Insurance & Financing

Hi there I am new to this forum and I have a lot of jitters concerning insurance. First let me tell you my dilemma I have BCBS OF Alabama. My employer has 2 plans one of them is the cheaper plan where you have to see your pcp in order to get a referral to see a specialist. I am on this plan, in November during open enrollment I will be switching to the higher cost plan due to the plan I currently have excludes bariatric surgery and anything to do with it. Once I change in November it will become effective in January 2014. I am nervous because I have decided to go ahead with the 6 month diet, I have seen the nutritionist, I have my photos proving I have been obese( I am u…

I was denied on April 30th from BCBS Federal because 3 weights out of my 2 year history went below a 40 BMI (the lowest was 38.1) but this was because I was on phentermine at the time. My parents insisted that they help me write this denial letter (my mom works with insurance companies for a living) and I'm grateful for their help but it is going on a month and a half and I'm still twiddling my thumbs waiting for them to help me. My insurance runs out in January so I don't have a whole lot of time to get this surgery done because I have to fit it in during breaks from school. Does anyone have any tips on how to write this appeal letter? I feel like if I don't do this my…

Had my sleep study last night but didn't get hooked up to a CPAP during the night. Does this automatically mean I don't have sleep apnea? I don't go back for my follow up until July 9th and I am curious to know. Anyone who has had a sleep study please let me know if you were not hooked up to a CPAP but still have sleep apnea.

Submitting either today or tomorrow so excited! Just depends on when my patient advocate recieves my paperwpork fax. I'm in Orlando going to see Dr Keith Kim and have finished all of my surgical clearances for his office. Super excited fingers crossed praying we hear Monday.

I have BC/BS of Al. & they won't pay for it. Can I just find another insurance & pay for their coverage? Does anyone know of a specific company to use?

Does anyone have any experience with Viva through peehip? I am a school teacher with bcbs peehip but wondering if I can swap to viva & get approved for the sleeve....

I had lapband in 2008 and had an erosion and had surgery for removal.....at that time the surgeon saidnwhen I was ready he will do the sleeve for me...after much hesitation and all my weight gained back I'm more than ready....but will by high mark bc/bs cover it?

Does anyone have BCBS TX? I went to my seminar yesterday and now have to schedule psych eval. BMI was 40, and I have lumbar stenosis. Just curious how many hoops I will have to jump through with the insurance?!

Ok so how many times did you guys call to see if you were approved before the final answer. Tomorrow will be a week since my case was opened with the insurance for approval- thinking about calling tomorrow just to check the status.

My patient advocate called me yesterday afternoon and told me they submitted my packet to bcbs federal! I'm so excited and scared! Praying for an approval!!! It should take an avg of two weeks, Hopefully sooner!

Just wanted to add, Aetna changed their protocol from 6 months to 3 months of monitoring MD visits .Feel like I hit the lottery !!! Not even 10 days to get approval. Feel very blessed.....hope I can tolerate the next 2 weeks. Wait a minute....know I can deal with it !!! Surgery scheduled for February 7th....my 62nd birthday is Feb. 9th...Birthday present to myself!!!

have anyone had the Band and then got the sleeve and ur insurance paid for it's please help me out

has anyone had the Band had to Get it remove and got the sleeve did it insurance cover both I'm with uhc united health care In Georgia

Hi all....does anyone with BCBS have experience with 35 BMI being approved...no comorbidities yet...testing for diabetes on Saturday.. I was originally banded in 2008 and had it removed because it cracked and was causing interior abrasions. Because my BMI fell below the required my revision to the sleeve was denied under United Healthcare....(my insurance). I then went under my husbands and (BCBS Empire) and waiting. My BMI is only 35.4 and no co morbidities.....getting really depressed but my internist said he'd write the letter for me as medically necessary. I'm hopeful that and believe and know this is the best thing for my health. D Has anyone had success wit…

My paperwork has been at BCBSIL for 6 business days today. I sent them an email yesterday, but haven't heard back from them yet. I like using the email as it is given a tracking number so it has to be addressed. I didn't want to call just in case one of my co-workers heard me (I am keeping this to myself). I'll let you know what I hear back, wish me luck!!

FOUR stressful weeks of waiting, missing paper work, errors by insurance company and today I got the call call from my surgeon's office....APPROVED!! Appointment on Tuesday with scheduler. My heart rate might slow down by then.

