Insurance & Financing

I'm having a really difficult time with Kaiser (SoCal Riverside) I met with a doctor and was told I'm approved for surgery since I have a BMI of 40. He said as long as I show proof that I've tried at least a twelve week program before then I wouldn't have to do their program that costs $200. Well I showed proof that I've had a personal trainer with all my weekly session logs, printed out a confirmation from when I bought 3 months of nutrisystem, and printed out a bank statement showing that I've done weight watchers ( I couldn't find my logs ) and they're saying it is still not enough to show that I've made an effort on my own and need to do their program! 1) I …

Greetings: All I need someone to explain how this insurance works. Already been preapproved for VSG Dr. charges $12k cash for turnkey job, all costs covered. My insurance co pays 15k max for surgery and all related expenses. Found out hospital estimate to me after surgery and insurance payout will be around 14k. ??? This puts total payout to hospital around 25k after paying my Dr. Somehow the math doesn't add up. Help !!!

I got a call today from my surgeons office coordinator... She is great and has been doing her best to get me approved by my insurance Anthum blue cross blue Sheild. I'm nervous because she said they need more information from my primary stating more health issues. I'm 5'4 225 and pre diabetic I've tried every weight loss program out there. And to top it off my husbands insurance changes June 1 so we are on a time crunch!!!! Ugh so upset? Anyone been here before? If so please advise. I'm ready to give up!!!

Round 3! Hopefully the third time's the charm! Round one-Anthem BCBS, would have been a go except long story short, hubby's company excludes wls from their policies! Round two-Aetna, tried and denied twice because my BMI is under 40 and my comorbid, hypertension is controlled on two medications, not 3! Aaargh! Round three-HSA qualifies BCBS, hubby now self employed and have this new insurance. Waiting a few weeks before hitting the new plan with this request. Anyone ever been approved for the sleeve on an HSA BCBS plan? I so hope this one is the winning round! Let me know your experience if you've had one! Thanks!

I just started this process. My PCP referred me to the NUT. I saw her today and she told me thAt my medical group (Hammond Clinic) requires I attend 8 months of dietary meetings then they can refer me to the surgeon & then he will submit the request to the insurance. Since it is an *** everything has to go thru the medical group. This is very confusing. I am still not clear who approves the surgery or why I have to attend eight months of classes. My fear is that I will attend the classes and they will turn me down. I am 5.5 tall. I have a BMI of 36.8. I also have high blood pressure & cholesterol, sever arthritis in my back & I am going for a sleep…

Hey everyone I know all insurance companies are different... But how long does it usually take to hear an answer? Should I call my surgeons office and ask them how it is going along? So confused and anxious and hopefully excited!!!

Does anyone have health plus ppo? Did they have issues with health plus approving the surgery? Just curious I have everything done just my referral is pending with health plus and this is all new to me, do was looking for in sight on this!! Thanks

I had my last session with my NUT Monday. Found out they had submitted the preliminary paper work on the 15th. They submitted my clinical notes on the 23rd of April. Now the 5 day wait begins. Fingers crossed I get approved. Worried because most everything I have read Cigna is a nightmare. Excited, can't wait.

Does anyone have coverage by them or been approved or denied by them?

I spoke to United this morning and they have received everything from my surgeons office yesterday. I am lucky to have a plan that did not require the 6mo nutritionist/medical diet. I got a little delayed because I was laid off in the middle of the process and had to wait for Cobra to kick in but everything seems to be going in right direction. I hope they approve me soon so I can have a May date since I am holding off on finding a new job. Otherwise I have a short window of time to get on another insurance plan at my second job, but they use Aetna and I would have to start the 6 month medical supervised diet. The timing is so right for this surgery to happen now tha…

I got approved today with one dietitian visit and a therapist clearance. I am 5'4" 215 pounds and have type 2 diabetes, high blood pressure and anxiety!! I am excited. They turned in the paper work Monday and approved me on Friday! I am scheduled for April 29th.. I put these details because these are things I was curious about when researching about insurance approvals and people's situations

Has anyone had any luck getting Canadian insurance companies to cover Lapband? I heard from a friend that great west life denied her. I hope I have better luck with sunlife!

Can I just say that waiting is horrible. I have no patience when it comes to waiting for approval. My impatience is so bad that yesterday while I was drugged up on benzodiazepines from major dental surgery I called both the insurance company and the surgeons office. OMG...there is no telling what I said and I remember some of what they said. Did I mention waiting is horrible? -.-

Any tips about this insurance now that I only have one more physican supervised appointments left !!!!!! Bcbs federal NE

Expected it but still devastated

I have blue cross blue shield of Texas. I have a lap band and am wanting a revision. I called the insurance company to see how long it would take to process my approval and they told me that they had already reviewed my case and they needed more information about my band from the doctors office. My band has not slipped and is working- just not effective. I'm really worried they are going to deny me. Has anyone had a similar experience? Or anyone just wanna guess if asking for for info is good or bad?

