Insurance & Financing

Hi my fellow sleevers ! My sister wants to know how to go about the first process with this type of insurance. I was sleeved on jan 5 th. just wanted to know if its pretty much get the referral from your doc. He sends it to the insurance Than go from there ? And how much is the co pay for PPO

I have less than a week before surgery and now I am so nervous. On the verge of crying. I hate reading negative stories and it scares me like crazy. I know I need to do this but the what if's are driving me crazy. What should I do? I meet with my surgeon tomorrow for my pre-op appointment. Wish me luck.

Hello, I am new to the forum and needing advice. I have tricare standard north region. BMI is 45 and I have hypertension. My surgeons office indicated that I needed to go through a 6 month doctor supervised diet to get approval which was fine but tricare has denied to pay for these visits. They cost $165 each month and I cannot afford to pay this out of pocket. My question is this- why can't my surgeons office just submit my paperwork for approval without these 6 months of doctor visits? I have all of the other tests completed for approval. Are these doctor visits for the surgeons or is it a real requirement for tricare standard? I am wanting to call my surgeons office a…

So I had pulled requirements from my insurance companys website and was prepared to do the 3 or 6 month Aetna pre-op stuff. When my surgeon's office called to pre-verify everything before even scheduling my first visit (which took WEEKS, when it should've just taken minutes...first batch of time wasted), they stated that the insurance company said I just had to have "tried and failed" to lose weight in the past. But couldn't say anything about specific diets and there were "no specific requirements." I asked multiple times if they were sure. I called my insurance company and asked and they said to follow my surgeon's instructions. So here I am, on March 4, after wa…

I have Federal BCBS, which requires, among other things, a two year history of being morbidly obese. I have a unique situation. I am a wheelchair user and cannot stand. Because of this, my primary care physician has been unable to weigh me. My VSG surgeon's office was able to weigh me with an accessible scale. However, I am concerned that I do not have the 2 year history documented. Thoughts?? Ideas??

Did anyone have TRICARE and had approved to had the ban removed and had RNY

I just received a Medicare notice that they now cover the gastric sleeve. Here is the link for their updated bariatric surgery policy: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8028.pdf

Just waiting on my surgery date, can't wait to start my new journey... Gotta love Aetna!! <3 Good luck to all the March & April sleevers! #teamsleevers

Hi ! I would like to know if depression is consider a comorbidie for insurance approval. ... I have papers to fill to my first appointment with the surgeon, and they ask me if I have had a anxiety, depression, PTSD, or panick attacks....I dont know if is good for me put this information on my record. ..maybe doesn't help with my insurance approval or with my surgeon? ? I don't know Im so confused...any help or advise I really appreciate! Thanks

I am scheduled to be sleeved on March 5, 2013. I contacted my surgeons coordinator today to find out the status of my approval because I am now on Day 7 of a 14 day liquid pre op diet and you know getting a little anxious ...to my dismay she told me that they may not know the approval status until this friday or the day before my scheduled surgery. My surgeon has told me not to concern myself about the approval because I am a prime candidate. I have Aetna with a BMI 49.7 and pre-hypertenstion. i have completed all of my clearences and so far Aetna has paid for everything. Should I be overwhelming myself with the thought that next Tuesday will come and go??

I was just told that the procedure is not covered. I'm supposed to contact the Pre-determination department. Any advice?

I have all the cormobidities to be able to be approved ... But I have been denied 6 times. Going thru the appeals dept. We have appealed over and over. I lost hope in this surgery center. I am currently switching to a new surgeon. To see if they can get me approved. Any tips or advice for allied/Aetna insurance ppo. State of Cali.

