Insurance & Financing

I'm approved and I'm scheduled for surgery Dec 4th 2013. It took a while trying to get my medical history because I haven't had regular doctor visits. But now I'm on my way to getting back to the "Real Me" Woohoooo!

My Cigna policy is self insured -meaning the claims are paid by my husbands company and not by Cigna. Cigna is the administrator of the policy. In my 70 (exaggerating) policy guidelines it states the following and does not refer to Cigna's bariatric guideline. "Exclusions, Expenses Not Covered and General Limitations Exclusions and Expenses Not Covered Additional coverage limitations determined by plan or provider type are shown in the Schedule. Payment for the following is specifically excluded from this plan: for medical and surgical services intended primarily for the treatment or control of obesity. However, treatment of clinically severe obesity, as define…

I'm screaming from the mountain tops, doing the happy dance. Thank you sweet and wonderful God.. I had bcbsfl submitted yesterday approved yesterday ... Best of luck to everyone.

Good day sleevers! I've been awaiting approval for over a week now. Has anyone ever experienced this long of a wait? For some reason my paperwork ended up in the wrong hands and now they have resubmitted my paperwork. .I'm becoming worried as I see all these pre ops getting approved in 1 day. Sighhhhh. .. I'm starting to lose my mo jo...... patiently waiting

Hey there, well i'm 16 and under fidelis child health plus insurance and i've been mulling over weight loss surgery after my back pain and asthma started to affect my life on a daily basis.I researched and decided i really don't want any surgery but VGS, but recently i heard (through the grape vine you know) that medicaid finally approved it. I think this is a sign from god because as soon as I was sure about it the surgery was approved my medicaid. but anyway I'm really nervous because I don't know if the hospital i want my surgery done at will operate on a minor, and i can't afford to cover more than $2000 dollars, my parents can't help me they don't have much money, …

Hey. I have Medicare that practically pays for anything ( 80%, I pay the 20% ). I was wondering if any of you had your RNY paid through Medicare. How much was the surgery? What did they pay?

NOw I was told to go on the liquid diet and lose weight for my next appt or AETNA won't approve. Talk about motivation!!

I called Aetna and they told me that my medical group has to approve my surgery and that they won't even see my paperwork for approval! I then called my medical group and they told me the same thing. I then called my surgeons office and they said the same thing. But know one can tell me for sure what hoops I have to jump through! They all made it sound that as long as I do what my surgeon requires and he thinks I need the surgery I will be fine. Has any one ever dealt with this?

Hey everyone! New here, and just started my journey of getting approved for Gastric Bypass. I already called my insurance which is Medicaid - Specifically Maryland Psyhisians Care. Has anyone has the 6 month requirement before being approved for surgery? They did not mention that as a requirement but unsure if that will come up when my PCP tries to send in my forms for approval. I am a bit nervous about that because when it comes to the excercise part its pretty difficult when you have Fibromyalgia, Plantar Fasciitis and a pinched nerve in your back. Thanks!

I would like to know what's gonna happen next. They said my insurance BCBS federal was approved. And made me an appointment with the doctor. So what happens next. Dose this mean now the doctor has to approve me.??

I am so upset and confused I could scream! Last night I couldn't sleep so I decided to go through my insurance coverage more thoroughly. I have 42 BMI along with CAD. i have had 2 heart attacks and am trying to get myself right before the third one takes my life. About.a year and a half ago, i started seeing a nutritionist and a personal trainer. 4 months and nearly a thousand dollars later and i was lucky to lose 17 lbs. so I gave up. When I went to see that nutritionist I was already considering WLS but thought I would give it one last ditch effort. Now I started the process going so far as to have the psyche eval all done, my first gastro appt tomorrow and th…

Who has had their surgery in the states and done self-pay? Just found out my insurance doesnt cover the procedure, but I still want to have it done. How much did it cost overall AND was it worth it?

Anyone have any experience with submitting to them, how long it takes to get a response, approval rate? From what I'm finding (and what the insurance coordinator for my surgeon says) they seem to be approving a lot of people very easily right now. All of my pre-op work is done, except the last consult with my surgeon before surgery and setting a date. Let me know if you have any experience with them!

