Insurance & Financing

Hey everyone, I've been reading alot on this insurance topic but havnt seen much about horiZon nj direct access.... Just wondering if anyone had some info for what they require. I called my insurance and all they said was I just need a letter of medical necessity and pre auth.... I am 5"3 about 210... I have pcos arthritis and very high blood pressure, my surgeon said I was a good candidate but I'm nervous about the approval process. I already did my upper ugi swollow study saw the psych, the nutritionist, a pulmonoligist and my regular dr. I have an appt on Monday with my surgeon again. I'm wondering if they will send my stuff to the insurance at that time? Any help from…

I have UHC. They have 3 requirements which is BMI of 40 or more, a 5 yr weight history and show that I have tried and failed. The only time I have been under a 40 BMI in the last 10 yrs was when I tried a diet and was on liquids for 8 mths in 2009/2010. I lost weight, but failed obviously. My insurance denied me for trying. I have an appeal in, but has anyone ever won an appeal? Thanks

Hey everyone, I'm currently in the beginning stages of getting a lap band and I was wanting to know of any issues people have had with BCBS of IL. I've had my initial consultation last week and I have a psych eval, meet with a nutrionist and I get my physical all in one appointment. I was also wanting to know what to expect in this 3 in 1 appointment from everyone I'm going to meet. Thanks!!

Even with insurance coverage what were your cost after surgery.... Anesthesia?? Hospital stay???etc

Hi people@ I would like to know if anyonee in the forum has insurance approval to sleeve with 35 of BMI, and diabetes or any other comorbidities???? Thanks!

I have BCBS of Minnesota and I have to have 6 months superivision by a Dr. with a diet. This is so frustrating to me because I have been trying to lose weight on my own forever and I just want to get the surgery already and move on with my life. Anybody know any ways around this? Any success stories?

Anyone have Aetna insurance with 4 month wait and 3yr proof of 40 BMI ? If so did they put you through the ringer or were they cooperative...i just don't want to be all geeked up and the big insurance company try to throw a wrench in it to save their big pockets

Hello Everyone! I am trying to find out for a friend who has Medi-cal (LA Care) if they approve/cover bariatric surgery? I was telling her she should really look into getting referred but she isn't sure if they even would offer it to her.

I'm covered by hip and I have no idea if they will cover a gastric sleeve surgery. Has anyone heard of hip covering it?

How much do you have to pay for surgery if you have a primary and secondary ?

I went to dr and my bmi is 50.7 he put in for referral also attended a bypass seminar. got great info so I called my insurance and they said any weightloss programs I choose are out of pocket. They read me a long list which basically says no matter what my doctor says even life threathing its not covered

Hi All, Well 3 years ago I joined these groups in search of forum to learn about lapband. I went to the orientation in Fremont, and I found out I was pregnant shortly after starting. Now my twins are 2 years old, my son is 5 years old. I HAVE to get healthy this year and looking at asking Kaiser for a referral again. I live in the East Bay so Fremont is pretty far haul for me. Richmond is so much closer, but at the time they were not taking new patients. Does anyone know is Kaiser Richmond taking new patients again? I see Sacramento opened it's own unit so I am hoping this means Richmond is taking bay area clients again. How long does the process take from start to f…

After a denial and sending an appeal letter, I just got approved!!! Super exited! Surgery next month

I have read through many of the Cigna posts trying to determine my chances of getting approved based on the successful Cigna insurers on this site. But there have been a few things I wish I knew so I could compare stats! If there are any of you approved Cigna sleevers who post on this site and would be so kind to help me out with filling in the gaps, it would help me better prepare what may potentially be my chances of approval. Can you share your approval stats like: BMI, how long with that BMI, co-morbities how long have you had them, did you do your weight loss plan with your dr or Nut. If your coverage required 3 or 6 months weightloss. I sort of meet insuran…

Prior to surgery in October 2012 a case manager had called to ask if I had any questions or concerns and called again right after surgery in the hospital for the same reason. I had a rough start and had several dr visits and EGDs for a stricture. Now almost 6 months later and close to 100 pounds lost and I recieved a letter from BCBS Texas asking for me to be apart of a case management program. I had never heard of such a thing. Has this happened to anyone else?

