Insurance & Financing

Hello, I got my lap band surgery in Arizona when I had Blue Cross insurance. I moved to San Diego and can't find a doctor who will do the band adjustments for me with MediCal/Community Health Insurance..if anyone has any idea who I can make an appointment with in the San Diego area, please, please let me know...Thank You so much...

I was wondering if u guys think ill get covered im 5'1 & 200 pounds with no health issues?

Paper work just got turned in to insurance company. Now just to wait. Hope it all goes well and fast. I am ready!

I got a call from my surgeons office 2 weeks ago saying my insurance would pay for only the sleeve. I got a letter today saying they approved the gastric bypass.. So I'm very unsure

Just had my last consultation, so my paperwork will be forwarded to my insurance (BCBS Fed) for approval. My surgery date is tentatively scheduled for 3/19. How long have people waited to hear from BCBS? Also I was told for out of pocket to expect about $3000, can anyone confirm the accuracy of that?

When the insurance says one of the requirements is an evaluation with a nutritionist what exactly are they looking for? What needs to be documented for it to qualify?

I am now waiting and its driving me nuts! Please no one jump down my neck cause you don't know my story!

Hello Everyone, I am so excited and scared all in a bunch....After all the pre-op testing I just got a call from my Dr.office that I am approved for surgery on1/14.... God is Good!

I am searching for a Doctor. I will be a self-pay. Does anyone know the cost. Live in Tampa Florida. Will travel if I need to for a good doctor and affordable procedure.

My insurance (BCBS of MI) requires 6 months of physician supervised diet. What qualifies? My doctor is aware I've been dieting forever. I've gone around and around on Nutra-system, Weight Watchers, perscription appetite supressants, calorie counting, Adkins.... His records note all of this. Will that be enough? Does anyone have experience with this? I'm just in the beginning of the process, and I'm afraid they're going to make me do another 6 months!

Does anyone have any experience with this hospital based insurance company and gastric bypass? I work for a major hospital in their EMS (ambulance) dept. The insurance clearly states that it "does not cover weight loss surgeries, unless proven medically necessary by one's physician." I live in GA, and would love to hear some responses from people with encouraging feedback.

a friend of mines has aetna and called to see about wls they initialy said they couldnt find info on it and then said that they dont cover it at all is this true or did this person not look into it enough? or does it depend on the type of plan she has?

how long from first consultation to surg? im hoping mine goes fast! any helpful info would be appreciated! im 27/ 40 bmi...

Ok, so I called my instance three times before I went to my seminar and 2 out of three people said that lap band was 100% covered. Now the doctors office is staying they're not sure because of how things are worded. My insurance says it covers "surgical bypass" for obesity.. Doesn't that mean only gastric bypass? I'm losing hope.

I haven't been here in a few months but I had not given up on getting VSG surgery approved. I've written some posts which tell more of my story if anyone is interested and is going through the same thing: http://www.verticals...er-suggestions/ This has been such an emotionally draining time that I wanted to share that I have finally had SUCCESS and I thank all of those who encouraged me to keep trying. I will be having a Lapband removal and revision to Sleeve - Surgery date not scheduled yet since my surgeon's office said they have to see if any pre-tests will be required. I was originally denied by UHC in August stating that I had not met their requirements sin…

Who had bcbsga

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

Paperwork submitted Dec. 7th.. My surgeon is Jonathan Taylor in Baton Rouge, la.. I can't get an appt to schedule surgery until I'm approved. I call every three days and I'm still pending. I was told by UHC coordinator because I don't have a surgery date could be the reason for the delay along with the holidays... Not a good feeling... This waiting game is driving me crazy

Has anyone ever gotten there supervised diet waived from the insurance company. I can't lose weight because I have bad knees and can't exercise and the doctor has noted this is his file. I have done 3 months already and I am afraid that going 3 more months I will suffer and still have no results. Any luck with getting it waive..I'm with Bcbs of wny. Thanks

I am on my first month of the 6 month plan and my employer is staying with my origional insurance instead of switching which is Priority Health. I';m lucky and do not have a deductable. So out of pocket will be $1000. But I have a question about the 5yr weight proof. I am at a bmi of 40 right now but 2 years ago I lost some weight and got my BMI down to prob 36/37 then gained back(story of my life) Do I have to be at a bmi of 40 for 5 whole years or just over 35? Not sure how nitpicky they are about this. Anyone out there denied by prioroty and any pointers will really help. Thanks

