Insurance & Financing

My doctor states insurance requires pcp to have a medically structures weight loss attempt. Does this mean I have to join Weight Watchers.I dont want to mess this up

HELP!!! Question about FEDERAL BCBS NYC Diagnostis of Mobid Obesity for 2YR Prior to Surgery I dont have the 2yr prior surgery documentation of mobid obsity...what do i do if insurance denies my package....how do i get around this requirement... i have the federal blue cross blue shield of nyc...dr is george fielding. any advice is greatly appreciated.

Ok waiting in the waiting room today was nerve racking for me. My leg was shaking in the waiting room and that NEVER happens to me. I met with the Insurance Coordinator who thanked me for faxing my letter of med necessity and 6 months of weight loss with Dr ahead of this visit. My next appt is 9/20 w/ Dr Ache (this is when I get my surgery dated. and then 9/23 with dietician and Psych

so i was sitting here paying bills and it occurred to me i had not been billed for any of my visits so far. i have received multiple explanation of benefits each showing me an amount due.. I've tried calling the billing office but have not gotten anyone to answer I have the High deductible insurance with Cinga who approved the banding as an out of network surgery - Have no idea what that means. Is any one else as confused as I am or am i the only one.. trying to figure out who the right person to call is I'm willing pay what ever but would be nice to know ahead of time..

My Package was sent just this morning, I know my insurance company has 15 business days to review and make a decision, I am super super nervous. This is by far the most stressing part of this journey so far..... AND IT JUST WAS SENT TODAY!!!!!! lol, how am I going to hold up over the next 3 weeks.... ugh.....

Is there anyone who has been approved by this insurance for lap band? I am interested in knowing how long it took and what was required for approval...

My insurance requires 3 consecutive months (<90 days) of nutritional evaluations, so here is my question. My first appt was 8/15, my next isn't scheduled until 9/27 and the next is 10/25. Clearly, the months are consecutive - August, Sept, October, but the difference between my first and second month is over 30 days. The time between my first visit and last is under 90 days, but i'm concerned about the timeframe between my first and second. I've asked my surgeon's office and insurance coordinator, who said it is fine, but I can't help but be concerned that insurance is going to decline because of it. Anyone know what they really mean when they say consecutive?

Hello everyone, I have a sister who is needs this surgery so bad due to health issues, problem is she works for the City of Tomball and will not cover her surgery and she cannot afford to pay for it out right. She has BCBS just as I do, but I work for a University and they covered most of mine and I was able to have it done. I just wanted to see if anyone had come across this problem, and if you know how to get around it. She has all the health issues needed and more and her BMI is well above the 40%. Thank you for any suggestions.

I am sure every state varies but if you had a state medicaid did you have to pay anything out of pocket and did you get denied or approved

My insurance is making me wait six months before I can get the surgery, and I am going crazy with excitement. It's only been a month so far...I think I'm becoming obsessed with the thought of having this surgery. I constantly read about it online, I can't help but tell the people I know that I'm in the process of getting the surgery, and I can't stop looking at before and after pics of people who had the surgery. I just need to calm down but idk how, and I know my family is getting tired of me talking about. Is it just me or does anyone else feel the same way?

Starting off with a BMI of 41ish. Working with PCP and NUT and I am really liking the new lifestyle and feel great....And am losing weight. At the end of the six month mandatory wait, I will surely have a BMI less than 40. I know I have the ability to lose weight (have lost 50+ lbs twice in my life, regaining both times). So I would like the sleeve as a tool to keep the weight off. (Husband and I are both doing it). Anyone have a similar experience (BMI under 40 with no co-morbidities) at the time of application and still get approved? Thank you!

Hello everyone! I have Tricare prime which is now run by United Health Care! I've gone through the mandatory requirements to be considered for the surgery and yesterday my PCM wrote me a referral! I'm beyond excited that the ball is officially moving but I've read horror stories about people's experiences with Tricare Prime West. Has anyone really recently went through this process with the new switch to United? I'm petrified that I'm going to be denied even though my BMI is around 49. Thanks!