Due to them not responding on your file or some how messing up you process of approval? Bcbs of alabama... ? High level manager taking to the board to request waiving as they didnt communicate or call me when it was declined for 6 month diet not being within the last year.... If I would of know declined in Sept, I could of started over the diet and been nearly done(by march) supervisor agreed and submitted file when he found out they hadn't told me.... U think I should be hopeful? Anyone had it waived ? Through your ins? Or bcbs?? Thanks and fingers crossed!!!!!!

My best friend is doing her Options classes through Kaiser in So Cal. Requirements are to lose 21 pounds. She has lost 6 pounds and has a about a month left for her last weigh in. Has anyone gone through this process? We are scared that they will deny her if all the weight has not been lost!!! Advice needed, help please

Hello my name is Melissa this is actually my first thread on here. I'm 24 years old. My whole life I've suffered from obesity and my weight has constantly been a yo-yo. I started my journey to get the Lapband in December I saw my dr in northern va and we decided the band was the best option for me. My BMI has always been close to 40 or over my entire life I've seen my primary care for 10 years now and have always maintained an ideal 'overweight'. Well Aetna required me to do 4 nutrition visits which in the beginning they said it was 3 since I started in December when January came they all of a sudden required 4. I had my psych Eval and passed that. My weight in 2010 was 2…

Hello everyone. :-) my job has a total exclusion..so i am a self pay...13200...but they will remove my gall bladder because i have gall stones..my insurance should def pay for that,.i really hope i can get some of that cash back...anyone had this happen???

After hearing from my Dr's office that they have found Untied healthcare to be rather picky, with a rash of recent denials, they sent my paperwork over at 4:45pm on Feb 11th. This morning I receive a phone call telling me that my insurance has approved me! I am so excited!!!!!!

Will insurance typically deny surgery if weight is not lost during the pre-op diet?

I am looking for some positive experiences with Cigna... My doctors office is submitting to my insurance this week and I am more anxious now than i have been the whole last 6 months. Here is what they are submitting I have a BMI of 40 I am on medication for high blood pressure PCP clearance Cardiologist clearance 3 month dr assisted weight management Eval and recommendation from bariatric doctor Psych eval and clearance Only thing that I can not prove is that I have been at a 40 bmi for 24 months or greater... But, no where does my coverage info state that is required.. I am really having trouble with my patient coordinator and I am actually calling and spe…

Hello everyone, I am fairly new to this forum. My question is has anybody went through AvMed Insurance? If so, was the 6 months supervised diet complicated?

I have read so many horror stories about Cigna. Anyone get approved the first time? How many business days do the have to respond ? My insurance coordinator said they always come back the first time saying they are missing paperwork. Hope to be submitted after my last NUT visit on 4/22/13 Any tips would be awesome.

I just got off the phone with my doctors office. I have my nutritionist appt. this morning and they called me and said to attend a financial counseling class they were offering at the hospital today. Why would I need to attend this class if my insurance is going to pay. Keep in mind my paperwork has not,been sent in for approval yet so I am freaking out that my doctors office may think I may have to self pay. Or am I just freaking out for nothing?

Hello everyone! I was wondering if any of you know if volusia health network covers the lap band?

I finally got the nerve to call my insurance company to see if I was approved. They said as long as they receive the letter of medical necessity, it's a covered expense, so no problems! I'm amazed how easily it was!

I was approved today!!! Paperwork submitted 'Monday afternoon . I was approved by Friday at 10am. From what I have seen posted here, I was really worried. But It appears that those who are denied are denied due to missing documents or requirements. . If you do a search for Cigna Bariatric surgery, you will find a list of everything that is needed. I would make sure to check that before submitting. Good luck for all pending approvals!!

I was just wondering if insurance pays for all of the fills if they pay for the initial surgery. I have Tricare/United Military insurance

Fingers Crossed

Just curious the reasons for denial

Now i have 2non working days.....this ins.approval is killing me...well not actually......

Do they cover? If so, how much? Any requirements before approval?

