Insurance & Financing

I have been delaying my surgery for years because I just kept working doing the bet I could with my health issues until I found myself unemployed. Now I'm more than ready to commit to my surgery and new life so I can seek new employment a much healthier person. I'm noticing that employer's are discriminating against me because of my size in weight and age. Can anyone please HELP! ME! with this dilemma? I've already completed all but two more appointments before Scheduling my surgery date which I was hoping and praying it could be before the end of the year. I've met with my surgeon and the bariatric team at MUSC. Tanya

I was denied 11/8 for the gastric sleeve and dont know why yet as I had called and got my answer. So I'm waiting on the letter they send out to tell me exactly why. How long did it take if you got one? 7-10 days is the normal they said but I'm praying itll be less! Or did your surgeons office get the letter emailed first?

Hi everyone! I was wondering if anyone had any info on bariatric (VSG) requirements with Prestige Insurance (Florida Medicaid)? I was told by member services that it is covered when medically necessary, but they wouldn’t tell me what the requirements were ie., length of time for supervised diet visits, specific BMI info, nutritional and psychic evaluations. I am scheduled for an informational session in Tampa in a week, but I can’t get any info from my insurance or perspective surgery center and it’s so frustrating. Also if you have any other FL Medicaid insurances and know the surgery requirements for them, pls let me know what they are, bc I’m still within the time fra…

Hello everyone, I'm having a bit of a tough time filling out my short term disability for my surgery coming up on December 12! I have CIGNA, so my questions are as follows: 1. Do I fill out the short term disability before or after the surgery (I've already filled out FMLA paperwork as well.) 2. When asked "when did the symptoms first start?" - is that when my morbid obesity became an issue? "Have you had this illness before?" I've had it pretty much my whole life, so is that a yes or a no? Anyone else care to share what they put down for their short term disability? Thank you in advance!

Anyone in Michigan with BCN insurance? Just wondering the approval process? Once doctors submit paperwork, how long did it take?

Hi guys! I just got insured by my new employer and I have BCBS PPO Options. Have any of you guys been covered with this plan? I’m just in the research phase still, really, since I haven’t had insurance til yesterday lol but honestly, finances scare me more than the actual surgery! thanks! Christina B

This may have been discussed before but for anyone covered by CIGNA or one of its affiliated companies, they have abandoned their prior formal requirement of a specific duration (e.g. 3 months) in favor of this language: • A statement from a physician/physician’s assistant/nurse practitioner/registered dietician (i.e., other than the requesting surgeon) that the individual has failed previous attempts to achieve and maintain weight loss by medical management. This is the old language: • Medical management including evidence of active participation within the last 12 months in a weight-management program that is supervised either by a physician/physician’…

Hi All: I was wondering regarding BC/BS of Mass gastric bypass approvals. I received the pre-auth form. I have a BMI of greater than 50 with 2 co-mobidities sleep apnea and diabetes. I've met all of the other testing and nutrition criteria except for the psychologist visit. Is 6 mos pre-dieting is required for approval? Is pre-surgery weight loss required for approval? I was wondering if anyone was denied for gaining weight prior to the surgery.

My apologies if "cross-posting" here is bad form - - just wanted to share a Halloween Blog that's very relevant to the season!

Hi there. A newbie here. I am just getting started and have my first info session next week, but have a question. I am currently on my husbands insurance(Aetna). The plan does not have bariatric services. Since open enrollment is coming up, I am going to switch to my employers plan (Highmark BCBS DE) because they do have it. If I start seeing the Dr. and start that 6 month clock before I switch carriers, will they make me extend the 6 months? TIA Jen

I am switching providers again (3rd time) because now I finally found a doctor who will do both surgeries (Lapband to RNY) at the same time. I was approved for lapband removal with the (1st doctor) but he will do the RNY 3 months after the removal and the second doctor has the same feeling but for a different reason. I completed the nutritional classes and psych evaluation with the 2nd doctor. All I need now is a PCP letter and I will get that Monday so that I can submit it the 3rd doctor. I will have the 2nd doctor send over the psychological report and medical records showing that I attended the nutritional classes. Has anyone experienced anything similar and had issues…

