Insurance & Financing

Did anyone have to write a letter to their surgeon, explaining why they want to have the surgery? I'm not sure if this is a requirement from my surgeon, or my insurance, or maybe it's not a requirement from insurance but my surgeon submits the letter with all of the paperwork for good measure... Anywho, just wondering if anyone else had to do this, and if so, how personal you got? Shan:)

How long after submission does it take medicare to respond to the insurance people at the surgeons office?

I have fedelis in NY, I was under the assumption that they don't cover banding.

I have been trying to get feed back on bsbc tx..i had bsbc of Tennessee and was told they had a wls exclusion ..now I've started a new job that has bcbs of tx on their website us covered luckly the wls doctor i went to a yr ago after being denied has a 1yr history already..ANYBODY KNOW ANYTHING ABOUT BCBS OF TX?

So, My case went before the Obesity Work Group at Kaiser MAS on tuesday. By Tues evening I checked my referrals online & they had approved my referral for Dr.Mayes!!!! I called up his office & snagged an apt for tomorrow Fri. They tried to give me the whole stall of you have to attend our seminar before we'll schedule you but luckily a fellow sleever gave me the heads up to get that done months ago. ( Thanks Isleevedit) I have a Nut visit on tues. Today I also drove all over to get my copy of my psych exam, blood test results & medical history. So hopefully I'll get a date tomorrow for sept- fingers crossed. I'm nervicited= nervous + excited. …

Hi all.. Can anyone tell me their out of pocket expense with BCBS Personal Choice PPO insurance in PA? If anyone has has surgery or any experience with Barix Clinic and the fees and process such as pero op testing.

I have done my 6 months of "Weight checks" and have jumped through all the hoops that Aetna wanted me to do. My request for approval was submitted on June 12th. I was told it could take up to 6 weeks to hear back. I am a teacher and am wanting to have the surgery ASAP, so I have plenty of time to recover and get everything figured out. I am starting to get annoyed, because I am going on 3 weeks and I called insurance to check and they said that it is in clinical review and won't really tell me anything else. Anyone else with Aetna have this issue?

I was denied today by HealthFirst because the ppl at my surgeons office forgot to include my cardiologist clearance and my nutritionist visit ... Apparently They lost my documents so I have to get these items and resubmit by Friday... I'm so pissed has this ever happened to Anyone? !!!!

Maybe you guys can help.. went in for my first visit with the surgeon today and I was a little shocked when I was told that I have to come up with roughly $2,000 out of pocket for "Physicians fees". They participate with my Ins Co. and should accept what they pay... or so I thought.. anyone else have this issue??

My first seminar for WLS was at the end of July, and my first consultation with the surgeons office wasn't until August 5th. It wasn't until my consultation with the surgeon that I found out I needed an actual letter, not just medical records, from my PCP. The bad news, my PCP retired and closed his office on July 31st. Now I don't have a PCP, and I'm not so sure that if I find one, the first question I should be asking at my first appointment is, "will you clear me for bariatric surgery?" Has anyone gone through a situation like this? It's really my only hiccup in this process so far:(

Just wondering if anyone out there has had any experience with Medical Mutual Insurance?

I have bcbs insurance and my policy language specifically excludes weight loss surgery. I am wondering if anyone else has had this and if they have had any luck getting it covered by having the doctor submit a letter of medical necessity? Should I even try to fight that battle and wsste that many months or should I just start to find ways to pay for it myself.

Hello All, As of last week Tuesday my surgeon's office has all my documents. I've tried multiple times to get some help but my coordinator does not return any of my phone calls or emails. I have GHI and I am trying to figure out how long it takes to get my documents approved? Will I be notified by mail or by a phone call? How to go about scheduling my surgery etc. I'm starting to feel like I'm starting to feel ignored. I have GHI, I'm in NYC, and I'm working with the NYC medical center. Any advice you have or can provide would be greatly appreciated. Thanks in advance.

Hello everyone!! Yesterday I had all of my paper work submitted to my insurance company. Highmark BCBS (PA) anyone else have this insurance!? How did the approval process go for you? I know every case is different but just looking for some others with same insurance for their experience. I am nervous about the approval process. Thanks.

I have United Health Care. I am doing the health roads program. Has anyone been through this?

I have Regence Blueshield of Idaho insurance and they specifically exclude any treatment or surgery related to weight loss, including complications that arise from any such treatments. (Despite paying over $3500 in premiums to them every year....F.....ers!) anyways, I've researched several other insurance companies in Idaho and they are all the same (ditto to previous exclamation). Does anyone have individual insurance in Idaho that has had bariatric surgery covered? I'm going to self pay for the surgery itself because I'm not about to kiss their as....es and jump though all their hoops, but I was hoping to have coverage for any post op complications that may arise. Than…

I got a letter in the mail saying that fepblue no longer requires prior approval for vsg in patient procedures (after the office submitted for approval!). This is not what I have heard from others! When I went back and read the handbook it doesn't exactly say you need preauthorization, only that you need to meet the BMI, Psych Eval, three month nutritional requirements to be covered. It does, however, say that for any inpatient procedure you need precertification. Isn't this just notifying them of the procedure before you go in? Has anyone else had this experience? I don't know whether to rejoice or cry (if there is something else that needs to be done)! Calling the sur…

