Insurance & Financing

Does anyone have the same insurance add me? If so what are some of the things you've had to? Is there a 6 months diet required? What percentage do they cover cuz I have called my insurance and they are dumb one person didn't even know what bariatric surgery was.. please help

All I can say is make sure your submission follows their requirements to the exact letter!!! https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf I was denied my first submission and approved on appeal. The process took about a week each time. Quirky points: Your doctor must BOTH clear AND recommend you for the surgery. The supervised diet must be documented monthly for a duration of >= 89 days and contain documentation of diet, exercise and weight EACH month. Summary reports are not acceptable, even if each visit is detailed in the summary. My coordinator tried to reason with them but…

I think waiting for the insurance to respond with my approval is more nerve wracking than waiting to find out if I was pregnant!!!

I have been desperately looking for a doctor in Monmouth County that accepts Medicaid or Horizon NJ FamilyCare. I found a doctor in Livingston, NJ but that is like a 2hr. drive in rush hour for me and I just can't imagine I will be able to make that trip for several appts. let alone if I need to make weekly trips to get me fills. I called all the local hospitals to see which doctors were associated with them, I also called my insurance company but their list of doctors was not right. Anyone who knows of any doctors in the area I would love a little help. My current appt. in Livingston is scheduled for July 5th. So I have until then I suppose to find a better/closer fit.

my pcp just recommended me to start the process for wls but i am concerned about getting approved i have harvard pilgrim for insurance and my pcp reffered me over bcuz i have pcos i am 5'2" at 240 lbs unable to loose any weight for many years i am also starting to have problems with my blood pressure it has been slightly high for the past 3 weeks i have urinary incontinence, and problems with my knees and acillis tendons (not sure of spelling) due to overweight my pcp said i was a perfect candidate for wls and recommended the sleeve my question is can i get approved with just these conditions or does it have to be like a bigger medical condition?

OMG United Health, on my last month with 6 month program. BMI 40.5. Mi primary Dr. Acting stupid had a visit with him because my back was hurting really bad. Remind him about my bariatric surgery and he was acting like I have never spoke with him about surgery. I had Lab Band for 8 yrs & they took it out 2 years ago. Helppp what to do, what if primary Dr. Don't approved any sugestions

I'm out of surgery 5 months and may need to leave my Job and I will lose my insurance. I want this to be successful!!! Anyone know approximately the monthly cost?

Does anyone else have this insurance? I was told I have to paid my deductible plus copay plus 30% of the allowed amount? That's seems high to me...

Has anyone used GEHA insurance for the surgery?

Hi Everyone! I have been lurking for a few weeks as I found this site right at the time I started my journey to have WLS. I have learned so so much! Currently, I have 2 outstanding items before submitting to BCBSIL. My PCP's letter and my visit with the NUT. I have everything else. I just got about the best news today, my firm will pay for Short Term Disability 12 weeks at 100%. I can't imagine I will need 12 weeks, but nice to know its covered. I am in St. Louis, MO and am going throught St. Alexius Hospital New Start which was 1 of the BCBSIL recommended hospitals of excellence. Just wanted to come out of hiding as I am at the home stretch now... Good luck to ev…

Well, once again I have been kicked around by the insurance company. After being advised by my benefits coordinator and several others at work that we are covered for banding now I find the information the says it's excluded. I am beyond frustrated with the insurance company and I'm starting to look into paying for my band myself. I don't know what to do anymore. I need to take care of myself but unfortunately paying over 10k for this seems a little out of the question right now. Frustrating!

So I found out I was approved!! Next question is they said it would take another two weeks to call to set up date. Does that seem right? And how long of a wait is it to the scheduled surgery date?