I was just wondering, any1 that already had their surgery, how long did it take Aetna do give your approval. (Especially in SC) BE BLESSED!!

I have submitted my letter of medical necessity along with proof of 6 months of physician supervised weight loss and my report from sparkpeople showing my intake and activity for the last 6 months. I am curious as to how long until UHC approves my surgery. Any ideas?

So after 1 seminar, 6 weigh ins, 2 therapist apts, 1 support group, and an h pilori blood test....I'm approved. The only good thing about my approval process, is my ins. Company gives instant approval. What a long process....but very thankful now!

I'm doing my weight management classes right now so I'm wondering how long is it going to take after I'm done with my classes to get set up. Anyone been trough this with bsbc Michigan?? Thanks!

Hi everyone! So I am just in the begining stages of my journey towards a healthier me but I have a few questions. Now I understand that even though others may have BCBS of MI, plans and requirements along with coverage can differ. With that being said I am just checking to see if any of you fellow BCBS of MI members have ever went through a similar situation. I am 24 years old with a BMI of 52 along with hypothyroidism, pre diabetes, metabolic syndrome, and PCOS. I have already spoke with the insurance company and verified my coverage, and the sleeve along with RNY and lap band are covered if deemed medically necessary. Which with my comorbities I meet that. Also, I was …

my husband is month 2 of his 6 months but his GERD is so very bad that he is getting ulcers from the acid. Since the doctor has to fix his hiatal hernia anyways, does anyone think the insurance company would just do it now instead of waiting 4 additional months? Thanks in advance for any advice

My husband is retired military. We live near Fort Bragg, NC. My pcm submitted my bariatric surgery referral July 5, 2013. I was pleasantly surprised when Tricare referred me to Womack Army Hopital's bariatric clinic. July 22, 2013 I attended first class at Womack. I had my first one on one with surgeon, Dr Jennifer Perkins today and I am scheduled for a sleeve September 16, 2013. I am happy because Tricare requires 6 month dr supervised diet ( not necessary at Womack), Tricare does not cover sleeve (Womack performs sleeve), Tricare does not cover nutritionist and I am seeing one at Womack. All services at mtf are free except small daily fee while staying in hospital. I t…

So I called my insurance company today to find out if they've made a decision about my surgery. They said that they didn't have a request for it. They also mentioned that it usually only takes them five days to get approval. So I called my docs office back and told them that they said they submitted it two weeks ago. She told me that they send it to the hospital and it could take a month for the insurance to get back to them. I told her that I insurance said five days and she said "wow your on the ball ". Then she told me that the hospital goes over everything and can't tell me how long they will take to send it in from there and then she asks if I have a secondary insura…

I received my approval letter today from BCBS Fed (Yay!!) but I'm kinda confused by the verbiage. It states: "We have reviewed the preauthorization request for INPATIENT CARE and authorized it as medically necessary. This authorization is effective for the service we've defined above." The part that confuses me is the INPATIENT CARE part. Does that mean the WLS? I'll call BCBS on Monday to confirm, but for now, I just wanted to see what others experiences were. Thanks!

Hi All, I had lapband surgery 2006. Went from 265 to 200. Have kept 65 lbs off until I had a sudden issue with my esophagus. Lapband removal on 6/20. Today I was approved for gastric sleeve surgery. BMI 37, high blood pressure, displedima (sp). Before surgery is scheduled I will have to have a normal EGD. 2 years of medical records 2 nutrition classes Physical evaluation Psychiatric evaluation sleep study Paperwork was submitted on Friday, 7/12. Praise God!!!

Hello everyone! I found out about this app through Instagram and am so glad I found it! I was wondering if anyone had any info about insurance financing through blue cross blue shield in Washington, D.C. Area? I called my insurance and they said that BCBS does not cover any weight loss surgery under any tier of their insurance (I'm employed through my job), but I see many bcbs getting approved! Any and all info is helpful... Thanks in advance!!!