Packet was sent n.. im waiting on ma Approval from Medicaid... *rolls eyes*

Does anyone have Cigna insurance? If so, can you advise on how your approval process went? I'm being told that they require a 6 month weight loss program before they will pay for the surgery. BTW, I'm in IL. Thanks in advance

Hi everyone, new to the site and was just wondering how long has it taken anyone to get approved by Cigna. I had Blue Cross Blue Shield of Illinois and had did everything required, seen doc, psych eval, and my 1 nutrition class that was required. It was close to Christmas and couldn't get in by one day and I had to wait until the new year(2013) to use the new insurance. I was real disappointed because Cigna required 3 nutrition classes, ughhh! Now that I have completed that I'm just waiting on approval from Cigna. It was bout a week so I called Cigna they never received anything. Got on the phone with insurance coordinator and she had sent the paper work to Blue Cross. So…

Does anyone have Anthem CA? if so what are their requirements for coverage? Thanks

Hi I have two questions. I have illinois medicaid will they pay for a lap band? Second what are all of the hoops you have to jump threw to get it approved? Can someone give me an idea on what to expect. Thanks

I just heard from my insurance company and they denied my claim stating that I did not have valid comorbidities? The comorbidities that my dr. listed for me are high blood pressure, high cholesterol, reflux, osteoarthritis. Are these not valid comorbidities? The surgeon has scheduled a peer to peer review with the Medical Director. Can anyone tell me about these?

Well I had my sleep study last night, I'm glad that's over. He said that I have mild sleep apnea. He did say that I can get that under control with weight loss and Jr recommends the surgery. I pray Aetna approves me! I'm praying hard!

Got my approval letter in the mail yesterday! Only took about 4 days to get approved! March 6 is my surgery date

HELP I really need to find a insurance company that covers bariatric stuff. I have had a bad slip and I have to have it repaired with surgery its going to cost me 18thousand dollars I have insurance but not that covers any of this. I pay my insurance out of pocket and I dont have a job im a stay at home mom. So is there any insurance out there that I can pay out of pocket that will cover lap band stuff?

Does anyone know if you have your surgery in mexico: Can you use your cafeteria medical savings plan? If you have short term disability through work can you get travel time to go to Mexico as Part of your disability?

I have bcbs Texas. I've already met my deductible and have met $800 of my $2000 out of pocket maximum. For my specific insurance plan, there is a $5000 doctor copayment for the gastric sleeve procedure. I was told that some doctors waive this??? Anyone have this happen for them? Anyone know of any surgeons who do this in the Dallas area? Thanks!!!

I just wanted to introduce myself. I was just submitted today to BCBSMA and am hoping for approval and a mid-april surgery date. I see there are a few people with my insurance, so here's hoping I have your outcome!!

Has anyone been to an excellent local surgeon in the NW indiana? I'm looking into being sleeved and I will be private pay. Has anyone been down this road that can give some advice? Im not going to travel to Mexico for the surgery but I'm not opposed to traveling to another part of the states to save some money if there is a great surgeon there that is also cheaper but I am just now just starting so Id love some advice. Thanks in advance!!

Just wanted to see if anyone has found a way around this...I've been referred for a band removal (Big Surprise, NOT!). I was hoping to get referred to the nearest MTF so I could hopefully revise to the VSG because if I have to go civilian I can only get RNY due to the Dr they want to send me to. I will not even consider RNY, severe malabsorption, stricture risks, the five year failure rate, etc. it's just not for me. I was self pay for the lapband 4.5 years ago; circumstances have changed and I can't afford to self pay again. I'm desperate to not regain ALL the weight; my highest was 278 I'm at 233 now but I WAS down to 203. Any thoughts/help will be greatly appreciated.

Hey all, I need your assistance! I'm new to this site. My aunt had her VSG last August and looks amazing. I attended a seminar 3 weeks ago that my aunts surgeon asked her to speak and share her experience. She and my doctor recommended this surgery and I was so hyped to learn of this procedure, turned in my insurance information at the seminar and enrolled into "the program" Thispast Monday was my appointment to go over insurance, and she immediately told me my UHC Premium PPO has a lifetime max of $15,000 and I must have a 5 year history in order to qualify. My out of pocket would be $3200 which is do-able... however the surgery will cost well over $15,0000 and I do…

I'm just starting the process for trying to have the surgery and while I've participated in medical weight loss stuff in the past, I don't trust that they even took the right records to provide adequate documentation (They could never seem to submit the insurance forms with the right codes, despite claiming to prepare the documentation for Aetna all the time, so I ended up even having to pay most of it myself.) So, I think I'm going to to do the 3 month multi-disciplinary surgical preparatory regimen through my surgeon's office. There is one complicating factor. My BMI normally hovers around 38-39 but I have gained some weight after my last dieting/weight loss clinic fi…

All my paperwork was submitted to insurance today, I have bcbs tx, bmi is 54. I hope it gets approved!!!........ Congrats to all that have been approved!

