Insurance & Financing

Has anyone dealt with Health Alliance for a revision. Some yrs ago I had BCBSIL and they didn’t even want to cover my hernia repair let alone the revision. So here I am three yrs later trying it again. The only difference is this i Sudan remains requires you to meet all requirements plus have a complication. I’m just nervous of trying it again to be let down and still be in pain.

Did anyone have surgery with Dr. Lyons in arlington, tx? I'm waiting on insurance approval and wanted to know if you are allowed to set up a payment plan or do you have to pay all up front? I have Cigna which should be approved but haven't reached my deductible or oop

Well, this is a new one for me. So I received the approval letter via snail mail from my insurance company yesterday, which is great, but... I’m confused. The form is a standard approval letter that indicates that the procedures has been deemed medically necessary. It also states that the procedure is approved for a specific date, but the approval date was 8/5??? Huh? My doc’s office wasn’t even notified until late Thursday/early Friday. So how does this all work? How does a letter get sent out past the date of procedure approval? Now what happens? Does my surgeons office just ask for an extension? I’m supposed to go in for my pre-op appt on Thursday. Does it have …

I have Aetna PPO. I was trying to get an estimate of what I will have to pay for the actual surgery. Anyone else have Aetna PPO?

Hey y’all, Im new here from Ny and I have HealthFirst ,Medicaid and Medicare, I literally just finished an entire 6months of weigh ins along with all other necessary procedures needed by my insurance. I’m pooping my pants with so much anxiety because I’m nervous of being denied. After my Endo , I tested positive for H-Pylori-a (please excuse the spelling) and have been taking medication to rid of it. Did anyone find Health First to be difficult? Im a nervous wreck?!

How many days has to be between each diet visit??

Hi there, I was able to have VSG through NYS funded health insurance. Anyone else have the same insurance or situation and want to share tips or stories for future patients? Or just want to ask questions? Lets do it here!

My surgery is already scheduled for July 31st. I received a letter from my insurance company, Anthem BCBS on Friday denying my request for my sleeve surgery. They claim I have not met all my requirements which I have. I've been under my surgeon's care since December. I have met all my surgeon's requirements. BCBS is saying I have not been on a supervised diet for 6 months. I plan to appeal their decision but this could not have happened at a worse time for me. I just found out I have 60 days to move!! Its been very stressful the last few days. I'm super bummed and feeling frustrated and overwhelmed by everything [emoji24]. I've worked so hard to come this far and to get a…

Anyone approved by Cigna recently? My surgeon's coordinator just submitted my info to Cigna today and I'm SO nervous! She told me that denials don't happen often and they are usually able to overturn them if they do. She even gave me a surgery date already. April 24th! I met all of the requirements and I know the team knows what insurance companies look for. Just can't help but freak out a little! The last few months have been crazy and it would suck to be denied when I'm finally almost at the finish line. I'm curious to hear recent experiences with Cigna. It seems most of the topics I find on here about Cigna are from a while ago.

So a month ago I had my DS surgery here in NJ Virtua. I am a self pay and scrimped and saved for this. I had paid my surgeon, anesthesiologist and hospital all pre paid. My hospital payment had the big ESTIMATE qualification on the quote. Understood. If I had special tests, specialist that needed to see me, more time in the hospital, all understood, it COULD be higher. Understood. A risk we take. So I leave the hospital a DAY EARLY. They sent me a bill for another 3k. are you kidding me? I had nothing out of the ordinary, no tests, nothing extra, nada. They are sending me the details but I am pretty furious. Again, I get the entire "estimate" thing, but how…

I have an appointment with my regular Dr in a couple days to talk about getting sent out to a bariatric surgeon. I was just hoping if anyone could give me an idea of the requirements Alliance requires for the surgery? I read where you have to be enrolled in Weight Watchers or a similar program in the last 2 years for them to approve it. Any information would be extremely appreciated!

Does anybody else have Kaiser Permanente as their insurance and also the medical center where their WLS will occur? It seems to be a one stop shop for me. I guess this is a good thing? Kaiser is huge anymore and I'm not sure if that's good or bad. Anybody have good or bad experiences with Kaiser in the Seattle area? Ed

Hey guys! This is my first post here! I just wanted to share that I’ve been approved by my insurance for VSG!! I have Cigna insurance, and I only had to have one nutrition recommendation, one psych recommendation, a letter recommending me for surgery from a doctor who isn’t the surgeon (my PCP provided this), and a letter from the surgeon recommending me for surgery. The whole process took a couple of weeks because of my schedule, but I got the green light! I DID NOT complete a 3 month or 6 month (or any months, for that matter) physician supervised diet. The letter from my PCP was very general and just listed that they had been monitoring my weight and all of the thi…

Hi, I have United Healthcare Choice Plus...My Dr submitted to Insurance 5 days ago, But is calling to have them mark as Urgent! (to get it processed faster)... I was wondering if anyone else had Submitted as Urgent, and How long it took after to get an Answer?! Thanks

Does anyone know how far out you can have your surgery after being approved?

