Insurance & Financing

I personally had no problem my insurance is all for it. However my daughter has many weight related conditions and twice they have said no to WLS. Their reason is because her conditions are treatable with medication. She just is not sure how to go about it at this point. Just wondering if those who ran into these road blocks, how you went about getting it approved. Thank you and Happy Fourth of July one and all!!

Not sure if anyone else has posted this in the past. WLS was one of those items that my insurance would not pay regardless of your health condition. But they will pay several hundreds a month in medications to treat the side effects of being overweight. I have a 401K at work that I had been paying into and inquired if it was possible to withdraw funds from it for WLS. Their answer was yes, but any distribution would have a major penalty. But they suggested that I do a loan against my 401K. The advantage is that the interest rate is very low, 4.0%, and that any interest you pay on the loan goes back into your own account. There is the risk of losing your job and the loan g…

I am new on here. I have BCBS fed'l standard (85%/15%). I went to my intake appointment 8 business days ago. My question? How many of you contacted your insurance to find out if the submission has been received/approved? How long did you wait? I Should get approval with a BMI of 45.5 but Who knows.

I have to do the 6 month program in order to get approve with my insurance. What i want to know is how long after do you get your surgery date or have surgery. I know everyone will be different but i just would like some insights. Thanks

Hey all so my coordinator at the surgery center said she would have all my stuff sent in yesterday. I was told they have 14 days to either approve or deny. I keep hearing to just expect a denial but that seems so unfair. I have a bmi of 41 or so I believe plus type 2 uncontrolled diabetes. I meet all the medical criteria but am still feeling like I might as well just be prepared to be told no.... I have bcbs of Oregon and get employee benefits because my husband works for Regence. Just praying I find out soon and its approved....

i just called my ins company to check on my claim status i was told that my nurse closed my case bc she hadnt heard from me after i called and left numerous voice messages...i am pissed. The case has been reopened and assigned to someone us so im waiting even longer but all my paper work has been received by then....geez!!

Does anyone have a medical card for Il. If so can you tell me the process . Like from start to finish. And how long did approval take.

Just got off the phone with BCBS. My doctor submitted for approval about a week ago. The person at BCBS just said that someone put a note in my file today saying that the "medical criteria has been met" and then he said that the "approvals" usually go out by mail. Does that sound like an approval? I'm hoping it is! I was afraid to ask for anymore details because I might jinx it

I am a 70 year old woman with no comorbidities and a BMI of 41.8. Medicare is my primary insurance now but BCBS has to approve to pay what is not covered by medicare. I have my fingers crossed. Anyone have any personal stories with BCBS of NH?

I knew it was coming but I can't help but feel upset. I am a revision candidate from the band to sleeve. They have approved my band to come out. That is a prayer answered in itself. I have had pain and complications for almost 5 years and 2 insurances have denied taking it out. I will be doing that in June. The letter said I have to have a Nut and Psych appt. which is normal. But the letter said that I need to PROVE that I followed my diet and exercise program after my first surgery. Which part? While the band was working I lost 32 pounds. A few month after surgery I had complications and got to where I couldn't eat at all so obviously I gained weight in starvation mode…

I am contemplating getting the sleeve. I have BCBSNC and I just wondered how long it has taken some of you to get approved. I am going to a seminar on this coming Wednesday. What should I expect? Does the process begin after the seminar? Thanks, greenivy

I read in a post on this site recently that Tricare retiree beneficiaries did not have to go through Tricare to have the surgery done in an MTF. That is not necessarily true, at least in the North Region it's not. Womack at Ft. Bragg told me that we had to have a referral put in through Tricare. My doctor supposedly put the referral in requesting the MTF, but it came back approved for a civilian doctor, but of course Tricare does not cover the sleeve gastrectomy. I was also told by some at Tricare that all I had to do was to call Tricare back once it was approved and tell them that I want the MTF. Well, I tried doing that today and was told that they just can't change i…

I'm covered by United Healthcare and they've told me they require 6 months of medically supervised diet. I'm doing that with the nutritionist at my Surgeons office (Dr Williams at UPenn in Philly). I've had all the tests done and no flags there, so I'm starting to get a little more positive this might happen! My question is this. I'm a little hazy on the timing. If my nutrition program started in April then my MWL window would end in the sept/oct timeframe. Given that window, when would I get a surgery date, and would that happen before or after the request is submitted to UHC? Thanks!

My WLS doctors office submitted for pre approval for lap band last week. Saturday I received a letter saying it was denied. It stated I lacked documentation of per and post - operative nutritional assessment and counseling. My WLS doctor sent me to a nutritional class back at the end of Nov. Anyone else have nutrition counseling? I have a call into the dr but just waiting on a call back. Thanks!