Hi All. I started the process in January of getting everything together for gastric sleeve surgery. The surgeons office have me a list of things I needed to do I.e. X-rays, blood tests, psych Eval, EKG, visits with dietician, etc. I was told I needed to see the dietician until she thought I was ready and needed to lose 15 lbs. I saw her in feb, march, had to reschedule April and may and saw her again in June and July at which time she signed me off. Finally 2 weeks ago I had my sleep apnea study complete and all was sent to insurance. I got denied because I didn't have "6 consecutive months of medically supervised weight loss program"!!! NOBODY told me I needed that. …

I was wondering how they were about approving me...The said they cover 100%..but I don't know how long it takes them..

To make a long story short, my bmi is 37.5 and my sleep apnea score is the exact number they say it has to be to qualify. I read the sections of my summary plan description dealing with bariatric surgery, and have talked with a representative twice. There are no mentions of supervised dietsb( although I did one last year and am submitting that ) , not even weight history ( they just want a listing of what you have tried, however I submitted 3 years of weight history ) . My insurance company's requirements seem lenient compared to other folks, but I am afraid they are going to " come up with" new requirements once my paperwork is in. And I work with insurance everyday…

I've been told that Cigna requires a 2 year weight history, a 5 year weight history (by doctors offices and WLS patients) however I contacted Cigna and they state that is not required. I also looked up their policy and requirements for WLS and nowhere does it say a past weight history is required. I've been at my current weight for almost 2 years. Any insight?

kind of typing through the tears here...after having one center tell me that not only was my CIGNA plan covering the VSG in full, but even at a 3 mo instead of 6 mo turnaround, the doctor who I finally chose to move ahead with discovered that my actual policy has an employer-imposed bariatric exclusion. I was supposed to meet with the surgeon on Friday. This was all supposed to be pre-screened three weeks ago when I made the appointment with him, or at least discovered a month and a half ago when the other ins. coordinator supposedly contacted CIGNA. To rub salt in the wound, when DH asked the HR rep about if it was an across the board exclusion, or if there was a bett…

I'm not sure if it's too good to be true or if it's really happening!! I have my consultation with my surgeon next week. The woman I scheduled it with took my insurance info and said she'd call me if there were any problems. I hadn't heard from her but my mind wouldn't get off the topic, so I decided to call the insurance company (Horizon BCBS-NJ pos) myself just to know what direction I'd be heading in. I was told they will pay for everything in full - 100%!!!!!!! I'm in tears!!! I'm not telling too many people about my surgery yet (only told my dad, aunt, and 2 best friends), and I wanted to share the news with people who will really understand how much this means. Now …

I was told last week that all of my paperwork had been submitted to insurance. Yesterday, I called Aetna to follow up, and learned, much to my chagrin, that nothing had been submitted! I called the surgeon's office and was told they needed a few more days - despite the fact that they have everything they need (or so I was told). While I have complete confidence in the "Center of Excellence" surgeon I've selected, his office staff certainly leaves much to be desired. They've been the biggest pain in the rear to work with and I've had to beg for information along the way. But how on earth can I even complain when I'm at their mercy???? So frustrating!!! Just needed to vent.…

Even if you had controllable high blood pressure. Lower with medication? For a co-morbid and bmi of 36?

Just talked to program coordinator, I CAN do my 6 months supervised weight loss with my PCP. But I would still need to see they're dietician for 1 visit and pay $175 out of pocket. Then they include the psych eval at no charge. Big relief! Once I satisfy those 2 things, the union will open my surgery benefit! Such a pain in the butt! 8 months working on this, now another 6 more!

Does anyone have BCBS of IL but not live there? I am trying to get a feel on how long the wait is, or how much "trouble" I might run into. I do not have many comorbidies but I have high BMI and heart disease as well as diabetes runs in my family. The people I've talked to have been less than helpful since I do not live in IL.

