Insurance & Financing

Anyone of you didn't need this letter for the insurance approval? I don't know if I need one...

I have insurance through our local hospital where everything is paid 100%. The bariatric surgeon moved and left leaving them with no bariatric program. I went to another city who's covered under my pop through bcbs. Thinking it would be covered 100%. I went through the whole process waiting for a call with my surgery date and she says I have a 2,000 dollar ded. I need to come up with 1,000 now to get surgery. I'm screwed. Or can I keep checking other surgeons within my ppo that will allow payment plan for everything? No cash up front.

Im just wondering do anyone have aetna and have been sleeved or has gotten and approval from them? If so what all do they require as in paper work? Do they ask for a 2 year weight history? Im asking because my husband wants to get sleeved but he is the type to not get sick and don't have a 2 year weight loss history. So anyone that can shed some light on this situation PLEASE let me know ASAP!! Thanks!!

BMI 40.5 healthy but had lab band taken out 2 years ago sledded.

I have received a letter at my on set of my journey in April that I qualify for VSG but that their is no guarantee of payment. I am doing the 6 mo monitor with my PCP and I have 3 co morbidities. My surgeon insurance lady --- says I have to pay up front and they will refund what the insurance pays. This just doesn't sound right to me has any one else experienced this with united healthcare choice plus??? Looking to have surgery 1st of October.?????

Hello everyone! Currently I'm staying in Biloxi Mississippi and I'm having a hard time finding a doctor to get me started on the lap band. I am over 40 BMI so I'm guessing it shouldn't be as hard to get this done. My main concern is where do I start and does my insurance cover it? I have already tried gong to a nutritionist and other steps so what should I do?

For BCBS Federal, has anyone had a BMI of 40, but during your two year history, you had a BMI of less than 40 but greater than 35? If so, did bcbs require a comorbidity?

Yessssss!!!! Called Cigna @ lunch and got an approval code!!!! Sooo excited, waiting on scheduling to call me!! God is good all the time!!!!!!

Hi everybody, I received a letter from my insurance company (explanation of benefits) stating that the Surgeons used to do my surgery were out of network and in the letter they told me that i'm responsible for $ 21,000.00. I called then billing Department at my Dr. Office and they told me no to worry about it because they will appeal. they repeated no to worry about it. they told me to wait, that they will submit paper work and at the end i will be only responsible for my deductible and my co- payment, i'm nervous because i can't be responsible for $ 21,000.00. Has someone heard something like this ...???.

Has anyone done self pay with him!!?

Anyone knows how long it takes for approval from UHC. I know the dr said about 2 wks. In anxious.

I just received the phone call from my nurse at united healthcare stating I was approved!!!! Thank God!!

Has anyone had any experience with using efinancial solutions for financing their sleeve procedure? Good or Bad!

I have a BMI of 35 with high blood pressure. Wondering if I will be approved. Also my insurance is a PPO, what does that mean and what kind of a difference does it make? Wondering how long the process took for others with this insurance and what other requirements they want.

My bcbs ppo just changed to this, wonder if its still covered

Hi Everyone! I am new to the group. I attended an informational Bariatric seminar the 2nd week of January, and ultimately decided I would like to go forth with the sleeve option. I saw my primary care physician yesterday morning to obtain a referral to see Dr. Jeannine Giovanni – (Bariatric Center of Excellence). I received the referral, and I see Dr. Giovanni on Monday! I am really excited, however, I generally have a little black cloud that rears its ugly head just when things seem promising. I am 5'2", weigh 223lbs, and my BMI is 40.13 (just made it), I am wondering what hoops Harvard is going to make me jump through, is anyone familiar with their requirements …

Hi..I'm so upset and frustrated. I did my 6 months supervised diet and everything...my paperwork went in first of may and insurance denied Romney the 15th. Said I didn't do a doctor supervised diet. I met with my doc...she approved and then I met with a team.nurse..nutritionist ..pt...for 6 months. My doc called and did a peer to peer review with insurance yesterday and they denied again.. my doc said I can start over...meet her and the team once a month for six months... ughhh...I can not take that much time off work again for the next 6 months. I'm really sad...I so need this....sorry for whining

I live in Fort lauderdale and I have Best Choice Plus Insurance. I have finished 3 of my 6 Nutritionist/Primary Care appointments. I am do not know what to expect when I submit for approval. Has anyone out there had Best Choice Plus for a gastric sleeve?