I finally have my date for surgery,,, Jan 22 , I'm so excited and scared at the same time ???????? Sent from my iPhone using RNYTalk

So one of the things that I had to do for my insurance to approve is to do 6 months of supervised diets. That felt like it took forever. After that I am supposed to submit the stuff to the hospital so that I can meet with a nurse, dietician, and a mental health person. These are the steps that my surgeon's office said to follow. I called the hospital because I have finally completed the 6 months diets and they say oh you could have come to see us after the 4th appt with your doctor. I am mad because I could have already met with the people and I would be submitting to insurance for approval so now I am waiting for the hospital to call me back which can be days.

I've checked my insurance coverage at least a dozen times since I started this process. Everything tells me the same thing, 80% of eligible expenses. Problem is, I can't, for the life of me, find anything that explains what the eligible/non-eligible expenses are! Anyone have a clue? I have UHC.

I went on my insurance website and checked my claim status. So far The tally is up to $72,000 dollars plus change!!!! And to think I was bellyaching about paying $3,000 dollars out of pocket? I am truly counting my blessings today. Wondering how much others have paid for sugery? Curious to know if there is a difference depending on your geographic location.

Ok I got the bill today and proud to say that I have to pay $6 out of 35,000 excited hell yeah I am

Ok, so I'm a little irritated with my hubby. Apparently, our insurance changed at his job and he didn't pay attention in the presentation. I'm confused about what our benefits are and even what insurance we have now. The letter says our insurance has changed to GWH Cigna (which is Greater Western Health???) but at the bottom of the letter it says if you have any questions to call Harrington Health, which is who we had and does not cover VSG. I looked the policy up on Cignas website and it states that VSG is a covered benefit. According to the policy, I've met all of the requirements. My BMI is higher than 50 and I've been in a medically supervised WL program sinc…

I've read a lot of forums/comments and am even more confused. Some folks seem to sail thru the process without a hitch. But there are others that are required to have 3, 6, or even month doctor or dietitian visits. My question is who makes that decision if not your plan?

Has anyone had major issues with approval from bc/bs of Alabama

I just wanted to let everyone know, if you have BCBS FEDERAL do not worry!!! I am 255 a BMI of 41.5 I think? Something close to that. I have only been at this weight for a year, which I had no documentation of. I had it documented about 6 months ago at 245 BMI 40. Previously I was pregnant and they do not accept that weight. Prior to that I bounced up and down with BMI between 35 to 40. My doctor did not write a letter of medical necessity. He REFUSED to. He provided my weights, and a script for evaluation for bariatric surgery. Which I am pretty sure his nurses wrote, and otherwise he would not have done it for me. I had MILD sleep apnea, very mild, and was nev…

Does anyone know about the process for BCBS of NC or BCBS of Michigan. I am covered on both. I am new to this. I just made my seminar appointment. I have been overweight my whole life however I do not go the the Dr. often. I would say I am probably around 90 to 100 pounds overweight. Will not having a lot of medical information keep me from getting approval? Thanks!

I got approved to have my lap band removed now waiting to see if they will cover the sleeve Bcbs new England 1199

I worked up the nerve to call my insurance company and just ASK. YES, the VSG is covered as long as it is a "medical necessity" and not for cosmetic reasons. That's it. They said the doctor just has to document the necessity. I didn't want to jinx myself and ask about the 6 month supervised diet so I asked if there were any other restrictions or documentation they needed and they said no. Oh how I hope this is true! I have Empire BCBS in NY.

Hi all, I was originally told by my surgeon's office that the insurance "approved" the band-to-bypass revision, but unfortunately there were some miscommunications on their end and the insurance company actually denied (they are saying that it's not sufficient enough to approve this surgery because the band is still technically in place and hasn't "failed" even though medically it has failed in terms of WL success and more than occasional vomiting). Talk about a roller-coaster - - excitement and hope followed by sadness and dispare... but I want this badly (and NEED it), so I'm about to draft an appeal letter. Do any of you have advice on what I should state in the appe…

I have gate way insurance and my coordinator told me don't be surprised if you don't get approved the first time. I went on Monday for my final weight check she sent in the paper work and I got a call yesterday saying I was approved can't wait to get it and be healthy again

How long does it take to.be approved for lap band with tricare prime if ur bmi is 41 and have high bp and a diabetic? Do they require u to do a 6 month diet?

