Insurance & Financing

I am looking for some advice or guidance. I currently have insurance through my employer, but they have fully excluded any and all WLS. My husbands employer on the other hand covers WLS. His open enrollment is now and I checked the exclusions and pre existing conditions clauses and I pass both of those obstacles. I even called his insurance provider and verified the surgeons I have chosen (but have not had any appt's with yet) are in network. I want to make sure I have checked everything. Is there anything else I should check before I move forward with changing to his insurance. It costs so much more money than mine, but would be soooooo worth it.

Need your opinions please. I can't get a straight answer about the 6 month diet. My docs office says it's a requirement for my insurance (even though they haven't filed for prior auth yet). My husbands HR department said it's not one of their requirements. I've called UHC myself several times. Been told it's not needed. The last time I called I was told it's not on my personal policy, just a general requirement of UHC. The lady on the phone didn't know if I needed to complete it or not. What do you think? I'm confused.

Just went to my first appointment with my surgeon. I was expecting to have to do a three month supervised program...but was told I only need 1 visit with the Nut and the psych eval and they can submit for approval. So, it appears what I figured would take until February might just be a few weeks away. Anyone have experience with Aetna Medicare?

Hey y'all! I have Blue Cross/Blue Shield of Texas and I was hoping to hear from some folks who've also dealt with them. I've gone through the evals (including psych) and my surgeon's office submitted a request for authorization to BCBS last Thursday. I'm told it'll take "up to two weeks or more"...I love how they don't want to commit to anything even remotely general. What was everyone else's experience with BCBS of Texas? A full two weeks? Over that? Less than that? I realize there are different levels of coverage, I'm just hoping to get a better idea of what to expect. I'm hoping it's not 2 weeks or more...trying to have surgery by the week before Christmas.

Okay, I had my first appointment at Emory on October 23. My insurance requries a 3 month supervised diet. I go back to the surgeon on November 26, which is about a month after the first visit. That means one month is done with the diet, two more to go. That means at December 2x appointment, I will finish month two and January 2x appointment, I will finish month three. At that point, I should be able to send off insurance information and have surgery shortly after, sometime in February or early March.. BUT why are people telling me that a 3 month supervised diet actually means 4 months? And why did the front desk lady say that my supervised diet doesn't start until my…

I was self pay for my surgery (I wasn't heavy enough for long enough....grrrr) and I thought I saw a post a while back about fills. Someone said even though insurance didn't cover the surgery, they were covering her fills. Is this happening with anyone? Any ideas on how I can get my insurance to spring for the fills?

Hello everyone! I am new here I'm currently battling with BCBS of IL. I had my surgical consultation Sept 13th and had a BMI of 39.93 on that day. My plan denied as my BMI wasn't 40 - one more pound and it would have been 40! Anything under 40 requires 2 co-morbid conditions which I don't have. I am now going in for a 2nd consult with him October 25th to be weighed again so he can submit an appeal. He suggested I wait a bit so it wouldn't seem as though I was gaining weight on purpose, however we are talking about ONE POUND here. Weight fluctuates daily, weekly....etc. I have now gained 5 lbs in 4 weeks - is that bad? Should I try to make it more like 1-3 lbs? Thi…

I got approved this week after onky 24 hours. I was planning on surgery in November due to new insurance on december 1st. What do I do??? I need it in November I called today but they said they csn put me on the cancelation list. What can I do

Has anyone dealt with EBMS? I am very anxious about the insurance approval process..How long does it take usually? Where you denied first...

Hi Everyone *excuse my english* Aetna denied me last week and i'm trying to appeal now. the reason of the denial was because of my BMI . 39 with no comorbidities. so now i got a letter from my pulmonologist to show that i have asthma i scheduled a sleep apnea test. actually i gained wight after my paperwork was submitted. so i'm wondering if i can appeal with my current wight ? *which is going to change the bmi to 41* any advise to get the approval ?

