Insurance & Financing

I just got a call from my surgeons office. They told me that they had been in touch with my insurance and that I had coverage for lap band. They also told them what my out of pocket would be after my deductible. The only requirement they had was 5 years of my weight records. I have 4 years, but not 5. The fifth year, I only went to my obgyn and he has since passed away and I don't know where the records are. The surgeon said he would probably be able to get past the insurance because of not knowing where the records are. Has anyone had anything like this happen to them? Did you have luck with insurance, or was it a tug of war? I am keeping my fingers and toes crossed. I a…

Does anyone have Capital Blue Cross Traditional that was approved for a gastric sleeve? Thanks

Hi, I have highmark BCBS (railroad ins). I called and requested my insurance contract details concerning lap band, they will cover 100% if your BMI is over 40 or if you have a comorb with a BMI of 35. My PCP preformed labs and I have high cholesterol, asthma, insulin resistance, and my BMI is close to 39.7, is there anything anyone can recommend for me to do or document? Do you think I will be denied for just finding my cholesterol? I have been on rx diet pills off and on for over 5 years. Thanks in advance.

I'm planning on withdrawling the money for the surgery out of my 401k. Does anyone know the penalties for withdrawling from a 401k? I figured I'd ask here before I googled it and got lost.

my 25 yr old daughter had to have her lap band removed as an emergency surgery after 3 years...she had lost 120 lbs and has now regained 60. we are looking at the vertical sleeve; however the costs in the ny/nj area are cost prohibitive and there is no bariatric rider on her insurance. she has a hiatal hernia and was wondering if anyone can recommend a doctor in the ny/nj/pa area who might be willing to fix her hiatal hernia (which is covered) and then we would just need to self-pay the vsg.. any thoughts? thanks, sonja

Commonwealth of Virginia making me wait 12 mths. Ugh. I have 9 more to go. If you've been through it, how did you spend your time?

I am have United Healthcare. I work for UHS. They told me on the phone I am covered for Bariatric Surgery and only gave the requirements of BMI 35 to 39 with two co-morbitities or above 40. I am worried I read all the hell the insurance companies have been putting people.

I was just wondering if anybody has bcbs-ca they say I only have to have one nut appointment and on psych eval I have my nut apppointment on the 3rd and psych on the 14th hope that's all they really need.

How long did it take to get approved after everything was submitted to insurance? Everything should be submitted this week and I am just SO anxious! And then, once you were approved, how long did it take to get your surgery date?

please watch my video i hope it can answer some of your questions you might have on how i got my insurance to pay for my surgery

Got the phone call this morning from the surgeon's office - I'm approved! We submitted around December 14th - I was left pending before the holidays and called this morning and was told STILL PENDING. So I asked if they could escalate it since surgery is Monday - and they did. I called the surgeon's office and told them still no news... asked if they could call too to maybe see if the nurse already had a decision and just hadn't gotten around to keying it in. They called back about an hour later with yes, you're approved! UHC through HCA hospitals requirements - 5 years of showing me at a high BMI, 6 month medically supervised diet, BMI > 40 or 35 + with comorbs. …

My bariatric coordinator submitted everything to my insurance (Cigna) 8 days ago. I've tried to stay patient, but just can't. I called Cigna Monday, and they said it was still under review, but they should have an answer within 48 hours. Then I called yesterday, and they said the same thing except now they will have an answer within the next 5 business days...uggghhh! I'm obsessed with getting an answer, and really stressing over this. I just have to call again today. I wonder if I'm hurting or helping by calling so much? Or if it doesn't even matter? Anybody else waiting IMPATIENTLY with me?

I've been thinking of getting this surgery for some time now. I am 5'1 and 228 lbs with a bmi of 43.1. I am nervous about the whole "getting approved" thing, but ready to try! Not quite sure how BCBS of Texas is with WLS as we are new to the plan. What's the first steps to all this?

Ok ! So I'm excited my papers are getting fax to the insurance company today I just wanted to kno what are my chances of hearing from them before New Years I don't kno what to say I'm claiming this I have a good feeling pls send good vibes my way

Ok...this is my first post, so here we go. My insurance policy says that any bariatric procedure is not covered. Is there anything else I can do or does this mean I will have to be self pay? Background: I had lapband in 2010 and had to have it removed in May 2012 via emergency surgery due to severe food poisoning that caused the band to slip. Now have different insurance plan altogether. -Becky

I work for the Franciscan alliance ( medical field) we have a choice between premier $0 100, 1000 or the advantage. Does anyone know anything about these from Indiana?

