Insurance & Financing

Hi all, I'm a newbie to the boards, but I can tell I'm going to be here often! I've been trying to get my insurance to cover my surgery for about 2 years now and I finally got approval. In my prior attempts, they wouldn't cover it because I didn't have any co-morbidities. Ironically, I recently got diagnosed with hypertension and NOW my insurance will cover it. But...not until I jump through all their hoops. One hoop is that I have to follow a physician-administered weight loss plan for 12 consecutive months (and the doc has to sign a form for each month and they will verify records at the doc's office too). Well, that sure would have been nice to know a year ago when I…

Anyone get this answer and then move past it and get sleeve?

I also have United Health Care. My insurance payed 90% in network. And since I had all my deductibles met I payed nothing. I saw the doctor 1st week November. And I had my surgery on December 5th. 1 month from surgery I am down 40 pounds. I see the doctor tomorrow. We will see how much. I am do happy I did this. The financial advisor and I worked to together to gather all the information to be approved before I saw the doctor. Our work payed off. At my appt. The doctor said as soon as we get the approval we can schedule the surgery. I told him we can schedule. I had to follow the liquid diet for 2 weeks and see him again. I saw him on the Monday before my surgery.…

Does any know how long it takes priority partner of md to approve surgery?

Anyone know how long it takes to get an answer once it is submitted to the insurance company? I have medicare/medicaid so I am thinking it may take a long time to get approved for the sleeve. So anxious to here something.

My sister had surgery a year before I did, we were both self pay. She said we couldn't deduct it on our income tax because it's considered cosmetic, since we did medically qualify for insurance to pay.

Am scheduled for a consultation for gastric sleeve on January 20th in new Iberia, Louisiana. I have lived in monroe, Louisiana only since 2012 so this doctor was recommended to me because of the lower cost. I would rather stay here to have it done. Does anyone know what the cost is in this monroe? I am a cash paying patient because my BMI is lower than 40.

Hello guys I received a letter yesterday from my insurance company(my copy) they also sent one to my surgeon, stating that they received the request to cover the laparoscopic sleeve gastrectomy, however they need additional information to determine if the inpatient admission is necessary, does this mean the surgery is covered but they're questioning my need to be inpatient? I am so nervous I'm scheduled to have surgery February 10,2014, I am 5'7 248lbs, have completed all my pre testing I do have one premorbility DM2, I have Cigna as insurer please help I am so nervous, any insight would be appreciated.

I'm a single mom on Medicaid. I live in North Dakota. I heard Medicaid will cover the gastric sleeve if you have a BMI of 40 or higher and at least one other comorbidity. I have a BMI of 41 have high cholesterol and sleep apnea. I am also completing the 4 months of documented diet, including meeting with a dietician once a month for 4 months. However, the bariatric clinical coordinator does not think Medicaid will approve since I'm only 24 and my cholesterol can be lowered with medication. I have been struggling with my weight for close to ten years and even my primary care provider agrees this is a great choice for me. What do I do? Finish the 4 months of the diet and su…

I received a call today from the hospital regarding my approval or denial so this is how our conversation went Me:Hello Her: Hi, Can I speak with Ashley please Me: This is she Her: This is Mary from Bariatrics Me: Hi, How are you? Her: I am fine I was calling to schedule your surgery because your insurance APPROVED the surgery. Me: OMGoodness are you serious ? Her: Yes, How is Feb 5th Me: YES, are you serious? So I have been screaming at the top of my lungs since she called and told me... I would not be here or would have achieved any of my goals with out GOD, HE has been my ROCK and my SUPPORTER, HE has seen me through it all and I THANK HIM

My insurance messed up my birthday. My birthday is january 24th and they put january 29th..I tried to fix it for months and each time they assured me it was taken care of. Now, 3 days before I get sleeved, I got a call from the hospital to inform me that there is an issue with my DOB. They went on to tell me that this might postpone my surgery. so now i'm freaking out because it's friday and my surgery is on monday, there is no way I can correct this in time.

