Insurance & Financing

I guess bc of what I do everyday, I just wanted to remind everybody of some things about insurance. 1. Two people can have a united health care plan ( or bc bs or whatever) and those two plans be VASTLY different. I see people ask all the time " anybody have so and so insurance ". What really matters more is who s the employer? Especially in the case of major companies, they may be self insured ( they pay all the bills, not UHC. For example). In this case, the write the rules of the plan. If not self insured, there are a gazillion plans they can choose offered by bc bs for example. 2. Your employer hr dept should be able to provide you with the SPD for your…

Confused about my insurance verification form. I see a number at oop, a different number for oop met and hospital copay. I understand the hospital copay, but not totally sure about the other two. Does anyone know how to interpret? I feel silly for asking.

Hi all, My daughter's insurance company doesn't cover WLS. I'm just wondering what the range of cost for the sleeve is if you're self-pay. If you know the average for all-in, surgeon, hospital, anesthesiologist that would be great. I know it will vary widely, but we're just trying to get an idea of what to expect. She's not interested in traveling out of country. Thanks!

I'm done with all tests and now waiting for approval, wish me luck, anyone with the same insurance I have? any info? Tks

I have medicare and secondary medicaid in Texas and I have no co payment or cost with gastric sleeve. I'm posting this because I had looked for this same answer before my registration at the hospital that will preform the surgery. I'm blessed and thank God that I don't have any out of pocket cost. Thank God!

Hello, been a roller coaster of a ride this week re: gastric sleeve journey. Good news: my husband has come around, and said he will fully support my decision to have the sleeve. So relieved! Bad news: After I've accepted the changes, mentally, and invested a lot of time w/lab work, Upper GI, psych eval, and meeting w/the dietician....there may be a snag with insurance! So, apparently, Aetna has a requirement that you have had a BMI of 40 for at least 2 years. Currently, I have a BMI of 40. However, my BMI for the last couple years has been between 33-35, well, actually as I'm thinking about it...probably 37-38. I asked the gal at the Dr's office who schedules the surg…

Procedure now covered by insurance since July 1st. Was approved for surgery. Went to consultation. Dr. told me he knows it is approved, BUT...he had no idea what the criteria was to follow through with. SO, he made 2nd appointment so he could find out exactly what proverbial hoops i need to jump through. I had already waited a month to even see him! Jeez....is he incompetent or what? I was told by his nurse that i only have a six month window to have the surgery. Plus the coverage for only 6 appointments...1 per month...to still be qualified. Does this sound right? Am i wasting precious time???? Also, he is only surgeon in state. So i have to just wait it out....uggg.

If you've been approved for VSG by Medicare (or have been told by your surgeon's office that you should be approved), please post and tell us which state you live in. Also, if you know, does your state have an upper age limit for VSG? Thanks so much...many of us trying to figure out the Medicare rules and regs, which vary by state.

Hey Everyone.....I want to help create a long list of Providers that serve those who have Medicaid/ Medicaid Managed Care. Hopefully, All Users can add. This list is not organized, or listed. I will NOT Organize it, since I have other important things to do in my life. If you have medicaid, and you want the band, BAD; you gotta work for it! You can do it! I will start the first entry. These are the hospitals I know Bellevue Hospital Center Bariatrics- New York, NY Phone- Harlem Hospital Bariatrics and Metabolic Medicine- New York, NY Phone- St. Luke's/Roosevelt Hospital Department of Surgery Phone New York Bariatrics Group/ Dr. Javier Andrade Phone-

I've googled and yahooed and binged and I can't find anything about my strange insurance question. Wondering if maybe someone has a little more insurance knowledge than I? I am insured by UHC (primary) and Cigna (secondary). Both are self-funded plans by my & my husband's respective employers (I think this may be an important fact). UHC is aware they are primary, and Cigna is aware they are secondary. As many of you know, UHC has a 6 month supervised weight loss requirement and Cigna only requires 3 months. When I first began this process, my husband called Cigna to find out about the coverage. He asked the person if Cigna would still cover the surgery if I CH…

As anybody been told that due to Obamacare that weight loss surgut will have to be covered next year?

Im excited but im a bag of nerves right now. I really hope I get a speedy approval....

Anyone have any issues with them? They told the office I have coverage and I have my consult appointment set but when I called they told me no coverage so a little concerned

Hi. We currently have Cigna... Worst ever! So my hubby is willing to switch and have 20-30 more a month out of his check to make it easier for me. Has anyone done this? Will there be a problem starting the process with one and switching to another? Thanks.

