Insurance & Financing

Hi All... Anyone out there who has had Dr Cirangle and BCBS, can you please let me know what your out of pockets expense were? thanks!

Anybody have Anthem in Nj, I wanted to know their requirements. I know everything but the nutrition. The policy is not clear, when I called they said there is no specific amount of time. The office coordinator says 3 but im not sure. I did 3 starting in November. I also did 6 months a year and a half ago. Does anyone know if they will accept this. All my info has been submitted but im afraid to call the insurance. I think they will tell me im denied.

I have been really thinking about getting this procedure done. I would like to know if anyone can assist with this. Does medicaid pay for the procedure and what are the qualifications for this procedure. I do have health conditions which includes asthma and sleep trouble would these be considered health reasons for the procedure . I am 34 years old 5'3 with the weight of 309 am I possibly considered for this?

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Has anyone else gone thru this with medical mutual of Ohio. Wondering how they are. Waiting on approval.

Does anyone out there have family health plus healthfirst??? And can tell me how there approval process goes and what they require. Thanx

Can u help? Insurance doesntq have surgery on its policy. What to do? I need help asap.

I just found out that the insurance pproved me!!Yay.....tentatively scheduled for Aprtil 9th Next up is the liver reduction diet.......any thoughts,advice?

I thought I was finally on the path to getting an answer from Anthem. I called yesterday and all the work that my surgeon's office had done was in vain. My surgeon's office submitted paperwork to them on 01/23, I called to see if they received it and no that hadn't. I call everyday and still no paperwork. I decided to conference the surgeon's office and Anthem on the phone and they give another number to build a case. My surgeon's office has done everything that they have said. I called on yesterday 02/01 and they say the wrong person input my case and that my case was canceled and now my surgeon's office has to get with someone else. This is ridiculous. I have talked to …

Please help: my friend has Aetna but it doesn't Cover weight loss surgery. Any suggestions? Can he and his primary fight with Aetna to get the sleeve approval? Thanks in advance

hi, was wondering if anyone has anything good or bad to say about anthem blue cross california ppo. i have all my pre ops done and should have the paperwork sent to them today or tomorrow. hoping its not to bad and that theres not too many hoops to jump through. kinda anxious.

So I agonized over having this surgery for two years, trying diets, working out etc. Finally decided to do it, & was all set up to have my surgery on February 4th, but my new insurance BCBS Anthem as opposed to Empire BCBS that my company had last year, denied my surgery 3 days before I was to have it! We are in the appeals process right now, but it is sooooo frustrating! I was so mentally prepared for this, I had set up my FMLA, sick time, my wife took a weeks PTO to be there for me, we shifted our lives around for this moment and now it's just turned into a "sometime soon" scenario. Anyone else have anything like this happen to them?

May be looking at a job at Parkland hospital in Dallas. Just wondering if their insurance covers WLS? Thanks.

Went to my seminar out here in San Diego this week with pacific bariatric. I have blue shield of ca ppo. I am 5'11 275lbs male with High Blood Pressure, high cholestorol, sleep Apena on CPAP, Gerd, reflux, joint pain. I am hearing bad things about blue shield. I was in kaiser options about 3 years ago but chickened out of the surgury. But I have all my records from kaiser as well as my primary physician now recommending me to do the Rny. Looking for advice, really don't want to have to wait 6-7 months for a surgery date if I can help it Thank you!

My paperwork was submitted last Tuesday and I called this morning at 8am and it was still pending ...I'm debating on whether I should call now during lunch or not. How many times is too many to call in one day? Lol

I am about to start on my 3rd month of the supervised diet and I wish it would hurry up I'm so ready to get banded!! Although I will say I'm learning a lot about restriction.

First of all, I have BCBS of AL and it does cover WLS. So, I am on month 2 of my 6 month supervised diet. I went to see my surgeon a few weeks ago and they gave me a list of other appts. that I've got to have with other doctors (ex. psych visit, nut. visit, sleep apnea test, ect.). My question is how are those appts. covered under my insurance since I haven't been approved for the surgery. The surgeon's consultation was filed on my insurance, but I got a bill today for over 300.00 with my insurance not paying any of it. I can't afford to pay it and out of pocket for all of the other tests and appts. that I've got to have. Anyone else have an issue with this? Can any…

I have Capital Blue Cross in PA and my doctor's office submitted everything online today and they got instant approval with a March date. For some reason my insurance runs Feb 1st to January 31st. We never had a co-pay before, but now have a $3,000 co-pay. All things considered, it is still better than self pay in Mexico! Now I am completely freaking out. Just had some surgery last week for some girlie part issues and and I am still tender at the incision site and there were only two. Plus I am still a little dizzy and nauseous. The Sleeve is a much bigger surgery so I am feeling a little scared but keep thinking about the end result and how many hoops I have been …

Anyone have United healthcare Oxford? I'm supposed to have 6 months of monitored weight management by a doctor. I have 6 months in the past year but not consecutive. Just wondering if they will possibly approve me. All test are done except bloodwork, which I get this week. BMI 41.5

I was approved today. My insurance coordinator called me. Its gonna be a great year.