Hi. I was jus wondering if there is a way to skip the 6 month wait before surgery

I had high hopes from all the stories I heard about people getting approvals in 1-3 days. Its been a week and still nothing yet. One kind customer service agent at my insurance company gave me a number to give the insurance coordinator so they could put a rush on my file, but my surgeon's office refuses to call. I can't get a surgery date until I get the insurance approval. (That seems weird to me, because everyone else I talked to said they had a date set before now. hmmm). I'm just very, VERY anxious about this. I've been waiting six months since I went to the seminar to get everything in place, I've been on the pre-op diet for three weeks already, even though th…

So I will tell you all the reasons I should have the band- BMI of 55 Heart attack at age 32 I am 34 now High BP Depression Pseudotumor Cerebri with severe papillo edema Hx of Pulmonary embolisms Pre Diabetic Reason Aetna denied me today- I gained 1.8 pounds since May!- they said they would have denied me with even an ounce gain. They implemented this new rule this month. I have been jumping through the Ins hoops for four months now. I was suppose to get banded Sept 27 instead I have two more weigh ins I am crushed.

I'm considering changing employers. I had my surgery done under Cigna care and the new place has the Tufts *** coverage. Their benefits person checked and the plan does cover bariatric surgery and they will cover aftercare with an office copay. Just wondering if anyone has this coverage now and what your experience with them has been like. Thanks!

I am just beginning the process through kaiser in Southern California! I am signed up for my orientation and lifestyle courses but I need to bring proof that I have tried to loose weight within the last 10 years for a minimum of three months and weight watchers isn't giving me my records. Do I have any options here?

I did all the months of going around to different doctors and got all the clearance letters, met with my new surgeon and he was surprised never go a patient bring in the papers before meeting them, anyway after I gave him all my clearance letters he gave my a surgery date and even booked my post op appointments.... What I'm confused about is does this mean my insurance approved my surgery? I want to get excited about my surgery date but I keep thinking they are going to call me and tell me my insurance didn't approve it I'm so confused ! My question is will the surgeon give the date before being approved or does this mean I AM approved?

Does anyone hve aetna?? If so how successful was u get approve?How long did the approval take?

I talked with the scheduler today and she told me that they was missing the month of may from my PCP doctor. I spoke to medical records and she sent them over but I couldn't get with Sally at the insurance company today before they closed, but Jennifer(my scheduler) told me that they would take a meeting with the dietician instead. So have a have the appt. moved up to Nov. 6th. She told me that as soon as she sends it that the insurance people will turn around and send the approval letter. If I can get the month of May sent over then I won't need the Nov. 6th appt. and she will give me a date. Aaaaaaawww! This is all so much but I am blowing everybody up to get this done…

Ok, I have been approved for weight loss surgery in my state but there is a number of issues. The bariatric department is rude, unorganized, and not that educated. But the biggest issue is My PCP said I need the Gastric Bypass not the sleeve or band. But when I talked to the surgeon he said no I am too big for bypass and plus I have anemia. However my anemia is related to heavy long periods which is related to my obesity. So, I called Medicaid and they said you can not go out of state for surgery unless the out of state Dr. is under Medicaid and there is some paper work they will have to fill out. But when I google it it says something different. I really need the surger…

I went to my seminar last week and was told all my insurance required was a psych visit and a visit with a nutritionist. They scheduled me to meet with both on Nov 13th and to meet with the surgeon yesterday. My surgeon was great, told me I was a great candidate. When I asked him how long until I could actually get the surgery he checked my file and told me all I needed was a psych and nutrition visit and they were already scheduled. I should be looking at a late Nov. early Dec. surgery date. Yea! Or so I thought. Then I met with a nurse there to get informational packets for my meeting with the psych/nutritionist. She tells me that my insurance doesn't require a 6 month …

I'm scheduled for surgery, but I'm still awaiting approval. I have BCBS of IL which I was told approves very quickly. It's been a week so far and I thought it would take 24 hours. I have a 44 bmi and severe sleep apnea (the worst my doc had ever seen) and borderline high blood pressure, as well as reflux. My surgery is not scheduled at one of the blue centers, but I'm only $3k from my max out of pocket for the year. I would probably self pay if I got denied, but I'd rather use insurance. Should I be concerned that I'll be denied?