Does anyone have Medicare? If you do, what did you have to go thru to get your surgery approved and how long did it take? Thank You, Antonette

Anybody have bcbs of la. ? I want to know how the process goes with that!

I GOT APPROVED!!!!! Thank GOD!!!!!!!!!!!!!!! It's been a whole year fighting with my insurance!!! Multiple appeals and finally after writing my own appeal letter they approved me!!!!!!!!!! I got it in writing its official! I will be banded 10-22-13. Woot woot!!!!!

Revision, how long did it take your insurance to approve you?

Great day went to the doctor today and she said im whipping the sleeves ass lol down 54 pounds since June 4th.

My insurance requires me to fail a 6 month medically supervised diet and my surgeon's office told me to see my primary care provider once per month and document those visits for 6 months. However, I'm getting conflicting answers from employees at the surgeons office whether I'd have to go 6 times or 7 times to complete the 6 months. I'd like to hear from those who have all ready completed this requirement...how many visits did you have?

Just wondering if anyone has been successful getting PCIP to approve the surgery...please share your experience. Thanks!

I found out today that the hospital my doctor performs the gastric surgery at is NOT on the centers of excellence list of approved hospitals. So now I have to start over with a new doctor; he or she may have an entirely different list of requirements. I now see how people can get inpatient and go to TJ. I don't have time for another round of hoop jumping

Ok I have a couple questions for anyone who can answer! 1st- how long did it take your dr office to submit to the insurance, once all requirements were met? 2nd- I have UHC Choice plus, and my only requirements are a BMI over 40, dietician and phsyc consult. Has anyone been approved quickly with these turned in?

Insurance approved my surgery today. I'm so excited even though I don't have a surgery date yet. Next time you hear from me will be when I get my date! Woohoo!

I've met all my requirements and am ready for my file to go to insurance for approval. Please pray its quick.

Has anyone switched their insurance to Kaiser after being banded? I just changed jobs and they only offer Kaiser for medical insurance. Will Kaiser administer fills or provide care for any lap band issues that hopefully will never occur?

Hello all. I have IBC Personal Choice PPO coverage in PA. I was wondering if anyone has this insurance and been sleeved. I have all my pre-op things like nutrition classes (2) my psych evals (2) my sleep studies and now been on c-pap for 1 month faithfully (actually love it), my hgbA1C is 5.9 so heading towards diabetes, excruciating foot pain and knee pain. I'm 5'6" 243 lbs so my BMI is not that high. I have my surgeon consult on the 8th of August. I'm so afraid I will be denied. Can anyone please tell me what to do to make this sleeve happen. I need help. The sleeve is my only hope. Dieting and exercise or diet pills dont work! I am tired of the yo-yo'ing weight. Any he…

I'm just curious how long it to everyone to get insurance approval? I just submitted mine and thanks to a fellow Sleever I will call to confirm it was submitted correctly!

I'm asking for a family member that is also geting this done... She had smoked weed this week and lots of it and she is unsure if the insurance requires drug testing for this... Has any1 else been drug tested?

I have a tentative surgery date of Nov. 25th. I'm excited and nervous at the same time. More nervous about getting an approval more than anything else. I have to do a six month dr supervised diet and I have been following it very strictly, however, I have managed to put on 1 lb every month! Any one have experience with Humana? I'm just hoping and praying for approval!

I'm so excited now that I've made the choice to Pursue RNY that I'm going crazy. I have Tricare Prime South. I've read so many different things and am so confused on what the requirements are and what the timeframe from first visit to surgery. A lot of the post are old. Has anyone else started the process recently and has Tricare?

Hello! My paper work was submitted yesterday. I'm super nervous, anyone dealt with BCBS of TN? Just wondering how long they take to give an answer back. My stomach is in knots! Hoping for an approval!

I have blue cross blue shield Federal, Basic Option. Can anyone explain what out of pocket expenses are? It says mine are $5000. In the explanation of benefits it says I will pay $150 admission fee/surgeon fee & $150 per night I'm there (2 nights) we have no deductible with basic option so I'm curious how the out of pocket comes into play or does it? I was reading the explanation of benefits like I would only pay the $450 total.