So I got a call from my surgeons office today and I'm approved!!!!!!!!!!!!!! So I wanted to post because during my 6 months, I looked at postings to get hope. I live in PA, and I have Highmark Blue Shield PPO. Clearly I'm totally excited but wanted to share my "stats" like I said so others can compare... My surgeon's office submitted exactly 2 weeks ago and I got the call at 11:30am today that I'm approved! My date for surgery is June 17th! I'm 35, 5'2" and 212lbs so that makes my BMI 38.9 and I was told that is rounded up so it is 39. My insurance is like many others...with a BMI of 40 or higher, sleeve, band or RNY is covered 100% with no out of pocket and wit…

Hello All, My Job required me to have a BMI over 40 (which I have) plus 6 months of supervised diet (my Las app was on 05/02/2013), I also had to do an EKG, Cardio Echo, phycoligest evaluation, Speak to a nutritionist and do a sleep apnea test, they also needed a 5 year weight history. I finally finished all my requirements. I am now waiting on my approval. My doctor scheduled my Surgery date for 05/31/2013 I know I know I should have my approval before they schedule my surgery blah blah blah lol but honestly I can’t wait I feel like I have waited so long. I called my insurance company and I keep getting the run around, One person will tell one thing and another perso…

I just found out that my insurance will not pay for seeing the diettitian. I saw her last week and am being charged $272.00 for the one visit. Called both insurance and clinic and neither one can help. Asked for the contracted rate from the clinic and they said they won't give that since insurance denied the claim. So frustrated I won't be seeing her anymore at that price. Insurance said they only cover if you are pregnant and have gestational diabetes. Well I sure am not going to get pregnant just to see the diettian. Any one have and suggestions?

So I was wondering what would make a person get denied for surgery? Does the drs office keep submitting the paperwork or change the paperwork until it gets approved. Surely the patient wouldn't go thru all that time and money and not get approved. Or could that happen? I'm just curious . Any info would be appreciated I have anthem blue cross H M O

My insuance, Emblem Health, requires me to either have 6 months of supervised weight loss with my regular doctor or 3 months with my surgeon. I want to have my surgery in early August, but would really love if I could have it in July since I will be returning to school in the end of August and want as much time as possible to adjust. So, my question is since my first weigh in was in May then my next will be this Tuesday, and my third will be early July does that mean that I can have the surgery in July or do I have to wait till August? Do I need a full 3 months or is it just calendar months not days?

I was in the process in Cali with kaiser to get the lap band, but for job reasons I moved to AZ and they do not have Kaiser here. So, I called United Health Care of AZ and they said that because my bmi isn't at 40 (my bmi is 37) and I do not have diabetes or high cholesterol, I do not qualify for the surgery. I do however have PCOS. Which puts me at high risk for diabetes and heart disease. . I asked the lady and said, so I can gain 5-10 lbs and be at a 40 bmi and or have diabetes and so forth before you will help me? No preventive steps? Doesn't make sense. I called a dr right after to set up an appointment to see if they can help me with getting this done. I don't…

Feeling very discouraged today. I called to follow up on the preauthorization for my band removal, and after placing me on hold, the rep came back to tell me they'd decided today to DENY, on the basis that it's "not medically necessary." This, after the surgeon has said it needs to come out as soon as possible. Apparently a badly dilated pouch, with nausea and vomiting, isn't what they consider "necessary" to deal with. :( Has anyone had success appealing for band removal, with no revision surgery? Especially with BCBS Federal Employee Program?

I am hoping to get some information about the affordable health care act in regards to weight loss surgery, I am not familiar with this at all. Here is my story in a little nutshell. I was all scheduled approved and ready for surgery, one week before my surgery date I was denied and told I should have never been approved and it was their mistake. I have been researching MExico but do not have the funds saved up and honestly it would take me a few years to save up that much money (I am a mother of three and live paycheck to paycheck) I am been looking into financing but my credit is not great. I got approved with a medical financing company but need over $2000 still for a …

They received my information last Tuesday. It has been through a couple of phases, they say it takes 5 business days, but today I got told Thursday or Friday... The waiting is just getting so tough now that I'm so close to a surgery date. I know, I'm a whiner

I just got my approval this morning. I have my appointment with the surgeon next Thursday, and then the following Tuesday thd upper gi and egd..hopefully will get surgery date next week. Very excited.

Does anyone know if Caremore reliance medical insurance have their own surgeons ? And has anyone ever had surgery with Caremore and what was the outcome.

I probably misspelled that but oh well! I am trying to find ou tif my insurance has received my file for eval! How would I find out? Sent from my iPad using VST

Little nervous, have everything set and ready to go but the surgeons office submitted aproval for gastric bypass with a 6 day stay in hospital :/ I want to have VSG not RnY. I wander if they just submit the most invasive just to see ? I have not seen surgeon in months. He said at that time , I didn't need to make a decision on what kind of bariatric surgery I wanted. I was still on the fence at that time . Going to all office first thing Monday but has this happened to anyone else?

I called my insurance today and was informed im not covered for any type of wls. So sad I just want to cry.

Received the approval from my health insurance and scheduled surgery for July 15th when I get back from Scentsy Convention!!!!!!!!