My job just announce we are getting bc/bs, but im stuck in which plan to choose please help! I can choose either the premier $0, premier 1,000, premier 500 or the advantage Indiana open access. I'm not smart with insurance stuff does anyone know about this stuff? ;-(

I am new here and was directed here by a friend on Facebook. My name is Misti Taylor and I need some answers. I was getting ready to finalize financing for the VSG in Mexico with a Dr. Alvarez when I was informed, by his staff, that they don't work with this particular financing company anymore. It has left me devistated and broken hearted. I have been fighting my weight for 11+ years. I am in pain on a daily basis that is weight related. Everytime I try to get insurance, I get denied BECAUSE of my weight. I am at a loss on what to do. I feel like just giving up and finding a way to accept my huge body. I can't stop crying and know that this will destroy me if I…

Do you have any info on the approval rates?

So my insurance was submitted a few weeks ago and they told my dr that they needed more tests done. Had the tests that they needed done on the 19th. I was wondering has anyone gone through this and how long does it take to get an answer now? ughhhhh This is driving me nuts!!!

Has anyone else had Tricare standard? If so how long did it take for your insurance approval to come in?

I am in the beginning stages of researching Doctors, costs, etc.... I have to unfortunately pay for any type of WLS out of pocket because my BCBS of Tennessee insurance will not cover any type of WLS. (My company has excluded it). I live in Indiana and have been surfing many websites over the last several weeks, but have been unsuccessful in finding any costs for lapband. I am the type of person that would rather have my ducks in a row before sitting through seminars and classes with Dr's before I understand the costs up front. Can anyone please give me a $ cost that has had to pay out of pocket in Indiana? Any help is appreciated.

So I just realized that late Jan or early Feb surgery is happening!!! It would be awesome if insurance would pay. But even if they don't, my 401(k) will! Found a surgeon who has a self pay that I can afford. OMG IT'S GOING TO HAPPEN FOR ME!!!!!

Has anyone been successful in getting their insurance to waive the 3-6 supervised diet requirement?

Anyone with BCBS of il? Do they require the three or six month diet for approval? Thanks all :-)

I'm super excited Aetna approved me in five days. I was so nervous because my surgery date is scheduled for December 26. My navigator did a great job. Thank you Tira of NJBC.

My husband 'bless his heart' was so upset about his company policy not covering wls that he has decided to look into dropping his work insurance and getting private insurance. Can anyone recommend a company to look into?

I am new to the boards...just joined today . I was trolling a little before though. I am borderline to be covered for the Sleeve and I just wanted opinions as to what you think my chances are. Honesty is fine... So I have had a consult with my surgeon and I was told that Highmark will use my weight at my first nutrition class so my weight at that appt. was 212.5 lbs and my height is 5' 1 1/2" so my BMI is 39.5. Per the medical policy for Highmark it will cover the sleeve with a BMI of 40 OR a BMI of 35-39 with very specific co-morbidities. I'm sure this is not news to most of you, but each insurance company is a little different. The co-morbidities are hypertensio…

Originally, when I started researching I didn't find anyone who used the same insurance. So,I figured I would sum up my overall experience with North Carolina's State Employee Health Plan through BCBSNC for the next person. I started my journey on Aug.16. I was not required by insurance to do any supervised diet. All that was required was extensive previous attempts, a 5 year weight history, and your typical BMI requisites. I had my decision visit on Tue, Dec. 18 and they submitted to insurance that day or the day afterwards. My doctor told me they usually have a turnaround of about 7-14 days. So, I definitely wasn't expected anything anytime soon. I just received the ca…

Anyone have any recent experience with a lapband surgery ubder anthem bluecross in ca with an hra/fsa ppo. Ins covers at 80% once deductible is met...and i have to go through the center for medical excellence?? We r switching to anthem effective jan and i want to start the process asap.

I have United healthy care, and i have gotten 2 calls today for my payment portions to be paid before surgery which is Dec 31st, but go for pre op visit tomorrow and have to have payments to them tomorrow. for the surgeon, my part, $520.00 for 1 year of counseling with Nutrionist/dietician - $75.00 Hospital with 1 night over stay - #1,341.00 Anthesiologist - $180.00 total for all $2116.00 does this sound right to yall. They never gave me the complete total for whole thing, this is after what insurance will pay and they havent been billed yet. makes me just a tad nervous but ok

So after being told by the Drs office that all of my info had been submitted to insurance for approval...I get a call from my Nurse advocate with the insurance company to give me a laundry list of info that they have yet to submit. Apparently the info was submitted some time ago and requests for additional info have not been fulfilled. And come to find out..I need additional clearance from a cardiologist. Man I thought this process would be so much easier!! Especially since I did everything that the docs office asked for. Having such a grrrrr moment!!