I will be a revision from the lapband, which was put in by Tricare, my surgeons nurse is concerned that BCBS wont pay to have the band removed. Has anyone been in this situation? Also I just started going by to the surgeon's office to get fluid out, I had been miserable for a year, throwing up and discussed changing to the sleeve. I had regained the weight I had lost. The office wants to have me make several appointment before the submit my paperwork to the insurance company. I have done my nutrition visit and my psy visit. I was so depressed today because now I don't have a clue when I will get this band out so that I can get a second chance. Has anyone experienced th…

I have blue cross blue shield of mn, and wondering how long it took to get approved, the only thing we are waiting on is for my psych evaluation to go to the clinic and she said she was going to send it Monday. So after they send everything in about how long does it take for insurance to approve?

Does anyone know the cost after insurance ? I have blue cross blue shield of Minnisota.

I had no idea! Now I get to submit everything to my h's HR department. This whole thing is so weird; but I feel like I have a better chance with his HR than I would with UHC. Wish me luck!

Now on insurance approval....hoping they don't take forever!!!!

Just curious to know what (if any) insurance do you use? Have you been sleeved? What kind of coverage have you experienced? I'm a school teacher with BCBS peehip. Just now submitted my request. Wish me luck - say a big prayer!

Just curious what kind of time frame I'm looking at. My surgeons office submitted it yesterday.

Just curious to know what (if any) insurance do you use? Have you been sleeved? What kind of coverage have you experienced? I'm a school teacher with BCBS peehip. Just now submitted my request. Wish me luck - say a big prayer!

I have BC BS of MS and I have to do 6 months of "Active Health" before I can be approved. In the meantime, I was hoping to get all the pre-op things taken care of, but insurance won't cover any of it until I'm approved and I'm not sure the cover the pre-op stuff even after you're approved. For instance, I had to get a pulmonology clearance because I have asthma. Since I do have asthma, you'd think a trip to a pulmonologist would be covered for me, but it turns out they didn't cover anything and I'm out nearly $400. I was going to get an EKG and have blood gasses taken tomorrow, but I called and they said they wouldn't cover it. What's annoying about it is that I won't get…

Just got my sleeve 6/6/13 at GBMC would love to find some sleevers near me!

I summit all my paper work already 6 months supervised diet and everything they required I'm just waiting for approval .. I would like to know how long do they usually take

I talk to the insurance today and they will have a decision at the end of the day no later than first thing Wednesday morning fingers crossed pray for me friends

Has anybody else ever fought BCBS about 1 WLS per lifetime? Please tell me your experience- bad or good! I need some help in that area. I had the lap band removed (emergency surgery due to erosion). But I want the sleeve (already approved by my dr.) and BCBS has the 1 surgery rule.

I got the labband in 2007. Had had some success with it, lost and have kept of right at 60 lbs. I have struggled with the usual problems that come with the band, heartburn, acid reflux etc. Well it was determined about three weeks ago that my band has slipped. The Doc recommended removal and revision to RNY. It request was submitted to BCBS for approval. Received a copy of the letter, and they have approved the removal but not the revision. I do not meet the criteria now. I have worked hard to losse this weight and try to keep it off, and I know without the band or something I will gain all of the weight back. I have been unfilled and it is already starting to ha…

Yesterday my surgeons office turned in all my paper for rny. I have Highmark Blue cross and Blue shield. Praying for a speedy approval!! Anyone have any experience with this insurance?

I have AETNA and I was just informed that I am approved. I have delayed the actual surgery until I come back from our family reunion in August but my official surgery date is August 14, 2013. Sooooo excited

FINISHED MY 6MTHS WITH MY NURTRIONIST, THEY SUBMITTED MY PAPERS JUST WAITING FOR A RESPONSE. THEN MY DOC WILL GIVE ME MY SURGERY DATE. FEELING SO ANXIOUS CANT WAIT... GOOD LUCK TO ALL BEST WISHES

Hi All. I'm wondering if anyone has had this issue. I'm a self pay and the hospital my doctor performs surgery at is not in-network with my insurance. My insurance excludes weight loss surgery, but they are subsidizing it in part because I will also be having a hernia repair. My concern is that, while my fee to the doctor and the hospital has gone down for the weight loss surgery, I'm going to be hit with a fee for having the hernia repair at a hospital that is out of network. Both the doctor's office and the hospital have assured me this is not the case, but I'm still worried. I don't know if this is the proper forum for this because I'm a newbie. I had originally…

I received my initial denial within hours of submission. My appeal was received on May 8. I've called a few times to check on status and they always say it's still being reviewed but will get an answer within 30 days. Anyone else had an approval after waiting this amount of time?

Has anyone else had an absolute nightmare dealing with BCBS of MN?? At first I planned on going the insurance route but once I started working with BCBS and realized how asinine their process is it looks like I will be self paying. They require the 6 months of doctor guided weight loss, which I am ok with. A BMI over 40 and a psych eval... like most insurances. But here is the fun part. I meet the BMI but they refuse to pay for any of the doctor guided stuff or the psych eval because they don't deem it medically necessary. Call me crazy but if I meet the BMI requirements wouldn't you think it be medically beneficial to me to have the surgery, in turn meaning …

I have BCBS Federal. I am required to have 3 months of a monitored diet, which I will do with my surgeons dietician, before my surgery. My question is, if I lose weight during that 3 month window, prior to the surgery and my BMI falls below 35 (which it will if I lose more than 5 pounds) will that prevent my insurance co from approving my surgery? Or does the only weight that matters is the weight I start at when I first started seeing the surgeon and my weight during the 2 years prior to the surgery? Thanks!