I am in the beginning stages. I have a BMI of 36 so I am borderline and per Aetna insurance I need to have a comorbidity. I did a sleep study and the ENT called me and said I have "mild sleep apnea". Has anyone every been told this. Would this qualify me for surgery? He said I didn't need a CPAP, but recommends losing weight and maybe a mouth appliance. I am worried I will go thru the extra time and expense to have all of the things the insurance wants me to do and may end up looking at a cash option or not getting surgery at all until I develop diabetes or another issue down the line. The other question I have. The surgeon (not insurance from what I understan…

Cigna had originally approved procedure, gave my doctor a list of clearances I will need. Then after all clearances were done they denied it. Has this happened to anyone before? Is there anything we can do about it? It is super frustrating to go thru all these tests and then be denied.

Hey! So I am just about to go to my second weigh in out of 6, so I have awhile to go until ready for surgery. However, I am already freaking out about waiting on insurance for an approval. I am hoping to have surgery in Dec, and really want it then since I have already met my deductible. How long did you with BCBS have to wait from when the doc's office sent in the request until you heard a reply? Thanks!!

After having hit a brick wall with Blue Shield (if your Blue Shield coverage is through covered california, you are limited to doctors/facilities in Southern California, and the closest one for me is 6 hrs away), I am considering switching to Kaiser during the upcoming open enrollment. If you've had the procedure approved and you're with Kaiser Northern Calif, would you recommend them? Are their requirements so strict that a lot of people get declined? I had read somewhere that they require that you've been morbidly obese for at least 2 of the last 5 years. Is there somewhere I can find a list of the co-morbidities they consider? I have high cholesterol, fatty liver and s…

I am haveing my scripts processed as we speak through insure nutrition for protien drinks and scar cream with the added bonsus of free vitimins. I have paramount advantage(ohio medicaid). Please post reviews, insurance you have and rather you were denied or approved. I will keep you updated on mines as well!

Has anyone with blue shield of California recently went through the process, what was the requirements?, any help is appreciated. I’m switching over insurances mid process.

Hello lovelies! So I was approved for surgery and have scheduled my surgery date for December 12, 2018. I have CIGNA insurance. The only thing I'm coming across as an issue at the moment is trying to figure out how to start the process of filing FMLA. I will also be taking a bit of short-term disability, but the majority of my time off (I'm wanting to take four weeks off) will be based off my vacation time. I talked to my supervisor and he said that it would be beneficial to the paperwork being sent to HR that I have a letter from the surgeon stating that I am having surgery and the recommendation of time out. I called my surgeon's office about it and they …

I have both personal sickness and hospital indemnity AFLAC policies and wonder if they consider a medically necessary Roux En Y gastric bypass surgery covered. My AFLAC agent thinks it is an elective surgery and therefore not covered. Has anyone ever filed an AFLAC claim for this surgery?

I talked to United Health Care and they told me i have no pre op diet requirements, does that mean after my appointments with the nurse practitioner, nutritionist, psychologist, etc i am ready for surgery?

In order to qualify for a Lapband to Sleeve conversion per my insurance requirements (Blue Shield of California) I need 1) to undergo a medically supervised weight management program for at least 3 consecutive months and 2) Have a BMI of over 40 or a BMI of over 35 with a comorbidity. (I do not have a comorbidity that I know of) Now. I signed myself up for a medically supervised diet plan on November 30. I thought to myself, hey, the more I lose now, the less I will have to lose after my surgery (logical right?). Well within the 4 months I've been on this diet, I went from a BMI of about 43 to a BMI of 38. Do any of you have experience with this posing an issue to gettin…

