Insurance & Financing

Hi, I have United Healthcare Oxford Exclusive Plan/ Freedom Network. My paper work said Bariatric Surgery is covered with Limitation of Benefits. Would anyone know what they mean by Limation of Benefits. I have emailed the insurance company because I cannot view my Certificate of Coverage online, I get a error message saying not not available try again later. I live in NY. Thank you in advance!

Im new to the forum. I had a successful lap band 7 yrs ago and lost over 120 lbs but soon after I had my baby I began having problems with my band. It has slipped and needs to be removed. I'm looking at doing the VSG this time. I paid cash for my band and will probably be doing the same with the VSG, but was wondering if anyone has had any luck with qualchoice paying for VSG?

I am currently waiting for my insurance to pre-auth my surgery. I had a psych eval which was done at the place where I have been going for years. I had never met the psychiatrist before. All seemed well until I was able to review my exam and he said that I had bulimia. This was not brought up during the eval. He had access to my medical records and I have a past history. It is no longer an issue. I have a policy through BCBS IL and they specify that they will not cover WLS with an eating disorder. Has anyone gone through this? Will I have the right to appeal the decision despite this requirement?

I am so frustrated.....I need to vent so here it goes.... I started this process in July. Being that my BMI is greater than 50, the 6mo weight loss program was waived. I submitted all of my information at the end of July to my surgeons office- OSU. I went to an informational seminar on August 5th. First appointment with the center on August 31st along with the psych evaluation on August 30th. On September 30th I had an EGD. On October 9th my information was submitted to BCBSM for pre approval for the sleeve surgery. October 9th and 16th I had my dietiatian classes for life after surgery. On Ocotber 29th and three times before that I had contacted BCBSM to verify they ha…

Anyone know the wait time for approval?

I'm thinking about heading to Mexico for the surgery. Has anyone had any good experiences? And with who? My dad has a family friend in Mexico, in the capital, who said we could stay with her if we decide to do the surgery there, so that's a huge plus.

Anyone have experience with this insurance for band to sleeve revision? Health Net HMO originally covered my band in 2007 after 2 appeals but I'm more hopeful with the PPO I'm getting starting Jan 1

Just found this today! It explains which states currently plan to offer bariatric and/or weight loss coverage on their Obamacare plans: http://asmbs.mediaroom.com/download/State+Exchanges++5-6-13.xlsx

I'm just curious what some of the reasons are.

Just got my approval letter in the mail. Just waiting to hear from my dr. to set up a date. can't wait to get this going!

Sh*t just got real! Confession: I haven't practiced not drinking while eating. Feedback welcome.

I was submitted Tuesday t11-26-13

Hey everyone. I started my lap band research back in January 2012. Wow it's been a whole year can't believe that. When I started I had issues with my husbands insurance not wanting to cover the band. I was told that I would have been able to appeal the insurance company and more than likely win the appeal. Well.... 2 weeks before my 1st appointment the drs office called me and said no matter how much appealing I would do the insurance wouldn't cover the cost. Omw. Talk about depression and being down. So.... I've picked my self up and went on and trying to save up money to pay for it out of pocket. Just recently my husbands company switched insurance companies a…

Anyone have Blue Shield HMO? What wee your requirements?

I have humana coverage, and I spoke with them and my policy do have WLS coverage. I am 5'4 222lbs, hypothyroid, severe knee pain and heel pain, adrenal fatigue. I have tried every diet under the sun. doctor even had me on diet pills and I didn't lose any weight. don't have major health problems. hope my insurance will qualify me. Please let me know if your any of you guys insurance approved you without major health problems. I do have family history of high blood pressure, diabetic. thanks for replies.

Hi, I'm new here. My 1st appt with surgeon is 12/16/13. I have AARP Medicare Complete (HMO). Can anyone who also has this insurance help me by letting me know what their requirements are to have the sleeve? Is there any monitored weight loss programs requirement, etc. Thanks for any help and info you can provide. Very anxious!

I have been thinking about weight loss surgery pretty much since puberty, but now it has become "medically necessary" I have high blood pressure and Pcos, I am also being tested for sleep apnea. My question is this, I meet all the requirements in my policy to have the surgery however it has one sentence that says it must be pre qualified by Anerican Health Holding. Anyone dealing with this? I called AHH and they won't give me any answers! I have put so much time and energy into going to the appt and paying out of pocket for my psych eval and I'm just scared they are going to deny me. I guess I am just looking for reassurance.

Is anyone a State of Cali employee with CALPers Insurance??

Has anyone had the sleeved paid for by Indiana Medicaid (not Medicare)? I have been told that Medicaid will only pay for the RNY or Lap Band. I have Hoosier Healthwise (Medicaid) and looking to be sleeved in January 2014. My surgeon is at a Center of Excellence, I have completed my 6 month supervised weight loss, have a letter from my PCP recommending surgery and scheduled for my psych and dietician visits next week. Just really had my heart set on being sleeved only to be told Medicaid in the state of IN does not cover!