Hello. I was banded May 2010 and lost 80 of 200 lbs. I have since gained all my weight and then some. I went through the insurance process to get approved and was denied because I had a previous WLS. I am appealing the denial by the insurance company. My husband is a union plumber and the ins is through the union. When I was denied I was told that I could appeal the decision in front of the board of trustees. Tomorrow I am going to the meeting and will plead my case to them. The only chance I have at approval is that the only WLS that was allowed by ins at the time of my decision was the Lapband. Now gastric bypass and Lapband is approved. I was not given an option. Th…

My last weigh-in is this Thursday and psych eval is on Friday then all will be submitted to BCBS FEDERAL... I'm just starting to get nervous, what IF they don't approve me?? I met all the requirements..did anyone have a easy approval with bcbs fed???

I don't think I've seen anyone post anything about avmed pos. Please let me know about your process and how long did it take to be approve for surgery after your last visit.

I'm very nervous, my BMI is 46 and I have Humana, I do not have high BP and I'm not diabetic. I do have migraines but don't think that will help much, I also have a family history of obesity and cancer. I was without insurance for about 3 years until Jan, when we talked w the insurance company at the start of the process they said there was no pre existing clause. I really hope that my approval letter comes soon and I can get this ball rolling. I do have my EGD scheduled for the 12th of June and hoping to do my Pulmonary Function test while I'm in town (about 2 hrs from home) I hope my letter comes soon and I pray it is an approval letter!!

I have an *** run by anthem in CO, in previous years it was set at a 14,000$ max. It now says benefit Determined at place of service. Anyone know what that means? Is it better coverage or worse? Suzy

Aetna denied me twice. UHC (my secondary) approved me and I was sleeved 5/28. My doc submitted for the 3rd time to Aetna a few days before my surgery date. Today I get a notification from Aetna that I was approved!! I have no idea why they finally approved me. Nothing changed from the second time they denied me. Insurance companies confuse the hell out of me!

So frustrated right now. I was banded in May 2011. My insurance at the time covered the surgery, dr's visits, and my fills. Well....Ive since relocated and my new health insurance covers NOTHING!! Ive been having serious issues with acid reflux lately and know i should make an appointment but the thought of a 200 dollar office visit just makes me sick to my stomach. Just needed to vent

I was on these boards like 8 months ago or so... My family DR had found private financing to "sponsor" my surgery. Last minute, those plans fell through. I have no health insurance, no savings and bad credit because a family member took a loan out on my name (desperate times call for desperate measures) Anyone have any ideas? I'm 25 and don't want to dig myself into debt ....what options do I have??

My surgeon spoke with BCBS and specifically the official that denied my surgery because my stupid PCP completely screwed up my letter. After Dr. Le spoke with them, they told Dr Le what to change on my paperwork and told them to send it to the original reviewer directly. He said that there will be an approval forthcoming. Yeah (I hope)

Question: I am done with everything! They called me almost a week ago a d gave me my surgery date, June 19!! But then called and told me Thursday that they just faxed my info to the insuraunce?? Can I still be denied?

Hi everyone... I am looking to hear from people who were approved "on the cusp"?? My BMI is 37.5 and I have reflux and asthma. I'm about 70-80lbs. Over weight and going through my 6 month pre-approval requirements. I'm purposely not losing any weight because I feel I could be denied if I lose even 1 lb. anyone in this boat as well??

Anyone have or heard of the insurance process with BCBS? I called member services to make sure it was covered and under what qualifications but I read other BCBS plans have required a 6 month waiting period!?! I PRAY not!!! I'm too anxious to get this done and not that I'll lose my courage in 6 months but if my mind keeps racing and obsessing like it has for the last month, I may not survive LIFE for another 6 months!!!!

So I got Auth for Sleeve from Insurance company (BCBS)but a nurse from there called me today and I missed the call any thoughts why they would be calling me???

I'm new and have many questions about this surgery... I honestly don't have any riches or anything... I don't even have insurance... is there anything anyone could give me advice on what to do? I really need this I've killed myself working out eating healthy nothing is working for me I'm diabetic... I just want to be healthy but I feel as if the odds are always against me if anyone can give me any advice I'd appreciate it very much.

I just saw this and wanted to share. My insurance paid all of mine, but wanted to help others! Good Luck! www.wlsfa.org/looking-for-help/

I have insurance through both my employer and my husband's. My primary is United Healthcare (mediocre coverage), and secondary is Cigna (fantastic coverage). I meet the requirements for WLS with both companies, however UHC requires 6 months of physician monitored diet and Cigna only requires 3 months. Do you think I can go ahead for Cigna approval after 3 months? Will there be any payment issues with Cigna if UHC never approved the surgery? Thanks!

I got a voicemail from my insurance(Aetna) which said she wanted to discuss some incentive program and then it was also a courtesy call for my upcoming procedure and to give her a call back. Has this happened to anyone? Does this mean I got approved? I'm so confused and sooo nervous!!

Does anyone here have Kaiser? As anyone had the surgery through Kaiser?

Anyone here had to get pre-authorization for removal of the band, without any further revision? Mine is causing problems (serious pouch dilation) to the point the surgeon wants to remove it ASAP, but it's being submitted for pre-authorization. If you had to go this route (as opposed to ER sudden removal, etc.), did you have any trouble getting it approved?