So, I started this whole journey in October 2016. I had just started a new job, whose insurance plan does not cover any weight loss plans, including surgery. So, I opted out and started calling around to different companies. I THOUGHT I found a plan that would cover it (the saleslady said it would!), but, I was duped. Fast forward 7 months, my parents agreed to pay (they are not wealthy people, so I know what the burden is). Now, here's the thing, I started with such a high BMI, that my surgeon refused to do the gastric bypass. He also advised that I probably would not find a surgeon who would. Instead, we decided to do the procedure in stages. So, I have a gastric s…

Today I went and met with my surgeon and set up a date but because I gained 14 pounds when I quit smoking and I've been lifting weights and working out and lost everything but 4 pounds. Now they say they may deny me bcuz of 4 pounds.. has anyone have a problem getting approved?

Is there anyone who has UPMC Health Plan and has already gotten their approval? If so, how long did it take between your last check-in and when you got approval? I'm trying to get an idea of when my surgery might be so I can plan accordingly.

Tuesday, I went to see the weight loss surgeon at the surgery office who placed my lapband in 2010. I went to discuss removing the band and revising to a sleeve or RNY. Well, he does the procedures in two different surgeries, with the weight loss surgery being 3 months later. They submitted the paperwork for the removal and I was approved for that today without evidence. My issue is I don’t want to wait 3 months and have to go through with another surgery. Will I be able to switch doctors and keep the approval for the band removal? I know I have to get approved for the WLS as well. Another surgery center excepted me as a patient today and will do the removal and revision …

Hi All, I just wanted to share my experience with Anthem Blue Cross CA. My surgeon submitted the request to them on June 8. I called them on June 13, and it was still pending. On June 15, I looked up my plan documents, which clearly stated they have 5 business days to make a decision. So, I called them around 10AM on June 15. They stated it was still pending and that they believed that they had 15 days to make a decision, so I quoted them what my plan documents state, and gave them the page number it was on. They stated they would let the reviewer know, and I should call back later that afternoon. I called again about 2:45, and after being on hold for 20 minutes I wa…

Do staywell medicaid pays for surgery in orlando fl

I researched and verified all the requirements for my Cigna insurance before getting started. I started my process on May 29, 2018. This was my first of the 90 days worth of appointments for medically supervised diet. I attended seminar on June 10, and saw surgeon for initial on June 26. I attended my nutrition class, for my psych eval. Then on July 15,2018, Cigna put out a NEW policy on Bariatric surgery coverage and requirements. Really?? Who does that in the middle of the year?? Anyway.. the new policy does not require the 90 days anymore. It requires a letter stating you have failed medical weight loss in the past and that it is medically necessary and that you are cl…

Hi everyone! I have Horizon NJ Health Medicaid, they required me to come to their office once a month for 3 months to participate in a medically supervised weight loss program.....i only have 2 things left to do. The sleep study and the endoscopy. My current weight is 217 ,bmi 38.5 . I have high cholesterol and excessive day time sleepiness. Does anyone know if I will qualify? I'm so anxious to know, I really so hope I qualify I have been struggling with my weight my whole life

Question...I have bcbs Alabama insurance. I have completed all of the steps for submitting my request for surgery. I did not have 3 years of medical records but used dates photographs and the past 18 months of medical history. My insurance denied my claim within a day of my request. My surgeons office says this is normal when they submit a claim with photographs but that they resubmit and get the approval. I am freaking out here with all the time and money I have already invested! Has anyone else ever had this experience or can share what your experience was with my same insurance? Any info would be helpful. Now I am wondering if I need a plan b and try for self pay in Me…

Hello everyone. I’m thinking about weight loss surgery. Can anyone tell me how to go about getting my Arkansas Medicaid to pay for it?

I have finished all of my required stuff for insurance and it's been submitted to BC thru my surgeon and they are looking at it now. So just guessing how long will reviewing take? I just gave to them last Tues. and they have already sent it to BC so maybe I will hear? I am so excited!

How long did it take for authorization for you Blue shield first said my doctor wasn't in network even though they referee me to her and I prior checked everything before my 1st appt .I'm scheduled for Wednesday and start liquid diet Monday but have no clue if I will be authorized on time .I have called them several times .What do I do I'm so bummed.

