Insurance & Financing

I am from Texas and im here to let everyone know That Texas Medicaid will pay for lap Band surgery yes you heard me right the clinic has to be a center of excellence before medicaid will pay for it to be done and there's other things you have to do If anyone needs more information or the clinic im going to have my done at in Oct i hope fill free to e-mail me Ill help you anyway I can Michael:thumbup:

Hello everyone!! Sorry if I'm posting this in the wrong place but im new here and still haven't gotten the hang of how to use this . I'm Leeya 22 from NJ I went for my gastric sleeve surgery seminar yesterday and was given some paperwork to fill out . I'm now extremely overwhelmed if I won't get approved by my insurance because of the questionnaire form. My Bmi is 49 I have asthma and have always struggled with my weight from dieting on my own . Diet pills . Smoothie , salad diets you name it . As I began to read a lot of threads online most people have more to add to their medical history and why they may want or need this surgery I'm worried if I won't qualify with just…

I have medicare and medicaid in north carolina and do i have to go to classes and do 6 months or will insurance go thru

Im having my surgery for the sleeve on April 11, 2019 but I’ve seen where others have had excess skin removed I’m sure I’ll need that also after my weight loss does Ins pay for that also?

I have meet all requirements for the bypass surgery however BC requires a diagnosis code of Morbidly obese even though I dont fall under that based on my BMI. I fall in the Obese with a co morbidity. Anyone else have this problem and what diagnosis code did you use. So frustrated. Its been a year. Ive done all the preliminary work I just need the approval for the surgery. So ready to move forward.

After you receive your final approval from your insurance, in my case Cigna; How long is that approval good for? How long do they give you to schedule surgery? (The reason I am asking is my 90 days is up at the end of May. So I am hoping for a surgery date in June. So far only one of my co workers is asking for vaction during that same time period. Also we have our annual audit in July and I have to be here for that. Otherwise I will have to have surgery after July, and I didn't know if insurance gave you a "window of time" to have the surgery performed.) I am asking for 2 weeks off just like a regular vacation. My manager knows about the surgery but I have not …

If I lose weight before surgery so that I am just above the 40 bmi, get approved, and then go on the month long liquid diet and drop below the 40 bmi right before surgery will they not pay for my surgery? Just trying to plan out the next 6 months. Thanks! Kat

Hello everyone have a few questions about incision they make during surgery. Like how long did it take for your incision sites to heal? How many were made? Did it leave a mark?Thanks in advance[emoji173]

Just received a call from my insurance company telling me that i am approve for wls (which my surgeon already told me in approve but hey). I'm so excited, scared & nervous at the same time.

Hi, Im currently waiting for insurance to approve/deny my surgery. I did everything insurance required, I have a BMI of 37.4 with several co-morbidities. Super nervous about being denied. Curious to see others experiences with being denied and the reasons the insurance denied you?

I'm sure I'm not the first one to post about this. But I am really discouraged by the 6 month supervised diet requirements..or maybe I'm impatient, and just frustrated by another 6 months of the struggle and after making this decision I just want to move forward asap! Does ANYONE know of a surgeon that will "work around those requirements" is there any way to omit that?? Any advice? BESIDES the whole lecture about how it's all worth it and the 6 months will be good for me. I'm sure I might feel that way too if I'd already gone thru it, but I'm trying not to. PM me with any help you can provide. I'm in MI Thanks [emoji4]

Hi all! I’m new here. Had my psych eval and she recommended this app (plus all the YouTube videos I’ve seen as well). I am wondering if anyone has CHP... I only have 2 visits with a nutritionist (last one is at the end of this month) and one psych meeting. Met with a pulmonologist and he said he’s not testing me for sleep apnea because he sees no reason, since I don’t wake up tired. Only major things left are my cardiologist appt and endoscopy. At the start of this, January 4th, my BMI was 41. I had the flu pretty bad, plus the supervised diet, I’m now down to 39.28. I have no comorbidities... except GERD, I’m guessing. Sorry for being long winded!! I don’t have anyo…

Any pay for the surgery out of pocket in the US? My insurance won’t cover it and I’m not comfortable going to Mexico. I’m wondering what happens if I have any complications. Does the insurance refuse to cover any issues related to the surgery. Planning to ask my doc and the insurance company. But I’m interested in any info from the group too.