Just talked to my coordinator, shes going to submit today. Fingers crossed guys. Lets see how long this takes.

So my insurance navigator request 2yr weight history for my approval. I got 2010 and 2011 weight history but she says the BMI for both yrs has to be over 40. My BMI for 2010 is 39.85 and 41 for 2011. I'm concern Artna my denied me because of 2010. Should I talk to my PCP or to leave it as is? I don't want to be denied because of a decimal short. My PCP did write a notice saying my BZmI should be consider 40 given for the past 10 yrs I been struggling with obesity. Do you think this helps? Any advice or comments will help.

Does anyone know if the gastric sleeve is covered by medicare/medical?

Wow, this process seems like it is going so fast for me! I have been tossing the WLS idea around for years, but I only decided to pursue this at the end of November 2012 and had my first surgeon consult then. Then I decided to do ALL of my pre-op testing visits in January using my flex spending account money. My insurance only required an upper gi barium swallow, a stress echocardiogram, a psyche eval, and only one nutritionist visit so I was able to get them all done as of two weeks ago. Then I just had to wait for them all to send their reports in to my surgeon. After a slight bit of prodding, the office submitted it to my insurance today! What next? Should I…

So I completed my sleep study last night and I am so glad that its over! Not the most pleasant experience… I have my cardiac clearance on Monday and I have my last appointment with my PCP on Thursday and my 6 months of visits are completed. I also see the nutritionist on the 12th for the final time and my paperwork will be submitted. My tentative surgery date is February 21st just waiting on my insurance approval. Anyone else using Highmark BCBS?

I. Receive a letter from Anthem stating request for coverage is pending. They are asking for documentation of previous wl efforts including medication. Diagnostics tests and doctors notes. A year ago I had a different insurance and they denied me because of the diagnostic test results. Now I feel they will deny me.

Well, I called the insurance today to find out that I was denied again! Last year I didn't have the 5 year weight history- skipped going to the doctor one year......... Resubmitted this year thinking, yes, now I have the 5 years! But wait, now the insurance is saying that I was not diagnosed with high blood pressure until 2011. They are now saying that I have to have the weight history and the co-morbidity for 5 years! Both for 5 years! So, I have to wait until next week until the surgeon's office receives written notification that it was denied. They can then do a peer to peer to see if they can get approval! This is crazy!

Anyone have keystone mercy? If so how long was approval date

I saw my surgeon on Friday 1/25... My BMI is 41 and I have BCBS of Massachusetts they only require a BMI or 40+ or 35 with comorbids. Since I'm a 41 I qualify. My surgeons office sent in my paperwork and I'm awaiting approval. Does anyone on here have the same insurance and if so how long did it take for you to hear something? I'm so excited to have surgery, nervous but excited!! Please someone help me calm my anxiety about getting denied...it's like my worst fear

I had to wait for insurance approval. Now they say THERE doctor has to review my cardio approval. I feel like they are putting me off. Why can't they go ahead and give you a schedule? Guess I'm impatient! Lol

Has anyone had surgery with Humana as their insurance? If so, is the approval process through them easy? Original insurance was Cigna with the lapband 5 years. Now, I'm trying to have revision surgery to the sleeve with my company's new insurer. Any helpful information would be greatly appreciated. Thanks

Okay, I was self pay but my doctor checked me for a hernia and I had one. So since I had one the surgery was almost half the price because they were going to bill the insurance for the anesthesia, hernia repair, and I am paying for the band. Well surgery went great last week I received a bill for 48l. My insurance said not paying because the doctor was not in my network. First I'm concerned because without the hernia my surgery was gonna be 10k with the hernia it is 5,500. Where in the heck did 47k come from and who do they expect to pay it?????!

....but still have to pay 4,000 through True Results. Sound right?

Does anyone have PEIA insurance??? I'm currently on my fourth appeal for surgery.

OH MY GOD!!!!!! I'm APPROVED!!!!!!!! I can't believe it!!!!! February 11 HERE I COME!!!!

Hi all, today im going in for my first consultation. i'm a bit worried. my bmi has dropped under 40. ik now this is really a good thing, but im worried my insurance will have issue. the bulletin states bmi must be recorded as over 40 for 24 months. I have record of it being over 35, but not over 40. has anyone had similar experience? were they approved anyway?

ok so ive gone to see the skin removal surgeon and im not yet at my goal but close to it but when i went to see him he said that medicare doesnt let them know until after the surgery is done if it has been approved or not im just wondering if this has held true to anyone else and what was the outcome??? im not sure if i can take the chance of not knowing and then get a huge bill in the mail later and not be able to afford it!