I submitted all my paper work on Friday 03/15/13 to the coordinator ... Now I have to wait to be approved by Cigna hopefully I am not missing no paper work????

6 month diet over, all evals over, according to the surgeons office - they submitted everything to insurance yesterday- so now I wait...... Nervous since my Bmi is between 35-40 but off of their list I have 5 comorbities listed in my letter from my pcp. Fingers crossed.

I'm thinking way ahead, but have questions about loose skin issues and removal. I'm 215 now with no surgery date yet, and my goal is to lose 80 lbs. Is losing 80 lbs going to leave me with saggy skin? Is there any body lotion/cream to help me keep from having loose skin as I lose weight? I doubt if my insurance would pay for it if considered cosmetic.

Hi.... anyone here has experience with these insurances in MA area?? Thanksss!

Still pending because I decided to use a out of coverage doctor....has anyone with aetna Ins face this problem?

My surgery is scheduled for Tuesday 3/12 and today (Friday) after 12 pm they want 5 years of my documented weight. I have called any and everyone including my eye doctor to see if they wrote down my weight. Freakin ridiculous.

So I have my last meeting with the nut in my surgeons office, I lost,gained lost but think I have gained. I have been sick, was on steroids and three different antibiotics. Will insurance deny me because of the gain? I am also diabetic which hinders me losing. Any advice. Thanks Sissy

How long...did it take

My insurance (BCBSM) said covers lap band, but have to have BMI of 35 with a comorbidity (sp).... My BMI is right about 33... Should I discuss with a lap band dr or just forget about it?

Has anyone on here delt with Aetna Insurance? They require a bmi of 35 and 2 comorbidities. I have 3 of the major comorbidities but my bmi is only 35.3. I have had my first appointment with the surgeon, first nutrition consult and my psych eval is next week. I am very nervous about approval. Any input would be much appreciated!

Does anyone know anything about magancare insurance. I have it throught my exhusbands job. I believe it is local 888 union. I cannot do much research online b/c i do not have a home computer and many sites at my job are blocked. i cant find anything on the magancare site about bariatric surgery, the 800 number is like talking to the wall i cant seem to get a live person. The only thing that i was able to find on the website was that the surgeon i am looking into is "in network". Anyone know the requirements for this company? TIA!

Hey all! Does anyone happen to work or be well knowledgable in the change over? I received my approval to see the Surgeon and attend the seminiar. But in April Tricare changed to United. I was informed over the phone that as of February Triwest/tricare required 6 months of documentation with the Surgeon - that meant all who were priorly required to see a nutritionist had to start their 6 months over. We are Air Guard, so we only have the insurance for as long as my husband is activated (October will be his end date). Does anyone know how things will change? Will I have to start over? And will they require the 6 months to start over too? I was approved before and my …

How much is surgery with Dr. Kelly in tj? I ibtried looking online but didn't see anything about pricing... Just trying to find out before I inquire with them.

I have United Healthcare, and they do cover weight loss surgery (yay!!). However, my policy states that I should have a pre-authorization letter on file 6 months prior to surgery. I don't have to do any diet during that 6 months, nor do I have any other requirements - I just have to wait 6 months. It's frustrating because I seemingly have to wait for no real reason. The coordinator at the surgeon's office said that she's never come across a UHC policy that requires a person to do this, and she agrees that it's silly. Do you think it's worth it to call UHC and inquire more into WHY I have to wait 6 months? Is there some sort of appeal I can do? Or should I just suck it up …

Thought I was submitted last week but BCBSMA "lost" my info. Resubmitted Monday and just found out this morning that I was approved!!

So my doctor office sent the precert on 3/19 I called Aetna on 3/20 just to make sure they received the request and they did. I called them back today 3/25 and its still in review. I will be calling them back Friday. I am praying this all works out in my favor.

Long story short, my insurance approved my surgery..then 7 days before my surgery they denied it. This happened 2 weeks ago…trying to get over it but still determined to have this surgery. Does anyone who went to Mexico know if it is possible to use any type of financing or anything like that, I say mexico because I know it is about less than half of what it costs here in the US. If anyone has information on financing for here in the United States that would be great as well…about how much would you think someone would need to finance in the US?