Insurance & Financing

Hi all- I am just beginning the process, contemplating being banded. I had looked into it, attended an info session, 3 years ago, but had Blue Cross of NJ at that time, and they required 6 months of a medically supervised weight loss program. I was inpatient, as well as engaged to a very unsupportive man so I didn't pursue it. Fast forward 3 years, I now have Amerihealth POS Plus, and am living with a wonderful man who will support my decision 100%. I called my insurance company and they were very vague as to what's involved for approval. I am attending an info session tomorrow with a different surgical group (the one 3 years ago seemed a bit like a factory to me - too …

hi everyone, waiting on my approval or denial from my insurance company, wondering if you guys have experience with blue cross blue sheild comorbidities. i have osteoarthritis, kidney disorder, acid reflex, difficulty breathing, hs (skin condition). family history of diabetes and heart conditions and obesity. Also have proof of 5 yrs of being obese. i clocked in at a bmi of 37. gave all my paper work, nutrition classes, group meetings, medical necessity letter and phyc eval. what do you guys think? approved or denied????

37 year old female, 255 pounds, 5' 10", 37ish BMI over 35 BMI for at least the last 8 years 3 letters written for medical necessity - surgeon, PCP, back specialist 1 personal letter from myself Documented Conditions (comorbids but not "technically according to Aetna) - depression, chronic migraine syndrome, metabolic syndrome, high triglycerides, prediabetes, herniated discs, spinal stenosis, joint pain Just trying to take the lightheartered approach since its now out of my hands, lol. Submitted April 11th and I confirmed Aetna has the file. They have up to 15 days. Any bets or Approval/Denial and when... kind of like the baby due date/sex game

I have Humana. I went to the surgeon for the first time last month - he scheduled a Venus Doppler and EGD, etc. A few weeks later I get a bill for $289 for that appointment. Not the tests...just seeing the doctor! I called Humana and they said the surgery would be covered but not the visits to my surgeon. I think that is insane! They said they don't cover anything coded "morbid obesity" other than the surgery itself and lap band fills, which doesn't apply to me. I called the billing department back and they said they would try to rerun it with a different coding, but they couldn't promise anything. Has anyone else run into this? Louisville, KY ~ RNY June 2013 ~ Sent fr…

Hi. I am having RNY next Tuesday. My insurance company has a specific clause disallowing all WLS. I am self paying 26k out of pocket for this surgery. However, I am getting EOBs from earlier visits for nutrition, lab tests, psych eval that have all been submitted through my insurance company and they are paying those charges! They didn't pay for surgeons visit, but basically everything else. Now, on Thursday, I have to pay my 26k. But they have already been paid for items included in the flat fee. When I asked at the clinic, the lady said, oh well they weren't supposed to charge that through, you are self pay. Duh... I know that. S I told her that her office did. Sh…

Ok I my insurance pays 80/20 and I have out of pocket max of 1500. I have to pay surgeon 800. How does the hospital bill will I have to pay them upfront or what??? The most I can pay out is 1500 but I just want to know and they are busy and I've left voicemails no callbacks

Most, if not all, of the bills are in: $66k for the hospital, $32k for surgeon's fee, $31k for assistant's fee, $3400 for anesthesia, and various lab and xray charges. I'm at almost $140k, before insurance. I was a simple, no-complications revision: one night in the hospital, 4 hr operation. All claims received for doctors and ancillary providers have been processed and paid, insurance paid out almost $5k. The allowed amount for one night in the hospital was $9500, but insurance has denied the claim in full, and I'm responsible for the entire $66k (I know I can negotiate this down, but am not to that point yet). The reason they denied it, is that they say I've maxed…

Happy to report that I was approved today! 40.1 BMI- waiting for my pre-op scheduling!!!!

Hey everyone, there's an awesome $500 giveaway contest being drawn, by Carnie Wilson, at the WLSFA (Weight Loss Surgery Foundation of America) event on Saturday night. Everyone can enter. The info's below in case you want to take part! There's only 5 more hours to enter, before the contest closes! RealSelf.com $500 WLSFA Giveaway On Saturday, 18th May, 2013 RealSelf.com will be giving away a $500 prize, to one lucky person who has entered the RealSelf/WLSFA giveaway. RealSelf will also match this amount, by donating $500 to the WLSFA. In order to enter, you simply have to write a review of your WLS journey, which will then be shared on RealSelf.com. You can do this b…

A little over a year and three Drs later its finally going to happen.