I've been denied by atena . I don't wanna give up I've been crying since may 21st <---------------- surgery date it just not fair ive been heavy all my life fear of dying at age 55 like my dad 10 years from now. I've been heavy all my life have bmi of 39.5 high cholestral high blood pressure I know there r people who have written letter and got approved I need help who do I write it to and a little help and ideia what people put in their letters.please and yes I'm begging for help here I have atena

I got the first initial denial And now we have to submit an appeal letter. I know all the obvious info. To include plus all the doctors notes on his end. But is there anything else I need to include that'll boost my case? It's a cut & dried case to me but apparently BCBS doesn't think so. I am trying to get the sleeve since my band was removed in February in emergency surgery due to erosion and a hole in my stomach. I loved the band- it totally worked for me! But my surgeon doesn't even put them in anymore. So he suggested the sleeve. I'd appreciate any suggestions, comments, secret tricks! Thank you in advance for even reading my posts- I LOVE getting "real people" a…

I heard back super quick from insurance... Denied because my coordinator failed to send in all the paperwork needed.... Anyone know how long an appeal can take. I have my date set for the 29th do you think it will have to be moved. I am so angry....

So I submitted to insurance on Friday to remove band and revise to sleeve. Its only Monday and I keep checking my phone and email. This is gonna be a loooooong wait! Lol. I've made the personal choice to only confide in my husband and my best friend who do not have weight issues. So you're my support while I go coo coo playing the waiting game! Peace & Love - Nicnac

Does anyone here work for AT&T and had their insurance pay for the lapband? I am a former Cingular Wireless employee and obesity surgery was excluded in 2005. Now that I am under the AT&T umbrella, I would like to know if surgery was excluded prior to 2008 (this might help in my appeal) Thanks...:thumbup:

I saw my orthopedist today because of terrible knee pain and occasional swelling. I've had knee problems since I was a kid (I've always been overweight), and the knees have only gotten worse with age and excess weight. Anyway, so I went see my doctor to discuss the pain I have every time I try to exercise and every morning when I wake up. Before I could tell him about the pain I was having, he peeped his head into the exam room and asked if I'd had X-rays yet (on this visit). Long story short, he took one look at my X-rays and said that my knees are awful for a 33-year-old and riddled with arthritis. I told him that I was in the process of getting approved for weight loss…

My surgeon just submitted my 1st request & the office called to tell me it said it was denied because of the 1 WLS per lifetime. Am I screwed now? Is there any way to appeal that "clause?" Would the peer to peer help? Or would ANYTHING help? I am sooooo discouraged now- more than ever. My surgery is a revision to the sleeve because of an emergency band removal in feb. of this year. (Erosion & hole in my stomach)

I don't have any of Aetna's short list of comorbidities (sleep apnea, heart disease, hypertension and diabetes). Has anyone been approved by Aetna with a BMI less than 40 and some *other* obesity-related issue, such as orthopedic problems and asthma? I have a BMI that's fluctuated between 37 and 48 over the last three years. My BMI was highest while pregnant and I'm sure insurance won't accept that. Pre-pregnancy BMI is just under 40 and post-baby BMI is 42ish.

Anyone have BCBS FEP? I was wondering how much altogether you had to spend. I'm pretty confused because I had my labs and the insurance paperwork said I didn't have to pay the difference because it was an in network provider and i had met my deductible. yet the lab sent me a bill... Guess i'll be calling insurance tomorrow just to make sure. ! I asked the financial counselor, but everything I ask she says she doesnt deal with! lol i'm almost ready to ask what do you deal with?? The only thing i've been told is I have to pay $250 before surgery...