My paperwork was suppose to be submitted Monday. The patient coordinator said she was going to actually mail it because of issues in the past with faxing. I'm going to call BC Monday to see if its been received. I followed there guidelines to the letter, so hopefully I will get a fast approval! Anyone else have experience with them?

Does anyone know or have experience with whether or not MS is covered as a condition for Medicare coverage for WLS? I have a friend who has it and is considering the surgery. Any help would be greatly appreciated!

I currently have BC/BS of AL and I already had the lap band, which had to be removed because it eroded into my stomach. I LOVED the band - it totally worked for me! But unfortunately my dr. Had to remove it. So that made me fall into the category of "only 1 WLS per lifetime!" But my husbands job has the Excellus BC/BS of NY. I wondered if anyone has used them and what their experience has been. We are a family of 6 being covered under my schools BC/BS and it is overall better coverage for less money. I don't want to jeopardize my whole family just so I can "possibly" get covered! But I'm just at a roadblock because I really need/want the sleeve & my dr. Has recommen…

Approved in one day! Date aet for July 8th! Two weeks! Nervous and excited!

Submitted to insurance on June 10th. Called insurance everyday to no avail...then I called today an low and behold 5:12 on Friday figured i'd call one more...when the guy said "APPROVED", I literally had a rush of emotions....thank you Jesus surgery is scheduled for Tuesday

I am beyond excited I was approved today by elmco and received my surgery date of July 9

Everyone say a quick prayer to whatever u believe in & cross your fingers & toes for me! My patient advocate just called, she's submitting my info for approval!!! I'm so nervous. I've provided everything they ask & according to her & my surgeon, I have the best & quickest approval insurance (BCBS Federal). Thinking good thoughts, I SO want this & I'm SO ready! Thanks everyone!

I am having gastric bypass surgery July 3rd and my drs is also taking out my gall bladder since its full of stones. Is my insurance gonna cover the cost for the chole removal? Anyone know.. my insurance is Aetna..

Oh my goodness!!! Thank you lord!!! I'm so thankful!!! I'm waiting on the surgeon to give me the surgery date . Any recommendations of what I should buy to prepare for my post-op surgery?

http://www.cnbc.com/id/100829102 This is an interesting article. The way insurance companies look at obesity may be changing. Do yourself a favor and skip the comments below the article. They sting pretty bad.

Hey everyone, today I finally got everything in order and saw my 3rd surgeon for my last & final consult! (The other two I saw closed practices... ) and I finally got everything submitted to insurance today for my surgery! I'm so excited and cannot wait for the next 7 to 14 days to go by fast! I'm nervous and anxious to get my approval from insurance so I can set up my surgery... now, I started this process last august hopeing I would have had surgery in april. Well that wasn't the case cause I had to switch insurance plans because it was open enrollment this year for me. And now I'm definitely going to be having it next month! Cannot wait its been very stressful tryi…

Just found out I was denied today. The bariatric center called and informed me. I have not received the denial letter myself so not sure exactly the reasoning. I know they mentioned more psych visits?? Bariatric center suggested that I compose a letter, along with one from the surgeon as to why this surgery is needed. If anyone has been in a similar situation and had success, please share your wealth of knowledge. I don't know what I could say that would help or be any different then what my surgeon would say. Feeling a little down today..

Alright! I tried to search the forums for information specifically on this but I really couldn't find anything, so my apologies if this is repetitive! I have Aetna. I've done my 90 days of documented registered dietician visits, which is outlined in the requirement of Clinical Policy Bulletin 157, and I've done my psych eval, I have a bmi of like 42...(I'm 5'4" and teeter-totter between 247 and 253, and i have for the past 4 yrs) My question is this: The part where you have to submit 24 months, or 2 years, of weight loss history....I went and picked up my records today from my previous doctors visits to take to my surgeon, and it only goes back to August 30th, 2010....…

All my paperwork was submitted on Weds, May 29. My insurance coordinator called today to let me know that BCBS had received it. Now the waiting begins and I am unsure on how to pass the time. She said it could take up to 14 business days. UGH!

I received the call yesterday that I was approved for surgery! So I started trying to get my ducks in a row on all my copays, deductibles, and other expenses so I would be prepared when they give me my date. Called the surgeon's office, I owed a 1$ for my portion bc I had a credit with them! Called the hospital, I owe $320.00 and I have already met my $150.00 deductible so all I owed the day if surgery was $100.00!! So for $101.00 I will have my surgery!!!