Okay so I have read several things on here about them and have some questions. 1. Do you have to do a six month supervised diet to be approved? 2. Do you really have to pay up front for your surgery and if so how much estimated? And does that include the deductible? 3. Is UHC hard to get approved through? 4. Also, does UHC cover a tummy tuck for any reason? (Like for a hernia?) Just some questions that have been buzzing through my mind, thanks for input!

Hello! I am 37, in Dallas. 5'5" 200lb. My husband is a Teamster and we have excellent coverage thru BCBS of Illinois....BUT...all WLS are deemed cosmetic and are excluded. Here's my question: I have a documented hiatal hernia, been on dexilant for the past year. My insurance will cover hernia repair at 100%. I am thinking it should not be the entire self pay price to get sleeved along with hernia repair. Has anyone else had a similar situation? ~ L Nor in TX

I don't have any kind of insurance any advise on finance companies or any other options if any?

So i got a called last friday to say that i was approved...the lady was was talking on the phone but all i could hear after that was waaaah waa waah waaaa wah ( i was just zoning out from finding out) and i asked if the approval was for insurance says yes, that there is more paperwork to do and that a few more appointments before actual surgery (she hasnt given me any dates for anything so far) i was like ok ....but then i wanted to double check just like a lot of people do so as to cover all my bases. I call bcbs of mi and asked if surgeons office sent info to get approval.. says that no they havent sent anything but that is not so much as a paper approval letter from BC…

I have BCBS FEDERAL...they require a 2 medical history of being obese... I have been overweight since I was 7 (I'm 22 now). Thing is, I had my daughter in 2009...my 6 weeks post-partum appointment was the last doctor appointment I had until Nov 2012...there is a 2 1/2 year gap of no weight documentation But, I did weight watchers from 2010-2012, thank goodness I used the e-tools to track my weight online.... has anyone submitted documentation from WW as weight history and been approved??? Thanks!!

Has anyone had to pay more after their insurance's percentage? For example, my insurance will cover 80% so I will have to pay 20%. So I know how much that will be, but what about the anesthesiologist, hospital room, etc.? I know everyone's insurance is different, I'm just trying to get a feel.

Have any of you applied for a loan through surgeryloan.com? If so, how long did it take for them to get back to you? I've tried calling customer service to check on the status of my application, but it seems impossible to get through!

I'm new to the boards and have been researching the Lap Band, specifically the Lap Band with plication. I'm curious how much it costs for self pay in NYC. My insurance covers weight loss surgery but I don't think I have a chance of getting approval. My BMI is 35 and I have no comorbidities. I do have a family history of diabetes, high cholesterol and sleep apnea.

I was going to get the band till my Dr. Told me straight out not to do it that the sleeve would work better for me. So now I have BCBS *** IL and was wondering if anyone else has the same and can tell me what to expect. I have already done the 6month diet documented by my dr. I have met with my bariatric surgeon now I'm waiting. Can you give me time frames of what you went through from the time you met the dr till surgery date!?!? Plz any info would help

Secondary approved Aetna but primary denied anyone had this happen ? And does secondary usually pay like a primary would

So at my last trip to the surgeon he told me I had a hernia... I have horizon nj direct. I completed all my appointments and thought I was good to go but then the office told me they also wanted 2 years of weight history.. Which for me has become a challenge getting that, and also a few years ago I was put in methotrexate which is chemo therapy for my sever arthritis and lost some weight becuz it made me sick to my stomach, so 2 years ago I wasn't at a 37 bmi as I am now... My whole life I was heavy n now they want the only time I lost a few lbs becuz of chemo! So my question is if my insurance denys me becuz of those 2 years but they approve to have the hernia fixed how …

My paperwork was submitted to my insurance yesterday. I'm disappointed that they said it could take up to 30 days to hear back as I had to do 6 months of doctor visits already.

Im super worried they wont approve me because of my age or something im dreading it helpp?

Yeahhhhh I'm APPROVED!! Got call today May 10th @ 4pm!!

Anyone have BCBS Anthem and get denied? I have almost 38 BMI, severe obstructive sleep apnea, high cholesterol (on meds), very high triglycerides, thyroid issues and fatty liver. My doc thinks I wi be good and so do I but I have read so many horror stories.

The surgeon's office said it could take Anthem BCBS 14 business days to respond. Now I look at my phone every ten minutes to see if I missed a call lol

Have anyone had to wait on a peer to peer review with aetna ins to get approval?

Blah... everything submitted on April 11th. Keep calling to check for updates and was told today that they are requesting an "interpretation of my weight history". WTF? My PCP submitted my weights for the last several years in a graph form, which clearly shows the weight and date it was taken. What else do they want?? The surgeon's office said they will take care of it but I'm so irritated, lol.

