Insurance & Financing

I have BCBST....I have been working towards completing the requirements needed to receive approval. My PCP just sent me the paperwork, which includes the five years being obese. I have a lower Vmi, but have the co-moralities needed. She didn't complete the paperwork correctly, which I will have to address, but what if I only have like years? Like I know most people on here, I have been on diets off and on my whole life....so what if some of the times I went to the doctor I was on a diet and my weight was lower? Has anyone had this experience and what was the outcome?

Just got Approved it only took two days!!!!

Just to give you a little background I had the lap band surgery 7 years ago. I have had minimal success and a lot of problems. I was a self-paid patient for the lap band but am now considering the vertical sleeve and will have to be approved through insurance because I cannot afford another surgery. I called my surgeon's office this morning and it seems as though it is up to me to find out if I am covered for bariatric surgery. Ummmm.... okay now what? I assumed that the surgeon's office would take care of all of that for me. This is all so Greek to me! What should I do?

Hello I have UHC just got a call from my surgeons office asking for me to send them more info about weight history. Do you think this is a good thing or a bad thing. 10 mins later I got a call from a UHC surgical nurse, asking me if I wanted to take advantage of a program covered by my insurance for pre op patients. Have anyof you had this happen. And do you think I'm on my way to be approved??

Has anyone had any experience with horizon bcbs? I am 6 weeks away from my last required 6 month supervised visits. I have a Bmi of 37.1 but have 5 comorbities. According to the 15 page medical policy- I have to have atleast 1 of a list of diagnosis and I have 5 off the list. Wondering about my success rate of being approved and how long it may take. My doctors office said they have 30 days to approve.

I got a box in the mail today of all the post op chewable Vitamins I ordered. I got so excited to open them all up and try them (chewable Calcium tablets, yuck) but I stopped and realized that there is a very real possibility that my insurance will deny me. I got some opposition this week with my bmi being "low" and my blood pressure being only diagnosed for 2 years (as opposed to the required 5 years). My case manager basically told me to be prepared for a "no". I know that I can appeal it but its just a very depressing thought. Also that if I'm denied I will lose my slotted surgery date of April 15 that I feel so ready for and married to. I'm just feeling really d…

I have uhc and am finished with my 6 month dr diet and then they asked me for a 5 yr history which puts me below the qualifying bmi with 1 comorbitity. I'm so frustrated as to why they didn't tell me 8 months ago when I talked to the nurse from uhc. Venting. Sorry.

I just got the phone call that it was approved!! Yay! I am waiting for the second call with my surgery date. So happy!'

does Tricare cover gastric sleeve?

Anyone have any experience with approvals in Kansas with Coventry?? Mine was submitted this last Tuesday and I'm so anxious... I know it hasn't even been a week but this is the worst part!

Well, my Dr. Just completed my "medical necessity" letter. My surgeon is ready to submit on Monday so prayerfully it doesn't take too long. Can't wait for my approval because surgery is scheduled for March 27.

I had surgery in Dec. & was approved by UH. Yesterday, I got a letter from UH saying they had received my appeal to their denial of procedure on the date of my surgery. Anyone have this happen to them before? I will call tomorrow but it's very confusing.

Hi everyone, long-time lurker here I just started a great new job last month and it will come with full benefits after my 90 day probation period (some time in May I am guessing.) I've been on government insurance the past year or so. So when I have my insurance, how crazy would it be of me to just flat-out ask my doctor for this surgery? And would the insurance just laugh at me since I would be brand new? I've been looking in to this surgery for almost a year now. Just been waiting on the right time. If it helps at all, I'm 24 5'9 297 lbs.