So I will give you a brief history of my situation and hope someone can offer any advice and support. So about 5 years ago I decided I wanted to consider surgery, but it seem rather drastic considering that I had never "really" tried to lose weight. So I made a deal with myself that I would join WW and do my very best to lose weight than if that was not successful would consider surgery. Well long story short I weighed in at my first meeting @ 314 lbs. OMG! and started the program. Over the next 18 months through much sweat and tears lost 107 lbs. I hit a plateau and was very frustrated after about 6 months of not getting any support through my group so decided …

Wondering if anyone with Blue Cross Blueshield of Illinois has had success with getting a panniculectomy covered?

I just found out that my plan with BCBS of Michigan does not cover the surgery, which means I will have to pay out of pocket if I want to go through with it. I talked to my family and they are behind me. I have a doctors appointment in a few days but I was wondering, how much did you pay if you paid out of pocket?

I started the process to get my surgery in January 2012. After doing 6 month of supervise diet and exercise, my insurance dropped their weight loss surgery benefit and I had to stop. Paying out of pocket is not an option for me, because I have terrible credit from past Er visits and things of that nature. A month after that I got a new job, with great health insurance. The doctor that I was seeing before was not considered an in network provider, so I had to choose a new doctor about 80 miles away. By the time I got my insurance cards and made the appointment, most of the nutrition and other things I had done expired. The only thing that carried over was my psyche eval. W…

Well we submitted last Monday and I still haven't heard anything however I'm holding out hope because when I submitted in July and got denied it was within 1 day my doctor's office keeps telling me that by them not hearing anything that's usually a good sign is that true

I just called my insurance they submitted my paper work on Jan 21st and they approved me on Jan 24th now just waiting to see the surgeon to get a date woo hoo!!

Was wondering about the required diet/weigh in-s at primary dr's. I am getting a different answer every time I call them. 1 person tells me they only require 3 months of supervised diet. yesterday I decide to call again to double check because I have completed 4 months of weigh-ins , and then that person I spoke to says it is 6 months..aaaaaggggghhhhhh. So my question is has anyone recently submitted for approval to Cigna and did you do 6 months of the diet? Thanks, Valerie

Ok so... to have my surgery I had to pay the cash price for the assisting doctor which was $ 400.00 and was guaranteed that once insurance paid his fee then I would be reimbursed the $ 400.00. So I call my surgeons office today since I knew they had been paid from my insurance company. They proceed to tell me that I owe them money... They couldn't explain why and would call me back tomorrow on that. I owe them the money AFTER keeping my $ 400.00. My insurance paid everything it was supposed to! If they refuse to reimburse me then I'm canceling my follow ups for the rest of the year which should cost them roughly a grand and will follow up with someone else. In the words …

People with GHI: How long did you wait to get approved?? I have to wait until Feb 1st for them to send it in, but my date is set for Feb 12th! I'm so nervous!!!

Hi! Guess I'm a little older than many...47 :-) It's taken me 3 yrs to get to this point and now I am gung-ho to go!!! I have my husbands Empire NYS plan. I weight 255# I'm about 5' 5ish". Does anyone have any experience with Empire? Would love to connect with others like me?

DOES ANYONE ELSE HAVE THIS INSURANCE AND BEEN BANDED YET? I WAS JUST WONDERING WHAT THE PORTION YOU HAD TO PAY WAS. I HAVE NO IDEA WHAT MY BALANCE IS GOING TO BE AFTER. NOT THAT I CARE, I WILL PAY MONTHLY WHAT I CAN TIL ITS PAID. ITS ABOUT MY HEALTH NOT MONEY! BUT IT WOULD BE NICE TO KINDA HAVE AN IDEA! LOL. THANKS EVERYONE! ASHLEY

I have been calling my doctor's office every other day for 4 weeks now in waiting. First I was waiting for the paperwork to be sent to the insurance company for approval. I was first told that it was submitted only to find out on my call the following week that the girl responsible had the flu and was out the entire week and that the paperwork had not been submitted as promised. At this point I went directly to the doctor and voiced my frustration of having the ball be dropped by their office staff when I had jumped through every hoop required on time and without any delay. He not only apologized but overnighted the package to the insurance company and emailed me the …

I set up my consultation today to get the ball rolling, so I called my insurance (blue cross Alabama) and they told me there were "no restrictions" against this procedure, and that the surgeon must state that this is "medically necessary" to get it approved. What about the "6 month period" I'm seeing people talk about?