Insurance & Financing

Hi Everyone, This is my first time posting! I have been visiting the site for a few years and finally decided that it was time to ask this hugely supportive and inspirational group of people for some advice regarding my situation.... I am 24, live in San Francisco, and am desperately trying to find a way to pay for my surgery. I have numerous weight related health problems but, because my BMI is 34.5 (not 35) I have been denied coverage by Premera Blue Cross. I have appealed their decision twice, with no luck, and am instead taking the self-pay route. I have been saving for 6 months because I know what a difference the band will make in my life, but Dr. Cirangle has q…

Ok. So here goes. I'm going to try to explain this as best as possible. My BMI is 46, and I have sleep apnea and some form of arthritis we're still in the process of determining. I have completed all of my pre-op testing and just had my 3rd weigh in with my PCP. I have United Healthcare Community Plan in NY, which is a Medicaid HMO. They cover gastric bypass fully with prior authorization and as long as it is medically necessary. My surgeon's office tells me I need 6 months of supervised diet, so I have been doing that....BUT, I have called UHC Community Plan multiple times and when I ask about requirements, they say there is none listed, but the surgery has to be deeme…

I have my psychological evaluation Wednesday morning....my last class is the 23rd then consult with the surgeon.....

I am on my last class for Cigna,and was now told today by the Dr office I can not make an appointment with a dietician until a month after my last class is finished? Has anyone had this trouble?

My doctors office called today, May 1st; my paperwork is being sent out, does this make sense? Preop is April 23- I'm diabetic, I have sleep apnea- I have united health care Oxford liberty, you think I'm gonna be approved? Help!

Hi all! Was wondering if anyone had any issues good or bad with Blue Cross Blue Shield NY EPO? Thanks in advance !

I am so frustrated I am in tears. I have been denied by medicaid for my procedure for not having an "uncontrolled, life threatening event". I am a Brest Cancer survivor and have issues with lymphodema and back pain from my surgeries. I have a hiatal hernia they were going to repair at the same time. It is documented that weight can increase the chance of cancer recurrence. How much more life threatening does it have to be? I have done all the prep and preliminary doctor visits and even had my surgery scheduled. Does anyone have any input or suggestions?

I called Cigna this morning and found out that they approved me last night!!! I am soo happy...now I've been approved by both of my insurance companies and shouldn't have to pay alot out if pocket!!! I have an appointment with my surgeon on April 11th (which is my birthday) to schedule my surgery!!!! Yayyyyyy!!!!! *SheExhales* CrimsonDiva

Just got my hospital bill. I had zero complications and was in the hospital two nights. In the US. The surgery itself was $29,000. Anesthesia, OR fees etc., made up the remainder. It's incredible how much money it is. In my research I read on some sites that people only paid $15,000 for everything (and in the US, like me)... So anybody who is thinking of self-financing in the US, be CAREFUL and don't trust everything you read online. I've yet to see how much my insurance will cover (they did approve me, but who knows what the final bill will ever be with insurance companies).

M on board for having rny but I'm wondering if Medicare now covers the sleeve? I'm in Michigan. Thanks!

This is my secondary insurance. Primary is UHC but they don't cover it because of my husbands company. Whatever Anyways, anyone have experience? How did approval go? Thanks!

I want to know what the pre-op steps are and how long it took before u were approved

My insurance only pays 50%. I need to finance the rest. Anyone have recommendations?

My name is Alisha and I am 26. current weight 216, height 5.2 I have family history of diabetese, stroke, cholestrol, sleep Apnea, hypertension, kidney disease. Infact my mom has all of these conditions on top of morbid obeisity,, she is currently in the process of gastric sleeve surgery. When I went with her to her appointments I had a realization what uf I become this in the upcoming years. So far I dont have any comorbiditys but I am very overweight and ubhealthy weight wise. I have done many diets and programs only to gain all that back. I thought since my mom has sleep apnea, I might too and that will help me getting appricedr. By the way my bmi is 39.5 I have thyr…

Has anyone out there ever used Lindstrom Obesity Advocacy? If so, were they able to get you approved?