I have been trying with no luck to get the surgical clearance letter from my primary care doctor. It is required by my insurance for approval for the surgery. I went to see him again last week and he says he can't do the letter with out a new EKG, blood work etc. He did an EKG last month an blood work 2 months ago. The first time I spoke with him regarding this letter he was very negative about lapband and wanted me to try weight loss pills thru his office. He also old me all pre-op stuff needs to be done by him because he knows my history..........I think he just wants me to come to him often so he can charge my insurance :-/ I'm worried that if I go to a new doctor for …

Just curious if anyone has been denied insurance coverage but then approved on appeal? If so how did it happen and with what ins company?

So I have done my 6 months of time which included PCP supervised diet, 4 meetings with a registered dietician, met with my surgeon, met with psych, met with my surgeons dietician... Every hoop I have jumped. Now my surgery is scheduled for July 29 the and pre op for 18th. Awesome right!! Well my coordinator said that July 1st she sent in paperwork. I checked with my insurance July 5th and nope nothing. Granted it was a short week... So my insurance lady I talked to call early Monday and they said they would fax everything on the 8th... Well I just got informed that they sent it in yesterday morning.. My insurance lady said the utilization team hasn't entered it so we…

Anyone have experience with a BMI of 35 and no co-morbidities? I have BCBS PPO. I am doing a sleep study next week and having hba1c blood test. I have a family history of sleep apnea, diabetes, hpb, thyroid issues, but for now, i don't think i have any of these. I have plantar fasciitis, major depression (on meds) and urinary incontinence. Do those help?

Have anyone in NYC who has Medicaid/Amerigroup had wls? If so please let me know your experience. Thank you!

Called Cigna today. Received my paperwork yesterday, now its in nurse review. She said she has 5 business days.. but at this point when did you call back? Should I try tomorrow or wait?

I am self-pay and I will be sleeved in less than a month by a doctor that offers BLIS Insurance coverage and I need to decide what level of coverage to take. As part of my decision process I would like to hear from anyone who had surgery that was covered by BLIS and who actually had a complication. I'd like to know if everything went smoothly or if BLIS tried to avoid covering something that should have been covered. A friend of mine who is an attorney once told me "Insurance companies are in the business of cashing premium checks and denying claims." I want to see if anyone thinks this would apply to BLIS as well.

Hi! I'm new here....wondering if anyone had to gain a little weight to be covered by insurance? I am 5'6" and 241 and in order to be a 40 I'd have to gain six pounds. I don't think I have any co morbidity. Healthy as a horse, just fat!!!

I am in the process of gathering information as I am close to making the ultimate life decision of getting a lapband So in terms of insurance. After the initial surgery are the follow-up programs covered? Are fills or checkups with surgeon/doctor covered? And if there are complications in the future are the things necessary to fix them covered as well? Appreciate any answers J*

It's been a loooong road. First UHC told me I didn't need a six month diet. I waited until everything after our move was settled, then did all the tests, was denied for the six month diet. I spent HOURS on the phone trying to get WW to send me something verifying my attendance dates. I just gave up and wrote a long son story letter with my phone records showing the hours I spent. Got my appeal denied. This has been one of the most stressful things I've been through. I just get to a point where I can't do it anymore. Finally I called WW corporate and she is mailing me a letter. I pray it is correct and that UHC will approve me. (already checked and WW is accepta…

Did any of you use the True results self payment option? Did you have to pay any money upfront?