So, I have been lurking around on these boards for a bit, but was forced out of hiding yesterday when for some reason out the blue I decided to call my insurance company to discuss coverage. I have excellusbcbs and they directed me to their online policy which can be found herehttps://www.excellus...57-09ef8ac1a985 (if you care that much). When I asked about the obvious contradictions ( I meet the initial criteria and may or may not have a co-morbidity as my blood pressure problem tends to disappear when I lose weight and I think it is resolved but havent been to the dr to verify) I was told to contact my surgeon. I dont have a surgery date yet, and my surgeon doesnt cont…

Hi. I was wondering about vsg Medicaid requirements. I get different answers when I call. I am 35 bmi with comorbs...now when it says you have to have been obese for at leat 5 years, is that 35+ or just medically obese (30+) and do you know if WW counts as their 6 mo diet?

Has anyone got approve w the medical card in chicago???

I just called bcbs fed and... i met all requirements and that I'm APPROVED! They submitted the paper work 5/28 and it was approved 5/29 now I just gotta wait until they send the official letter! God is good!

I went to go get my bloodwork done and my A1C was elevated. They said they now need a clearance letter from my endocrinologist. Well my endocrinologist will not sign off on it until I get my numbers down. I have been trying for a month now to get them down and I am not having success. It is not from a lack of trying. I am exercising, eating the right foods ect. I have my last doctors visit next week and then they will be submitting the paperwork to my insurance company for approval. I am very worried they will deny me based on my bloodwork. Has anyone else had any similar situations and what was the outcome?

Does anyone else have this insurance? My surgeon printed out what my insurance requires, so I am in the process of finishing up the list.. My surgeon says I qualify...does that mean I'll be approved

Well I got some answers yesterday! My file went to the wrong department! Apparently UPS has there own review department and it was sent to the regular one! The girl I spoke to was so nice and she is having them put a rush on it so I should hear tomorrow at the latest! Please keep your fingers crossed for me!

Took 7 days and got my round 1 denial. My doctor need to both clear and recommend me for surgery. He only recommended me (inferring that he cleared me too.) Not good enough, he needed to state both. My nut submitted discussion of the three visits in one report; Cigna wants it in 3 separate reports. So on the plus side, these seem like minor issues that can be easy fixed. On the minus side , it's disappointing that Cigna is so nit picky!

I am somewhat long winded when it comes to writing, so I will attempt to be brief! Sorry in advance if I end up with a long post! Anyway, I have been on this journey now for almost a year and a half! I began in November of 2010! At the time, we had Anthem bcbs. I went to the wls orientation and met with the dr. to find out if I was even a candidate for this type of surgery since my BMI is not 40. I am about 215 lbs and 5'3" so my bmi is about 38. I have several comorbidities, includig high bp, GERD, arthritis in hips an knees, and high cholesterol. He determined that I was a candidate, so I called Anthem and was told by a rep that yes, insurance covered the surgery so I p…

Got the call I've been waiting for!! My surgery is June 25th!! Thanks everyone for your crossed fingers, toes, and prayers!!!

So I was denied because atena is looking at my medical records from 4 years ago ( I recently got insurance back so I haven't been at the doctors) in that mean time I gained back 70 lbs and was diagnosed with PCOS and countless other issues so now they think I'm "skinny" when I'm bmi 43 and 278lbs! Now I have to go through this appeal process uhg and get doctor letters and stuff my bmi has fluctuated between 38-43 I'm so nervous they will deny me again!!!! Any advice? Has anyone else been denied too for this issue? Or their bmi but still was approved!???? !! I'm terrified right now

After jumping through hoops for my bariatric surgeon, and putting up with constant screw ups on bills for me to get to file with my insurance (even though my doctor is a PPO) I finally got turned down last week why? My patient advocate failed to look over the PCP letter when it was sent to them, then when all of my required visits with the doctor and nutritionist, the phycologist and exercise physiologist, they (the office staff) failed to proof the letter from my PCP and it had glaring errors the immediately made me ineligable for surgery. My PCP, even though he never asked told Blue Cross that I never exercised or made any attemp to lose weight even though I had a bac…

Can someone please send me an example of what you had for this requirement?? My doctor didn't do six seperate notes...I think he needs an example! Thanks! alana_macaluso@Yahoo.com

What r some things people wrote in their letters they sent to insurance company

Has anyone experienced that your RNY surgery is approved, but insurance denies to cover the removal of the Lapband. I can't have the RNY with the Lapband still inside me, so it doesn't make sense to me. However they approved the RNY. I have appealed and they still denied the LapBand removal.