Still shaking...still crying....so relieved!!!!

So I'm almost done with my 6month weight watch requirement. I only have two more visits left and then I will be able to be scheduled for surgery. I was just wondering if anyone who had to do the 6months had a problem with having gained weight and being approved? I've gained 7 pounds in 4 months and I'm afraid my insurance is going to deny me if I don't lose the gained weight or gain even more. My BMI is 41 and I was told by my nutritionist that I should watch losing too much weight so my BMI doesn't dip too low. But what if I do t stop gaining? I'm eating right. It's just portion control that I'm having trouble with. But the surgery is going to basically control that. So …

So for those of you who have decided on the Lap Band surgery and that have Medicaid who has gotten approved for full coverage for the surgery. And if you havent how many times did you get denied before you got approved and how long did it take, also do they cover tummy tucks for lose skin caused by LB surgery?

IN 5 days! I called the customer service line to check my authorization today....and it said I was Approved and my approval number! Usually I would get a live person to explain where things were. My surgery is on Wednesday the 24th...so to all you Cigna insurers....follow their criteria exactly as outlined for approval. I used my PCP to do my nutritional 3 months of supervised dieting. Coached her on how to do 3 separate clinic notes and the buzz words she needed to mention so that they were highlighted in my clinical picture. My BMI was 38-39. With a long documented history of OA of both knees and severe sleep apnea( diagnosed during my assessment and complaints o…

Does anyone have UHC and have to go thru BRS for approval. Please tell me all about it. I know my ins covers the surgery I'm just wondering how long approval took for u after they submitted and if u ran into any problems.

After one deny I finally got approve thanks god surgery may 16

Hi everyone. So I was banded 2 yrs ago....in the state of New York where I lived. I just recently moved to West Virgina (Summersville) and I am in GREAT need of removal of my band. NOT because its not working, because I am having sever problems with it. (Not being able to swallow, eats most foods, constant heart burn, throwing up blood at times) This has been going on for over 9 mons. I was very, very nieve and ignored all this simply because I thought it would go away! But I am at my breakign point. So heres my issue, I am uninsured, again, I lost my insurance because I moved out of state. I am TRYING desperately to get insurance so I can go to a Doctor and for remova…

Wondering what the cost is to have a band removed, if you were self-pay?

I also posted this in the Band to Sleeve Forum. I was banded in 2005 and did great - lost 140 pounds in 2 years and maintained until leak in 2009 and also found out I was pregnant - so no restriction and pregnancy was not a good combo and couldn't get band repaired until after baby. Gained half the weight back and then in 2011 got the band repaired (ended up just the port had to be replaced) and lost the weight back. Last October, noticed I did not have any restriction and fluro xray confirmed a leak again (where unknown). I have now gained over 40 pounds since then! I am a federal employee and had GEHA since 2005 (BCBS would not cover band at that time). Both my hu…

I still have not heard back from case manager.. I call every day and my paperwork has been there over two weeks... I spoke to case manager Monday and she said she would be looking at my case that day or next day... Called back yesterday to check again.... And cust service said oh it's been changed to In process... Big deal... I'm trying to stay posit ie but getting harder and harder... My partner is having baby at end of year so I was hoping to have surgery before that happens. The only thing the lady said was well its just a busy time of year ...

My surgery is sched. For may 30th... My paperwork was just sent out... So my question is when should I start checking the status. I have horizon nj direct access! I'm so anxious, excited, and mostly worried that I'm getting myself so excited and then I won't be approved!

How long did it take to get your answer? My stuff is getting submitted on June 3rd and then as soon as I get approved we can schedule!

I currently work for my insurance company which is good and bad. Good thing is I know what needs to be done and the process of approval a little more firsthand. Bad thing is, I actually KNOW the people who will make the decision. With HIPAA I'm not worried about my business being spread but more so with a decision being based on me personally. I qualify completely and once I meet guidelines Ill submit for a decision but has anyone else had an experience like this? They can't base a decision on "We saw you eat a chip at the work party so you aren't committed" type of deal, right? Just looking for input. Thanks!

Long battle with Aetna ...finally approved....better health here I come!!!!!!!!