Will someone that has had the lap band recently tell me the out of pocket expense and where they had it done. (no insurance coverage)

Has anyone ever dealt with Hines and Associates for pre-certification? I have completed my 6 month supervised weight loss program and all my testing. Now I am just waiting on approval.

Hey everybody, this is my first post here. I have recently been looking into getting the sleeve. I called my insurance company, AETNA, and they told me that I have an exclusion on my policy for bariatric surgery. I called one company here in the Dallas area who said that although there is an exclusion on my policy, that they asked a few more questions and it may still be able to be covered under insurance. Has anyone ever been able to get their surgery covered under insurance with an exclusion on their policy? Thanks!

I thank God for this and I am thankful for the support that I have received on this forum. I wish everyone the best as we share in our success!

I am new to this forum. Have been reading alot and learning as well . I finally got up the nerve to call the local doctors office and sent in my paperwork. They were to contact me within 5 days and its been two weeks.. So still waiting to schedule my initial consult . Nervous and second guessing myself ... But so sick of losing the same 30 pounds over and over again. My BMI is just over 40 so haven't been eating well .. Anticipating that they will put me on a diet after that appt. ( need to lose 5%.. That shouldn't be hard as I've done that 100 times ) Any advise would be welcomed as I haven't told hardly anyone..

I thought I'd note my experience with Tricare Standard (West) and removal of the Lap Band. I've had it since 2007 and lost a fair bit of weight (75#). The past month though I went mostly vegetarian(fish one night a week and meat on one other) and dropped another 15#. Then my port flipped on me. The doc said it was most likely due to weight loss. Had some lower GI pain and blood in the stool same day as it shifted which freaked me out initially. Anyway, I'm pretty dialed in now on portion sizes and just wanted it out. The surgeon had a xray taken for my visit. Tricare did approve the removal in two business days and had it out the day after approval. I had read o…

Does anyone know of a free or low cost hospital that does wls. My God daughter is 300 pounds, college student, no insurance, diabetic.

My Dr submitted all my paperwork yesterday morning and I just got off the phone with UHC and I'm approved! I can't believe it within one day! I'm so excited I could scream. But now I'm nervous cause its really gonna happen! Sent from my iPhone using VST

Hey everyone I was just wondering if anyone has been approved with HealthSmart Benefit Solutions insurance? I do know they cover the procedure and I am just waiting on my Dr. to work out the details with the insurance company, but I cannot wait... Just was wondering what some of the requirements they want.... Also I am a litte worried because I just found out today they want me to pay HALF of a EGD that was scheduled for this week, I hope they don't expect me to pay HALF of the sleeve!!!! Thanks, Karen

Please help! I am confused..... What does it mean on the insurance approval letter when it says: "Authorization Effective Date(s): 03/08/2013-03/09/2013? Does it mean that I have to have the surgery on March 8th? I don't get it. Thanks! Sandy

I'm new to this sight but was wondering if anyone out there has been denied by Highmark BCBS & won their appeal. I have a bmi of 42 & have been denied because I'm under a bmi of 50. I know that the sleeve is the best option for me but am wondering if there's even a chance of having it overturned. They will cover lap band or bypass for me but am not comfortable with those options. When I first looked into surgery I thought lap band was the way to go but upon doing more research the sleeve is definatly the best option for me. So if anyone has any advice or tips for me please help!!

Yeah! Dr wrote letter and medicated me for cholesterol! I now meet all my requirements per UNITED HEALTHCARE ! BMi over 35.... 2 cormorbites... 6 month diet .... Phyc eval..enrolled into bariatric program .. And dr that works in center of excellence hospital! Just have to wait 2-3 weeks for nurse to call , guess they are behind ... Then I can resubmit everything to insurance . Working on this since June hopefully this approval process is near its end!