My surgeon is submitting on Jun 13 so I am curious about other's experiences and how long it took for anthem to approve or deny them. Thanks!

I’m revising from sleeve to SIPS and was told by my doctor that I need 6 months medically supervised diet psych evaluation and all the other fun stuff. I called my insurance today and they told me there’s no requirement except I have to go through a different dept. which basically guides you through and make sure you are ready for surgery. I’ve had WLS twice. From band to sleeve and I’ve never heard this before. I have UHC. Has anyone else ever been told that??

I am so impatient. I just called UHC and asked about my prior auth and she said I was approved as of 4/30. I called Anita, my insurance nurse, and left her a message. I'm so excited and hoping now some of my anxiety and stress will diminish. For stats if anyone is wondering, this was my process: *6 mo physician supervised diet/exercise *5 years of BMI (didn't have to be over 35) *my co-morbids are osteoarthritis, GERD, borderline DM, borderline hypertension, borderline high cholesterol *my submitted BMI was 37 (I maintained my weight for 6 months, didn't try to lose weight) *cardiac clearance *psych clearance **didn't need sleep cle…

I’m on buisness day number 10 of waiting for a answer from United health care choice plus. I called a few times but they just tell me it’s still in review. They said they have 15 buisness days to make a decision. Is this a bad sign? Does it usually take this long? I’m scared I will be denied!

I have La Care medical. Has anyone been approved? Also how much did you pay out of pocket. If so can you please help me start the process. I would really appreciate the guidance❣️ Have a great day.

Does anyone have Washington Apple Health / Molina? What are your experiences with getting approved and the timelines? Thanks in advance!

I had my surgery on 3/12/19. I watched my insurance carefully because I'm slightly obsessive about numbers. I had called my insurance several times prior to surgery and was told once I met my out of pocket I was fully covered. Out of pocket was met in January. April I start getting bills. I call the insurance company who keeps patching me through to a company called accolade who says I am fully covered and they don't know why the drs office is saying I owe coinsurance. They will send a note to the insurance company. I have called the drs offices and the insurance company and accolade weekly since April about these bills and started making $10-20 payments so I don'…

Hi Everyone, I'm really, really early in my weight loss journey. This board has been invaluable. Still in the insurance phase. I was initially all for going to Mexico because a friend went and had great results as well as the attractive cost and basically not having to wait and deal with red tape. I also feel the drs. in mexico are just as good. I did find out my Aetna PPO will cover in the USA - Hurray. I have a choice of 6 month nutritional counseling or 3 month nutritional and primary dr. visits. I'm opting for the 3 month obviously because I'm an impatient person. I really wanted to go to Jacksonville Florida to the Mayo Clinic. But the Mayo clinic bariatric said I wa…

Hi all - I'm really stressed. My insurance denied my DS surgery. My surgeon is appealing. She's very experienced with this an is tenacious. Surgeon wants me to keep attending pre-op classes/appointments and stay on the schedule for surgery June 14! (Insurance person at her practice says they will likely have an answer w/in 15 days). While I hope I win the appeal, I have to ask: if I'm denied again will I be on the hook for the many doctor's visits, nutritionist, psychologist, pre-op testing, etc. that have led up to this?! Why don't docs confirm the insurance *first* before getting patients in the pipeline and giving what may be false hopes? Thanks in advance f…

Anyone here have QMB as the 20% that pays for surgery, after Medicare? The billing office is being stupid saying they need a pre-auth, for QMB. I've talked to my caseworker, and Medicaid. They say no pre approval needed! What's your experience?

Do any one know how easy it is to get approval for a lap-band revision to RNY through Highmark BCBS TN or if they even cover it? Approval was easy for the lap-band but wasn't sure about revision surgery. I have to have lap-band removed and wait 3 months and have revision. Not sure if they (BCBS) would count as having 2 surgeries and would pay for the removal but not the revision. I checked the website and it seems unclear to me and I am afraid to call them and ask or do the physician's office take care of submitting whatever is needed to check for coverage and what percentage? I know my questions sound redundant but I am really seeking sincere advise. Thank you in advance…

Hi, Im fairly new to this process. So far I have haf my initial consultation woth the surgeon, nirse and dietician. I was told that I would be able to get the sleeve in 3-4 months since Fidelis has no program requirement for approval. I have my psych appointment on May 22, my dietician appointment for June 5th, my pcp appointment (for medical necessity letter) on June 6th. I also have to get my labwork done, which I will be doing next week. In your experience, what else does Fidelis need to approve? Right now my only concern is my PCP approval letter, because he hasn't discussed much other than dropping to 1300 kcals a day in the past. I got pregnant shortly after th…