I have AETNA insurance. After 2 1/2 weeks of waiting on an answer, I was denied. Apparently, I haven't been over 35 BMI long enough. I have only been below, with the help of my PC who specializes in weight management. I have had 1-2 visits with him per month for 4 years. I have been over 30-35 BMI for YEARS (since I was a pre-teen.)My PC office sent 70 pages of documentation. I have his support for the Sleeve. I am devastated that I was denied. So, I did get a call from a patient advocate. What will they do for me? Do I have any chance of getting approved, or do I need to stay at my high weight for 2 years? It just doesn't seem right that I have worked hard, but …

Ok, I am getting started on my 90 day that's required by BCBS FED as well as getting all my medical documents from past 3 years...BMI has been 35-40 and hypertension as a co-morb but im so nervous I'm going to get denied because in 2011 I went thru a divorce and got smaller than I'd been in my entire adult life and my BMI was 34.7.....2009, 2010, 2012, and 2013 it been over 35.... I'm also boarder line diabetic and going fir sleep test.... Anyone have any info or insight on this? Do I loose weight on the 90 or fail to get approved, anyone know if BCBS FED uses initial weight before 90days or after 90 days?

I was just approved through care credit for $11,700 (if only that was enough to cover my surgery!! UGHH) and I'm wondering if anyone has used Care Credit and what your monthly payment is. I know the interest rate is going to be 14.9% but it didnt give me any info other than "low monthly payments". If you used Care Credit, how much did you charge and what's your monthly payment?

Hello, my name is Kristie and I have been trying to get sleeved for a couple years now. At first my insurance didn't cover the surgery so I planned to go to Mexico to get it done. Then we discovered both my kids are special needs( one is autistic and the other has a brain cyst which has severly slowed his development. DH and I agreed that they come first so paying $9000+ out of pocket was no longer a possibility. Then in oct of 2011 he switched jobs and his new job doesn't offer insurance and thanks to me and my weight we cant afford private insurance because most refuse to cover us because I am consider "high risk" and the ones that will want $600 a month JUST for me. So…

When I first called my insurance 3 months ago and got the list of requirements ... I made it a point and asked not 1 but 2 reps if I had to do a weight loss plan, they both said no! Now here I am 3 months in and they are say I need 6 months or 2 different 3 months:(. I sent in my membership to weight-watchers online, my slim fast membership and plan , proof from a dr that I used for weight loss for a few months and gym membership I've had from 2010 till now(shows my visits, but not my weight). Also documents from my PCP where he noted my weight and issues from 2011 and 2012,But all this is combined from a 2 yr period. So my approval is pending.... My heart is so broken I…

Does anyone have any experience with this or a similar scenario: I have Anthem *** as my insurance thru my job. There is no WLS rider. I recently got married. I was added to my husband's insurance for his job and it is BCBS PPO and WLS is covered. In order to be put on his insurance I had to KEEP my insurance thru my job and use his as a secondary. That being said, one doctor's office I contacted about having WLS told me that if my primary insurance doesn't cover the surgery then my secondary will not either. However, I called my husband's insurance and the rep that answered told me that wasn't the case; they needed to submit the pre-authorization form and go from there.…

I started this journey in October 2012. I'm so excited to be submitting for surgery on tomorrow! This has been a strenuous process! There have been a lot of ups and downs and I hope they were worth it! I'm a state employee and this is their first year covering WLS. I had a 6 month weight management program requirement with 3 months being consecutive. My physicians office is unsure of what the insurance's mindset is regarding approval as there has been a lot of back and forth surrounding the requirements! I'm praying that God sees me through this 2 week waiting period!

Hello everybody... I would like to have a plan b just in case my insurance doesn't want to cover my surgery. I want to know prices in New England (MA, CT)area or near....I appreciate the help!