I am a little upset. On my first visit to the weight loss institute, I went in they weighed me. I was 277 and they asked my height and I told them 5'11. I was a college basketball player and always told people I was 5'11 so that was my first thought. They never measured me. As we went on with my visits I told my nurse that I was not at a 40 bmi and I didn't think my insurance was going to cover. I went on to tell them that I haven't been measure in several years...so they measured me and sure enough I was 5'9 and some. So they said they were going to put a note in with my submission to insurance....well sure enough I was denied. When I called the insitute they had no reca…

This morning, I got the phone call from pre-registration wanting my money. The actual cost of my surgery as billed will be $63,201. Insurance allows $18,909. So I'm on the hook for my deductible ($500) and 20% coinsurance to a max of $1500. I've already met quite a bit of that, so they just took a grand from me and I will pay the rest when the bill comes and all the dust settles with other claims that are pending. I was shocked at what the actual bill will vs. insurance though, and I know I've seen other people ask for those numbers, so here are mine.

My bmi is at 53.3 I'm 28 have really bad pcos problems, plus infertility problems. I went a fertility clinic and she said there was nothing she could do until I have the surgery. Any words of courage

New to this, first appointment on Monday with Dr. Nicholson here in Texas. I'm 263 and 5'8 which puts me right under the 40 BMI. I have insulin resistance without being diabetic (yet), arthritis, high cholesterol, etc. I lost 60 lbs about 6 years ago, and have put it all back on in the past 2 years. I have been trying on my own to drop again, for the past 6 months with very little success - metabolism has plummeted. I have zero energy and am depressed and sleep is my best friend. Has anyone been approved by Cigna without a 6 month wait? The thought of waiting for this when I've really made the decision is tough to think about, and I'm already discouraged with myse…

Im so frustrated, just forked over $550 to surgeons office for non covered testing, only to find out that I dont have a comorbidity (the fact that I take Metformin isnt enough because im not diabetic, only insulin resistant). My BMI just barely hit 40, so I was told that they could submit pictures from the last 3 years to show that i was obese to hopefully cover the past 3 years, then i would have to have supervised weigh ins with dietician for 7 months and not lose an ounce to qualify. They even told me to leave shoes on and stuff in pockets. My question is has anyone had any luck with Blue Cross AL approving them with photos instead of weight history? (My BMI wasnt up t…

Policy states BMI 35 or > with 1 comorbidity for 3 yrs, does taking metformin count even if its for increased Insulin and not glucose?

After a long journey all my documents were sent for approval, 5 days later I got denied. My surgeon's office will send an appeal letter on Monday hopefully I get approved Any suggestions? Should I call BCBS my self?

Does anyone have Amerihealth Mercy in PA. And if so, what hoops have you had to jump through, how long did it take to get approved? And any other info you could provide would be awesome.

Just curious

Has anyone gotten approved for their surgery through them. I've wanted to get banded for a while now but my husband lost his job along with our insurance. He just got a new job and medica is our new insurance so I don't know if there difficult to get approved through. Anyone know?

Well I was recently informed, (7 days before my surgery) that I was not eligible for my insurance anymore, so I am still determined as ever to have this surgery, probably in May or June now though, because I am a teacher and will need to wait until summer break, instead of spring break. So I am thinking my only option now is going to Mexico. I would love any information on not only Mexico but from anyone who has gotten some type of loan or financing for surgery. What are the different options I have? I will not be able to save up more than $1000 before summer. Thanks for any advice!

Finished all my appointments in December and my coordinator sent all paperwork about 2 weeks ago. He said usually they come back in a couple weeks with an answer. It wouldn't hurt to call the insurance and check on it right? Anticipation kills me! But I am just clueless as to what to say to them..? LOL

Hello does anyone know how long for bcbs to sebd approval or say that I'm approved?