Has anyone been denied by their insurance for having a BMI of 39.9? I have no co-morbidities, so my insurance (Blue Shield of CA) requires a BMI of 40 to approve the surgery, and next month will be the final month of my 6-month supervised diet so I was hoping they'd be able to submit. I'm 5'8" and at my last weigh-in I was at 262.5 - a half-pound off! Since my last visit I have had my gallbladder removed and have lost a few pounds (and at my last visit I wore really heavy clothes, left my shoes on and kept my keyes in my pocket), so I know I will be further away today. This part frustrates me to no end...

I have Virginia Premier and was wondering if anyone knows anything about their process of approval. I saw my family physician yesterday and they are working on the preapproval process. I have had two spinal fusion surgeries and am getting no pain relief because of my weight. Any help would definitely be appreciated because I'm ready to get this done ASAP!!!

I was told during this whole process that my insurance would cover my procedure. I was approved by insurance. Well, I was looking at my explanation of benefits and it turns out that is not the case! It is too late though. I was sleeved on feb 12th. My surgeon does have a contract with BCBS of Tx and that will be covered. But the part that won't? The endoscopy I had done in January. That doctor (of which I had no choice of and had no knowledge he doesn't have a contract with BCBS) is not going to be covered (4000). The doctors office also billed 2 generic appointments under that doctor instead of my surgeon (at 1000 a pop). I am super mad! The doctors office told me to cal…

Hi all! I am new to this forum so bear with me. I am still on the fence about doing the surgery. But I'm almost all the way over. Now I am just concerned about financing it. I have contacted my insurance company, Humana, and have found that the approval seems fairly simple. But the benefits are different than my regular benefits. They pay 50% of the surgery and only pay $5000 lifetime max for anything obesity related. Which is fine by me. I can pay for my own fills afterwards. My question is, has everyone had to pay upfront or has anyone been billed after the surgery? The hospital I am going through is Baylor System. My regular doctor is within the system and I've had ima…

I have finished all of the requirments for surgey (6 months nutritionish visits, weight loss classes, surgeon infor sessions) and now I am waiting to hear if I was approved or not. Is there anyone in with Kaiser that has had to wait for approval that can tell me how long you had to wait? Or if there is anyone that had Dr. McKenna for a surgeon? Any information would be greatly appreciated!

I thought my case had already been submitted to insurance, but I found out from my surgeon's coordinator today that they are still waiting on the letter of recommendation and TSH results from my PCP. I called my PCP's office and they said the letter is ready to go (surgeon's office wrote it, PCP just had to sign it) on my chart, but that their medical records lady says that the request is in her queue. When I pressed about this and said it's holding up my insurance submission and surgery scheduling, Miss Medical Records says that she has 30 days to respond and that's considered 'reasonable' by law. What??? I'm so tempted just to have my surgeon write a script for TS…

So I made an appointment with my surgeon to discuss WHY was it taking so long for Medicare to approve or give the GREEN light for the Gastric Sleeve. His response was " Here can you read this", It was an email from the head of the insurance dept at the hospital from about a month ago. It stated that MEDICARE was still NOT approving the sleeve in PA. So I returned it and continued to inform him that how is it that they were the only hospital in PHILADELPHIA that was not processing patients because that I had an appointment tomorrow with another surgeon and he has reasurred me that he can submit to medicare. Funny how being your own advocate can move mountains, I had not ev…

Hello, So, I kind of started this process last fall but my PCP was against the surgery stating that he felt I was healthy enough to do it on my own. He told me to go on the Optifast diet and the large expense was too much for me financially so I tried again on my own. I meet the requirements that my insurance has set for the surgery, however, i'm not sure where to go from here? What steps did you take with your insurance?

So excited! After a long wait and many hoops jumped through, I finally found out I was approved this afternoon when I gave Cigna that daily call that I've become accustomed to making. Now to get my surgery scheduled. :-))