I'm really nervous about the whole insurance thing. My most concern is being denied. I have PCOS, Pre-diabetic, Hypothyrodism, Insulin Resticance. I did have gall bladder disease and had it removed in emergency surgery last March. I've already been on a Diet since April 13' (this year) with my pcp. I have my first Surgeon Visit in June. And will have 3 classes with Nut and 1 with Psych. I'm just really nervous on the whole Cigna insurance since I've seen people on here its taking them months to get approved.

So I'm gathering all my info for my surgery. I am so nervous that once I submit I won't be approved. I know my plan covers the surgery I am just hoping they approve me. I just wanted to know has anyone had to try a couple times before being approved with BCBSTX or have you been approved on the 1st try? Also could you tell me how much you paid out of pocket? Any info greatly appreciated.

My coverage with Cigna indicates that I only need to do the weight loss management program with my PCP for a minimum of 3 months. My surgeon's office submitted my paperwork to Cigna last month and they denied me on the fact that I supposedly only did 2 months of doctor supervised weight management. Here is the kicker... I actually did 5 months as I thought it required 6 months instead of the three. I am so frustrated right now about this because it's just stupid! My surgeon's office thinks we have a new person in Cigna and that they are counting the first visit as the "initial visit" which then means you have to go 4 months instead of 3. Of course in my situation tha…

I have blue cross blue shield of il with the plan of ppo, i was just diagnosed with polycystic ovarian syndrome and put on a type 2 diabetes medicine. Will my insurance see that and instantly approve me. My bmi is 40 according to my endocrinologist and both my pcp and my endocrinologist recommended for weight loss surgery. Any situations similar to mine and your results??

So I got a call from the Hospital telling me that they are finally going to submit my papers to the insurance company. Well about time.... Kinda, because now I am feeling Anxious and Scared and Nervous and Terrified. I have placed all of this, my concerns and everything into God's hands because I know and understand that I can not handle this by myself. Long story short, Things just don't fall in place for me and this seems to be falling in place the way it is suppose to without the fight and struggle I am use to so to me it seems to be a set up for disaster... this is why I am so concerned and scared.... Sorry for venting my family do not seem intereste…

I recieved an approval yesterday from blue cross blue shield for the gastric sleeve. I should be excited to cross this obstacle however with three days left to the new year and my doctor no longer accepting surgerys for this year, I'm nothing but nervous. My policy changes Jan 1 when the new year starts.. I called bcbs and my new policy will still cover the surgery but I'm wondering if my approval will remain good going into the new year with the policy change? has anyone had this similar situation. I'm with bsbc of louisiana

Has anyone had issues with being a self-pay, then having your doctor bill insurance also? This happened to me and my insurance company doesn't seem interested in recovering the payment. Basically, they took my money as payment in full; but they billed a bunch of hyped up add-on charges to insurance. I say it's double-dipping. Anyone have a similar experience? Noone seems to mind as long as it's out of the insurance carrier's pocket, not their own!

Did anyone here use Weight Watchers logs as their 6th month diet? I have the logs and proof of payment. I have heard that they will but I don't want to get my hopes up so I figured I would put it out on the forum to see if I can find someone with first hand experience. Thanks in advance!

Are most of you required to get medical clearance from your PCP before the band removal? Is this an insurance requirement or a surgeon requirement? My dr office throws this at me today in a letter when she called me last week. It's just another step and another thing they failed to tell me about. So frustrating

Okay so I got a call from Dr. Mirza's office and they told me that my insurance will cover the procedure, but that they are considered out of network for my provider. Now I am sure that they will answer all my questions when I have my first visit with them on the 10th, but I am curious to know what this means for me. I have a higher deductible for out of network providers, so I am not sure at this point if I want to go in for my appointment with the office. I did some research and found that he is a great doctor, but I don't want to spend thousands of dollars on something that my insurance has agreed to cover. So does anyone further along in the insurance process know wha…

