Insurance & Financing

Has anyone had Medicare pay for there sleeve surgery I have been told they won't pay for the gastric sleeve but that they are working on changing that or is there a way around it to get them to ok it .I have done all of my appointments and now find out they don't don't cover it .Such a let down after all the appointments they payed for all of them thanks SAD AND DISAPOINTMENT...SOON TO-BE DEPRESSED...

My approval was so fast!!! Barely 1 week I swear so thankful for this. I have no pre existing clauses no requirements. Excited finally gonna have my surgery

I am so excited!! I just got notice today that Humana PPO / Medicare approved my surgery!! I don't have a date set yet, but I am hoping for early spring. I know I had all sorts of questions about whether humana would approve me or not, so I wanted to document my process in case someone else needs to hear about it. I started out the process at 318 pounds, BMI of 45.6. I have NO co-morbidities. No high blood pressure, no pre-diabetes. No real joint issues that have been documented. I was told that I needed to have 6 months of doctor supervised diet - and I had 3 months, then a 2 month break, then 4 more months. This didn't seem to be an issue. I didn't lose wei…

I have been told that I have to go thru a 6 month supervised diet..by united healthcare ....do I need to lose weight at this time to be approved ...I'm afraid of losing too much or gaining not sure what I have to do...HELP!!

I am a teacher in Texas and have TRS BCBS. It was submitted to insurance one week ago, today. How long does this approval take with them? Thanks!

Hi, I have BCBS/Tx and my paperwork was sent out a couple days ago. I called today to see if I was approved or denied and the woman told me they had notes on it but no decision yet. I was wondering what this meant and if anyone had this happen to them before?

What are people's experience with HPHC? To me it's black and white.....I need to have surgery in a center of excellence, which I am.....and my BMI needs to be over 40, and it is. Praying for approval!

Hello - I have Highmark BCBS PPO and I was wondering if anyone else has it and could tell me the costs you had to pay for the surgery.

Does anyone know how much a sleep test costs with Highmark BCBS?

Hey all I'm still looking into different options before my seminar and everything. I have some questions tho. My current insurance is united health care choice plus and in my plan any obesity related surgery is excluded from my plan. 1.) I am going to try to appeal my insurance company to pay for my band But...... 2.) if they deny my appeal they have plans to where I can drop off of my husbands and pay for my own and it's like 18.00 a week. I guess my question is if I do that (drop my hubbies and go on my own) for the surgery and ins and outs will it be considered insurance fraud?? Then when it's time to renew my husbands and my time is up go back onto my…

A question ive been wanting to ask...last week i put in a application to a job closer to where i live,my medical file has been submitted to the insurance,if approve nd have my surgery done nd quit my job afterwards ,will my insurance continue to pay or will i have to pay the remaining balance?! If i do get the job closer to my home i will enroll for health insurance....

Do anyone know how long it takes for keystone approval to approve my gastric bypass surgery? My surgeon said its policy procedure to send all approval letters to insurance in 2 weeks before surgery date which is march 6,2013. Is that enough time? Please help....

Hi Does anyone know if I can use my FSA towards my lap band surgery?

I started my 6 month diet for Highmark BCBS in July with my PCP. I went July, August, September, December, and January. February should be my last appointment and i have been tentatively scheduled for surgery the last of February. I missed my visits in October and November. I am wondering Will I be denied for missing these appointments or will 6 consultations count. The nurse said as long as they had 6 weigh ins I would be fine. Does anyone else have any info on this?

New to site I've been approved for lap band or the gastric bypass, I was rejected for the sleeve by highmark Bcbs of Pa. I am trying to write my first appeal letter. Does any know or were I can get help writing a good appeal letter any help would be greatly appreciated. My bmi is 42 they said I need to be above 50. Thanks

Has anyone been working with BCBS Highmark? How long did it take you to get approval and/or a response? I am being told 14 business days which is really hurting me because I really need to do this before Christmas in order to have to time to recoup before returning to work. Do you have any tips to speed the process up? They received my papework on 11/15 and sent to Medical Review on 11/16.

Hello all, So I am currently trying to become a "bander" and my insurance doesn't cover it. I am aware that I will need to get in touch with my hospital that is going to hopefully preform the surgery. In which they have been more than helpful. What I am wondering is how long does it usually take to get an appeal? Or have an answer reguardless of the out come. I am going the 6th to talk to someone there to start the paper work. I will also hope to have 2 different letters from my doctors explaining why this is nessary for my health and well-being.

So I had a VSG on Monday 1/14. Absolutely no complications. NO additional tests, out in 24 hours. Got the claim summary today. The hospital charged BCBS AL 35K and BCBS allowed 6K. Wow. No wonder people with insurance can't afford to get sick because us with insurance get huge discounts. Kinda disgusting if you ask me. Jenn

I have bcbs of Michigan, they were supposed to cover 100% of my surgery. I've been logging on to see what they covered. They denied a charge for "surgery assistant" for over $8000!!!! I have no idea what this is or why it was denied. They paid the dr and the hospital fee completely. Freaking out since I can't call the dr, the office is closed.

