Insurance & Financing

After six months of jumping hoops..my paper work will be submitted this week..please pray for me!

Well my docs office told me all my documents look good and ready to submit to Aetna. They gave me January 30th as my surgery date. I will have to sign all consents forms on January 15th. They will be submitting all paperwork on Jan9th because is my last req. visit. I am so excited everything ran smoothly. My office nurse said it won't take more than 8days to get confirmation. Do now I am ready. Ready to start a new life!!!

I was freakin approved today. BCBS nj. First try. Woot woot

Today was the last of my 6 months supervised diet! But i was told by my PCP in order to submit i have to have an xray and cardiac clearance..my question is..do i have to have cardiac clearance before my advocate submits to the ins company...i hate to have this hold of submittal???

Well, My consultation went great and the office sent over my paperwork to United Healthcare for consideration......fingers crossed I will hear some good news soon!

Anyone care to share your experience with Coventry.

Becuase my Primary Dr didnt specifically stae i was cleared medically for the surgery (only that she recommended it due to my medical history) the insurance denied. Now that i have the medical clearance, they are doing a peer review tomorrow. Both sides tell me that I should be approved. My question: if you have been through this, how long did the approval come after the peer review? I am on a timeline, due to my work schedule. If we cant do it by the first week of march, i will have to wait to the end of april.

Hi. I am new to the board and wanted to know if anyone has Anthem Health Keepers Plus? I have just started the process and still do not know what to expect. It would be nice to talk/message someone who is or has gone through the process.

After 7 mo of doctors and scales and no progress, nutritionist, and physiologist. My case was submitted and approved 2 days later. I'm so happy and scared all in one. I have been over weight all my life and after having my son last and almost dying 4 days later I knew I needed a change, I was looking in mirror and knew I didn't want my kids to grow up with a fat mom. I actually wanted to run and play so this approval letter is a new start. I am scared of things that could go wrong but keep telling myself if I don't do this I could die to. Hoping for the best.

Did anyone get approved without a letter of from their pcp? On Aetnas policy bulletin they don't require one. The lady at my surgeons office said it wasn't necessary. I figure if they see I have high blood pressure and severe sleep apnea what's the need for the letter?

Has anyone had any experience with them trying to get approved for wls? Please share in need of an insurance buddy!

Hello! This is my first post! I have been reading here and on some other forums, and I have felt so inspired by all the people who have made this huge decision and worked so hard to make it work. I had never even thought about WLS until very recently, but after reading and reading and reading, I have started seeing this little ray of hope that maybe there is something I can do about my weight and help to ensure that I will be healthy and alive as long as I can for my daughter. I called my insurer (Federal Employee BC/BS Basic) and got all the information about what is required. I fit within their criteria - BMI of 35+ and co-morbidities for at least 2 years (althoug…

My paperwork was submitted on 28 January. My insurance expires 28Feb. I am scheduled for surgery 26th Feb. I've done all my pre-op testing and attended 2 hour NUT and Education class last week. the 7th is my pre-op and start liquid diet and the 28th attend 3 hour class at hospital. But i am not approved yet! Tomorrow will be two weeks. As of Friday the nurse had completed review and the medical director was reviewing. I'm on pens and needles. This is the second time submitted. First time it took 5 days to deny because i didnt have three month diet program and and additional letter. Does anyone know how long it takes for the medical director to review and app…

So does anyone know if you are a self pay and you have to have additional surgery for a slipped band, does insurance cover any of that expense?

Has anyone doc ever handwritten the letter if medical clearance for the insurance company or surgeons office? Im nervous!

So... Just wondering what some of you have paid or are about to pay out of pocket. Any ideas of the negotiated rate with your insurance company? I have 50% coverage for everything, so from what I have seen I could be out of pocket a lot of $$. I usually have a good negotiated rate from the other surgeries, so I am a little hopeful! But, how much is your health really worth? That is what I keep telling myself!

Finally!! I just spoke with BCBS and I'm approved!! Got my case number and everything!! I'm so excited I'm shaking!!

My insurance denied my bypass surgery ???? i had a tentative date of Jan 30 ???? i was so excited we sent in a food log and also all the appt that i had. They denied due to lack of evedince i have blue shield i dnt know if i should wait or submitt again im so sad i have mixed feelings ????

Does anyone know how difficult Anthem Bluecross is in California ?