OMG. The waiting is soooooo hard. My surgeons office submitted all the paperwork to the Insurance Company on March 5, 2013. Exactly one week ago and its killing me!! Still pending authorization. Any idea how long United Health Care takes in reality? They say 7-10 days. But I'm so impatient! Ughh

Wow... After 2 months of having my initial paperwork faxed, 2 denials, and on the 1st Appeal, I was Approved on August 1st. YAY !! Im so Happy, and relieved that this saga is over... God is really Good!! This whole insurance process has been very daunting, exhausting, and down right aggrivating, but through all of this this Ive learned some valuable lessons, and I plan to write a separate post on that soon. I have not recieved my letter as of yet, but the rep stated that it was mailed out, and I should get it this week. I will call my surgeons office tomorrow morning to figure out our next step... hopefully to schedule a date real soon-- maybe a August sleever ????

So...I am in the early stages of this process. I know that Aetna requires a waiting period, but I have heard both 6 months and 3 months. Does anyone have any personal experience with Aetna POS II and can shine some light on this? Thanks, Leslie

I have Anthem Blue cross. I was approved in 4 days. Their requirement is that it be done at a hospital facility and the Doctor must be board certified. Which I don't mind at all!

Feeling pretty bummed this morning. My doctor's office informed me that Anthem Blue Cross will not make their decision on my surgery until I have 3 complete months of evaluations from a nutritionist. I know it's only a setback and it definitely could be worse but I'm still very annoyed since I had to wait till less than a week before the planned surgery to find it out. Has anyone had a similar experience? Is it worth calling the insurance company to see if they will waive this requirement?

I have Tufts insurance and was told I didn't have to lose any weight prior to surgery. I gained about 10lbs between Oct and Feb bc of the holidays. When I saw the np for a follow up in Feb she said she wants me to lose the 10lbs by the end of March bc she doesn't want insurance to deny me. I've lost 5lbs so far and am so nervous that I could be denied over a few lbs. Has anyone had this issue before??

BCBS of MS approved me on Friday. Labs etc...scheduled for tomorrow. Surgery scheduled for April 3rd. Cant believe how fast this all happened. Started this journey in October with my best friend and she was approved today. Her surgery date is scheduled for April 2nd. So happy for the both of us because our insurance just started covering bariatric weight loss surgery in January of this year.

Ok so im new but i have been reading and this place is awsome.....Tomorrow I am going to my initial appointment at True results.....I really hooe I can get approved through insurance. How long does this process take what will i need to do? My BMI is 40.4 i dont have any health issues that i know of...is that a problem?

Ok...I have BCBS of Alabama. I am 4 months into my 6 months supervised diet. I am scheduling all of the testing that has to be done and I have some questions. First of all, I saw my bariatric surgeon a couple of months ago and my insurance claim for that appointment got denied b/c the insurance hasn't approved me for the surgery yet. My question is...do I have to pay out of pocket for all of these tests (psych eval, nutritional eval, labs, etc.) since I haven't been approved by BCBS yet? I called BCBS and that can't say for sure b/c they don't know how these places will code the tests. Anyone with the same experience?

So BCBS of Il approved me after only 24 hours! Soooo, why don't I have a date you ask?..well it's because I only know because I called the company today, they said they sent out an approval letter to me and my surgeons office. I left a message with them so I'm hoping for a date tomorrow..aaah the waiting game.

Has anyone been approved with a BMI lower than 40? If so what were your comorbitities? Also I have seen a lot of people who are denied, appeal and win, I have yet to see someone who was denied 2x. What is your experience? I have Anthem BCBS. I have a 37.7 BMI and I am waiting for results from my sleep study. I have high cholesterol high triglycerides and indigestion. I have been overweight for 20 years. If I don't have apnea I plan on making sure I "put on" the few pounds needed to get to 40 BMI.

Does anyone have avmed?

I just received a letter from the hospital saying my surgery cost 35,000. That's no where close to what my Dr quoted. I hope my insurance pays for it all. What is the average price ?

Anybody with Tufts Health Care in Mass?

HI SOMEONE HAS HAD ANY REFUNDS FROM ALBERTA HEALTH OR CANADIAN GOVERMENT

Anyone with Avmed insurance?