I've been reading through this forum's posts and I don't see anything current about ChampVA. Since I wasted four months going through the hoops my surgeon's office put me through because they didn't understand what ChampVA wanted, I'd like to post the information that may help others. This is directly from a current letter (February 2013) from ChampVA. In most cases WLS does not require preauthorization. Coverage is provided for lapband (Lapband brand, btw), vertical banded gastroplasty, gastroplasty (stomach stapling), Roux-en-Y, and revision of gastric restrictive procedure. "Surgical correction of morbid obesity benefits may be extended only when one of the foll…

Hello all! At 33, I am 5 feet and weigh about 230 lbs (weight has went from 190-230 over the past few years). I have high blood pressure for about 6 years and take 3 medications for it. I have always struggled with height and nothing has really worked. I can lose 10 lbs but then just get stuck and will gain 20. Based on your opinions and experience, does it sound like I would be able to get approved??

Hello, I am doing my research into the procedure, but for those of you with health insurance (I have United Healthcare), how much do you have to pay out of pocket? Also, if you have to pay anything, do you pay your portion upfront or are there payment plans? Thank you!!!

Hey I am new to this app and I am tremendously nervous and scared that I may not get approved my BMI is wayyyy over 40 and I am border line diabetic. I am waiting on my psychiatric report to be sent to my surgeons office. My question is has anyone had to deal with Cvs medcost or CVS Caremark? Is this insurance hard to get approved with? ANY advice at all is greaty appreciated. I hope everyone has a great weekend and Happy Mother's Day!

I am trying to do the Aetna 3 month program however there are no dietians around me that take Aetna. I know I have to see one with the surgeon but will that be enough to cover the requirement? Also I am stressing because I do not have 2 years of weigh ins on file BUT I have been overweight and basically the same weight and size since I was 16 or so. I just have been moving around a lot and haven't been to a PC in a while. I do have 3 weigh ins in the last 3 years. Has anyone had trouble getting approved because of the 2 year history? I am so nervous but I really want this surgery soon.

I've called my insurance regarding having the lap band surgery and what my coverage was and they told me I have no coverage for bariatric surgery unless they got a letter from the dr saying that it was medically necessary. I have yet to see a bariatric dr(I'm going to a seminar on Tuesday) yet and I'm a little scared/nervous that he won't see it medically necessary for me. I've been 100+ over for about 6 years now, my BMI is 45 but I have no diabetes, high blood pressure or sleep apnea or anything like that. (i would like to prevent that). I've tried dieting on my own and have been unsuccessful. Has anyone had any experience with having there Dr write up a letter? And wha…

I am so extremy nervous and anxious that i will not get approved... I heard from a lot of people the Empire BC/BS is somewhat easy going and has not really denied anyone... Anyone else have this insurance ??

So my doctors office faxed in my stuff for pre approval about 2 weeks ago. I began calling Friday to see if they had approved it or not yet. They swore they hadn't received anything. Repeated that Monday, Tuesday, and today...still nothing. So I called the doctors office and they said they'd re-send, but call Cigna and get them to check the "fax cube." I did and guess what, it was there the whole time! They still say it'll be another 5+ business days before getting a response.

I just met with Dr. Cirangle yesterday and decided on the sleeve. Anyone know the out of pocket cost or can I get a loan for the 10% not covered? Which is a good financing company to go through? If anyone has any advice I'd greatly appreciate it. Don't wanna get too excited if it's out of reach.

My pcp will not write another letter supporting my case for the band... I'm waiting on approval from Anthum BCBS... I wrote a convincing letter myself and hoping and praying that it works to get me approved... With a bmi under 40 and no other aliments I'm feeling doubtful. I'm so ready for this surgery I can't think about anything but getting approved!!!?trying to stay hopeful.

I had seurgery for the Lapband May 2010. I lost 80 lbs and have gained it back plus more. I called my ins and they said that bypass is covered (it wasn't at the time of my band). I have completed all my requirements needed in order to be considered for the surgery but today I found out that the ins only pays for one WLS per lifetime. Will I have a chance if I appeal? The denial has NOT been received yet and I am hoping that it will still be approved based on all the documentation. Any ideas? Thoughts?

I have UHC and from what I've read of other people's posts on here I'm starting to get a little nervous. No one has mentioned anything to me about a required 6month dr monitored diet, no ones told me anything about possibly having to pay my portion of the costs upfront. Do you really have to pay upfront before surgery? I've never had any kind of surgery or procedure before, so I never even thought of this as a possibility. If that's the case, I may not be having surgery after all.

