Insurance & Financing

I had Oxford and as of jan 2012 they require 6 months and I changed to Aetna because its cheaper and found out they require 3 months I was wondering if they have any issues or other requirements that I maybe unaware of

Hello. I am new to the forum. I am a Tricare Prime beneficiary and am so frustrated about the fact Tricare won't cover the sleeve with civilian docs. After reading a lot of posts, I realize I am not alone! So I thought I would start a thread that would create a list for people to use when seeking a procedure through an MTF. Here is what I have found from other threads: Naval Hospital San Diego (Balboa) Portsmouth Naval Hospital (Hampton Roads Virginia) Can anyone out there add any to the thread? Thanks much! Shan

BCBS of Ill PPO is the VSG covered. I would also like to know the cost of the surgery n the surgeons name.

Has anyone dealt with blue cross highmark? It's the railroad insurance plan. I was wondering how difficult it is to get approved and what steps I need to take, I am praying to get approved.

I'm trying to find out if there is anyone that finances the surgery 100%. My mom is willing to pay for the surgery for me. She has been approved, by Care Credit, for her cosmetic surgery & they only allowed her a certain amount. If they will only allow that amount, then, we will have to come up with about $7,000 & neither one of us have the money. But, if I can find a company that will finance it 100% for me, then, surgery will be a go. If anyone may know that Care Credit will finance it 100%, please let me know. Thanks.

I found out that my plan does not require 6 mos. of a supervised diet. I am anxiously awaiting the next step!!!! I am waiting for my carrier to put compile all my information for the center I am going to attend for the procedure.

Anyone here use this insurance if so please tell me about the approval process????? " Supo's Wifey "

Soooo I finally got the ball rolling after going through the famous 6 months of monitoring my weight with a physician, Today I got the general surgery referral, I was soo thrilled, then I called the office to find out, this Dr. only performs the lap-band surgery, my problem is that I want the RNY, and tri-care was no help trying to find a general surgeon in the area who also specializes in bariatric surgery, or atleast can walk me through the general surgery part of it, just to get the approval from them and then be reffererd to a Dr who will do my surgery (which I am guessing will be in Atlanta). So my question is....Has anyone went through this process, how did you wor…

I am so totally frustrated with my insurance. I just spoke with them. I need to do a 2 week liquid diet prior to my surgery which would be scheduled on the 26th. I would have to start it on the 12th. Can't do that because my packet was submitted on 11-30-2012 and they are saying it will take at least 15 days to get an approval. REALLY! WTHeck. I am so frustrated with them. I could just scream. I have completed everything they required. Just get on with it already. UGH! You would think with paying 1400.00 a month for insurance they would be a little more user friendly. I am so frustrated. The lady said I would probably not get approval before the 21st. FML.

Hello, I found out yesterday It took ten business days! I have UHC and I called for the first three days then decided to give them a week. So I called on Friday and found out I was approved! I almost cried on the phone haha and then my surgeons office called me and told me to start on my clearences (blood work, EKG, etc). Wow I'm soooo happy! Good Luck to everyone

My paperwork was submitted Wednesday around noon. Is today too early to start calling and pestering!? the nurse told me to call and pester them and sometimes they will push it through quickly. Also, who do I call? I have UHC..do i just cal the number on the back of the card..maybe this is a silly question I am just stressing.

Has anyone used carecredit to pay for surgery and how did you like it? Is there better financing for this type of surgery? Of course my insurance excludes any WLS or problems from WLS. I looked at carecredit last night and if you don't pay them off completely in 24 months the interest rate is really steep. They also only give you 23 days before they demand credit again..meaning one day late and the interest rate climbs to 26%!!! I'm despertaly trying to find a way to pay for this revision since my band has failed. Thanks for answering.

I have cigna and I know they cover the surgery. I've studied their policy inside and out. Just to make sure my plan really did cover the surgery I called them today only to learn that my father's employer (who I am covered under for another year) has chosen to still consider bariatric surgery as "cosmetic". It sucks because I was so hopeful that I could finally get healthy and feel good. I know the surgery will cost them less in the long run...but is there anyway I could appeal to his employer? Anyway around this other than self pay?

The surgeon's office let me know everything was sent for approval today. Fingers and toes crossed. Hopefully this is the beginning to the end of the waiting. . . . . . .

Ok, I have BCBS Federal so it's really a good insurance to have. It requires 3 months diet with NUT BMI with 35-40 with comorbidities or BMI over 40. My BMI is over 40 and I have a month and a half to go on the NUT thing. My problem is they also have to submit a two year history from my regular doctor showing a BMI OVER 40 I'm one of those people who bounce all over the place and lose and gain weight constantly. Last December I was 180 now I'm 250. I don't know if I was over 40 during the last two years when I went to doctor. I am waiting on my records from my PCP. Anyone else experience this? Trouble with the two year history? How strict is the insurance company?

I have Anthem Blue Cross Blue Shield. How long did you have to wait for approval? What is your experience? What is your insurance? I'm clearly being neurotic !