Has anyone found an insurance plan under the Affordable Care Act that provides coverage for Lap-Band surgery?

Just thought I would share - was speaking to BCBS's insurance person about my upcoming surgery and a couple other non related things. He seemed really knowledgable and was researching things before giving me answers. So I asked him if having plastic surgery was an option if a doc said it was medically necessary. I have read through my benefits book from them and it clearly states plastics isn't covered. But the insurance guy told me he has seen it approved several times as long as it's deemed medically necessary by a doctor, particularly in cases of extreme weight loss. This gave me a little hope that i might not have to pay for this out of pocket.

I have my sleep study tonight. I have a low BMI of 36 and high BP but my insurance requires one more comorbidity. I do snore but don't know about sleep apnea. I have never wanted something that is bad for you so much! lol. I don't have my follow up with the sleep clinic for a couple of weeks either so I won't know. Already met with surgeon just waiting on these results before we go further. I have bcbs of il PPO. Anyone else in this position?

Just curious if this has ever happened to any of you whose insurance company requires two comorbities if your bmi is at least 35 but under 40. I have bcbs of illinois, PPO. I have one which is high blood pressure but but they require two. If my blood work comes back fine and my sleep study comes back fine I'm wondering if I have any chance or should I just give up. Should I just continue with psych eval and nutrition class and have my doctor submit and see what happens? I wonder if they would pay for those things if I didn't get approved. Grasping at straws here!

Hi Everyone, I am wondering about approval for RNY with Medicare with a Bi-Polar diagnosis. I just filled out my questionnaire for the psych evaluation and it specifically asked about bi-polar and depression. Does anyone have experience with being bi-polar and getting denied. I am scared because I need this surgery desperately. Thank you, Mo

I was wondering if anyome knew what Insurance company was most likely to approve surgery

I received my EOB for surgery and pre op testing....62,000! I'm so grateful for insurance. Just curious if this was congruent with other folks costs.

Are there any Connecticut sleevers that have Oxford insurance? ?? My dr office just sent everything to them for approval this past Tuesday and I'm just wondering how long others have typically had to wait. Getting antsy!!!!!! Thanks, hope all is well with everyone! !!

I'm pretty new to this but I have United health care insurance thru Best Buy. It says I have to do a 6 month surpervised plan but my surgeon said no. Does anyone have experience with uhc or Optum. My Optum nurse & I have been plaing phone tag for weeks!

relying on this hardship 401 k loan. But ING is asking for papers obesity solutions said they can not provide until after the surgery. I got home and applied for care credit and got denied. Hitting roadblocks and feeling stressed at this point. Anyone had any experience with 401 k hardship withdraws? This is our last hope financing this surgery.

Greetins to all! I love this site and find the support overwhelming, thanks to all! Question to anyone with BCBS of MI. I am in the early stages of this and did the seminar, met with Nut for the first of 6 monthly visits but fear that the insurance company will make me jump through more hoops? Anyone have this insurance and if so, can you share your storie/experience? I appreciate any input. Thank you

Cigna OAP has denied me conversion from slipped lap band to sleeve because I haven't seen a bariatric doctor in 3 years. I moved away from my surgeon and just got insurance that has bariatric coverage. From Feb of this year to current I started gaining weight - in excess of 40lbs which lead me to believe something wasn't right. They won't even take out the band unless it is emergent surgery. I'm having problems, not life threatening, just uncomfortable, but I need help either getting a sleeve or revision for this band as my weight is climbing and the problems of reflux, gas, pulling in abdominal area, etc. are not easy to deal with regularly. The PA put me on a 100g …

So I just got switched from my parents insurance to a new insurance through my employer since im 26 now and I have been making doctors appts going to seminars to have the gastric sleeve. My heart was set on this and I thought for sure no problem my insurance would pay for this i have high blood and many other problems. I had a 4 hour doctors appt set for next week to make my round of appts since my doctor has most everything in house. So i call my insurance this morning and ask about coverage and told me No they DO NOT cover it whatsoever... Im completely devastated and have had my heart set on this for awhile now, there is no way! i could do self pay...So needless to sa…