Wow it has been a life time since I was last on this forum! I would love some advice right now as I am pretty much over this whole thing! I was banded 10 years ago in Australia and have managed to lose (and keep off) over 150lbs. Now I am living in the US (since 2004) and am having major complications where I cannot sleep at night due to choking on stomach acid. The band has to come out or I am at risk of Aspiration Pneumonia, which can be VERY serious. All options have been tried, so I am not here to ask for advice on that. My surgeon has advised me that the only option is removal or eventually severe illness. I am already wheezing and am weak due to the foreign ma…

My first 3 dietitian appointments I lost weight and I did not have a cycle. Now my cycle came and I have gained 5lbs. My food habits have not changed. I am worried I will be denied. Has anyone else experienced this? I am starting a 2 day liquid diet to hopefully lose the extra pounds

Today is the day insurance has to render a decision, and it's going to be a long day! Insurance said they will fax the doctor upon their approval... Don't know if the doctor will immediately notify me or not, but I am sure they will be hearing from me (I will try not to bug her too bad! )

Yesterday, after calling my insurance company, I got my approval! The insurance rep said their was a date of service (11/20) on it. Does that mean anything? I haven't heard back from the surgeons yet , so I thought I would ask all of you.

I just got notice from the surgery coordinator I'm approved!!!!!!!!!!!!! :) :) I let out a whoop so loud a coworker checked to see if I was OK! This is SUCH a relief. I was so afraid of denial.

Hi guys ! My name is Steffi and I am 22 yrs old. I am new here. I have HealthFirst insurance n i required to do the 6 month supervised diet. I have submit the paper work at the end of dec. i am worry about getting denied bc i have just maintain my weight an my last weight in i just lost around 3 pounds so far. I am worried bc I am Not sure what kind of result is my health insurance looking for ?

Long, ranting post to follow: Since March, I have been jumping through insurance hoops. Have done anything and everything necessary to get this done. Have made sure my nutritionist visits and MD visits were spaced just so... Finally, after having GI clearance complete with EGD and all the other stuff, my surgeon's office has everything ready to submit to insurance. Everything submitted and the waiting begins. A little back story here: We have had our current insurance for 15 years. 15 years. My husband has had to make a job change after being with his current employer, for - yep, you got it - 15 years. The change could not wait another month or two. Opportuni…

Does anyone have Aetna through BNSF and have any problems getting approved? If so what issues did you have getting approved?

Does anyone have Anthem BCBS of Ohio? I have this insurance and I've heard conflicting answers on whether or not they require 6 months of medically supervised weight loss. I have called my insurance company 4 times and gotten different answers. The first time I was told there was no such requirement, that everything was done "on the honor system" (doubtful) and then the second time I was told there was a 6 month requirement. The 3rd call the representative didn't know and the fourth time I got an answer similar to the first time I called. I'm inclined to think that I don't have the 6 month requirement. However, I talked to a nurse at the weight loss center I'm going…

I went for my consultation last week. Although my doctors thinks I will have better resolution with the gastric bypass I'm still opting for the sleeve. When I sat down with finance I found out Aetna has a crap load of hoops and hurdles that have to be done before they will even allow the request to be submitted for approval. Are all insurance companies like this or just Aetna?

I just found out today that Cigna denied me. My BMI is 47 and I met all of the requirements and my insurance includes bariatric surgery!!!! Of course it's the weekend so I cant call my surgeon's office. Talk about a big let down!!! How can they deny me? ???

Ok. I wonder if anyone has had this experience with FEPB. I'm having lap band revision to sleeve or RNY. I call the insurance company on Wednesday of last week and the guy said I was approved. All excited... didn't rush into anything until the next day. I get a call from my doctors office Friday saying that they need more documentation ( 3 month diet plan, psych eval, etc.) I never had to have all this when I had my lap band in 2010 so I was fuming because I already purchased airline tickets for family members to come down to Texas for surgery. I called the insurance and they sent out two letters. One that is approving the procedure for lap band r…

