Insurance & Financing

Ok so here's my story...I met with my surgeon originally back in January submited paperwork and then found out I was going to have to jump through a bunch of hoops to get approved. Six month medically supervised diet, psych eval, nutritional eval, egd...ect ect. Well I got discoraged and didn't start the six month diet until April...managed to get back on track and get everything done. Last PCP appointment was 10/22...after both offices sitting on my paperwork everything finally got submitted to insurance on 11/9. Well I have been (not so) patiently awaiting a decision when I get a phone call this morning from my surgeon's office. Aetna has now requested a 2 year weight h…

HOW LIKELY IS IT FOR INSURANCE TO PAY FOR SKIN REMOVAL....IF....U LOSE 200BLS. N HAVE SKIN PROBLEMS BC OF WT LOST? ALSO I HAVE BCBS

What exactly does atena ask for before they except u Marie

I went and met with true results to discuss self pay options. Even tho my insurance covers it I don't meet the years of documentation they're requiring. The patient advocate said I may have a hiatial hernia because I get acid reflux often.. Which then they'd pay for nearly half of the surgery. Is anyone else In a similar boat? Or did u go thru true results? If so how was it?

Hello. I'm new to the site. I'm 21years old and I'm from California. I've struggled with my weight all my life. I've been researching about gastric bypass for the last few years. I need to get healthy or my life is just going to keep going down hill. I'm still young & I know that there's still a chance for me to turn my life around. I really want to get the surgery but I'm scared that I won't be able to. I don't have any insurance & my family is dirt poor. Do I have any options that could help me? Any advice is greatly appreciated. Thank you

the dr called tosay and said tricare came back and said they would only pay for 50 percent of the surgery anyone ever hear of this?

Are there any Kasier of Md, DC, VA members on here.

Do anyone know the time line for Kasier of Md patients

Hi does anyone know of any weight loss surgery financing option or what payment plans are available ? Sent from Indiana's iPhone using LapBandTalk

I am getting extremely nervous. I am 255 with no comorbidities as of yet. I have a sleep study on december 8th. If I have sleep apnea I will be golden for insurance approval but otherwise I might be screwed. My BMI is 41.9 right now. They want two years history of morbid obesity. I do NOT have this, because in the past two years I was pregnant and supposedly this does not count. Before that, I was only 215. To make matters worse, I was 250 after I gave birth but have no record of this. That would give me a 17 month history if I actually had it on record. I am so concerned about this. Before, the coordinnator acted like it was no problem. Now, they are acting as…

Does anyone have any experience with BCBS? If so, were you approved quickly or did problems occur? Thanks!

I'm so happy that Norway offers the surgery for free for those with a BMI over 40. I am 42.2. I feel so sad reading threads and posts about people being denied. I could never afford this otherwise.

JUST GOT OFF THE PHONE WITH MY INSURANCE (CIGNA) AND IT'S OFFICIAL... IM APPROVED I COULDNT BE HAPPIER SO SO READY TO GET THIS STARTED AND HAVE SURGERY!!!! IM LITERALLY IN TEARS RIGHT NOW. THIS TOTALLY MAKES MY DAY!!! HAPPY HAPPY GIRL RIGHT NOW

So i got the info today about my approval for surgery but never got to talk to my surgeons office today. So does anyone know what you have to pay upfront? My insurance says my OOP exspense is 15% of plan allowance. Does that mean i have to pay all before surgery??? Did anyone get to pay theirs in payments? Help!! Way too many questions right now Krysti

Hi everyone.. I have been working hard to get my credit up before looking for a loan. So I got it up to a 670 but now my medical financing is only giving me 10,500 and I need 16,500. Does anyone have any ideas on how to work out the rest without maxing out all my credit cards? And without begging someone to co-sign for me? I don't think I could aford to have multiple payments and intrest from a bunch of different cards... has anyone come into this problem? I am clear for surgery other than $$...

Has anyone hired these companies that advertise here on this site to fight for your appeal? What happened? PROS? CONS? I have BLUE CROSS BLUE SHIELD TEXAS RISK POOL...I would think since Obama care with its no exclusions we wouldn't have a problem....??? Idea and help please. They verbally said after their denial letter they will pay for NOTHING since it was an exclusion in the first place!! Thank you

I am just beginning this long journey and I see my PCP for the 1st time on Wednesday to start my 6 mth supervised diet. My fear is that he will not want me to do it and refuse to go along with signing off on my weight loss attempts and my clearance letter. I'm guessing he's going to try telling me that in my 6 month supervised diet that if I try I will be able to lose a lot and shouldn't have the surgery. Anyone dealt with anything like this before? I guess I 'm thinking my doctor will say that b/c that is what my husband keeps saying!

I attended the informational seminar in July, and Dietician visits started in August. I spoke with my coordinator regarding a timeline and surgery date and now she denies ever telling me the things she told me. First thing I did was contact my insurance company and ask if a medically-supervised diet was required and they provided me a link to view their guidelines -- there's no specific timeframe for bariatric surgery approval, it just says dieting efforts need to be fully evaluated by the surgeon. Hooray! So then I call my specific medical group and their requirement is minimum 3 months. Great! So I call the coordinator and let her know what I've researched and found …

I had Cigna for 6 years 1 more weight management then paperwork send in. How longs does it take for approval?

