrolled diabetes. Thanks for any information.

Hi guys! I have elected to have gastric bypass surgery and it is covered by my insurance. I currently live in Florida but my company's corporate office is in Ohio so I'm covered under anthem OH. My insurance requires 3 month nutritional, PCP referral, psych evaluation, I'm currently in my second month of the nutritional requirement and have my psych eval next week... As I'm half way to submitting to my insurance for approval I nervous as to what I will have to pay out of pocket. I feel like I'm so close to the finish line and I'm afraid financially is where I'm going to stumble... My question is to anyone who has the same insurance what did you end up paying out of pocke…

I am in the process of waiting for insurance approval for my band to bypass revision, but it is highly unlikely that I will be approved. I am trying to wrap my head around the possibility of paying for this out of pocket, and was wondering what type of medical requirements there are for self pay patients. I'm sure my doctor will fill me in when the time comes, but for now, those of you who were self pay, could you tell me if there was any special diet or other requirements your surgeon had you meet before surgery? Thanks so much!

Hi

So as you all know I was denied by my insurance. So I had to do an appeal. I sent in a lot of medical records a letter from my PCP and a letter I wrote. I sent all that in on Dec 30. They received it on the 31st. They told me it will be 30 days before they made a decision. So I checked about a hour ago and they reversed the denial and approved it. I AM TOO HAPPY. I TRUELY THANK GOD BECAUSE WITHOUT HIM, IT WOULD NOT BE POSSIBLE!!!!

I have my consultation appointment tomorrow - however, before going I thought I'd do some reasrch to find out if my insurance covers WLS. I spoke to my HR personel location in another state, she said it's excluded from our insurance & our plan does not cover ANY WLS....ugh *sigh*.....I guess I will still go to the consultation appointment tomorrow, but I just feel so down & upset now. I really had my hopes up. They told me over the phone another option would be care credit. But unfortunately my husband and I have enough debt & credit out that we wouldn't be able to get a loan for that amount. Does anyone have any other ides, or feedback that could help me in g…

Hello all I'm fairly new to this forum and to the whole VSG. My question is were ya'll able to make payment plans? I have health insurance through my husband so its the family plan United Healthcare choice plus. My deductible is 2,000 and I pay 30% of whatever the cost of the operation(UHC pays 70%). The thing is IDK the cost yet since I am so early in the VSG process. What is the average cost in Dallas, Texas and were you able to pay the remainder in payments? Does anybody know Dr. Colleen Kennedy in Dallas? I'm sure I missed something but these are my questions. Thank you in advance VSG community!

I recently attended a seminar and just turned allll my paper work back in. I have medicare insurance..will I most likely be approved? Whats the next step I should be taking? I want to be ahead of the "game" so to speak.. I want this now! Should I be scheduling certain appointments, crash dieting..what do I do now to speed things up IF approved? Any info will help. Thanks for everyone sharing their stories, I'm very motivated by them!

My paper work will finally be submitted on the 27th, but there is one issue that I am worried about. My coordinator at the bariatric center called and told me that I have to write a letter to my insurance company explaining why I don't have a five year weight history on record. So I wrote a letter basically saying that I haven't had health insurance in the past few years, because my salary was too much to apply for Medicaid and too little to receive adequate health care, therefore leaving me unable to create a five year trail of my weight history. Now I'm super nervous have anyone ever had problems with your insurance co. because of a lack of weight history.

So I called my insurance today to verify info for my surgery ..turns out the hospital I want to have surgery at isn't covered under my aetna plan ..for my insurance to cover I have to drive two hours away ...so I am back at square one again

I was approved for the sleeve last month and my surgery is actually scheduled for Tuesday. However I got a call from Cigna on Friday afternoon at 4:30 (lovely timing) saying that although they approved it, that particular code for the sleeve was excluded per my plan. They are saying it won't be covered now. I'm going to have my docs office call first thing Monday, but I'm thinking if there is no budge on the sleeve coverage, maybe they could switch to bypass and I could have that done Tuesday instead? I believe it's all the same WLS requirements and I know my plan cover bypass for sure. Anyone else go through this and got a switch quickly? I'm freaking out and …