My question is will Care First accept one month of "Weight Watchers e-Tools"? I have my bank statement to show that I have paid for a WW membership for the last year, plus I have my WW weigh-in card with the stickers. All the dates below that are in black are dates that I actually went into WW and received a sticker with my weight on it. The only problem is that you are supposed to have 2 three-month concurrent (back to back) periods where you tried the program. My card looks like this: Feb. 23, 2012 Mar. 1, 2012 Mar. 8, 2012 APRIL WEIGHT DONE ONLINE WITH E-TOOLS MAY WEIGHT DONE ONLINE WITH E-TOOLS June 28, 2012 …

Does anyone have BCBS of TX? I just found out my insurance is changing Feb. 1st and my old insurance co. covered the surgery but I can't get anyone at BCBS to tell me if it's covered. If it is can anyone tell me the requirements and pre-op process?

So I finished my 6 months of a supervised diet Dec 2, and the only thing i was waiting on was my mental eval. I had so much trouble getting a psych to cover bother mental evals for bariatrics plus medicaid. Anywho I found one and saw him the 11/19 he cleared me 12/19 and that was because I harassed them twice a week. Well psychologist sent my papers on last Monda, i called today to see what is going on and surgeons office claimed the never got it, so i called and had it sent out again and guess what they claim they still have not gotten it. So I will call again tomorrow to see if they have gotten it. This has truly frustrated me to the max today because my papers could ha…

Has anyone had any issues with using Cigna insurance?

I am from canada and going for a gastric sleeve in Mexico in feb. I was lookin to find additional medical insurance to buy incase anything went wrong. Eg ICU admission ect. Any suggestions??

Hello there all. I was going to post this in the rants and raves section but realized it might better be suited here. I saw my surgeon for the final appointment last Monday the 23rd. I am chomping at the bit because when I called my insurance company on Friday, my office had not even submitted my authorization yet. I know the holidays are busy and it was Christmas. I know I have made it patiently over the last four months, and it seems every day waiting is a little harder. I passed the crossroads of excitement and nervousness. All the nerves and second guesses are gone and I am completely head strong and ready to take the next step in my journey. I feel like once the insu…

Does anyone out there have Aetna? I have a BMI of 39.4, but still waiting to see if I have sleep apnea. I've completed all other requirements for surgery. Does anyone else have Aetna? Were you able to get approved? So frustrated and ready to go! Treatment shouldn't be dictated by my insurance, it should be dictated by a doctor! Grrrr!

I have had the consult with he doctor, the psych and nutrition appt. I have to get clearance from my PCP, who says I will regret this surgery, and doesn't want to give me the clearance letter. I am hoping to get the letter this week. Then my doctors office will send everything for approval. I have anthem blue cross blue shield. They said it takes about 30 days to be approved. What is everyone else's experience....does it always take 30 days, does it take longer sometimes? What are some reasons that insurance will deny it? I'm so scared I won't get approved for it..... Thanks!!!

Don't know where to to put this thread, so I decided to put it here. I just got off the phone with my surgeons office and they said that my insurance will be going through and we started talking surgery dates. Needless to say that was one of the moments I was looking forward too. We decided on the 23rd of this month and she is explaining to me all the lab work and hospital paper work and such. Then she explained to me about the fees that insurance doesn't cover. To be hones, I completely forgot about that. I've been just so focused with life I guess that I spaced the other fees. So sadly, I'll be postponing my surgery date till maybe early Feb. With a $5700 out …

Hi Everyone. I go for my first specialist appointment. I'm very concerned about my out of pocket expenses when it comes to surgery and post surgery. I'm with BUPA and have basic hospital coverage, do I need to up it? Can anyone tell me any pitfalls they have encountered? I'm also worried this procedure is out of my price range even though I'm thinking this is very much needed. Love to hear from others in Australia.