I am so happy, I got my approval! My doc's office submitted it on Wednesday and they approved it on Thursday! Just so stunned it was done so quickly, I don't even know what to think! After all that I'd heard about Blue Cross, I was expecting a denial.

Dr office sent initial letter of request on July 26th to insurance. On July 31st they sent all the required documentation and such and I got my approval TODAY!! YEAH!! That was the last piece that was needed. I am scheduled for surgery on August 15th in the early morning. I was so happy when I got the call, I actually cried!! Cannot wait

I had a conversation with someone recently that really surprised me. She had paid less for plastics in the US than she would have in Mexico. I'm still in the process of getting sleeved next month in Mexico but it made me wonder - how much did you pay for your vsg in the States ? Would love to hear from you.

My BMI is 39 and I have no comorbidities. I have my first appointment with the surgeon and nutritionist on September 11th and the first appointment with my PCP on September 13th. I was told by the surgeons patient advocate as long as my BMI was above 40 before the end of the six months that it would be okay. Has anyone been through this before and been approved? I am nervous of not getting approval based on this first appointment. Thanks for any help!

I have a couple if reasons I was denied by Cigna. 1. I had no nutritional assessment but I went to a nutritionist today! 2. I only had 2 months not 3 required of dr.supervised at loss 3. My Pcp letter on said I was cleared not cleared and approved! So my question is, can I add another doctor supervised counseling now or will I have to see the doc for 3 consecutive

Hi everyone! My surgeons office should be submitting my paperwork to bcbs sometime this week. Just curious on how long it took to hear back with an approval? Thanks!

I've been trying desperately to get approved by Cigna since April! I cannot tell you how difficult Cigna has been! I've done several medically supervised WL programs but not in the past 6 months! So, I finally get down to the one thing they say I'm lacking and that's 90 days with a nutritionist to go over diet and exercise! After our first visit, they said the notes made no mention of exercise so that one won't count! Well, I had just gotten out of a boot that week from a torn ligament in my ankle! The very next weekend, I ruptured a disc in my Lower back. I've been out 2 weeks on my back and just had surgery so I will be out another 2 weeks in recovery! I have a b…

Does anyone have an example of a grievance or appeal letter they used and were then approved?

I need help please, I need options on how to finance my PS in MX, what did u all do if you took out a loan, who was it with?? If you financed who helped?? Thanks!

I'm from Rhode Island and the medical I have is neighborhood Health plan. Does anyone else have this insurance and were you or were you not covered?

Quick question...part of my insurance requirement is three months physician supervised weight loss. Here is the question. After your third visit did your paperwork get submitted, or did you have to go in for a fourth time to count a solid three months? Maybe it's a silly question, but I am trying to get an estimate as to how quickly I could get in for surgery.

My test showed I have rem sleep AP. I stopped breathing 3 times an hour. No cpap machine needed Dr. said. Suggested in his report losing weight and sleeping on side should help. Do you think I could get away with this diagnosis as a co-morbid? Report also shows I have 11 episodes of bradycardia. Heart beat drops below 60 during sleeping times.

I was wondering if anyone knew if most insurances cover a portion of the lap band surgery when there is a hiatal hernia repair at the same time?

So happy..Surgery Date. .10/17/13 Sent from my Galaxy Note 2 using RNYTalk

Can anyone guide me what to say in my personal appeal letter to BCBS of AL? My surgeon & gen. Practitioner are writing theirs. But my surgeons bariatric coordinator told me to write one too. I just want to know if anyone else has done This and what kind of info did you include? Is there anything I "don't" need to say? Any tricks or hints to help my plea? I appreciate all you fellow WLS friends!

I am just looking for some information on the process through Aetna. Like how long they required the supervised diet and how long to get approved. I am 2 months into my journey and just looking for some uplifting hopefull news

What is the consensus between the waiting time from when Bariatrics center submit paperwork until you hear something