Hello, Ok, I have a problem. I am fighting tooth and nail with my insurance, like most people I see on here do. I have Group Health insurance.. so I am lucky in the sense that I don't have to worry about my insurance miscommunicating with my doctors.. They all are the same people.. At the same time I am unlucky because this means I am restricted to all of Group Health's rules and whatever else. Ok here is my story see if you can offer any assistance. In mid December, I asked my doctor to send in a referral to the bariatric clinic for me to have Weight Loss Surgery. For the following 2 and a half weeks I called in seeing what the process was, and where they where on …

I had everything set....then I got the call on December 23rd. My insurance denied my request for Lap Band surgery. When I first started this journey, I specifically asked my coordinater if my insurance required the 6 month monitored diet plan, and she told me that my insurance only required a 5 year weight history from my Dr. So, that is what I provided. I had just recently met my minimum deduction amount of $1,500 by getting all of my pre-surgery procedures, tests, and pych eval. Now they tell me I have to do a 6 month diet program. My coordinator says that since I saw the Dietician on Nov. 11, that we can go from that date. My insurance starts for the year on …

I found out that my doctors office just sent my claim to my insurance for gastric sleeve surgery on 12/30/2013. I hope that is enough time to get an approval or denial by my surgery date 01/14/2014. I called BCBS Federal and they confirmed the claim was received and is being reviewed. I am so excited and scared at the same time. I met all of the qualifications, with my insurance you had to have a BMI of 35-45 with one or more comorbidity, or a BMI of 40 for the past two years. I have a BMI of 39 with sleep apnea. I did my 3 month weight loss program which I actually did 4 months so I could wait until January 2014 to be sleeved, and my phsyc. eval. I am so nervouse.…

does medi-cal cover the sleeve? if so does anybody know what dr or facility in los angeles takes medi-cal?

Heard it thru the grapevine that you should have met 180 days in the program for approval but at my 6th visit, that only makes 165 days. Another user said that her nut had to use specific wording to try to get her accepted because she also only had around 167 days. Then the nut mentioned that she may be required to come for another visit. Anyone ever heard or dealt with this? Can we possibly be approved anyway??

Okay so my bariatric coordinator has been trying for 2 weeks to reach my insurance company Blue Cross Blue Shield of Texas to confirm that my plan covers the sleeve. However she can't get through to them. BCBSTX is saying they are still updating their policies. My coordinator said it wasn't only BCBSTX but also Illinois and Alabama as well as other insurance providers. Anyone else being stalled for policy updates?

So my nurse from UHC called me yesterday to give me the good news that I'm approved!! She said she just got off the phone with my drs coordinator and let her know, so I should be getting a call shortly to schedule surgery. Being ever so patient, I waited until noon today without hearing anything from surgeons office. I just called the drs coordinator and was told they won't schedule anything until they receive the written approval. Through the mail. Arrrrrgggghhh!! The holidays are coming fast and I really need to get something on the calendar so we can arrange for coverage at work when lots of people will be taking vacation time. Annoying.

Welp, got the news today. My case was denied because a lack of documentation of at least 2 comorbidities and proof of exhaustive measures. My BMI started out at 38.5. I have asthma, high cholesterol, depression, anxiety, and GERD. I'm preparing for an appeal. I'm not giving up! I have come way too far. Has anyone else been through a similar situation? Your stories would provide me encouragement.

So my bariatric clinics office called my insurance yesterday to verify coverage and I have united Healthcare through my husband that works for at&t. They could tell him that bariatrics is covered under my plan, but they could not tell him any specific guidelines other than the 40bmi with no co-morbidities or 35 bmi with co-morbidities. They said they just need to fax in my history and then they will determine what needs to happen from there...Isn't that just weird? you would think they would have set in stone that they require a 6 month monitored diet or whatever. So I guess I will just wait and see what they say. They are sending in 5 years worth of documentati…