I got the lap band in 2009 and it just has not worked for me.... I finally went back to my doc in Austin after a year of not going. I asked him about getting the revision from lap band to sleeve or another procedure as a revision. He told me that I have to see him for at least 6 months consecutive with no weight loss success or have complications in order for my insurance to cover it. Does anyone know any loop holes? Or, is this the same as what has been said to you? Any help would be greatly appreciated. I have basic right now but if I need to switch to standard to make it easier to get the procedure done..I will do that..just FYI

I have a state employee insurance policy , was wondering how long did it take for your approval process? What was your bmi and any co-morbids? What was your out of pocket Max? Thanks!!

Anyone with this insurance have surgery in Houston at University Hospital? What was your approximate out of pocket?

I have a state employee insurance policy , was wondering how long did it take for your approval process? What was your bmi and any co-morbids? What was your out of pocket Max? Thanks!!

I'm on a crazy posting spree lately! I have an *** with Blue Shield of CA and I was wondering if anyone else has this insurance? I'm not able to really get a price estimate until my pre-op consultation and I'm antsy to know what kind of money I'm looking at. I'm thinking most if not all will be covered since they had me to a 6 month program and meet with dieticians and psychiatrists etc...

Hi everyone, Question -- when you submit your paperwork what is it that the insurance company looks for? Is it supposed to show that you lost weight? Can you get denied if you went up in weight? I am trying to get my lap band done and I am struggling to get an actual date. I am trying not to get frustrated but it's crazy all the hoops they make you jump thru. Thanks in advance for your help. Susana

So my insurance dropped me( a very long story) and I completed everything I needed to complete ugh!!! Anyway, I need to know any insurance insurance companies y'all may have used and that won't deny me because if my weight!!! Please!! I need to have this surgery! Thanks in advance.

I live in NJ and have Independence Blue Cross PPO. I knew I was using an out of network surgeon. Never dreamt that my insurance would only cover $890 of the $10,000 bill. I had a 47 bmi, high blood pressure, sleep apnea, high cholesterol and acid reflux. If I had gone into an emergency room with a coronary and needed a triple bypass they would have covered all of it. I'm really pissed. I never would have had this done had I known that they were paying so little.

I just got a letter from insurance approving my surgery but it says something on there about a clinical review being required. Has anyone ever heard of this or know what it is?

I thought all my surgery cost were covered after I met my deductible. But I get this bill for anesthesia and I owe them $3,314.60. My health insurance is through Aetna and they just told me this was an out-of- network charge. They have paid some of it but I am left with this balance.The total charge was a little over $6,000. My surgeon is in partnership with other doctors and have an interest in the hospital where my surgery was performed. I spoke with the doctors coordinator and all she could say was "Sorry. I didn't know there were out of network." Sounds a little fishy to me. I have no choose but to pay it. Has anyone else been charged for anesthesia?

I am attending a info session at Brigham and womans hospital on Sept 18th . Looking for anyone that has had procedure done there and who has Harvard pilgrim as a carrier.

I want this surgery the issues I'm having are the company I work opt out of bariatric services and I'm overweight my bmi is 37.5 but I don't have any health issues. What can I do. Please advise. Thanks

09/13/2013 Hi, Does anyone know if there are any provisions in Obama Care for WLS? I heard on the news a few weeks ago that being over weight is now considered a disease. Does that mean that our insurances have to cover WLS once Obama Care is implemented? Wouldn't that be wonderful! Really Hoping Searching

I have my first appointment next week for a lap band. Does anyone know how long it takes for insurance and what they expect from the patient to get approved??

I emailed my ins coordinator to let me know when they sent in to ins and she never did. I called my ins company today and it has been submitted and they sent the letter out on the 11th she said the notes said that my surgery meets criteria so does that mean approved?

Had my last visit today! It's been a long 6 months and I know the next 2-4 weeks are gonna drag on waiting for insurance approval:( here's to a quick and good response!

So, a quick run down of my story. Any advice would be appreciated! Prior to children I weighed about 140lbs. Seven years, and four kids, later I am now 80lbs over weight. I have gone to the DR for medicine and weight loss plans, tried over the counter medicines, gone to the gym, the HCG diets, and most recently the It Works products. I have spent tons of money and time over the last 4+ years to lose this weight and nothing works! I have cut sodas & sugary drinks out, ate fresh fruits / veggies, no fried / greasy foods, no fast foods, etc. I may lose a lb here or there but nothing substantial or that lasted. A friend suggested looking into the lap band surgery and I de…