Hi, I am new to vst and also just started the process to get the vsg i want to know the requirements and steps to get approved for the surgery i have federal bcbs i live in Ri I will be having my surgery at the roger Williams hospital. I want this process to go as quickly as possible any suggestions or advice? Thanks,

Hello everyone!! I'm extremely excited, I FINALLY got a letter of approval to have a surgeon consulatation! After 1 1/2 of dealing with one insurance, and being denied, I canceled it and switched to HealthNet-Medi-cal (So. California) with Pinoeer Medical Group.To my surprise I received the 1 step letter for a consulation! I know it isn't an approval just yet for surgery but my goodness it's the first step! :D :D :D I was told by the surgical coordnaitor that they move quickly and that I meet the requirements with my BMI just alone, so this means I have a pretty good chance of being approved for surgery!!She told me that surgery can be as soon as 1-2 months!! I …

I posted this in another thread, but I have yet to receive any replys so I am starting a new topic. kind of a dumb question. I have oxford insurance. Its a cheap policy that I have been paying out of pocket for. I did the whole 6months of seeing a primary care doctor. I got an endoscapy, chest x-ray with breathing test, letter from a shrink, letters from the surgeon and my primary care doc, and a bunch of other things. So I got approval and I am slated for surgery on wed. I was looking through a packet that oxford sent me about a month ago. Just a standard packet showing policy benefits and limitations. On one page there was a list of excluded proceedures and bariatri…

Did any of you self payer's out there get the one year, 6 month, 4 month or one month insurance they offer self paying people??? Just wondering if this is worth it or not?!?

Anyone able to decipher the reponse that I received from my doctor's office? My question to them concerned band removal (which has been approved) and then approval for a separate surgery for sleeving. I will, of course call them, but I am traveling but in the meantime, I thought I would put a question on here. Thanks for any help! "I did already check with your insurance, you do have the writer. Come in and talk with us.

Hello, I'm new here.... been trolling for a few days. I was wondering if anyone knows if the only comorbidities Aetna will accept are hypertension, sleep apnea and diabetes. I have a BMI of 36 and I have asthma, joint pain and a hiatal hernia. I think I may have sleep apnea but I haven't been diagnosed. I plan on doing a sleep study to find out if I do. I called Aetna and spoke to a representative about them covering the surgery and under my plan they do. I found the NIH website that listed all the comorbidities that are considered relevant for weight loss surgery with a BMI under 40. Anyone get approved by Aetna with a BMI under 40 and another comorbidity that th…

I was approved today after I was denied yesterday I'm so happy everything was corrected ... My surgery is Aug 30,.... My health insurance is HealthFirst/ NY Medicaid!!!!! Thanks to the person who canceled I was able to get my surgery sooner than Oct :-)

I called both insurance companies. Nothing covered. Do you think there could be a loop hole with my sleep apnea, family history of diabetes and colon cancer, as well as serious joint pain?

Did any of you have any other expenses after surgery? I plan on financing the surgery, because my insurance does not cover WLS. So besides the surgery, I would like to hear what else you were charged or billed for. I want to make sure this is something I can afford. Any info would be appreciated. Thank you.

I finished all my requirements on Monday including nutrition class, psych eval, blood work, upper GI, chest x-ray, and two year health history and the financial coordinator submitted yesterday. She told me BCBSNC typically takes 24-48 hours and she expects to hear tomorrow morning. Nervous! Based on everything she had she does expects an approval. The next available date is in two weeks on March 27th. Fortunately/unfortunately I broke my leg in the fall and met my deductible plus $650 towards the maximum out of pocket of $2000. This should mean my surgery (with Dr. Omotosho at Duke) should only cost $1350. Fingers crossed!

My paperwork has been submitted to Healthfirst/Medicaid but I'm missing one thing Nd won't be able to get it till Monday so my surgeons office just wanted to start submitting what I have and just fax the last thing on Monday... I hope this doesn't screw me up.....I don't know how to feel right now...I should be excited...

I was banded 3 months ago with TR. I have United Health Care and it doesn't cover any Bariatric Surgery. True Results told me that if I need a hernia repair I just need to pay $5500, +$1500 copay to the surgery center and $400 for the EGD to see if I had a hernia. I paid all of this cash. So 2 weeks ago I got a bill of $2000 for anesthesia and a letter from my insurance saying I owed $25000!!!!!! I talked to TR and they transferred me to the surgery center billing department (external to them!) and they told me to scan the bills and send it to them so they will help me. That was 2 weeks ago, and I don't have a response. I don't know what to do, I'm buying a house and I'm …

So after researching LB for almost 10 years, i finally had the balls to get the process going. I looked into True Results because I was advised my coverage didn't cover bariatric surgery but they told me due to my hiatal hernia I would be covered for all but a $5500 out of pocket charge that would be split into 2 year payments. So.... I just got a few letters from my insurance and apparently I owe almost $30K WHAT!?