My surgeons office is submitting the paperwork for approval tomorrow. I have a Cigna ppo plan, but know little to anything about insurance. According to my plan, it says they only cover 50% of any weight loss procedure...but surgeons office said the most I'd pay out of pocket is the 5k yearly maximum. Needless to say I've been seeing doctors left and right to bring that 5k down. I'm still figuring I'll have to pay 3300 or so. Does anyone have a similar plan that didn't have to fulfill the yearly max?

Hi everybody. Has anyone had to do a peer to peer review? If so, how long did it take to get an answer?

Working myself into a frenzy that I will get denied. I have 37ish BMI consistently for 8 years. No "official" comorbidities but a lot of other conditions that are related. I will have 3 letters from 3 doctors (PCP, surgeon & ortho) stating medical necessity. I have also written a heartfelt letter (although I doubt that will make a difference, lol). My final appointment will be on April 11th and the coordinator will send everything over after that for approval. My question is... the Aetna bariatric surgery bulletin sets guidelines that I technically don't meet but I have seen other posters with a lower BMI get approved. I have heard some other posters say "it …

Okay so, I called insurance in November 2012 and again for the 5th consecutive year I was told NO we do not cover weight loss surgery or anything to do with weight loss period. so my DH and I decided we would pay out of pocket. I'm excited and am getting surgery in 8 days, guess what.... now my insurance will cover, BUT I have 6-8 months of hoops to jump through to see if I qualify. My Husband says lets just get it done he doesnt want to fight with the insurance, and so sweet he says to me, you have waited so long and worked really hard you've earned just getting it done, we've saved the money and theres no guarantee that the ins. will pay any way. I won't lie, I don'…

I was set for surgery literally down to my bags packed, groceries stock post op, lists made, bills paid, and several contacts in case of emergency besides my husband and over 2 weeks of fasting. I was ready. Less than 24 hours before check in, my PCC calls and tells me my secondary Insurance should have been my primary, because I have My Medicare, and my husband carries me on his plan as well, and because he works they have to bill his first and mine second. Keep in mind my surgeon's office called me less than a month ago, five months into this process, and said they were using my Medicare as the primary, but changed their story less than a day to go. For the next 23 …

My band has prolapsed & I've applied for approval to convert to sleeve. Does anyone know how much Medicare Complete by united health care would pay provided I'm approved? I live in Missouri if that matters.

My paperwork was submitted to cigna on Monday and called today for an update and they told the medical director had the case for last review. Its that bad or god???

OMG I REALLY CAN NOT BELIEVE THIS. I CALLED INSURANCE COMPANY JUST NOW TO SEE IF THEY HAD RECIEVED INFO SURGEONS OFFICE SUBMITTED ON MONDAY, YES JUST 3 DAYS AGO. AND I FIND OUT NOT ONLY HAVE THEY GOTTEN INFO THEY HAVE APPROVED ME AS "MEDICALLY APPROPRIATE FOR SURGEY"!!! YIPEE I AM SO EMOTIONAL RIGHT NOW, THIS IS REAL AND ABLE TO HAPPEN. MY LIFE CAN REALLY BE DIFFERENT. WOW SO SHE THEY ACTUAL LETTER WILL BE GOING OUT IN A FEW DAYS BUT I AM APPROVED!!! I AM JUST.....(SNIFF-SNIFF) WOW!

So happy received a call from my surgeons office today and I'm approved. My revision surgery was denied at first then it went for peer to peer review and they approved it! So 4/4 is the day I will get this demon band out and be sleeved!