YOU MUST READ THIS if . . . Your health coverage comes from Blue Cross Blue Shield of Illinois, Texas, Montana, New Mexico or Oklahoma in 2019! (And probably should read it even if you're not!) Why? Those 5 companies are part of HEALTH CARE SERVICE CORPORATION (HCSC) and they are making a major change which affects anyone insured by them in 2019 who is considering having bariatric surgery. The HCSC Bariatric Surgery Medical Policy no. SURG716.003 is going to become effective February 1, 2019 and, believe it or not, they are eliminating any formal requirement that patients engage in supervised weight loss for a particular time frame (e.g. 3, 6, 12 months, etc.) …

I just need to vent. Insurance approved my surgery but I have BCBSTX, so there's a separate approval for surgery and for the actual inpatient hospital stay. They have been saying the inpatient approval is pending for over a week now. My surgeons office is hounding them too. Why approve the surgery so quickly but then waffle on the hospital stay needed for it? Argh! I just wanna get my official surgery date already.

I live in PA and have Keystone Health Plan East Flex POS (the cheapest plan) through work and wondering if anyone has experience, if it was covered, what requirements were needed etc. Awaiting my phone interview (this wed) and trying to figure out if anything would be covered (thinking sleeve at this time, if not the switch because I have to get my gallbladder removed anyways) BMI in the 40's, gallstones, and back pain with family hx of diabetes, high blood pressure and the sorts. My website doesn't mention anything for coverage or not coverage and they were closed when I tried to call. Just trying to figure it all out! Thanks!

I am a teacher in Georgia looking to have the Gastric Sleeve surgery, Has anyone had any dealings with BCBSGA trying to get their surgery covered? Thanks in advance for your help and support.

My paperwork was submitted to BCBSTX last Monday the 4th, but wasn’t showing in their system till Thursday. I called Friday to make sure they had all the paperwork and they confirmed they did. The customer service representative told me it could take 7-10 days for an approval. Fast forward to Monday and I decided to call and check on the status. I was then told it could be 15 business days. So my question is this, should I be calling everyday? Do they show record of every time I call? I am anxious about getting my approval, but I also don’t want to delay my approval by calling everyday. Thanks in advance for any feedback!!

Does anyone have Washington Apple Health / Molina? What are your experiences with getting approved and the timelines? Thanks in advance!

I had my surgery on December 12. The claim for my hospital stay has been pending since that date and I've been waiting for the ultimate bill. My insurance stands that it pays 80% and I pay 20% up until my out-of-pocket max is met (which is $5,000.) After that, the rest is covered. I have a general idea what my bill will be and that's fine. The question is that it is now near the end of the year and soon my insurance will roll over and I will stand at $5,000 out of pocket maximum (throughout the year I've been working on reducing it.) Since the surgery was in 2018, will they be basing the amount I owed on what out-of-pocket deductible that I have left in 2018? Or will…

Does any one have horizon nj health and are getting the the sleeve. how long did it take you to hear if you were approved. I am also going to cooper.

I called my insurance they told me there requirements is a doctors recommendation. They didn’t say anything on diet/weight/bmi. Just it must be recommended by a doctor. I have an appointment soon to talk to my doctor. Is there anything else I should know or say? I Don’t have diabetes/sleep apnea or weight related asthma issues. I do have stage 3 hidradenitis & acid reflex issues my BMI is 38. Is a 38 BMI too low? My old insurance require an over 40 bmi. with me having a chronic disease like HS I’ve heard it can get better from weight loss. Not cure it but definitely get better. Could my doctor recommend weight loss surgery based off of Hidradenitis & acid …

Hi guys this is my first post and I have a few questions for those that have Cigna about the approval process. I currently have UHC, however, I will be starting a new job in January and they offer Cigna. I am currently finishing up the six months of dietician visits required by UHC and I have just one month left before I would be able to submit for insurance approval. However, now that I will have Cigna through my new employer I have been researching their requirements. From what I have seen all In need is 4 months of appointments however my fear is twofold: 1. I never discussed exercise with my dietician and I see that is one of Cigna's requirements, how strict are …

my psychiatrist said that someone with bipolar will automatically be denied unless they see the psychiatrist for a year (getting clearance) before procedure. My sister (who is doing this with me has Bipolar) I wonder if anyone else on here has had issues getting approvals because of that? [emoji991] Instagram: milaalmodovar [emoji317] SC: almodovarmila

Got denied for the Sleeve for not having 36 months of height and weight. Submitted photos as evidence, hoping it’s good enough. I’ve had BMI >40 for over 20 years, trying my hardest to change. So frustrating, hoping it gets cleared up.