I contacted Blue Cross Blue Shield of AL this morning to check on the status of my preapproval only to be told that it had been denied because I had not had a BMI over 40 for 3 years and did not have any of their 5 comorbidities used to determine approval. I asked to speak to the person that reviewed my case and was told that information was not available and that the reviewing doctor would not take phone calls. I was given the address for the pre determination department and told I could write a letter. Needless to say, after 6 months of weight monitoring, a psych evaluation, nutrition class, and general hoop jumping, I am feeling very discouraged. I don't mean to soun…

So, just started my 6 month diet required by insurance. My question is this....my BMI is currently 41. If I do my 6 month diet that the insurance requires, loose weight and fall below my 40 BMI requirement, will insurance still approve me? Anyone with any experience on this? Thanks!

Just curious on some of the things you had to go through for approval.

Has anyone Had mvp insurance? I Had Harvard pilgrim and they said they wouldn't do it. So I am getting mvp through work and was wondering if anyone Had any experience with them.

does anyone know the surgery copay for blue choice

I am waiting for anthem to approve my surgery. I know the chances of getting approved are pretty good but I can't help feeling stressed and anxious. I am very much a "take action" kind of person so waiting around is killing me. I just want to know. Now. Lol. How long did it take for your insurance to approve? I'm probably worried for no reason but I just really hate the waiting game.

Help! Doctor office called insurance and received pre-approval twice from 2 different reps. Went on and did all the required tests needed by ins company. All info then submitted to insurance co and i was then DENIED!!! Doctor office said that i was denied because ins co said my plan excluded bariatric coverage, but because ins co misquoted me i could get exception. Went to HR and they contacted BCBS who then investigated on thier end. Ins co claims they gave preapproval based on procedure code given b/c that code is not exclusion of policy but were not provided diagnosis code until the medical review was submitted. the diagnosis code was exclusion of policy. Docto…

If I get approved for surgery, does anyone know how long I can wait to get the surgery before the approval by the insurance company is not longer effective? I'll be submitting to insurance in 2-3 weeks and am hoping for a surgery the first week in January or late December....but there's been some issues that have been newly discovered at the start of this whole process that may need to get sorted out before I get this surgery =( Anyone know how long I can wait once I'm approved till it expires?

I know this is a shot in the dark but maybe someone knows something different. Does anyone know of any individual/private insurance that will pay for weight loss surgery? Not medicaid/medicare. If you do please share Thanks in advance

Fighting with the insurance company. My surgeon is scheduling a peer to peer with them. Does anyone know how long this process takes and what the outcomes generally are? So ticked cause I was scheduled for 11/20, then 11/26, now 11/29. I hope it doesn't need to get changed again. Praying I get good news soon.

My paperwork was faxed over to the insurance company for approval. Does anyone have insurance with this insurance company? If so, what is or was your experience for approval? How long did you have to wait for an answer?

Highmark BCBS did not cover VSG for bmi under 50. I just looked at the policy again tonight and low and behold it has been updated as of 10/1/2012. They do cover VSG with BMI 40 or highter and 35 or higher with co-morbidities. Great news! Upon further reading for VSG they want 24 months of contemporaneous (consecutive???) bmi of 40 proven thorugh clinic visits. Unfortunately for me I have not been to the doctor in over 3 years due to not having medical insurance. Does anyone know of a way around this requirement?

I wanted to share the story about why I am a self-pay. I have a BMI of 35. This places me in the Class I obesity category. I have two co-morbidities: high blood pressure and high cholesterol plus heavy snoring (not yet apnea). My insurer, Blue Cross Blue Shield of Illinois, denied coverage on the grounds that my surgery is not "medically necessary." Does anyone know what medically necessary means? My primary care physician and my WLS surgeon view it as medically necessary. The insurance denial is not stopping me. I want better health. I do not have a specific goal weight, though I do have as goals getting off of cholesterol and blood pressure medication. Has an…

So my insurance denied me back in July 2012 because the hospital I'm going through for the VSG is not a Center of Excellence (COE) The hospital finally got certified as a COE in September 2012 so I'm thinking e a getting closer. Great news right? Wrong! Now the insurance is having the hospital go through a contracts process which was only supposed to take a few weeks. So I spoke to the hospital this past week and they won't be finalized with the contracts process until late January or early February 2013. By then I would have waited 7-8 months since the initial consultation. The hodpita did say that they are working with the "blue" insurances to see if they'd be willing …

Anyone have experience with United Healthcare through American Airlines?