Ok. I wonder if anyone has had this experience with FEPB. I'm having lap band revision to sleeve or RNY. I call the insurance company on Wednesday of last week and the guy said I was approved. All excited... didn't rush into anything until the next day. I get a call from my doctors office Friday saying that they need more documentation ( 3 month diet plan, psych eval, etc.) I never had to have all this when I had my lap band in 2010 so I was fuming because I already purchased airline tickets for family members to come down to Texas for surgery. I called the insurance and they sent out two letters. One that is approving the procedure for lap band removal…

From Lisa Lampanelli to Carnie Wilson as the Ambassadors of Hope and a huge community of people just like you check out www.wlsfa.org. It's the Weight Loss Surgery Foundation. The WLSFA is a nonprofit organization powered by Weight loss surgery patients & their supporters, Bariatric Surgeons & their practices, Hospitals and Corporations. Together they raise funds and gather resources to give away in the form of Surgery Grants to people denied access to the medical treatment of obesity. They have funded 10, yes 10 grants so far since 2010!

I finally got my physicians approval. I cant see a surgeon til january bec of insurance reasons my bcbs of ill doesn't kick in til then. Any advice. Anything i should keep on top of or.. All and any advice is much appreciated. Thank you!!

I have BCBS and was wondering where you look online to see if your claim was approved or not? Is that just in the claim portion online? I just finished up my NUT and psyche evaluation today so they said they will be submitting within a day or 2. Getting very excited as well as nervous.

Unbelievable! Submitted 10/17/13 approved today...United Healthcare, Medica Choice! Feeling very blessed!

I have my 4th nut appt tomorrow along with the phys eval. Whats next when do I get to meet the Dr?? When do they start the paperwork for the insurance?? I feel like im in the dark!!! I ask my nut questions she just says "dont worry I will take care of It" Well damn I want to know my next steps!!! Any suggestions???

I was looking at at link about states going forward in 2014 due to me have PCIP insurance and had to change plans. I've learned that Virginia is not one of the states that offer it. I clipped some of the info I found. " Which Obesity Services are Not Covered? As with any rule, there are exceptions. The same is true for obesity coverage. While obesity screening and counseling must be covered by all insurance plans, the determination of what those benefits constitute will be left up to the states. In general, most states will not cover weight loss treatments. Counseling, as outlined above, is not considered a treatment. However, these services are: Bariatric surgery, …

Hi guys! Well my surgeon's staff submitted my paperwork and for some reason not all of it went through when they faxed it to BCBS of California. Well I got a letter from BCBS today saying they need more info (which my dr called already and said they were taking care of it) but on that form it said type of surgery: gastric bypass. I have been very clear I would be wanting VSG. What happens now?? I have to wait till Monday to call them and of course I'm sick to my stomach over this!!! Has anyone heard if this or had this happen to them??? I'd appreciate any input!

Did anyone get denied by their insurance for a revision? I have Barnabas health in NJ. My coordinator said she primarily needed my psych eval to send in to get approval which I did last week and they had to write a letter saying how the band failed me. I threw up from day one with the band. Was pretty much bulimic but only lost 15 pounds in 13 months. It just stressed me out. I was deflated 3 weeks ago and I'm feeling human again but gained 3 pounds already.

anyone know if tricare will cover for active duty family member for the sleeve?

BCBS Approved my surgery yay! No surgery date yet.

Aetna is taking their sweet time approving my surgery. I jumped through their hoops. I did everything they asked. Now it's time for them to step up. It's funny, when I needed a lap chole, I had an approval in... an afternoon. For a Lap Band, I have to wait four to six weeks?

Billed amount vs my responsibility due to a self insured plan. 1,000 ded & 30% co insurance. Overall costs include 40 x 8 dr/nut visit co pays & pharmacy co pays of $30 x3. allons-y

I will complete my 6 months in March that is required by bcbs Al. Well I found out tonight that my insurance will change in Feb to bcbs Al, local government plan (lghip) ,group 30000 .I'm so worried this new plan won't cover my surgery. Does anyone out there know anything about this new plan I will be getting?