Hi everyone, first time poster here! I'm a 21 year old female, and overweight... I was interested in doing the surgery after I saw the results a friend of mine had. He recommended his surgeon, which happens to be an in-network surgeon of UHC. I called the insurance company, and they said that this surgery wasn't covered... is that possible? UHC has an 'Estimate Health Care Costs' link, and I put in all my information, and according to that, they do... I'll I'd have to pay is $2,000 out-of-pocket. I have insurance through my job, PetSmart. Any suggestions on what I should do?

My surgeons office is going to submit my info to UHC either Monday or Tuesday. I am very nervous and excited and scared and every other emotion all at once. I have UHC through MD Medicaid and my question is through 6months of NUT visits and mental eval and 4 yrs of weight history. With all that how fast did you guys get an approval

I need it a co morbid issue since my BMI is at 47 not. 50. I got tested for sleep apnea, it showed I do have sleep apnea they sent me again Nov 12 yes I have it. They said I need it the c pap machine to "back me up" with the insurance well up to now I'm still waiting on the doctors office to call me with the c pap information. I called last Tuesday I was told I would get a call back and NOTHING I called today and the office manger told me she had sent everything to my insurance she was going to check my file if there is something there she would call me back if there isn't then she wasn't going to call me back. Well I took matters into my own hands I called my insurance …

My packet was submitted to Cigna on 11-18 and the took 5 days to deny me. The doctor's office forgot to attach my diet information from my primary. I had asked her on 11-14 if she got it and she said up its all there. They scheduled me for 12-13 which I was like heck no problem. Then because I was denied the day before Thanksgiving and we resubitted it on that day at 1pm they then said no the resubmit day was 12-2 because they were closed Thanksgiving and Friday and Saturday and Sunday. Then they keep saying not done maybe by Friday and then on Monday they said maybe tomorrow. I was so annoyed because my surgery is this Friday. Finally they told me to have the doctor's of…

Is it possible for food to get stuck right above the band for several days? I know I need to go to the dr but I can't because my insurance was canceled and I can't afford to go. Thanks Obamacare!!!! Here's the problem: I had my 8th or 9th fill in October. I had perfect restriction! Then the day after Thanksgiving I couldn't get ANYTHING down. Sliming like crazy etc. I never feel nauseous, never have acid etc. No major problems. Just super tight. I'm wondering if I have food above my band preventing me from getting stuff down. I can get all fluids down including Protein shakes with no problems at all. Last night I was even able to get some nachos down. Before this I coul…

I Know not everyone has a good experience, but I have Medcost here in NC and my employer self-insures. I had already hit my out of pocket max for the year and just got my bill from the hospital. $22,000 bill and my portion is ZERO!! Woohoo!! Just had to share my excitement!

It's just way more than I can afford... When I thought it was $3-5k, I thought that was something I could somehow, someway, scrape together with my (modest) job before end of year. Now that I have gotten an actual accurate estimate today (after practically cornering the insurance lady), I'm finding it's going to be more like $7-$10k. Bad credit I have. In house financing they don't have No supportive family with good credit to cosign Applied for carecredit today... denied. Called around to other local provider, only to find that they are more expensive. I have a bunch of stuff dropping off my credit in Aug 2014 so it'll be much better then. But I don't want to …

My boyfriend had to file for bankruptcy last year due to losing his job and insurance and then having to have some surgeries and hospital stays. He can't seem to find anyone to give him a loan. Does anyone know how he may be able to do this? Or does anyone know of a surgeon who offers financing through their office (not care credit as he doesn't qualify) please help....he really needs this surgery. He has a good job now but his insurance doesn't cover it.

Has anyone declined getting the C Pap Machine and was still approved for surgery???