Aloha, Cigna peps! So, I have done my check list and check it twice. I am only waiting to do my diagnostic imaging stuff. Empty stomach test, ultra sound, sleep study and a nasual acid test (24 hours). I have fatty live, asthma, GERD, high cholesterol and gastroparesis. I have my nut doc saying I am mentally clear, PCP sign off, my GI doc and his nurse practitioner sign off and my GI nutrition person sign off for the surgery. (My plan only required one nutrition visit!) Should I asked my surgeon to submit the claim without my diagnosis imaging stuff or wait?

I was denied in 24 hours for my revision. My surgeon stated that she is going to do an appeal however she used a different word was to upset to remember the word. I know it starts with a P. Oh well life goes on time to get some diet pills.

Approved!! ? My surgeon submitted paperwork to Cigna on Thursday afternoon and I received my approval Monday evening. I'm impressed with how quickly it was approved. I even received a letter yesterday stating that Cigna needed more information (it clarified that the letter was not a denial, just a request for additional records). Here is a recap of my insurance approval process for anyone who is curious how it went: Surgeon - Alisa Coker Johns Hopkins Bayview Baltimore, Maryland SW: 192 Height: 5'0 BMI: 37.5 Procedure: Laparoscopic Sleeve Gastrectomy (aka sleeve or gastric sleeve) Comorbidities: Diabetes, Hyperlipidem…

I am currently in Month 3 of my 6 month diet plan. Last week my surgeon did an EGD and discovered that I have a very large Hiatal hernia, that she will repair at the same time that she does the sleeve. From What I read, I should be able to submit my paper work for approval around Mid-August.. what is the usual wait time with BCBS of Michigan ? I am super excited.. But also very nervous!! Thanks so much for all of the advice!

I have staywell and I was referred to a group of surgeons by my PCP. They called a few months ago to set up the seminar. I finally got it done on the 14th, and then on the 16th I sent in my paperwork, releasing my medical records to them to fax to my insurance to get approval. Has anyone in the Jax FL area had a surgeon in Jax that accepted staywell? The website of the group of surgeons says they accept it but I’m just nervous!

I’m Just wondering if anyone knows if you have to go through the same pre-op requirements for revision as you have to for the 1st surgery??

I got approved thru Cigna. I just hope that my copay want be that much. I know its different depending on the various insurance companies .

Good morning. I live in Oregon and I am on Oregon health plan coverage through health share of Oregon with Providence as my coordinated care plan. It’s a Medicaid. I am wondering if anybody has any success with this combination of being approved. My concern is that I am only 227 and 5 foot four but I do have diabetes type two. I worry that they will say that I don’t have enough weight to lose or something silly. I have an appointment with my primary on February 14th to discuss it. Personally I have tried and stuck with a keto diet as well as a low-fat diet. With keto I have managed to get my diabetes more under control but weight loss will not seem to happen. I don’t ha…

Yes I got my approval today. Surgery date 6/3/2019

My surgeon submitted my information to my insurance company, My insurance sent it back stating that they needed a letter from my primary care physician. My primary care physician wrote a letter stating I needed the surgery. I was denied by my insurance company however my surgeon did a peer to peer with the insurance company. My surgeon called stating that they need another letter from my primary care physician stating that they she recommend the revision and the letter must have her signed signature. A little history I had the sleeve in 2015 and lost 30 pounds and have gained 30 plus back. Now I want the gastric bypass. Do you think the insurance company will now approve…

My information was submitted to my insurance company today for my revision from sleeve to bypass. I am praying that I get an approval fast, so ready for this surgery to work this time. I graduate in July with my BS and hoping that I am well after the surgery to walk across the stage. Praying I get approved and have the surgery in May. My surgeon stated that my insurance company takes about a month for approval praying it doesn’t take a month for approval.

I had gastric sleeve on April 29, 2013. In September 2015, I gave birth to a very premature baby boy, who lived in the NICU for 6 months before he passed away. During that 6 months, I didn’t eat. I drank so much coffee, and I had 1 sugar in each coffee. As you can imagine, I gained. I found out I was pregnant again 8 weeks after my son passed away. During that year and a half I gained back about 70 pounds. I have been trying to get back on track, but I can’t do it. My head just isn’t in the game anymore so to say. Yes, I still have 100lbs off, but I want to be where I once was. Has anyone else been in the same situation and got back on track?