I just got the call that my paperwork was submitted to insurance today!!! The waiting game begins... My coordinator says that they usually wait 7 business days before they follow up with insurance so I'm on pins and needles. That will be Nov. 1st. You can bet though, that I'll be calling my insurance on Monday just to make sure they got it! I'm not patient!!!

My insurance was approved last Monday and my doctor still hasn't called to schedule or for me to do additional labs. My husband was approved this Monday. Its getting really close the the end of the year and we have our deductible to worry about now.

APPROVED BY INSURANCE!!!!!!!!!!!!!!!!!!!!!!!!!!!!! First submission, and it was approved a week later. I called every day! Now just waiting for the hospital scheduler to call and set up my surgery date, and get my pre-op labs taken care of! SO EXCITED TO BE SLEEVED IN 2013!

I have been denied by Aetna. My BMI Has been 40-43 over the last three years. I have high blood pressure that is controlled by medication. Have sleep apnea, asthma that acts up with the cpap. My doctor just did a peer to peer with a doctor from Aetna (non-bariatric) and he insisted my sleep Apnea was not severe enough. My doctor repeatedly pointed out that the sleep Apnea was ultimately irrelevant because my bmi has been over 40 for over 2 years and that I meet all requirements listed in their booklet 0157. The doctor indicated I will be denied again. Does anyone have any clue what I can do. My doctor is even baffled. Help please.

In my profession, we rely on billing people's health insurance for services..... The word going around the last few days is that 50% of all Americans will loose their present health insurance coverage within the upcoming year......the number can go as high as 80% Primary reason is that the Federal Government has mandated that all Insurance companies must meet new federal mandates,,,,financially, the Insurance companies cannot meet all these mandate and stay in business....without raising premiums way through the roof....they will simply stop underwriting policies leaving people with no option other than sign up for the federal program... What bothers me is that whe…

I know surgery is covered but I'm wondering if they make it difficult to get approved. I want mentally prepared for battle if need be. lol.

So will the secondary pay for the surgery if I meet their qualifications for the surgery. My insurance the primary will not pay for WLS, but my husbands which is my secondary does cover WLS. Will the secondary pay at a lower rate because it is not my primary or will they pay at the full rate?

Please help, I just got a denial letter from my surgeons office saying that I didn't have 2 comorbids that have not responded to maximum medical management that are generally expected to be reversed or improved by bariatric treatment!!!! My BMI is 35.6 my comorbids are a high cholesterol of 254 and sleep apnea. I have had high cholesterol for years with no medication and I have had a sleep study done years ago but I dont use a cpap. Any ideas on how to appeal this decision?? My surgeon's office submitted all other requirements. I have tried other weight loss methods like weight watchers, used phen phen, atkins diet, dexatrim, slim fast, scarsdale medical diet, grape…

My new doctor Cleared me for surgery and my surgeons office is submitting to my insurance ! ???????? i have BCBS Federal anyone with this insurance if so how long does it usually take for them approve or deny?

Im so excited after months of trying to get my surgery approved!!!!!! IT HAPPENED YEAH im so happy after fighting with BCBS and than paying a crap load of $$$$ for COBRA due to being laid off in September. I finally get the approval. That was the best news.

I'm just starting all of this. I know they are making me do the 6 month physician supervised thing. Afraid I'm gonna go thru all this and they are gonna say No or only pay small part

My paperwork was submitted to Cigna yesterday. Now, I am getting a little nervous. Hopefully it will be approved the 1st time and soon.

My insurance denied me after I went through the entire process with my Florida surgeon. (FYI: I don't even feel comfortable going back to the surgeon here in Florida who did all my pre-op stuff because I know they are cheating people....long story). Now I am looking for cash pay options and I am wondering if I should go to Mexico. Are the prices posted all inclusive prices? I don't want to be get bills for "this and that" AFTER the surgery? Also, I would prefer to do surgery in US but I will do what I have to...... My BMI is 37.7 and 2 or 3 comorbidities, if that helps.

I know every insurance is different, but what were your out if pocket costs?