I had to appeal their denial for a subsidy because I DO qualify for it! (I make under $40,000 a year). I submitted my appeal over two weeks ago, heard nothing. I called and no one knows anything...appeals department is in a different location, we have no phone number for them, blah, blah, blah...the runaround! I have insurance right now but it doesn't cover bariatric surgery until I'm on the plan for year (which won't be until April 2014), AND, they're canceling that policy as of April 2014 because it doesn't abide by the new health insurance laws. To top it off, if I decide to purchase insurance outside of the Marketplace I then forfeit my subsidy (IF I get it). I called…

I am so nervous yet excited. Waiting for this approval will be like sitting in needles.. I will call first thing tomorrow to check up on my case

I'm so excited and nervous!!! Finally finally finally this time has come to where my 6 months can be sent out to insurance. I got a little side tracked since I had Emergency surgery on getting my appendix removed in Sept 13', so that set me back and I had complications after for a month. Finally got over that and got better. Yay!! But this past monday my primary care dr forgot to add Cleared for Surgery on the letter. Which for my insurance ( Cigna ), you have to have "cleared and recommend for surgery" in the letter. So had to go yesterday and talk to the surgeons office and then go downstairs to my primary care dr to write a note on what needed to be added. Then got …

My doctor will be submitting my case to my insurance on Friday 12/20/2013 right before the holidays. I am scheduled for Surgery on 01/14/2014 pending verification and approval through the insurance. My question is for those who have had blue cross blue shield basic and applied for approval during the holidays, how long did it take to get a response from the time you submitted your documents until you were approved or denied. Thanks for the feedback.

I was approved through Anthem Blue Cross Blue Shield, and have completed everything they've asked me to do up to my surgical consultation this Wednesday. My work decided to switch to United Health Care on January 1st. I'm reading on hear that the prerequesites for UHC are MUCH more strict than Anthem. I'm afraid I may have to start over. Has anyone else had to switch mid process? I'm hoping I get grandfathered in or something. I'm 32 and my BMI is almost 39. I have no co morbidities. Any information is appreciated.

The codes my Dr provided me are an EXCLUSION per United Health Care (my plan). Any suggestions before I self pay?

Hello everyone! My story is a looooooonnnnngggg one, but I'll cut to the chase. I've been with Horizon BCBS of NJ since April 2013 (it's an individual plan that I pay for myself). It's bare bones and only covers well care stuff but no pre-existing conditions. Fast forward to now, I was able to get the bulk of my pre-op testing done with my insurance covering it. I just have a few more things to square away the first week of January. Because of the pre-existing condition clause, this plan will not cover my sleeve surgery until I've been in the plan for one year (April 2014). In the meantime, because of the new health care laws, Horizon sent me a letter stating that my curr…

Hey everyone! I'm still pre-surgery at the moment and am getting down to the wire on sending in the request to my insurance. I wondered what everyone's surgery looked like finance wise for BC/BS California? No one will give me a straight answer. I know it's different for everyone, but a ball park estimate would be nice. All I have left of my requirements are to have an endoscopy and they say then I'll have my paperwork submitted and my date set. The major problem with blue cross, however, is that their deductibles reset twice a year, once in January and once in September, and they're crazy high. I'm trying and wishing and praying to have my surgery in December b…

Finally heard from my insurance company Anthem BC BS. They approved my lap band removal (out-patient) and denied my RNY bypass (in-patient). They were actually both requested as one surgery and in-patient. It has been 5 years since the lap band was put in. They said I had no current documentation of other required classes or current psych evaluation...and then it stated that the by pass was not medically needed because I had weight loss surgery before (lap band). But, because of my trouble with the lap band, they were approving the removal of the band. When I spoke w/the insurance person at the Doctors office, she said that what they meant was I have to go thru the…

What pre- and post- op services did your insurance cover? What I understand so far is the list below of what needs to be done. Consultation 6-month diet Physh eval x-rays EKG Blood work Follow-up visit with Dr. Surgery Hospital stay, etc. Post-op visits possibly more blood work