After 15 months of this tiring process, I have officially been denied by Aetna...TWICE! Just got the news today. BMI of 39+ with sleep apnea...not enough for them! You can kiss it Aetna! UHC approved me in one day!!!

Sorry to be a post hog today Was just wondering for anyone who went through the Aetna approval process if there is anyplace online to check? I have a reference number and the representative told me I could check for any updates online but I can't find where. Do anyone have any experience with that? I looked in my portal but all I see where I can check completed claims, not pending preapprovals.

Hi I'm new to this has any one had the sleeve though kasier total cost ?

Anyone know how long it takes cigna to give approval?

Have any of you financed your surgery through your bank (chase, wells fargo ect..)? I am still trying to find a way to finance carecredit denied me i am crushed! I have insurance but dont meet the requirements 100%...

So I have been doing my research for nearly 3 years now; and i had many issues when i had insurance trying to get approved for Bariactric Surgery. Now that I no longer have any insurance i am 100% certain that i want to Finance the full surgery... Have anyone in the Michigan area Financed the full surgery and What process do i have to prepare myself for? I am very determined to be healthy i currently weigh 292.8 and i'm 5'3. Is there anyone with any kind of advise?? Thanks in advance

Was informed that my surgery is gonna cost a lot more out of pocket than I expected. What are good ways to finance the procedure

My surgery was denied two months ago for not enough pre required visits, my insurance originally told us I only needed 4, 1 each month they denied within 3 days stating to my WLS office I needed 6 months of visits, I finished and they resubmitted yesterday! I called my ins today it is being reviewed and they said it can take up to 10 days, not to bad. But I'm so hoping they don't find or try something else stupid saying I need to do or I'm not qualified etc! I want to be revised from band to sleeve I'm so done with being overweight!!

Hi all! My insurance only required me to get a letter from my PCP and a psych eval to do surgery. Got the psych eval done yesterday and my letter from my PCP a few weeks ago. I called this morning to find out if they have received everything to submit to insurance. I didn't hear anything today. Do you think I should be "that person" and call again tomorrow? I really need to have this surgery this summer otherwise I'll have to wait till NEXT summer... I live in AZ and am being sleeved at BGMC if any if you are familiar with it. Any advice??

Aetna Ins... hell.. We have all this money deducted from our pay each pay period for ins....and still have to go to hell and back just to qualify for services, all the info they requested was turn in ..Why is my case still pending two weeks later?

My insurance is up for renewal in may. My surgery isn't until June/July. We have Medicaid managed care through united healthcare. My husband got a new job making good money so we will definitely be dropped. His job's insurance is horrible. I was wondering if there is any state insurances that I would be placed in, even if we had to pay monthly for it? I don't want to have my insurance lapse and have done all of this work for nothing. I NEED this sleeve! Thank you

Im going to be covered by heath plus in may. I'm starting the process of trying to get a sleeve. Has anyone been approved or denied by this provider?

Just need to vent, and open to any help of anyone with any knowledge. My story so far, ended up in the ER in November with a bad lapband slip (3rd slip) Doctor wanted to do an emergency removal, begged her to wait until after a family wedding in December (which we ended up not going to since I was so worried about the band, and flying). During my EGD it was discovered I have a bad prolapse of the band. food is getting caught in that pouch hanging down the back, pressing on the band and causing a lot of pain and stuck food. Checked with insurance (FEP Blue (Regence in Oregon)) about removal and revision. Was told 3 mos nut, PCP, psy, sleep etc which I did. Removal …

My insurance company said "No, we don't cover weight loss surgery and tried to hang up the call, but I didn't let them. I pushed and pushed and documented EVERY call, email, fax, etc. two months into this phone battle, they said they have no record I had ever called asking about this procedure. When I sent them my "notes" (date, time, name of contact, discussion points, action points, etc), they saw I wasn't messing around and suddenly became very cooperative. They approved my surgery after a six-month stall of Nutritional Counseling. I hated the delay at first, but now, I'm so glad I did it. It gave me the time I needed to TRULY make peace with his drastic life cha…

I was reading the benefits brochure and notice I would have to pay 30% for plans agents, drugs, and/or supplies administered. Can you share with me how much out of pocket this was for you. I am looking into have surgery at Emory University Hospital in Atlanta and wanted to know how much out of pocket I will need to pay.

Wow what a journey it has been for me! Last June i started this journey and have jumped threw sooooo many hoops. Was denied end of last year didnt have all info that insurance needed due to a coordinator not caring about her job ! Best thing happend she lost her job and i got a new coordinator that actually cared about my case! Thank u Tori! I have all my ducks finally lined up and should have no reason for denial! Bmi is over 35....2 cormorbites.... Phyc eval done... Sleep study done... Egd done... And 6 months worth of documented nutritionist visits....please send good vibs my way! Thanks y'all have a good day