So hi! Im super duper excited cause I have been blessed with the oppurtunity to have WLS done. I couldnt be more excited. Heres a little backgrounnd on me. Im 21, Im overweight and Im a single mother. Initially I was leaning towards the sleeve because I actually know someone who got it and it worked very extremely well for her. So I was approve for getting the sleeve which came as a shocker to me because I am on medi-cal and they typically dont cover it since its such a new procedure but anyhow I was approved and I did all my labs the psych eval went to the dietician mam and everythkng except the upper endoscopy. Im getting that done on the 21st then when the gi dr gets t…

Happy anniversary to me! Today's our 8 year wedding anniversary and I got the call from my surgeons office that they were submitting to insurance. I'm so excited! I'm praying to have my surgery date sometime after thanksgiving but before Christmas. My surgeon is still injured so only time will tell when I'll my date will be.

Surgery is scheduled for oct 29th and still no insurance approval! Pre-op blood work scheduled on Monday and I don't know what to do!!!

I think my boyfriend may go to get it done. But I have no idea where to begin to get the best surgeon and best overall experience at a low price? Can anyone help? Dr. Acezes seemed a little high. I would like hotel and airfare to be included, if possible.

I paid for my sleeve surgery. My surgeon didn't tell me he would charge if I had a hietal hernia. He ended up sending me a bill for $600. I told him I wouldn't pay it and he should check with my insurance. He charged my insurance a ridiculous amount and they sent ME a check for a large amount. Do I need to give him that check or I am only liable for the $600 he is charging me? Personally I don't feel he should get anything. He didn't provide me with any information that I would be charged for such a surgery. Advice???

I am in the process of requesting approval from slipped lap band to sleeve on Cigna OAP & my insurance rep at the Doc seems to feel I should get approved quicker than later b/c of my "complications". I'm wondering if anyone has dealt with this particular insurance and if I should be concerned about denial. So far the doc has stated I need to do the 6month diet and monthly check-up, but that with the complications I should be able to get approved sooner. thoughts??? thanks for reading/sharing

Hi, my name is Amanda and due to recently being laid off I currently do not have a fantastic health insurance I do however have Medi-cal california. I dont know much about whether they will or will not cover the gastric sleeve I have read of it being possible but if anyone knows for sure please do let me know. And please please also let me know how I would go about the process of being covered. I'm in dire need of this surgery. And I am willing to in-house finance so if you have information on that as well please let me know. Thank you very much!

So I finally applied for horizon today since my school insurance doesn't cover bariatric surgery but horizon does.. Anyone knows if horizon blue cross blue shoes epo plus makes you wait the 3months/6months before approved? Please please please share.... I'm in the process f getting cleared from my cardiologist only 3 more tests to go woohooo .. I found out that I have a little high cholesterol and blood pressure. I am finally a BMI of 35.5... This should be enough right?

Hi everyone! I've been lurking around here for a few months reading and researching I have to go self pay and would like to be local or at least a reasonably short travel distance from home. I'm having a hard time finding out self pay prices and was wondering if anyone had done self pay in CO and would mind sharing?? I know Dr. Snyder is $17,000. I have also considered going to Vegas for Dr. Umbach for $12,000. I'm still not sure how I will pay for any of it, but I would like to at least find the best prices around me to start. Thanks for any help!!!

I have cigna. Just got my paperwork sent in today. How long should I wait till I call them?

After a long 6 month medically supervised diet, I finally saw my surgeon on Tuesday and his insurance person submitted my chart to the insurance company that afternoon. The insurance approval letter I just recieved was dated the same day with a post mark for the following day! I can't believe that the letter has been in my mailbox all day and we just now brought the mail in the house at almost 11pm...so excited, I hope I can sleep tonight!

I have federal blue cross blue shield basic. Does anyone know how long it takes for a decision? Thanks

My surgeons office put in the paperwork Monday the 7th 2013 and it has been approved within 4 days. I am so excited. I started at 330 lbs and I have severe sleep apnea no other conditions. So my experience is good with the Insurance. I go Monday for medical clearance letter from my Primary care Physician.