After hearing all these wonderful things about Dr. Cirangle, I have decided to check out the program and attend next month’s orientation. I have been to two orientations thus far, one for Kaiser and the other for Alta Bates, so I am little reluctant to attend another one. Have any of his prior patients had BCBS FED PPO insurance? What has your experience been like in regards to insurance? Thanks!

Hello, Anyone ever have any luck with getting gastric bypass approved with having a policy with a written exclusion? It isn't a employer based exclusion just a general wls exclusion. Is there any point in trying to get it approved or should we just try to find financing options? Thanks,

Has anyone had augmentation and your insur pay for it. Just wondered when I loose my weight if I can get new ones!!! Sent from my iPad using LapBandTalk

How long did your coordinator wait to submit all of your paperwork to your insurance company?? I will be finished will all appts on the 15th..just curious?

I have wal mart insurance which is Blue Cross Blue Shield of Arkansas, but through Wal mart. I am curious to see if anyone has ever gotten approved for gastric sleeve with this type of insurance and how hard was it? I can not find any information anywhere to help me or give me hope!

So I've been on this journey since October. My surgeon submitted my paperwork on Jan 24, the requested additional info on 25th. The surgeon submitted the info on Feb 6. Insurance requested additional info again! They aren't satisfied with exercise notes. Insurance wants me to go to PT. My PCP says I don't need it, it's a waste of time in my case. I have Blue Cross *** of IL. I don't really do much exercise. I do take the stairs and have noticed my knees don't hurt as much since I've lost a few Lbs. Has anyone else had to meet this requirement? My surgery date WAS going to be March 6, if approved. Does anyone know how long it should take to satisfy this requireme…

I was banded April 11, 2012. I received an approval notice from Tricare Prime on March 17, 2012, my 38th birthday. Around August I start receiving cars from the doctor office and hospital reverifying my insurance information such as ID numbers. In September I was told as well as received letter stating my insurance company made an error. They were now reversing the charges. A whopping 47K with a 6K discount. Wtf/Wth. I don't have this kind of money. Therefore at the end of October I declared bankrupt. Now my doctor refuses to see me. Omg

Anyone have any experience with them on approvals, ect?

I got a call from anthem bcbs saying I'm approved. A few days later I get something in the mail saying that there is a two part approval process and that a form was going to my doctor to fill out. Anyone else have this happen to them?

Ok here is my story (short), ive been over 200lbs for like 7-8yrs and that makes my bmi between 32-39 and just found out i gotta have a 5yr history of being obese. What i didnt know is that its probably a bmi of 40+ or if under then i would need comorbidities. Well it wasnt 40+ and no comorbidities....im so upset because i really had my hopes up for this. I am so ready to finally get help losing this weight and feeling and looking better! Then this! Has anyone been denied by uhc because of the same issue? Can anything be done at all to help my chances???? Please help!

I have to complete a 6 month supervised diet as part of my insurance requirement. Just wondering where most people go...clinics, private docs, etc. thanks!

Hey all!!! My surgeons office submitted my info im thinking either last thursday or friday. Im just wondering how long it usually takes??? i've heard of people hearing back really soon like in a few days... im just REALLY anxious for a yes or a no... i want this so bad and the waiting seems like eternity!!!! Does anyone have cigna (NALC) federal insurance??? or cigna in general? i just wanna know how long it took for you to hear back from them?? Patiently waiting Krysti.

Hi everyone, Anyone have experience with CHAMPVA insurance, any out of pocket expenses??

I am new to the forum & very early in my journey. I am going to my initial informational meeting tomorrow night. They sent me an insurance worksheet and when I called BC/BS I gave them my codes & asked the questions. When I asked if I needed pre authorization she said no as long as the Dr can document all of the criteria have been met. Is this normal? Reading everyone's stories on here & just knowing how insurance works makes me a little leary. Does anyone have any input, ideas or experience with this? Thanks!!

Introducing myself... I'm 36 yrs old... current weight is 255. I'm worried because I'm 5'10" and my BMI has only ever hit 40 when I was pregnant. I suspect I have sleep apnea and will be getting a sleep study done soon. How bad is it that I want to be diagnosed with that so I can qualify?! This is such an emotional roller coaster. I don't know what I'm asking... I guess just some support from those who have been through Aetna.

Anyone has United Healthcare - a six month physician monitored plan is required. I was originally okay with the process, because I was trying to lose the wait on my own before surgery (a little success). I'm nervous, two months before my anticipated surgery...what if I'm not approved??? I'm freaking out!! Anyone has UHC? Did you get approved? Were there any challenges?