When I went in for a consultation, I was told that Tricare no longer covers the gastric sleeve at all. I am SO upset. That's what I was going to have. They used to cover it. Why the change I wonder? I'm definitely not getting the Lap-Band. I know 4 people that have had it, and not one of them lost more than 20 pounds and then gained it back even with adjustments. So I'm left with the gastric bypass which has many more complications. But there's nothing else to do I guess. : (

Sooo I was banded Feb 2008. I did awesome lost over 180 lbs. Bc/Bs stopped paying for any bariatric anything about a year in. I didn't care. My doctor cut me a deal on fills, etc. In Nov 2010 I had a panniculectomy and had 12 lbs of skin cut off my stomach. I believe during that surgery something happened to my band. I was still losing up to that point, but afterwards, I had no restriction. I filled and filled, and food still went down fine. However I had to have some removed because even though food went down liquids wouldn't. Weird I know. Sooooo now 2 years and 4 months later I have gained 70 lbs back. You.can imagine not being hungry for 2 1/2 years then suddenly STAR…

Just curious if anyone has submitted multiple doctor letters to insurance with their package? Is there such a thing as too many? I wrote one and also have one from my PCP, back doctor & surgeon. I don't quite fit the guidelines with "official comorbids" so I'm hoping this helps although I don't want to irritate them either, lol.

Hi everyone, finally Cigna approved and my date has been set for March 27th. Today I will be starting the liquid diet. Please pray for me. This starts a new journey and I am excited about it.

How did you discover your hiatal hernia???? I do not know if I have one or not but I sure would like to find out for insurance purposes...what do I do???

Hi! I am new here and considering the sleeve. I am a Failed lap band person, and was removed due to it slipping a couple of years ago. I have Coventry insurance in Florida and it does not cover weight loss surgery, however, the customer service person told me my policy does include a 'benefit exception' for medical necessity if you have co-morbids- which I do have. The good news for Coventry people is that the company is being purchased by Aetna. However, no ETA on if it will switch or stay until the end of the year. Since it looks like there are posts with Aetna approving, I am hoping if I can't do it now with Coventry I will be able to do it with Aetna by next y…

Took about a week, Harvard pilgrim insurance, even though I figured it would with my BMI of 49 still makes a difference to have it in writing. Makes this surgery even more real now!

Does anyone know what the requirements are for Virginia Premier/Medicaid to have the surgery done? I'm talking in terms of pre-op wait time?

Hi! Im so happy to find this website, and greatful information about lapband surgery. I have 38 years, yo-yo dieter since 18 yrs old. I m searching information about the lap band surgery, I have a low BMI 34. Anyone can help me, or advise me...I have Masshealth (Medicaid) with BMC Plan, and I dont know what is a good surgeon in this area (I live in Western Massachusetts)....I'm tired of loss and gain again pounds, and I have diabetes too. Really appreciate any information or help!! God bless!

I live in New York and I have Medicaid I wanna know do this surgery but I wanna know if my insurance pay for it.

Anyone have this insurance and used this surgeon? I am seriously wanting to be sleeved!

My coordinator called in my info on Monday 3/4 and was verbally told I would be declined because I didn't have a 6 month physician supervised diet (after being told in January that my only requirement was to have "tried and failed" to lose weight). She raised a fuss and I raised a fuss and we went ahead and submitted everything anyway and I planned on using Lindstrom if I got an actual denial. I called to check on it late last week and the nurses said it had actually been sent for a physician peer to peer review, which surprised me...I thought that was only for appeals, but she said the way THEY work (Aetna Signature Administrators...a self-funded plan being administer…

So our ins is bcbs of il - they say they cover half after deductible is met. Well we are going through that deductible pretty quickly this year. So has anyone had this pay half for ins? If so what were the amts like? All the administrator at the seminar could tell me was it wasn't half of the cash price (which is $12000) - different amt all together. So I have no clue price wise what I am getting into. Just curious if I am getting my hopes up too much and we won't be able to afford it.... I am in the process of getting all my records and paperwork in to get my first appt. just hate the idea of getting my hopes up and submitting everything to find out we can't afford it