Looking into the process and what is involved. Our insurance will cover with several requirements and there are several doctors in our area that I want to check into. My question is I see that most doctors state they will do a free insurance check. Will this hurt you, meaning if your insurance gets inquiries from multi doctor office's will they see this as she's just shopping around. But isn't that what you want to do? Find the doctor you are comfortable with.

Hello! I was just wondering if the following wording from my insurance policy would suggest that the 6 months of documented weight loss attempts can be my own record keeping? I have over 12 months of my weight loss/gain tracking. I'm sure it's been asked 42354877925 times, but hoping someone will know. I have attended a required seminar and have my first appointment on Thursday. I have been scouring the internet for months and am so ready to get this ball rolling!

I am hoping someone that also has Highmark can answer this for me. Once my surgeons office submits, will something show up on the Highmark website to show the paperwork was received? TIA

I have Florida Blue BCBS *** I wonder do it covered the gastric sleeve surgery and I have sleep apnea and high blood pressure?

Just an FYI to any Blue Cross FEP folks - check your EOB for your hospital stay. They charged me twice as much as they should have because they didn't realize my hospital was a Blue Distinction Center. I called them up and within a couple minutes they recognized their mistake and said they'd fix it.

Does anyone knows if Medicaid share of cost is accepted for gastric sleeve?? If so, where?? Which are the req??

6 consecutive month weigh in. Plus psychological evaluation. And nutrition consultation..I've been on quite the journey..Anthem Blue Cross Ppo

My pcp submitted the last of everything that was required of me in this process on last Tuesday, November 27th. I called my advocate at the weight loss center and she said that she had everything she needed and she submitted it to the insurance department. Well it been officially over a week and my insurance company says that they haven’t received anything. Also, if there was something pending or approved I would be able to see it when I log into my Cigna account. There is nothing there except my approval for removal of lapband. Should I call them? If so, how should I address them? I don’t want to nag but I also don’t want to wait to long and then they say they lost my pa…

Hello, I just reviewed the requirements from my insurance. I meet all of them however I am unsure how to document past attempts at weight loss. What was your experience with bcbs? How did you document and how far back was required? Thanks!!

Has anyone had to submit a letter to your insurance stating how the surgery will benefit you? I was told to make it brief, but how short is too short? Also, any key topics to put in to help with the letter?

I am coming to the end of the program. I have completed all be 2 months of Dietitian visits. I have passed my Psych Exam and I am meeting with a nurse, physiologist, and Program Dietitian this month. My BMI is 54.7. I have pre-diabetes, high cholesterol, osteoarthritis, asthma, skin breakdowns, PCOS, and high blood pressure. I have tried and lost weight several times only to gain it back. I am 35 and will need a knee replacement in the future. How hard was it for you to get approved through Caresource? I am afraid that I will get through everything and still be denied.

I just found out that Caresource now only requires a 6 month supervised diet instead of the 9 month. I don't know which diet to do.

Hi I Have United HealthCare Choice Plus in Texas! My Dr. Scheduled Surgery for Nxt Fri. Dec 21st, BUT I'm STILL waiting for an Approval from Insurance!! Dr said if I dont have an answer(by Surgery date), from Insurance they will have to Cancel Surgery! It was submitted on Nov. 30, Pending for 11 Days now! Ive been calling Everyday for an Update but said it can take up to 15 days! How can I get this expedited?! Anyone Approved LAST MIN?! I'm completely Stressed OUT! ? Thanks

Does anyone use Dr. Tishler in Hartford? I'm going nuts waiting for their insurance coordinator to review my file and submit to Anthem! I had my last nutrition visit on November 23rd, and they still haven't sent in my file to insurance. How long does it usually take?? Patience is not my strong suit!!