Sent in 1st request in September. That was denied. Peer to peer two weeks later and denied. 1st appeal denied 10/23. Sent what I thought was external appeal 11/7. Turned out to be 2nd appeal. That was denied 11/21. Sent in request for external appeal today. Called to find out what time limit ERISA self funded plans have for IRO decision. First I was told they only did one appeal and that's what was denied 11/21. And what I sent in today was 2nd appeal. And that most of the time UHC didn't typically allow external appeals on my plan. Then they tried to tell me WLS isn't covered under my plan. I was livid... It is covered. It lists it on the summary plan description. I have…

Finally after 3 months of dieting and 4 NUT visits and a psych eval I am approved. I am so excited. Now I'm just waiting to hear from Doctor. I'm starting to get really nervous.

Out of curiosity, I would like to know what kind of requirements you had to meet to get insurance approval. Six months of visits with doctor? 15 pound weight loss? Has anyone been approved without those things or with fewer visits? Weight loss history longer than 6 months prior to surgery, etc. Thanks. I am submitting my paperwork tomorrow and am anxious about approval.

Finally done with my 6 month diet support group. I thought it was never gonna end and god forbid you missed a call because they would start you all over. Everything so far looks good my health coach said so I should be hearing something really soon. Anyone else through with their 6 month dietician? If so, how did it go? Did they deny approve? I live in Arkansas and have quchioice and was working with Carewise.

have you had your surgery yet? have some questions for you

Got a super fast approval dr submitted thurs and I was approved today surgery oct 23rd I'm beyond excited its so real now so for next couple weeks I'm going to get house spotless and get myself prepared

I was banded June 2009. In December 2011, it was discovered there was a problem. The tubing had disconnected from the port. In October 2012, I underwent surgery and had a replacement port put in. My surgeon straight out told me it was a hardware malfunction. My insurance covered quite a bit, but I am still left paying $2500-3000 out of pocket. Has anyone else had this issue and did the lap band maker cover any out of pocket expenses?

Surgeons office just submitted my paperwork to the insurance company!!! So scared of being denied, but I'm trying to stay positive on a quick approval.

Can anyone give me an idea how long Aetna takes to approve? I am really hoping their quicker than some people are telling me. Some tell me they are slow and some people tell me they are quick.

Hi! I'm waiting to hear back from my blue shield *** insurance about approval for my surgery. Does anybody have this insurance and if so, how long did it take to get approved after submitting all the paperwork?

All of my paperwork was sent into UHC on Tuesday last week. I've done all of the requirements. I have a 46 bmi, diabetes, high blood pressure, and cholesterol. I figured it would be a quick approval. Nothing but crickets. I'm really hoping to have surgery this year, but time is slipping away. Is this common? I'm calling the case manager Monday to see what's up.

I'm right on the BMI line for the sugery, and I know I have to have a 2 year weight history submitted, does anyone know if it has to be a full 24 months, or say one weight that meets in 2012 and another in 2013. Or would I have to have the weight all of 2012, all of 2013 and then try for sugery in 2014? I hope my question makes sense.

I've heard that if someone is self pay they buy an extra insurance policy. Anyone do this in Texas and did it pay also which insurances cover the complications from WLS?

i'm 5'3 205lbs, have been obese my whole adult life. have bcbs of ma. my medical history is r-knee surgery, and both knees osteoarthritis, history of anemia, galbladder removed at the age of 18. 36 yrs old now. history of asthma. medical records of weights back as far as 6 yrs. letter of recommendation from orthopedic. kidney urethers duplicaions. do you guys think i have a chance of being approved?

So I have done almost a year of Nutritionist visits. I have lost 26lbs. I went Wed for my psych bariatric eval and passed. Then yesterday I went for orientation and my consultation with the surgeon. Everything went well, they said I should be able to be approved. They gave me a checklist of things that both the doctor and possibly my insurance would require. Nutritionist eval and documentation 6-12 months ^done Psych bariatric evaluation and recommendation ^done Letter from me outlining why I want surgery and what I am suffering from ^done Cardio clearance- EKG, stress test Gall bladder Ultrasound Blood work Endoscopy sleep study and pulmonolgy clearanc…

Has anyone had a peer to peer with Cigna? If so what was the outcome? My surgeon has an 830 call with them tomorrow morning, all because they read my clinical notes wrong. They hve verbally acknowledged their mistake but now since it was denied need a peer to peer

Just wanted to throw some hope out there for those looking for approval from their health insurance company. I have United Healthcare and my employer is Walgreens. They require a 6 month supervised diet and 5 years of documented weight history that shows a BMI of over 40 without co-morbidities or 35 with co-morbidities. I had some major fears about getting denied because I didn't have any health insurance coverage for most of the last 5 years, thus did not go to the doctor to have my weight documented. I decided to go for it anyway! I went to my first seminar at the end of February and began my diet in April. I contacted every hospital I had ever visited and reque…

Right now my biggest concern is what if I have complications after surgery and need to be hospitalized or reoperated on. My insurance will not cover complications from weight loss surgery. Is there anything to be done about this? Should I just close my eyes, have the surgery, hope there are no complications and I don't go bankrupt from it?