Packet sent in last Thursday, and still no word. Was hopeful after hearing people say it only took 24 hours for them to get a response. Called HBCBS NJ and they said they won't give me an answer over the phone, to wait for a call from my surgeon's office. I'm a stay-at-home mom right now so my days are wide open and I honestly don't know what to do with myself until I hear back!

Called my current insurance yesterday pertaining to the VSG surgery, they don't cover it. I need to call again just to make sure. It could be because my insurance is through my employer. Which I found weird... my boss has had two open heart surgeries with the same insurance since I've been there, and it was covered... I don't see why this won't be... I've found some decent monthly premiums that I can pay on my own (and not have insurance through my job), but how exactly do I know if the surgery is covered? And what insurance is better? Thanks! #notgivingup

I was wondering if anyone has been approved without doing a supervised weight loss program. I have Cigna which I thought always required some type of supervised weight loss program but my patient coordinator says that my self-insured Cigna Plan through my school district doesn’t require one. They do require that I have been employed with the district for 5 years and that the surgery be performed at a Cigna Center of Excellence. When I called Cigna they told me just the opposite that I needed to do a three-month program and that there was nothing about 5 years of employment. I also checked with my benefits department as they said the same thing as my patient coordinato…

I live in Maryland and have Care First BCBS. Yesterday morning my surgeon's RN called and said she was submitting my documents (ie: psych eval, clearance by primary care physician, proof of weight watchers, sleep study results, etc) to my insurance company where another RN would approve or reject me. This morning my surgeon's RN called me back and said the insurance company's RN contacted her and said that I had been approved for a procedure date of Dec. 23. I am obviously excited, but a little confused. Does that mean I am definately, 100% having my surgery, or is it possible that the BCBS nurse approves me and submits me to the insurance company and they reject m…

Hello to u all. I'm new to this app so bare with me. I'm in the middle of my preop hoops and wanna make sure I'm doing everything correctly. My insurance requires 6 medically supervised dietitian/nutritionists visits. Crazy question, but do the visits have to be with a nutritionist/dietitian or can they be just with a primary care physician? Any responses will be helpful????

I have BCBS of al & I want to know if their guidelines will change for 2014.

I have the HRA with my insurance and wanted to know if I could use that for the surgery?

Just wondering if anyone had united through Hca? And how strict they are etc .. My bmi is like 38 I have high trigly and high LDL and lower extremity edema. I am on HCTZ for edema no lipid meds. Other than that family history of DM heart disease. Just wondering if I have a shot or should I do self pay ? Thanks !

I currently have insurance (UHC) through my employer, PetSmart. My insurance doesn't cover the surgery, so I was thinking of switching insurances to one that does cover it. Is that a wise idea?Or should I go the self-pay route?

Heard from the Drs office today that my insurance denied my surgery and then denied me after the peer to peer review. I cant' get to the bottom of the issue. The Drs office is saying that they have done everything the insurance has asked. However, the insurance called and requested information from the Drs office 3 times. The "only" person that handles bariatric surgery was out of the office for 6 days, and no one else could send it in apparently, so that was the first reason I was denied (lack of paperwork). Last Friday they were supposed to have the peer to peer review, but the Drs office said the insurance medical director called early and he wasn't available, so…

Does anyone have any experience with this plan? I'm switching to it effective January 1st. I know it covers bariatric surgery but I don't know what guidelines need to be met yet.

On November 1st my surgeons office tried for approval with BCBS but on submitted the date of surgery and nothing else they blamed it on new changes the insurance comoanies submittal process. Then they had it voided and on November 14th resubmitted this time they did not submit any supporting documents from my PCP or regarding my comorbalites whhich I have several. When I spoke yo my surgeons office about my denial letter and that it stated they were informed by my Dr office that I was only requesting the surgery due to my weight she said she was not aware of the reason but that this was the only reason correct I advised her not it was not that I have Type 2 diabetes, sl…

I Am excited. My doctor office submitted my paperwork on Wednesday and I am waiting to hear back from Aetna!!!

Does anyone have any experience with BCBS TN? I'm so annoyed after meeting all their requirements, my surgeons office faxed in the paperwork last Thursday. Well they have a new form, so nothing was accepted : ( surgeons office resubmitted! Now just waiting!! I was hoping to have surgery Thursday (because of scheduling) but they say 10 to 15 business days : ( I'm hoping it doesn't take that long for approval!!!! If the psych didn't take 3 weeks to do report I would have been on time for Thursday!! Soo frustrated!!!!!

Insurance: Aetna Pos II My BMI for the past 5 years has been over 40 I have completed the doc visits, upper gi, nut visits (all 4), psy visit. My doc office submitted my paperwork for 2 wks and they finally received it last week. I just wish they approve me so I can hopefully get this done by the end of the year

So I have Cigna insurance and the clinic faxed all the completed paperwork last Wednesday (01/09). Now I get to anxiously wait by the phone. I was wondering, those who have Cigna, how long did it take from fax to phone call?? I might start bugging them towards end of next week (give them a full week).

Does anyone know if BLue Cross Blue Shield-Horizon Advantage Epo of NJ cover the sleeve? How long do you have to wait for approval? Do they ask for you to wait 3months? 6months? Any specifics I should be aware??? Please respond I am literally paying almost $400 a month just to get the surgery...