I talked to my coordinator this morning and she said that she submitted my packet to the insurance company on Friday afternoon, so we are just waiting on a response. I have Highmark Blue Cross Blue Shield. I don't see many other people that have this insurance and she said that they have never worked with them either but she figures that they shouldn't be much different that any other BCBS. I am patient for now. We'll see how I feel if I haven't heard anything back by the end of week. Hope everyone has a great week!

I'm sorry for all of the questions lately... So, my file was submitted to insurance on Monday. They verbally told my coordinator that I would be denied because I didn't have a 6 month diet (after telling her in January that I only had to have "tried and failed" to diet in the past...nothing about the 6 month diet). I called today to ask a question about the 6 month diet and the nurse told me that my file is in physician peer-to-peer review. I thought peer reviews were just for appeals after you have been denied? Did anyone else have a peer review with their first submission? I'm hoping that this is a good sign and there is a chance they will approve without the…

I applied for $8000 on care credit and the approved me for $6800. I did it online and I got an immediate approval with a code. But that's it..no instructions on what to do next...anyone dealt with them that could give me advice? How do I find out payment terms, etc? Also, has anyone had success calling and getting them to increase the loan? Thanks!!!

I am so devastated at the moment! I had my consultation, physical and lab work...everything was given the green light. I just needed to provide the financing, I thought I had it worked out through a family member financing and she was denied as a cosigner. Apparently my credit is great but my income is too low (I have my own business so my taxes show little income after right offs) .. well my cosigner makes a very high salary but her credit score was not as good as mine. The loan agent said my cosigner's credit score has to be better than mine "which is going to be hard to do" .... well that was nice to hear but also completely crushed me. SOOOO...now what? Ughh. Im feeli…

I just had my consult today. They said Cigna requires a 3 month diet history. I have a job where I travel every week. The coordinator said it did not have to be MD supervised and suggested Weight Watchers online. Has anyone done anything like this with Cigna's approval? I was under the impression (from research) that I had to have 3 months of MD supervised dieting. Thanks!

Hello, I am new here. I have decided to have the sleeve surgery and it seems my insurance (BCBS) is requiring me to do the 6 month conservative therapy documented by my doctor and be at 40 bmi or greater. They also state "Failure of conservative therapy is defined as an inability to lose more than ten percent of body weight over a six-month period and maintain weight loss." So at 268 lbs, during the next 6 months I cannot lose more than 26.8 lbs, but actually I can't go below 248 to keep my bmi at 40. Every diet I have ever attempted always results in a 10 lbs weight loss in the first 2 weeks because I know most of it is Water weight. Does anyone here have the BCBS…

I am so excited!!!!!! Approval took 24 hours. Thank you Jesus, ready for skinnier me!

I FINALLY got a call back and all my paperwork was submitted on Monday night. Please send positive thoughts! I'm really hoping for this and if so maybe I will start a YouTube about my journey!? Who knows?!

How will you know when you are approved through kaiser?

If you have used or are using Lindstrom and don't mind discussing the process and your outcomes, will you please respond here or PM me? I understand most of the responses will likely be PM, and that's okay with me.

Has anyone else had constent problems with IU Health in Indianapolis? I'm just trying to get my insurance straight and I am getting told so many things by insurance, the Dr.s office and the pre-auth dept. Almost to the point I don't think they want me to have surgery. It's so discouraging when the espouse such great results. Anyone else have road blocks like this?

Has anyone here gone through Tufts Health. " i can change program

I'm meeting with my PCP on Monday to request a referral to the bariatric surgery dept. I was able to grab a spot in the Preparing for Success class scheduled a couple days after my appointment. I have a couple questions about the Nor Ca Kaiser process and if any of you have been down his road that can help, I would GREATLY appreciate any feedback. One question I have is, how long in the process do you have to wait to start loosing weight? Sounds crazy, I know. But I have gained about 15 lbs to meet BMI requirementS, andI'm already dying to start working it off. Question #2 how long is the options program that you have to complete? I've heard all types of different a…