I chose the most expensive Aetna plan from my employer. It's Aetna choice II. Does anyone else have this? How long did preop testing take? Does it matter that I'm not required to have a pcp? Sent with kindness and support for everyone's journey.

I'm totally getting worried that my insurance won't approve my surgery in march... hopeing to have it in april. I am doing everything my insurance needs and I'm just scared its not good enough. I've never been so scared that insurance wouldn't approve because since the start I've had it all planned out in my head. I have my 6th and final weighin on feb 1 and then doing an extra month so that's march 1. Then having all my cardiology and pulminology stuff done in feb and then my psych eval around march 5. Then hopeing to submit to insurance by no later than march 20! And if all goes well and they approve (takes 7-10 days) then hopeing for surgery by no later than april 30! …

I have been calling Medicare for weeks now and the sleeve is not covered in Oregon yet and when I have called my AARP-securehorizons that I go throgh for my Medicare has said the same thing....Now last week Securehorizon said they cover the sleeve wasnt sure what to think so I called again and talked to someone else and they said the same thing... So today I called them one more time an they said yes again and gave me his name told me to wright it down and the date and time for my records of him saying it was covered... so now what I called and talked to the doctors office and she said no its not covered but she would call and let me know what she finds out I think I stil…

Hi all, Thought this might be helpful for anyone with Blue Shield of CA - just got this straight from the insurance company about what is needed for approval. This is by far the most frustrating part of the process... Anyway, I thought it was interesting that they will accept documentation from Weight Watchers and other programs as long as there is documentation for 6 consecutive months and they occured within the past year and a half. Good luck to everyone dealing with insurance!! The following bariatric surgical procedures are considered medically necessary when meeting the criteria listed below: . Open or Laparoscopic Gastric Restrictive Procedures with a Roux…

Does insurance cover tummy tucks. I've heard yes but how does this work?

Hi, Im Janet and im new here. I've recently started the process to get the band done and change my life for my 3 month old twin boys. currently im covered by not only my husbands insurance blue cross blue shield minnassota and my mothers blue cross federal, however my husbands company is selling and he recently found out the insurance will switch to blue cross blue shield idaho. I know every policy is different but i was wondering if anyone out there has had to deal with idaho and what the process was for them as well as how difficult it was to get approved ( or denied) Thanks for any help

Hey everyone, Just wondering if anyone has had BCBS of New England and gotten approved for the lapband revision to gastric sleeve. I've had my band for 6 months now I have lost no weight i've had fill after fill I feel terrible I'm getting acid reflux at night and I'm getting things stuck left and right. I go see a new surgeon on the 28th and I'm hoping he can help me out my old surgeon only did the band and he made me feel bad about myseflt the last time I saw him because I gained 5 lbs. I don't like the way the band makes me feel and I can feel the port all the time it really sucks. I wish I had know about the sleeve before the band because I would have gotten …

Hi I'm new here!! Wanting to get lap band done ASAP!!! I have AHCCCS insurance. I have history showing all the diets I've tried and have never really succeeded the weight comes back once I get off the diet pill. I am 5"10 and 255 pounds. I have birth to my baby girl 2010. And then recently this past September gave birth to twins and reached 300 pounds before dilivery! Will AHCCCS approve me or is it best I have my bf (father of my kids) put me on his insurance united health care plus choice?? I wanna get it done ASAP. Anyone know about this???

I may not be able to have the surgery right away due to work. Thanks,

So this is definitely been a long time coming and I really cannot believe that it is now time to submit for approval to my insurance company I was supposed to get my surgery back in July but because of a pre existing condition wait period I had to wait until today January 18th if you have had insurance for 1 year and have the pre existing condition wait period be over. After my to doctors appointments today I rushed home to call my insurance company and confirm that the wait period is now over and that is exactly what they told me I then went to my surgeon's office for my nutritional visit and it was the first time since my first appointment that I was actually in a good …

Hi I just got the bill from the doctor! I owe 4000. The hospital was covered under my insurance but the doctor was out of network. I thought I would owe 2000 the max! Pretty shocked at the price tag. Do you think there is anyway around this?

Does anyone have Aetna? I am still waiting on approval. How long did it take for your approval?

Hi all! I've been in the process of trying to get approved for LBS for awhile. I have anthem blue cross blue shield of Virginia. So I just called to see if maybe I had been approved and they said its pending from lack of clinicals (med records). Has anyone else had their insurance say this?

Does anyone have them? My surgical coordinator submitted paper work to them yesterday? Anyone know the length of time they take to approve? Just anxious feel like I've done everything to make sure I don't get denied for surgery and am looking forward to changing my life!