On my Quest to getting a gastric sleeve, sometimes I have felt lost and confuse with Sooooo much conflicting information. So I went digging and have found some documents that are plan specific to Anthem BCBS of CA. Remember each individual employer may add or eliminate requirements from these guidelines(also there are different requirements between PPO and H M O plans). So please call your Anthem carrier to find out if any changes have been made to these standard Anthem guidelines. http://www.anthem.co..._pw_a053317.htm http://s3.amazonaws....equirements.pdf I also attached this prior authorization checklist document for Anthem. Also attached is American Society…

Hi I have CIGNA as my insurance and I'm wondering if anyone with Cigna has been given a hard time for approval and how long was the process . Thanks

My bcbs of al just renewed on January 1st, I have contacted them and they cover 100% in a center for excellence facility with no deductible or co pays! My question is, do they have any rules as far as having a 6 month supervised diet or anything like that. I have not received my 2013 policy book yet and never thought to ask before. All they told me was cover 100% in center for excellence or 80% in network. I need prior approval and doctor will need to get a pre determination. Not sure what that means. Any info is appreciated!

Hi all, I was wondering if anyone went out of network and still got approved? I finally found a Dr. That I like a lot. I have Horizon blue cross. She takes my ins. But not the type I have. The ins. Specialist told me it is still possible they could approve it. I have hypertension and high cholesterol. I guess I have to fight for it and tell them this is the only dr. I am comfortable with. Was just wondering if anyone had this experience. Thanks everyone!

Ive done. Everything required by.tricare I just recieved my appraval letter.but im really confused What dies it mean when only laparoscopy biopsy is approved

How long was it before you heard back from insurance if you were approved or not? My last appt was 12/17 and then everything was sent off for approval. I'm getting so anxious waiting to hear if I'm good to go!!!!

I'm concerned because I'm currently doing the supervised diet for 4months and currently on month 3. My BMI is currently at 39 but I'm suppose to be losing weight. I'm thinking I may not get approved with the lower BMI and them wanting me to lose. So, has anyone been borderline and still was approved by Aetna?????

I was finished with Carewise on November 16th and the medical director has had my file since the 30th so they say. I was told that I would have an answer by last Wednesday at the latest. I am so tired of waiting. I just want an answer. They return my calls Every time I call but I just get the same old story. They have scheduled my pre op call and my post op call yet I have no approval or surgery date. Sent from my iPhone using VST

I tried applying for in house financing, but I need a consigner, no one in my family is supporting me on my decision on getting my gastric sleeve, so I don't know what to do

Just wanted to say that I looked into the lap band surgery several years ago. It was more trouble than it was worth to do anything. I am a Texas teacher. In January 2012, the requirements changed. You no longer have to jump through hoops. Your BMI only has to meet a certain requirement. If you were discouraged about your insurance coverage, check again. I'm glad that I did! Dana

Has anyone used this before? How long did it take from your first appt until you got approved?

I was under the impression that my surgeon's office would have to submit paperwork to Medicare for approval of the sleeve. In Wisconsin, it is covered as long as you meet their requirements, which I do. I was talking to a friend who is having the RNY and she had to sign a waiver that she would pay if Medicare didn't. She said that there is no pre-approval for Medicare. You basically take your chances and hope they will pay for WLS. Is this true for every state? I'd appreciate any information that would help! Thanks in advance!

I have my first appointment on 1/15/13. Any advise with Cigna? My pcp is writing the referral. I have over 6 months on Jenny Craig, currently going to weight watchers. My insurance will cover this. The doctor is in network. I have 3 co mor but my BMI is only a couple of points over the 35. Do I need to show that I had a gym membership? Like most of us I have done lots of research, I know what I will have to do to be a success and am ready to get going. Any help moving the process would be greatly appreciated. Thanks in advanced

My policy states for approval you must have a bmi greater than 35 for 5+ years. I have no documentation I can prrovide that proves this. Will that be a problem?

Ok its 2013 I heard that Oregon & Washington are making there decision now on weather to include gastric sleeve as a covered surgery as they do the band ,and bi pass... I know there should be some place to keep tract of this as I have read this on line when other states have decided to cover the sleeve surgery ( one is June 2012 and one was like September 2012). I'm due to have my surgery January 2013 that why I'm haveing trouble waiting on word from my Doctor I would like to look and watch for myself to see it oked if anyone can help out on wear to look please help me ,Thanks so much , Debi