My insurance coordinator let me know that everything was submitted to insurance today, and I could be in surgery within a month!

I was approved thru cigna Thursday and received my letter syaing I was approved today. I was looking on there and the authorization effect day, is that like the day they plan to take you in for surgery cause its exactly 3 weeks from my pre-op. The sheet they sent me says. AUTHORIZATION DATES 6/28/2013- 6/29/2013 TOTAL DAYS APPROVED:1 and something about a bed type. Ans says if I need further services past my one approved day that they will have to go thru insurance and make sure it'll be covered. Soo what id this authorized day?

Hi my insurance coordinator faxed my paperwork in to the insurance company this morning. I pray it goes through quickly. She'd said it could take a few weeks to hear anything, then snd asked me was I ready within the next 6 weeks if insurance approves. I told her yes mam I was ready as soon as possible. So to me it sounds like she believes I'll be approved. Let's hope so. I have bmi of 62, asthma. Sleep apnea. And a restrictive lung disease from the weight. Medically deemed necessary. I'm praying. I have 19 month old twins I've got to be there for, without this it will be a struggle as they grow up to keep up with them.

Is there anyone out there that had a 40 BMI with no co mids. Did you guys have any problems getting insurance approved. I will be submitting my forms here soon and Im terrified that I will be denied. I dont know if i can handle that emotionally. I really want the help of this surgery to help change my life. I want to be happy again I want to feel beautiful. I have never had that, So any insurance feed back would be helpful.

Has anyone had to wait a few weeks for a decision? I don't know what is taking so long and if its a good or a bad thing!! BCBS of IL got my stuff about 2 weeks ago and it was still pending this week! I'm going to call them on Tuesday, but I'm so nervous! Don't know what to think!

Hi ladies, I'm in the process of getting my approval just wondering. I have to have a nutritional consult, physc eval, done that, doctors notes--- I have asthma, sleep apnea, morbid obesity, and restrictive lung disease. Somewhere i need in writing that I have been excersizing. Who Am I supposed to get to do that? And does the insurance company really think you can excersize if you can't breathe. Will appreciate any help. Definitely need this surgery for my health.

I have NYC Transit BCBS anyone have a problem with approval? I'm waiting supposed to have surgery June 21 .

antena told me they never received proof of my high blood pressure high colestral,and bmi over 35 i have all of that every time i went for any testing including pre admission they wanted a list of medicines they are also on my clinicals .someones lying either my doctor messed up or atena is lying so they wont have to pay for surgery

omg i want thius so much been so depressed im asking every one to say a prayer for me please

Dishonest and crazy people!!! Where is she now? Disappeared like her post? lol

New to this group, and enjoying reading about everyone's experiences. After a lifelong journey of gaining and losing, I've begun the process for gastric sleeve surgery. I have so many questions, and I'm having lots of trouble getting answers. I am insured through Aetna. I'd love to know what your experiences have been! My current BMI is almost 41. My insurance requires a 3-year weight history, and I don't know if I've had to have a BMI of 40+ during that time frame in order to be approved. For the last three years, my BMI has been between 35 and 40, and I have no comorbidities. (If knee problems related to excess weight count as a comorbidity then I certainly have that!) …

Anyone else have it? I have it through my employer. Getting the surgery at the same hospital I work at too. I am meeting with the surgeon in a couple months but I'm told already by the PA that I shouldn't have any problems, by the looks of it. I didn't have to lose weight. I'm 43 BMI, age 23, with a couple comorbidities. My cholesterol is high, my LDL is high, I have insulin resistance. They made me have at least 5-6 weigh ins, which I have done already. I guess I'm worried about history. My PCP wrote my letter stating I have over 5 years of being obese. I have maybe 3 years documented at that one hospital of me being at least 37 (37 was my lowest, mostly been 40…