I have Blue cross blue shield of AL and they require the 6 month supervised diet. I was a weight watchers member for almost a year, the group I went to recently shut down but I was also an online member. I contacted corporate and they were able to email a sheet with my member dates and my weigh ins that I submitted online. It shows that I was a member for over 6 months and shows 3 different Months of weigh ins that I logged online. Does anyone have experience with this? My insurance policy states that weight watchers would be considered a supervised weight loss program. I have already started a plan with my PCP just in case it won't and should be making my first surgeons …

Hi all! I am a 31 year old woman who is 5'6" and a 256 pounds. I have HBP and constant pain in my feet, legs, and back due to my weight. I am a single mother of two disabled children, and it is imperative that I get healthy so I can be there for them 100%. I am currently on Medicaid in Texas. Can anyone give me any info on requirements for Medicaid to pay for me to have the Lapband done? Thanks in advance

OK LOOKING AGAIN ANYONE FOUND OUT IF THEY ARE PAYING FOR THE SLEEVE IN OREGON AND OR WASHINGTON YET THEY SAID THIS MONTH... OR CHANGING THE AGE IN OTHER STATES

So far I have a 7 page appeal letter with all of my documentation from previous denials and issues and then about 50 resources (each also printed and highlighted for info referencing). I am still being denied because I don't have a BMI of 40 for the last 5 years (even though my insurance summary plan description only states I need a diagnosis of morbid obesity from a physician for last 5 years -which I have- and standard for morbid obesity is Bmi of 40 OR 35 with 1 co-morbidity). The insurance has said there is specific language in my SPD that isn't even in there (I have copy and talked to employer and advocate) saying it has to be class III morbid obesity and a minimum o…

Went to my seminar and met with the doctor and it all went very well. I'm a great candidate for the surgery but.... Good news is my insurance company; BCBS of Texas and my policy covers the surgery, bad news is I have to wait a year to do it as its a new insurance policy. Sigh...

Hi. Has anyone had luck or problems getting aetna to approve? I'm 5'7" - 5'8" 260lbs. No comorbids that I know of. I was told by one doctor I may have sleep apnea but no test were ran Anyone have any success with this plan?

With my United Health Care Plan, they require 2-3 years weight history. My weight has been up & down through the years. 2010, my BMI was over 40. In 2011 & 2012, it was JUST UNDER 40 (39.8 & 38). I have no co-morbidities. My surgery coordinator says I need to find some professionally recorded weight for 11' & 12' or they wont cover. I havent been to the dr other than the ones I gave them, which were under 40. WHAT CAN I DO! I would hate for something so dumb & so close to qualifying prevent me from getting surgery. Is there ANY way I can get around this? Or is it pretty much hopeless? Do you think that since 3 years ago, I was over a BMI of 40 I co…

Hi All.. I finished all my appts.. & i have all my results.. Tulane(Kenner) is No Longer doing Bariatic Surgerys.. So i changed over 2 Ochsner(NewOrleans) The Type of Mediciad i have is Louisiana HealthCare Connections. Ochsner Doesnt take that kind.. My Open Enrollment is Feb 1, 2013!! But it doesnt take Affect til APRIL.. My 1st Appt @ Ochsner if Feb 6, 2013!! Thats the day i give them my file so they can go over it & schedule my surgery.. I GIVE UP!! I dont think it will happen for me.. ????????

Got my approval today....so excited and relieved.

11-1 surgical appt 12-14 testing 12-6 Surgery date 12-11 Insurance approval 1-2 Surgery date So I had a quick approval. I went in November for my first surgical appointment. Nov 14th i did all my testing in one day.Blood work,Ekg, chest xray,ultrasound, barium swallow, shrink . 12-6 Was given a surgery date (my scheduler told me they just do the process and schedule the date. kind of forces them to respond.) 12-11 Got a call from the bariatric section of BCBS telling me I was approved. The lady was surprisingly helpfull. She was a nurse, explained stuff for after surgery and let me know they would be part of my support system after surgery. To be honest I didnt exp…

I figured it was worth a shot...are there any BCBS employees that are willing to give any in site into the approval process?

I feel like I'm jumping thru hoops for Aetna. I'm on month four of my six month supervised weight loss..... Anyone else getting anxious with Aetna???? Help!!

Hi Everyone I found out today I was denied by Aetna for not having a BMI over 40 for the last two years. Well, the reason for my BMI not being over 40 is because I have been going to weight loss doctors and be issued phentermine. My BMI has never been below 37 (well at least in the last 8 years it hasnt) Needless to say, Aetna stated my surgeon can complete a peer-to-peer review with their medical director. Has anyone else (preferrably w/Aetna insurance) had this happen? IF so what was the end result? Thanks Jbright

DOSE ANYONE KNOW WHAT THE NUMBER CODE FOR THE SLEEVE WITH MEDICARE

I'm just so frustrated, they were supposed to submit to ins, I've had 3 different people call me from the surgens office for paper work they already have, I called the ins and they haven't recived anything from them... I know I'm rambling and I need to be patient, its just hard when I feel like I'm getting the run around... Sry just had to vent a lil bit ,,,,,,, :/

Hey everyone Im looking into getting the lap band done but my insurance papers specifically state the obesity related surgeries are excluded from our plan. My question is if anyone has had uhc choice plus and if they appealed them and won. My bmi is 45.6 so I'm considered morbidly obese. Any help will b appreciated thanks! :-)

I recently just had my first appointment with the WLS center and they did my BMI 41.5. I was told insurance required 6m supervision of a diet plan but that my BMI had to stay above a 40. Now how can I be on a diet and not lose weight?! Did anyone else have this problem? I really want to get the band but I'm afraid if I stick to working out I will lose below a 40.