Hey guys! I’m scheduled for sleeve surgery this Thursday, the 25th. However.....we are STILL waiting on my insurance approval!!! Nothing like cutting it close. Just wondering if anyone has Fed BCBS insurance and if you got denied, what was the reason? Or if you got approved, how long did it take? My insurance coordinator submitted everything last Monday but I have a bad feeling I’m going to be denied....

Hello everyone. I work for a public school system that does not cover the surgery. I feel like this is hopeless. I can not take out another loan for self pay. Paying on student loans and everything else. Has anyone ever been the pre-surgery process, been able to have the labs and other stuff billed through insurance under recommendation from a doctor? Has anyone submitted their documents and such to the insurance company after the pre-surgery process and been approved due to medical nesseccity? Any insight is appreciated. Thanks, Kelly

My BCBS is through the hospital I work for. The hospital has opted not to pay for bariatric surgery. My question is, who do I appeal to? If I have my doctors send letters, what department or job title do they send it to? The insurance company won't help because they say it is my employers choice. Any suggestions appreciated.

I am a revision from RNY to DS. I will be self financed as my insurance turned me down for this 2 years ago. I am back going through the pre-tests, etc. They have me seeing the nutritionist for the 3 months as before. My understanding previously is that the 3 month requirement is for insurance purposes. Since I am not going through insurance I asked if this was still a requirement. I have done all the other tests and have been cleared. I was told that I had to do the 3 month nutritionist. It doesn't make much sense to me since I am a revision, understand all the dietary requirements (also since I did the 3 month nutrition 2 years ago) and the last time lost 10 lbs. Needle…

Hello I am KEKE 42 and about 8 mths ago I started the process for getting a gastric sleeve. I called my insurance UHC which at the time told me that normally this isn't covered but if I meet certain criteria I could be. BMI over 40(check), high blood pressure, sleep apnea, tried every diet , and pill supplements prescribed and over the counter( check). So I had to do 6 months nutrition visits- which I completed without a hitch 2 months ago. Now time for the preapproval call- before the office could get a word out they just flat out said not covered. I was baffled at this because this is not what I was told at the beginning otherwise I would have figured somethi…

Anyone here with BCBS of Tennessee? Looking for experiences with approvals or denials and what the requirements were for surgery!

Just starting my journey. Had my first apt on the first with my surgeon, having my endoscopy on the 22nd, my nutritionist apt the 9th. .l also have been on a dr supervised weight loss program for close to 2 years now which she is currently writing up a paper to submit stating why she feels I’m a good candidate as well. My paperwork is coming together... but however, I’m just really thinking this is going to all be for nothing because insurance will deny me. I think it states I have to be with a BMI of 35+ for at least a year and I think I was at a BMI of 34 around nov before it started to go up.... not sure if that’s where they might snag me if they ask for records first?…

Hello everyone! I’m new here! So I’m anxiously anticipating the start of this journey. I have a consultation scheduled for 4/29 for a consultation with Emory Healthcare here in Atlanta GA. I have no idea what to expect. I recently realized that my Cigna insurance will cover 80% of this surgery. That’s all I know as of yet, but as I search the forums and do research I realize that I don’t have HALF of what other people have on this site. I don’t usually see a DR. I don’t even have a primary care physician. No medically supervised weight loss and no co morbidities. All that I have is a BMI of 43% PCOS and possible sleep apnea (fiancé wakes me up all the time because I’m…

1) Take a deep breath. Grab something to drink and a peppermint. (Peppermints work as a mood stabilizer and assist thought process.) 2) Open up your laptop. We are going to write a letter of appeal. 3) Have your denial letter handy. You will need that address. I will write a dummy letter at bottom for format purposes. 4) MAIL your letter yourself! Also give a copy to your Bariatric Team. You learned a long time ago if you want something done, do it yourself. This is no different. 5) What info needs to be in my letter? Glad you asked or didn't or whatever.. List your height and weight. List your BMI. Write about your life of obesity. When it started, approximately. Why it …

So happy and honored that today is our 23rd anniversary helping #patients fight insurers denying necessary care. Looking back, I see how far we've come and that gives me hope. Looking forward, I know we have a ways to go but we will continue to battle!

Hello y'all! I just wanted let anyone, who is being denied by their insurance company, to consider Lindstrom Healthcare Advocacy, to help in your fight for approval or overturning a previous denial! My story.... I was denied coverage for revision surgery (lapband to sleeve) twice, by insurance xyz (I am not naming insurance company, until I get reimbursed), and enlisted Lindstrom Healthcare Advocacy for 3rd appeal and subsequently, a review by an independent doctor. After a few months of diligent and expert advocacy, on my behalf, LHA convinced the doctor and insurance xyz to finally approve my surgery! And this was almost 3 months AFTER my surgery, in which I funded mys…