Hi everyone. I have BC/BS of Maryland. I'm not sure if I'm wasting my time or setting myself up for disappointment. I was wondering if anyone here has a similar story to mine and if so, how did it turn out? Ok so the criteria for my ins is pretty basic. 1. 40+ Bmi ; 2. 35-40 bmi with one comorbid (their comorbids are sleep apnea, diabetes, hypertension or "any other serious illness or medical condition related to weight") ; 3. Psych Eval. ; 4. 6 moths supervised weight loss. That's it. My only issue is my BMI according to BC/BS is 38.9. None of the comorbids. I'm getting tested for sleep apnea soon. Hopefully it will come back that I have sleep apnea. If not someone su…

Has any one ever been denied surgery by blue cross blue shield if so why. I ask because I will be submitting for approval soon and I want to be prepared

Hello! I am 24 yrs old weight is 226 I was approved for surgery May 19. Yey. However my surgeons office submitted the request to a hospital out of town which is wanting me to pay half my out of pocket which is $500 plus $200 deductible. Plus traveling & hotel I am looking at $900 before surgery. There is a credited hospital about 15 min away from that by doctors come I would have to only pay the $200 before surgery. If I tell my surgeons office to change hospitals they would have to cancel my current approval & resubmit & I could be denied!! I am stuck bc I do not want to get denied but $900 is alot for me to come up with at this time. What would u do if u wer…

Ok everyone it's lecture time. According to my little sister (a diabetic specialist) you either have diabetes or you don't. She gets so angry at the other physicians out there who Dx with Pre-diabetes. On average when a person is dxed they have had diabetes for 2 years!!!! There is a LOT of organ damage that can occur in that time. Maybe not damage that shows up right at that moment but a shortening of life overall. Anyhow, if we would rally out physicians to call it what it is, than that would help with the comorbidities and cut down on denials.

Hi everyone So I went to the seminar today and got a breakdown of the costs. Then I called my insurance provider (BCBS of Michigan) to ask what "tier" this surgery would fall under (I get my insurance through my provider, which is a hospital, so more of my insurance pays for services done at the hospital where I work, and pays for less for services done at other hospitals). I won't bore you with the details, but BCBS says that the surgery will cost my $400 dedictible and after that co-insurance will kick in. I will be responsible for up to $3000 maximum before BCBS will kick in and pay for the rest. But according to the packet I got at my seminar, it says that the h…

So my insurance requires a drug test before I start my 6 months and I can't even have cotinine in my system..I occasionally have a cigarillo or a cigar and I had a few puffs of one last weekend so the coordinator said I need to wait 30 days before she does a urine test..I keep reading that it only stays in your system for a few days to a few weeks but I am not a hard smoker. Either she's making me wait 30 days to make me not smoke for that long or the online sites are wrong but I'm thinking of buying a home test and if I test negative call her and see if I can do this early cause I don't want to wait till the end of June to start things.

Has anyone been able to get Humana to pay for Gastric Sleeve Surgery?

i had my first denial for my tuesday surgery for may 21 this thursday they r appealing it what if im denied again all my paperwork was sent the first time but they said they have no proof of they liued but anyway i was wondering has anyone been completely denied where they couldnt use insurance and also how many times can u appeal

I'm looking to change insurance policies due to BCBS only allowing 1 WLS per policy. Since I had the lap band I can't have another procedure. I only had to have it removed because of leak. I loved having it!

Anyone hear if Medicare has made any change to pay for the gastric sleeve I'm in Washington and having my surgery in Oregon .....

Hi all. Newbie here. Will insurance cover the conversion from lap band to sleeve? I was banded over 2 years ago and have had limited success with it and my doctor believes id do better with the sleeve. I have horizon bcbs insurance. Thanks!