How long of a history and what weight loss attempts did you submit for insurance approval? Did they ask for proof? I have BCBS FL, not required to do a pre-op diet. Only 3 months waiting period, and that's to complete the surgeons program. Thanks for the info.

Has anyone won an appeal from and exclusion policy for WLS ?

She claims I suffer from depression and anxiety. Wants me to seek pre-surgery pharmacological management, referral to psychiatry or counseling services. I'm doomed, doesn't have a sincere clearance for surgery. Enclosing has I wish you success in your effort. Anyone letter have that on it?

So last Nut visit was the 13th of aug. she told me that the review board meets on the 20th of aug but theres a chance that I get pushed back to the next board meeting. The waiting here is painful. Patience is not a virtue I possess. I did manage to lose 13.4 #during the supervised diet portion so I made the weight loss goal set for me by kaiser & then some. They told me I had to lose 3% of my body weight, which is 7 #. Waiting for a phone call! Going crazy, feeling nervicited. allons-y

Just got word that everything was submitted to Aetna this week. Please send prayers, good vibes, happy thoughts and a rabbit's foot my way. Hoping to be approved and to know something within the next two weeks!! Anyone want to share how long it took for you to get an answer from Aetna?

I was wondering how to start this process!! I have a appointment with my PCP on Sept 5th. But, I've already called my insurance and they do not cover WLS. Does this mean "at all". My BMI is 43 and I have at least 1 comorbite.. Will health insurance consider coverage at this point? Is that when I can do the 6month or whatever qualifying I must do!! Just trying to be prepared and not totally heartbroken!! Any help would be appreciated thanks ya'll..

So I am 99.9 % self pay. My concern is what would happen if something went wrong. Like if I had to stay in the hospital as a result of a complication... Would Cigna pay for the stay even though it was related to something I didn't go through them for? Or what if 5 years from now my gallbladder is removed... Do I have to pay bc I paid for the surgery? Just wondering how that might work.

I have been changing insurance (mainly to avoid the 6 month diet, just being honest) had HIP then my surgeon suggested I switch to healthplus. I changed surgeons because that guy was a prick. I went a Sleeve info session at Maimonides hospital in Brooklyn, Ny. During the session we were told if we have healthfirst we wouldn't have to do the diet..so being the impatient guy I am, I switched over to healthfirst. Now I'm being told I might have to do the diet. I really want to get this done before I start my next semester of college. Grrr XD

They just keep denying me.

does anyone have BCBS of Nebraska? I called the 800 number and they said I was not covered...does anyone else have any ideas? Or has this BCBS covered their surgery? I am so dissapointed!!

Today I had my pulmonary doc visit. He was very candid and told me right off the bat I would definitely get clearance for the surgery, not to worry. I kind of had the feeling I was moving through a conveyor belt. I am scheduled for the sleep apnea test in 2 wks. I have to have a chest X-ray, blood work and another breathing test the day before. The. The following week I will have the endoscopy. Sometime between now and then I need to have an upper GI series. Never had one, not even sure which doc sends me for that, but I will find out. I am also halfway through my 3 month supv weight loss... Things are suddenly happening so fast wi all the required procedures lu…

Sent in my insurance information and I'm just waiting for the surgeon's office to call me in for the free consult. I'm so scared because I have no idea what to expect at this point. With a bmi of 52, will insurance even deny me?

Call every day submitted in Sept ... Supervisor escalated to a level 3...whatever that means... I just want an answer after all the bumps I have gone through with them.... 3 months? Seriously.. I realize its the holidays but c'mon!? Since Sept... I had the entire diet done for 7 months supervised by a dr HCG...bmi 40+ years.. What is the deal? Anyone playing a long wait gain with them? Sharing would help me feel like I'm not alone...

I have a BMI of 33 but have type 2 diabetes and high cholesterol. My insurance covers the lap band but with a BMI of 35 with co orbit condition. Just curious if I should even jump through the insurance hoops or try to go self-pay route. Has anyone been approved with a lower BMI and if you had to finance it yourself with poor credit, how did that work. I was thinking about doing a credit repair to see if that helps but it is just MORE money.

I finally got my approval. It was supposed to have been submitted to my insurance on the 10th but she didn't submit it till the 17th and I called today and was told it was approved. Now all I have to do is wait for Jennifer the surgery scheduler to set the surgery. Finally I feel I can breath now!!

Doctor office has had all my stuff since last Monday. I call to get an update this morning and I was asked the same questions as last week... (Have you done your pysc eval?? ECT...) I told them everything was done and ready on Monday of last week and they were completely clueless??? I don't want to have to call everyday, but it seems as no one is staying on top of things... I work for a doctor so I have access to the authorization web site and there is nothing there pending for me... What do I do???

She claims I suffer from depression and anxiety. Wants me to seek presurgery pharmacological management, referral to psychiatry or counseling services.

As of Thursday, August 8 my Doctors office has all of the information, letters, reports to send to my insurance company. I really hope I am done jumping through hoops! Wish me luck, I have Cigna and have heard they are tough.

Doctors Office will be submitting tomorrow!! Does anyone know how long they take?? I'm going to drive myself crazy waiting!!

Does anyone here think paying out the above amount is good for band removal, and getting the sleeve?