I was all ready to be approved and then the insurance denied me because I didn''t have a PT evaluation. So I got that a week ago and finally today it was sent to the insurance appeals department. Is there any type of standard time appeals take? Even in general? Hopefully not too long because I really want to have my surgery before January, because that's the busiest month at work and I need to be there. This has been such an emotional roller coaster for me. We went through 3 years of infertility and waiting and going through this reminds me of all that stress. Please pray for a speedy approvals. Thanks, Pana

So, I am very new to this and still have so many questions. I have done tons of research on the different surgeries and have found that this is the best for me. I called my insurance and they do cover WLS, however their are certain qualifications that must be met...BMI over 40 (or 35 with additional health problems), and 6 months on a supervised weight loss plan with at least 3 doctor's visits during that time. I have been on many weight loss programs, but don't have any documentation of this and it has been consistant. Each time I'm on a weight loss plan, I do lose weight, but then end up gaining it back. My question is this, if I join a weight loss program and lose…

I was wondering if anyone has been covered or partially covered with Blue Cross Blue Shield for Lap Band and a federal employee. I am D.O.D. and group health doesn't cover it with my plan, but that is because my employer has denied it, but I was wondering if that is a:allowed and b: something that happens to many people. Any information would help! tia

Faxed to Aetna late in the day on 10/31. Yesterday they said it went to the medical director in the a.m. Today at 8:30am I am approved. Hallelujah! I still can't believe this is really going to happen. I keep thinking something is going to go wrong. I had lost all hope of a "normal" life for so so long. Checking all the boxes for the tests and stuff helps. I had my labs last week, EGD on Tuesday. Today I'm having my stress test, EKG, and chest X-ray. On the 27th I have my gallbladder ultrasound and my 3 hour info. class. Currently have a surgery date of 12/18 but I'm begging to get it moved one week closer to sometime the week of the 10th. Praying noth…

Finally got submitted to my insurance today! Does anyone have experience with Tenncare? If so, how long did approval take, or why were you denied?

I was approved today for the surgery of a lifetime. My excitement suddenly turned to slight this Maine when I was told that my hospital that I have to have the surgery and is no longer in network and they have ceased to work on agreements as of 2 days prior to my surgery the hospital will be come out of network. So obviously that puts a slight damper on my excitement being that means more money out of my pocket I am upset but at the same time I am so elated that I have this opportunity to get the surgery no amount of money is going to stop me from getting the surgery. Thank you all for listening to my rants and raves at times and I wish the same approval for all that are …

In 2005 I had a lap-band placed. Lost about 100 pounds, had a baby and a bad slip. 2009, new lap-band placed I have never had restriction in this 14cc band that is filled to 13.5 cc. Gained almost all weight back. I was just denied a revision to the sleeve but if I do a 12 month supervised diet they will look it over again and maybe approve the surgery. I have BCBS Cova care. I am so upset about this and cannot even imagine having to do another 12 month diet like i did when i was first banded....

Ok so I got a call today from the surgeons office and they've contacted my insurance and found out my insurance does cover it which is great. My bmi is over 40 so that's good. But she said they need 5 years (1 recorded weight via physician each year) I believe I may be missing a year. Anyone run into this before?? The next step is to meet with the physician on Thursday to see if he feels I'm a candidate then to submit my paperwork. But is it worth amortization g if I don't have everything they need? Thanks!!

I'll try to make this short and sweet I had lap band surgery in February of 2007. I was diagnosed as eroded in November of 2011 and was removed in March of 2012. I elected to switch to a new surgeon to perform the gastric sleeve surgery who required that I wait six months after the removal of my band in order for the scar tissue to heal and the adhesions to settle down. He also required that I have an upper GI, an upper endoscopy and an esophogeal monometry in order to ensure that I would be a good candidate for a high pressure system like the sleeve. I passed all tests with flying colors. I have BCBS-AL. They covered the removal of the band and the subsequent te…

I apologize if this is a dumb question, but is there a time limit after the insurance approves you that you have to get the surgery?

Today I received my letter of approval from insurance, but the insurance company had approved me for Lap Band when I am suppose to getting approved for the sleeve. I called my surgeons office and they informed me that it was an error on their behalf. So now they have resubmitted my info to insurance to have me approved for the sleeve instead. Has anyone had this happen to them? I was just curious if it would take them as long to approve this procedure? Also, since I was given a date for surgery by the insurance company, will my surgery date change now? I would be grateful for ANY input.

Paper work sent in by doctors office yesterday. About how long til you hear??

So I just received my approval letter from BCBS. It states that I was approved for inpatient procedure and could stay in the hospital for up to 5 days. I called Bcbs to see what my benefits are ( my third time calling) every time I call , I'm told something different. Now I was told about a 5000 Admission fee. What?

What does it mean when it says 50% covered after pre authorization? I know the surgery needs pre auth but does that mean I have to cover 50% of the cost?? Sorry guys I am so confused. I have Horizon BCBS EPO plus, with $30 copay and $50 specialist. Thanks

My peer to peer is scheduled for this Thursday. If the insurance company overturns their decision and approves me, my surgery will be scheduled for February. FINGERS CROSSED!!!!

Hi everyone Have any of you used MSI to fund your surgery? I have numerous clients that are in need of having a vertical sleeve due to extreme medical conditions.