Hello everyone this is my first time on. I have read a lot of your stories and I am honored to say that I am motivated. At this time I have did everything I need to do for a date except I have Hpylori today was my last day taking the medication so hopefully when I get retested i am cleared away. Another thing I'm battling is hoping that I get approve I read a lot of stories about denied surgeries. My insurance is husky health A.

So freakin' excited!!!! I have my final consult with the surgeon Thursday and we will set my surgery date! Hopefully it will be very soon!

when you call do you need a case number or code? or do you just give them your info. my paperwork gets submitted Friday and best believe im going to call everyday.

Finally finished my 6 month diet, and now the dietitian is dragging her feet in sending in the records to my surgeon. My surgeon says this is the last thing they need before submitting to insurance. BCBS of Alabama is telling me that it is taking about 30 days to get an approval, and my surgeon says that they are all scheduled up for November and December. AUGGHHHHH! I want to just go out and eat myself silly!

I was denied by Aetna and we very frustrated because the insurance said My sleep apnea was not severe enough to warrant surgery. With a BMI well over 40 for over two years, my surgeon believed it would be a simple peer to peer to explain the apnea was irrelevant. I was again denied. When I received my letter it stated my BMI had not been over 40 for two years. This baffled me, the insurance gave me dates of service when my bmi was 35-37 then 43, the following month. This didn't make sense to me as I know I have not lost any weight over the last few years. So I asked my doctors(gp) office to research. It turns out that there is another patient in the office with the same n…

I Have oxford freedom and next month is my last month of the 6 month supervised doctor visits. I will have everything else completed by then (psych test, upper GI endoscopy and bloodwork). I am having my surgery at NYU hospital. How long till approval?

I went to a seminar for lap band, the hospital employee checked my insurance and told me the insurance plan picked by my employer doesn't cover lap band. Seeing how there are only about 200,000 bariatric surgeries in the US (1/1500 of the population per year) and maybe run $15k that works out to maybe $10 per person per year to cover obesity surgeries in the US, so on paper it shouldn't be much more for insurance to cover them. Despite that, I think these surgeries are something an employer has to pick to get covered under their plan. I also live in Indiana, I thought in Indiana insurance companies had to cover the surgeries. Anyone know for sure? I may try self p…

Looking for someone that has UHC with Optimum health bariatric resources. I wanna know how long the wait is for approval once paperwork is submitted by surgeon. Not even gonna let the word denial in my head....lol I have my 4th visit of the 6 month Dr supervised dt. next week. I should be finished up in sept. and already have a tentative surgery date scheduled for late sept. But it all hangs in the balance waiting for approval. Just trying to get some idea how long they take. Thanks for any and all responses!!!!

Hello everyone, As you can see i am very new to this site i even had to screen shot this note because idk how to make a post on my ipad lol. So my question is does anyone here work for rite aid and got the surgery covered? I moved across country to get a new job so i can get this surgery i am very determined! And as you can tell need help. I start at riteaid dec 2nd but ive already called the insurance ( united healthcare) and asked if they covered it they said yes but im still really nervous.. Please help! Thanks.

I can't find much about anyone's dealing with this insurance company in reference to GBS and I am just trying to prepare myself for their response. 5'11 270 pounds Diagnosed as morbidly obese (rough to swallow) BMI - 39 Comorbidities: Chronic hypertension, left knee failing BCBS have covered my first surgeon appointment (good sign right) Most of my required testing will be done in the next few weeks. Any advice? Melissa

Have any of you changed insurance after surgery? Does an insurance that doesn't typically cover surgery cover aftercare after the surgery has already been done? I just got to thinking that the chances of me being with my current ins forever is slim to none and I'd like to know what my future holds with regards to insurance. If I switch insurance to one that doesn't cover surgery at some point then have issues (a stricture, leak or something else that is considered a risk from surgery for example) will I be screwed?? What about after care- like post-op appts to have vitamin levels checked etc.?

My doctor office submitted my documents last Wednesday and I called Aetna but they cannot locate my paperwork! And my doctor office submitted 3 times! I am getting a little frustrated because I want the insurance company to at least have it and working on my pre-certification. Did anyone else have this issue!

I spent a few hours last night reviewing this topic and now have doubts and worries and all kinds of swirly thoughts and potential dread! The practice said they don't submit anything they think has a chance to be refused, I hope their right. Here is what I know, 6 month diet done, bmi 39, sleep test resulting in a positive diagnosis for sleep apnea, GP recommendation, psych eval - was all good enough for them to submit. The insurance is Anthem BCBS out of TN, seeing other's anthem experiences it seems a little all over the place, so I don't really know what to think. The insurance company said its under nurse review and they have 15 days to render a decision. If…

It is open season at my work and at my husbands work. Both insurances and worker plans cover weight loss surgery. The UHC plan description is pretty clear as to the requirements for WLS are, Cigna not as much, but they do cover at over 40 BMI or 35+ BMI with comorbidites.. The costs are slightly higher for Cigna, 80% copay (Cigna) versus 90% copay (UHC) after the deductible. Any insurance gurus out there? If you had to choose, which one would you go with?