I have bcbs and I was told I had to have 35% BMI...is that at time of weigh in at the surgeons office...or is it a history of over 35?

I just wanted to share this, a friend told me about it and I am so thankful! I know this may not be the same in all states. My doctor did not even know about this. I have insurance with United Healthcare. My insurance does cover the lap band surgery, but only 90%. I am not able to pay the rest of it out of pocket, so a friend told me about a place called Arkansas Rehabilitaion Services. I made an appointment to talk to someone there to see if they help out with this. They do! Every case is different, but I was told that they want to help people that need to get a job or hold on to a job and can't or are having problems because of a health problem. In my case, It…

I got the call from the coordinator saying I was approved today. Have to go down and discuss surgery dates next week I'm Nervous and excited. Emotional overload but joy

I really dislike it when one asks, "Is this the total cost? Are there any other fees?" And the response is, "No mam, that is the total cost; it covers everything." Only to find out that there is a $1300 fee for the Endoscopy, $500 for the hospital registration, $150 gall bladder sono.... Arrrrrrrgggggg! I'm self pay and I barely have the money to cover the cost...would it be to much to ask of these people to give you the courtesy of a warning/heads up of these costs, so one can prepare? Instead of having to stand there like a speechless idiot because I'm shocked at the unexpected charges. SMH Sorry...just venting.

I'm under my husband's insurance which is health net. I tried to get approved but the employer excludes bariatric surgery/assistance. So we tried going the hernia route and because the band would be during the hernia procedure it was once again denied. Is this something I can appeal or is it an losing battle to begin with? Thank you for your feedback...I have been trying for years and it just doesnt get easier to get approved.

I'm having some questions about submitting my insurance claim for surgery with or without the sleep apnea sleep study. I know I have sleep apnea but my appointment isn't until after my submit date. should I wait until I after i do the sleep apnea study then submit to CIGNA or should I go ahead and submit it without it being done. Do you all think that having sleep apnea affects your approval? Has anyone submitted and gotten approved without sleep apnea ?

My doctor said they submitted everything on the 25 and I'm wondering how long this process will take.

Hey all, i was just wondering if anyone can answer my question. If i dont get approved by my insurance, and i won't be able to pay or save up by anytime soon. Can i still get a loan, i have bad credit am a student and have no job. What loans if any? Thank you

I have Humana PPO plan through USAA... Anyone else have them? I'm going to a seminar for lapband Friday and wanted to know if anyone else has had experience with approval through Humana. I'm hoping for an approval, just don't want to do anything wrong to prolong the process... Any tips would be greatly appreciated!

I'm almost done with pre op appointments & am extremely nervous about getting denied. I've spoken to Aetna's Bariatric nurse about 4 times and she feels that I'll be fine. I'm just so desperate at this point to lose weight. Any input would really be appreciated.

I have all the codes for tummy tucks,arm lifts,thigh lifts,Breast lifts and they can't tell me if they cover them they can only tell me if I need pre otherization =.= I have trillium which is state insurance for Oregon..

So I stated a new job two months ago and filled out all of my benefit paperwork and turned it in ASAP. I just found out that HR didn't submit the paperwork so I have no insurance! It was supposed to be effective as of April 1st, Now who knows how long I have to wait. I was all set up with all my appointments at the Dr,'s office and now I have to reschedule everything, I just want to get the process started. Ugghh. Once my insurance starts, it is 100% coverage, I have waited over a year to get the right job with the right insurance. I am so mad some stupid paper pusher messed it all up.

I currently have McLaren Medicaid. I lost my job and have been covered by them for the past year. My BMI is about 50 and I've had a couple appointments. In the beginning the doctor said surgery date maybe around end of September. But last week they put me on a PreOp Diet. The diet consisting of three Protein shakes per day, 1/2 sandwich, and a weigh watchers meal. Does this mean my date is going to be moved up? I'm getting nervous wondering what that means. I am scheduled to go back to work at the end of August. I don't want all this hard work to go to waste... NEVER LET YESTERDAY USE UP TO MUCH OF TODAY! BE BLESSED

I had lapband surgery last year and have had several fills. I am now on Medicare and a wondering if that will pay for future fills. Anyone have experience with this?