I know everyone’s experience varies but I was just wondering what other people’s experience was with this insurance? (BCBS of MA PPO) They don’t require any certain amount of weigh ins or anything so I’m really not sure what to expect. My initial consult with my surgeon is at the end of the month. How long did it take for you from initial consult to surgery? How easy/difficult was this insurance to work with? Thanks!!

Question Attached! Lol I have United HealthCare in Tx...

I've have my first appointment with the bariatric surgeon next week, but am becoming worried that my insurance, United Healthcare, may not cover the operation. I was told by them on the phone that hyptertension counted as a comorbidity. However, after reading the lengthy policy statement, it seems to indicate that insurance is only covered if your high blood pressure is not well controlled by medication. Also, I'm at the low end of the BMI requirements. If I diet for six months, as required for the insurance, I risk falling below the required 35 BMI. This all seems counterintuitive. Has anyone had experience with these situations?

I'm really just venting because bcbs tried to give me a heart attack. Just a little background, my surgery was pre-approved. Both my surgeon and the hospital were named in the approval letter. I got a notice a claim was finalized. They denied payment on the $82,000 hospital bill. I called to find out wtf happened. The eob said it was only covered if I went to a center of excellence. My hospital IS a center of excellence. She put me on hold and looked it up. It should have been paid. They messed up. Now it has to be manually redone and it will take about a month. I seriously almost had a panic attack. Thank goodness they are fixing it. I won't really be truly OK until it's…

Hi, I Called UnitedHealthcare today for an Update...Said "its still 'Pending' and everything looks good, and have all info needed. its just timing now..." I'm so worried ill be denied! Does anyone else have UnitedHealthcare Choice Plus?! How long did it take for Approval? BMI of 43, 5'4", Texas Insurance Thanks In Advance! :)

My company was bought and our insurance will change to Anthem Blue Cross in January. The plan is called Prudent Buyer. My new employer is California based however I live in Texas. We haven’t enrolled in our selected plans yet however my HR person gave me the EOC for this year explaining all the coverage and stated nothing will change. Bariatric is covered and the only stipulation is that it must be deemed medically necessary and performed at a BDCSC facility. There are absolutely no other requirements listed like wait times, nutrition visits, etc. Anyone else have experience with this plan?

I live in the state of Alabama and I'm trying to find a health insurance company that would help clover the weight lose surgery I work in the state of Florida but my job health insurance company dont clover it please if its anyone that can help me find a health insurance company r no anything I will appreciate your help I can't afford to pay out of pocket for this surgery I been trying to find a insurance company y it's open enrollment please help if can.

I was approved today to begin Stage 2 of Molina's bariatric program. I am a 5'5", 309 pound 35 year old female. My BMI is 50. I have one co-morbidity of high blood pressure, and a doctor who believes that WLS is medically necessary. I also have fibromyalgia, but I do not believe they take that into consideration when it comes to medicaid. My doctor referred me to the required orientation for Dec. 16th, 2015. I was approved today, January 11th, 2016. I have to complete these requirements by July 4th, 2016 12 dietician visits 12 physical therapy visits bariatric psych eval ( or my last years records from my counselor) EKG I live in Clarkston, WA. My PCP Tamar…

Hi everyone, I am going through the process of getting approval for gastric bypass in Portland, Oregon. I am nervously waiting for the process to move forward. So the rundown is that I have a BMI of almost 39 with moderate sleep apnea, and a family history of diabetes and high blood pressure. My PCP approved me though based on incontinence. I don't see on any website where that is listed as a comorbidity. I've gone through the three months of weight loss class and have my appointment for the orientation in October. My fear is that since I don't have severe sleep apnea, high cholesterol or diabetes that someone is going to tell me "no" and I will have spent 6+ months go…

Went for pre surgery testing on November 6th and surgery is scheduled for November 21st and no one from hospital has yet to reach out to me to say what I will need to pay before surgery. I have 2 different insurances one deductible is 2,900 and one is $750. At the pre surgery testing they did have me sit down with registeration but she just verified my insurance and employment. I am just about a week out and nervous about a surprise from the hospital after reading other people’s post. Should I reach out to the hospital? I wouldn’t even know where to start.

HOW CAN I GET MY FLORIDA INSURANCE COMPANY TO PAY FOR IT? IF MY INSURANCE COMPANY TO PAY FOR IT? PLEASE HELP ME.?