Hi there! I'm totally new to the wls/vsg world, my hospital visit is next Tuesday. I'm wondering if anyone's surgery has been covered by First Heath Network (aka Coventry Health Care)...I know the only 'real' was to find out is to apply, but I'm scared about getting my hopes up just to be denied. Anyone else have Coventry/First Health? Thanks

So I called my scheduler/ coordinator to make sure she had everything she needed to send in for pre authorization. She said yes I will send everything in by the end of the day. That was Monday July 1st. I talked to my insurance company today and low and behold NOTHING has been sent in from them.... I get people are busy and she may have put it off. But then she had Tuesday and Wednesday. And of course they are closed today... So hopefully Monday I can get some answers from someone... Sorry for the rant I am just super irritated. My insurance has 14 days to make a decision and my pre op appt is the 18th. Well why would I go to that if I haven't been approved.. Grrr

Hi! I'm new to this entire process. I've been doing lots of research on the VSG and I feel it is my best long-term, weight loss option. I have BCBS Federal and I am required to have at least one co-morbidity since my BMI is less than 40, but greater than 35. My BMI is currently 35.5. I called BCBS to ask them what co-morbidities they count as significant for approval and they said: high blood pressure diabetes sleep apnea I don't have any of these things. But I do have: migraines prehypertension osteoarthritis in my spine and hips scoliosis knee/joint pain BCBS did tell me that since I do not have any of the 'major' comorbids, that I higher level supervi…

Hey guys, anyone out there have Kaiser insurance? We are in Colorado and will have Kaiser July 1st, I was just wondering if anyone had dealt with them? Thanks! -C

Hello Sleevers, I have a dilemma. I went to a physician I've only been to one time in the past 24 months. She had my bmi at 39.7 (ridiculous) and I have no co-morbidities. Can I get a referral from another physician and send in only that information to the sleeve surgeon. I really did not do anything with this physician, I sat with her for about 15 minutes. I have scheduled myself to meet with another physician before my surgeon iniitial visit on July 29th where I plan to get a referral. Does anyone know if that is okay, I just want to make sure I am able to do that. I know some of you said you gained weight in order to be covered, did anyone have to go back to their…

I was to told be my surgeon that a Sleeve surgery was scheduled and Medicare would be billed to see if they would pay. Medicare will not pre approve surgery. I can't believe this hasn't already been done some where in Ca.

I am 35 years old. My BMI is 44%, I have co-morbidities but take medications that are successful. I am pre-diabetic, have sleep apnea, and a strong family history of heart disease related to weight. My question is, how do I appeal again? I wrote the first appeal letter basically saying I have all these co-morbidities and in the long run the weight will kill me. I got denied on appeal. My insurance requires you be 49% BMI for automatic approval without medical conditions, 40% with. Do I find a lawyer to help write it? Do I write it myself? Do any of you want to share your appeal letters to give me ideas?

I was wondering if anyone has United Healthcare jacksonville FL and how long does it take. I'm just starting everything now and was wondering how long I'm looking at. Also did you have to pay the rest of the amount the ins co did not cover right away?

My coordinator emailed me right before 11 AM today - said that everything was sent up to BC/BS of FL...I thought - now the waiting game begins. She warned me that it would be about a 10 day waiting period before we would hear back - but, she was very confident that it would be approved. Mind you - another co-worker just had her sleeve done last week (same employer/same insurance) and it took about 10 days for her to get a response. At 4:30, my coordinator calls me - she had contacted BC/BS to ensure that they had gotten everything, etc. They told her that everything was in order and it was approved!!!! Unreal!! She said this was a first! A 6 hour approval…

My surgeons office submitted to BCBS federal for approval this past monday. I thought that jumping through all the hoops would be the hardest part and that is just so not the case. I hate waiting. I have never wanted it to be Monday so badly! I am hoping to hear some good news on Monday! Last week when we submitted for approval, they asked for a tentative surgery date so hopefully that means good things.

The insurance coordinator at my surgeon's office recommended Horizon BCBS NJ as the easiest to get approved for surgery with. I want the sleeve, but the problem is I can't get the company to tell me if they cover the sleeve without buying a policy first. I really don't want to waste thousands of dollars for a plan for a few months just for them to tell me the sleeve isn't a covered surgery. Does anyone have any experience with this? It says that bariatric surgery is covered under several of their individual self-pay plans, but it doesn't tell me if there are exclusions to that. Thanks!