Did you have to pay anything upfront? I have a 2500 deductible then its 90/10. Would I have to pay this upfront?

Ugh! 2.5 months out and now I'm getting statements from my insurance company that I owe close to $6000 because my insurance doesn't cover gastric bypass... however they paid over $40,000 already for my procedure... I've completed and sent in my appeal along with their letter stating they would cover it so now I wait.... has anyone else had this issue? They repeatedly said the only portion I would pay was my deductible...

Fingers cross and prayers everyone my info was summitted today.

Hello, We thought my husbands plan (BCBS of FL BlueOptions PPO) covered gastric bypass. Come to find out it is a plan exclusion (trying to figure out if it was an employer based decision or just the plan. If it is the plan we will try to challenge on medical necessity). We are looking into self pay financing options either through a medical loan or personal credit line. If you self paid or financed, what were your down payment and monthly payments? How long could you finance the total? Thanks, Ab1986

Has anyone run into difficulty being approved by Anthem of Virginia? I started my year on February 1, 2012 and joined WW online. I'm talking regularly to the Cova Care Coach, and had my appontments with the nutritionist and counselor. I have my proof that I joined WW. If I don't lose weight on WW will they deny me or if I do? I had no co-morbidities when I started but have since gone on blood pressure medicine. Any information will be appreciated.

Hey guys new to this forum!!!! So I've been dealing with this process since June 2012.... I'm 26 years old, 5'5 weigh 217. I've had a hell of a time getting all the correct info from my coordinator which finally quit or got fired. So I got denied last month because I never did my 6 month diet and did not enroll into the biriatric program.... So I was like allright should be easy to complete right! So I had my pcp sign a form with complete 6 month diet info. And then tried to enroll in program. So have them all my info and they said there nurses are 2 weeks behind but someone WILL call me. Waited for a month and called them come to find out the UN enrolled me because now I…

Hello I am wanting to see if there's anyone here who has went to a psychological doctor that accepts Blue Cross and Blue Shield federal in the Atlanta area for the vertical sleeve gastrectomy? If so can you provide me with their names I'm currently having a hard time finding someone? Thank you

I been in my pre-op stage for 3.5 months because my insurance requires bariatric patients to take a 12 week course called Options. We met once every other week total of 6 meetings. This class teaches how to eat pre and post, pychological,social, physiological and emotional changes and ways to cope. Medications and vitimans take and avoid. Dealing with family and friends. Teaches you what type of eater you are with daily food logs. We talk about depression, body type everything from A-Z to me surgery a success. We also did our labs throughout the course (no co-pay) and this Tue I will be going for my physical, ekg and x-rays with no co-pay....Kaiser supports bariatric sur…

I haven't received my bill yet but worried and I def want to see cost estimate ..btw I'm allergic to latex so I'm sure it will cost more for nonlatex stuff ....I solely have Medicare only so I will plan to apply for Medicaid to help cover the cost any suggestions?

Hi! I'm going to be done on Feb 4th with my 6 month diet. After all the info has been sent in to the insurance (BCBS) how long on average was everyone's wait time! I'm getting impatient and anxious haha!

Anyone using insurance through the railroad? Curious to know about your experience.

Has anyone out there been approved only to have their approval reversed? I know its a crazy question. I was approved on monday and my appointment to see my surgen and to get my surgery date is on feb/20. Just wondering if something this crazy could happen?

Well, I am so excited!!! I had my last PCP visit today (#6), and then I went to see my surgeon. I have lost 9 since I started the insurance paperwork journey. He was satisfied with that progress. I was submitted today. Can't wait to get the phone call telling me it's approved. I am so nervous!!! I hope it is approved!!! This is going to be a long wait for the next 2 weeks!!!

I started my journey again for the 2nd time around on Jan. 10th meeting with the suregon he suggested sleep study (sleep apnea) this would make my second comorbidity that I need since my insurance (BCBS Anthem). I went yesterday for the results of the sleep apnea test the Dr. told me I have mild sleep apnea this info now being forward to the suregon then on to the insurance company. Will I get approve with mild sleep apnea and high blood pressure this I have had for years??

After reading all about copays etc I realized u hadn't check w my insurance to see how much my surgery would cost , just hung up and because I choose a hospital in my group only $250 for copay hallelujah ! I was so worried !