What's your insurance classifying this as? BMI of 40 and beyond ONLY or either 40 bmi or 35+ bmi with co-morbidity (like the National Institute of Health defines it as)?? UHC is really trying to fight on this as my summary plan description states I need a BMI of 40 today (which I have) but I slso need a physician diagnosis of "morbid obese" for past 5 years and shoeing records.

Has anyone had the opportunity to get an approval by united healthcare with Target? I just enrolled and I'm in the 6 month waiting process for surgery. But I am debating weather I should pay out of pocket. Can someone help?!

For those who haven't been following my story............... I was diagnosed with an eroded band in November of 2011 and had it removed in March of 2012. I had to wait for six months before revising to the gastric sleeve as my surgeon wanted to wait for me to heal completely and do medical tests before confirming that I would be a good candidate for the sleeve. I have complete those tests and he was satisfied that I could have the sleeve. We also found that I had developed another hiatal hernia (the first one was repaired when I had my lap band surgery). My predetermination request for the sleeve surgery was denied. They stated that I needed to complete a six mont…

Hi there - I'm worrying if anyone has had success in attaining WLS, when your insurance policy has a WLS exclusion put in place by the employer. My husband (and I) have excellent insurance through Aetna, but his employer has placed a bariatric surgery exclusion on the policy. I have spoken with Aetna, and they say no way, unless it's a'life or death' situation. Any information would be very helpful. Thanks

With any notification went threw 6mth require to only find out they changed it 1 mth after I started the process .They told me anything about a new policy! So upset:(

Anyone anyone? This is the latest from the insurance company daily call report.....

All my insurance sd that they require is a letter of medical necessity frm my primary care dr and attended 3 nutritional classes in order for my operation to b covered I have a bmi over 40 with sleep apena and frm reading these posts this seems to easy. Ne thoughts or comments?????

Hi guys! So yesterday my file was submitted to insurance in the afternoon. I'm keeping my fingers crossed! This process is so nerve wracking. Am I allowed to call my insurance company to check the status of my file or does that annoy them? This is crazy! I would have never thought I'd be up to this point where I am now

Has anyone got their insurance to approve surgery without one of their requirements being met? Mine requires physician documented "morbid obesity" for 5 years. I meet all of the requirements except that one. I have been "obese" for that time, but not "morbidly". My bariatric office doctor said to not worry about it. I don't know if he has had luck convincing them or what. But, I am still concerned that I will be denied. Any thoughts or suggestions? Thanks.....

Have Humana PPO through my spouse. I received the verification of benefits and I read my coverage booklet and did NOT see a 6 mos. managed diet requirement. Has anyone experienced going through any additional requirements that was not listed such as 6 mos of supervised diet, sleep studies, etc. I am JUST starting and don't want ANY surprises by the insurance.

Is it possible to change docs in the middle of surpervised diet? I have an upcoming appt w/ the current doc but can't make it and if I reschedule I would be pushed back.till next month. Has anyone heard of switching docs and how will this affect my ins. Case for approval?

Well I found out yesterday that Anthem is absorbing Empire so starting January 1st I will have Anthem instead of Empire. Due to this empire is sitting on my approval and saying it is being evaluated by the nurse . I was told by the coordinator they are usually very quick and she is surprised that they have not given an answer by now. They have had my information since November 30th. The coordinator and I believe they are sitting on it because Anthem is taking them over on Jan 1st. I am so upset. I need to start my liquid diet tomorrow Dec 12th in order to get my surgery on Dec. 26th which is the only date my doctor has left available for me for this calender year. I am …

So surreal! I was approved this morning by UHC. My date is January 15th and my liquid diet starts January 1st, New Years Day!!!

I am so tired of this prior authorization. My Dr. Has sent paperwork multiple times. But apparently is always too fuzzy. Really what is wrong. I have jumped through every hoop they have asked me to and now that it is up to others NOTHING IS HAPPENING. Anyone else have issues with Blue Shield of California?

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 ,,,,,,, :/

My insurance finally approved me too late to get my surgery on Dec.26th as we had hoped. They did extend my approval through the end of January so I guess it will be sometime in January that I will get my surgery provided I can save up the extra needed funds in time for my surgery date. I was still not given a date. It depends on when my WLS surgeon gets the biopsy results of a spot in my throat from a different doctor. It was nothing . The doctor who did the procedure yesterday said so but my surgeon has decided he needs this. ( he had told me prior that this had no effect on my surgery what so ever then yesterday decided he needed to see the report when it comes b…

Hi! After three denials from Tricare Prime, I'M APPROVED!!! Tricare approved me by the new BMI requirements. I didn't meet the old requirements because I wasn't 100 lbs overweight. My BMI is 35 and I have hypertension. Best of luck to everyone!!!

I've read on here that some people were required /told to get sleep studies before the surgery... What is this for? Insurance? Pre-op testing?