I have had a bmi of 35 to 40 for at least 5 years and hypothyroidism sleep study showed upper airway resistance syndrome ,has anyone been approved with similar dx I have been over weight most of my life I have atena and secure health care

Hi all im new here. I been lurking for a while and finally had the courage to type up whats been going on. So i was recently fired from my job and when i say recently i mean last week wed, im happy im not there any more because my job was beyond stressful, but it has happen at a very bad time. I was just in the process of my first consult with the doctor which is going to be nov 30th my insurance ends nov 16. I do have the option of Cobra and everything will continue like i didnt even lose my insurance. So whats the problem you ask? the cost... for me alone with medical is 537 a month, now with a one income home i'm just feeling so guilty. Do i feel that we can make the p…

I'm so excited that I'm approved for the surgery. This has been a long process and I didn't want to say anything on the forum until I no I was approved. I've really appreciated you guys posting information that has helped me along this journey! I will continue to update. I had Cigna

I got the call today that my pre-approval was denied because the sleeve isn't covered by medicare. Now I know some people out there have gotten the sleeve approved via medicare. I appealed it and the drs. office is resubmitting the forms for the gastric bypass. Anyone on medicare run into this?

So I have met my deductible, while also meeting my max out of pocket for the year. Does anyone know if I will have to still pay my copay for surgery even if I met my out of pocket max?

Almost three weeks, one denial and a "reconsideration" and I am finally approved. Thank you Jesus!! It's not gonna be in December like I hoped, but I can definitely live with waiting until January. Starting 2013 with the new ME!!

Ok I will ask one more time has anyone gone threw this with AARP medicarecomplete would like any info I could get all I know so far is that you have to see the dietition for 3 months BMI over 40 but what happens next and how long does it take to get approved after the 3 months .

What a day everyone. My original post noted that my last appt of the 3 month process was on 11/21 and that was the day they were to submit. Wellll here we are a week later and im more pissed than anything. First, my surgeons office, which happens to be the medical college here in richmond, has the slowest most unprofessional admin i have ever seen. Wait.... not just the admin, most of the non doctoral staff. When I call and ask abouy certain aspects of the submission/approval process, "i dont know" is not acceptable to me. Perhaps " i dont know but i will find ouy and follow up with you?" Ding ding ding! Thats works and shows that you are proactive. I digress. Needle…

Dose anyone known about medicare complete AARP that is my insurance they oked me to start the appointments but 3 months NUT then how long after till they aprove surgery

Hello, So I am currently in my 6 month diet classes in order to get the sleeve with United Healthcare in CA. I just found out that my dads insurance, which I am covered under till im 26, expires on Jan. 31st. I called my medical group which requires all of these steps and they said that they could not help me out and that these classes i am taking only count for their medical group not anyone else. I decided to change medical groups hoping that this other one does not require as much, but i cant get it till jan. 1st. I have thought about going to Mexicali to see Dr. Aceves and just pay for the surgery but i am not sure yet. if i do get my own insurance, then i have to p…

I've posted here before, a long time ago. Now I have different insurance and I'm still pondering surgery. Wondering a few things though: Had my gallbladder removed this past week- would that be considered a co-morbity (is that the right term)- have any of you used it? I also have a history with Weight Watchers and I did 12wks of an intensive weight loss/exercise program, would that count as attempts to lose weight? My insurance didn't say they had to be monitored by a doctor. I also went to a knee doctor last year and was diagnosed as having early onset arthritis in both knees, is that a co-moribity? Obviously, my insurance and future surgeon will answer these que…

Has anyone gone through mvp for that surgery?

Hi everyone, I was wondering if anyone has seen the example forms online which tell you how to fill out your paperwork with the right codes and wording. Found it once and now I am unsure where it went! I need to use TDI to supplement my time off at work. Any help would be greatly appreciated! Melissa

I was approved for the Vertical Gastric Sleeve surgery this past summer, but suddenly I had to have emergency surgery to remove my gallbladder in June. I have BCBS IL and my copay for weight loss surgery is $1500. I am now fully healed and ready to get a surgery date. I really want to proceed with having the surgery before the year ends because my maximum out of pocket and deductible have been met due to the gallbladder issue. I usually have relatively few health issues and have never met this much before in a calender year, so I want to use that to my advantage and have the surgery before 2013. So my question is, did anyone have option for their copay? I will not be able…

Hey guys well i just sent all my information to my insurance.... I have aenta insurance. Does anyone know how long it takes to get a surgery date once i submitted it to insurance???

I am just starting the process with bmi of 35. Insurance requires 6 months. I am worried I will be denied because of my lower bmi. Even though I have been heavy my whole adult life and I have family history of high blood pressure and diabetes I do not have them YET. anyone have any suggestions to ensure that I won't get denied?