Just wondering how long, in your experience, it took Aetna to decide whether to approve a band removal and conversion to a sleeve after the doctor submitted the request for authorization. I just found out that my insurance will be changing on Jan 1st and my doctor does the removal and conversion to sleeve in two separate surgeries.

Has anyone taken Bliss complication insurance out as a self pay? I have. My surgery is scheduled on the 15 of August. Has anyone had to use it?

Hey everyone!! I was wondering if anyone has recently had VSG with Fidelis NY/Medicaid as an insurance and if so how long did it take to get approved for surgery? Do they have a 6 or 12 month pre op diet? Thank you!!

I am new to this so excuse me! So I went to my consultation and my first appointment with St. Vincent's Charity Hospital. Met everyone and the patient advocate told me all everything I need for my insurance, which is Buckeye Community Health. She said my insurance is pretty hard to get accepted. Which is a total bummer to hear. I currently weigh 246 and I am 5'4" I have to do a 7 month diet/exercise plan. but I can only lose up to 13lbs or I will not have a BMI of 40. I don't think I have any comorbidities that I am aware of. (I just took my sleep test last Friday) My family doctor was very inconsistent with any of my health related concerns. …

I was just given the criteria for me to have the sleeve procedure...psych evaluation, 18 years +, BMI of 35 with comorbidity or BMI of 50+, and the 6 month on one structured diet or 3 months on 2 structured diets. I was told weight watchers or Jenny Craig. Ok now..I’ve been on ww off and on for years.. does that count? I’m doing real appeal now through United Healthcare..does that count? Please someone given me your experience or more information on this diet thing.

I was just informed that my revision from sleeve to bypass will not be covered by bliss complication insurance. I just called my regular insurance. They said if I was discharged and something happens that is billed due to the surgery which they did not approve they won’t cover. Any thoughts? Anyone have the same issue? Anyone have a complication that wasn’t covered by insurance?

Hi all, I have been working with a dietician for 4 months and she is very against any sort of bariatric surgery. I know for the United Health Care and Optum programs, you have to have 6 months of a supervised diet prior to surgery and I am so afraid she is against this. Does anyone know if I would be able to see another dietician through the Bariatric Center of Excellence for my last two months? Would that still count? It would be consecutive months but just with another provider.

So I have UHC. I am currently waiting for my “plan info to be downloaded” so a case manager can call me regarding my requirements. I’ve hear Uhc requires the 3-6 month diet and exercise plan. I’m currently enrolled in the real appeal program through United Healthcare. They pay for it weekly after I Check into the group meetings. My question is..would that program count as the requirement?? Hope so....

I am wondering if any of you have used Lindstrom to appeal a WLS insurance coverage denial? If so, what was the outcome? Thanks!

Question for anyone familiar with united healthcare community plan in NJ. I wanted to know if I need a referral from PCP prior to just the surgeon consult appt. My appt scheduled for this week and I didn't even think about possibly needing a referral until just now. I tried calling uhc, but the customer service agent didn't even know what I was asking when I said bariatric surgeon. He kept saying geriatric surgeon. So I was just wondering if anyone else had any knowledge on this. Lavette

Even though I told my doctor’s office it seemed like I couldn’t have a net gain they assured me it would be fine. Low and behold I was denied for a 5 lb net gain. I am 250 currently at 5’6 and they have suggested I do the six months again and this time just stay at 250 to ensure I am at 40 BMI since I only have mild sleep apnea and no other issues. My question is—at the end of the new six months will Aetna deny me bc I still didn’t lose the original 5 lbs or should I get back down to 245 even though that puts my BMI at 39.5? We considered doing a peer to peer and having the doctor say water weight etc., but felt it would be better to do six more months which is really onl…

Hi all, I'm new to the process, so I was hoping to see if y'all could help me with a few questions. 1) My insurance requires 6 months of documented weight loss, but not only would the end of the 6 months be an inconvenient time for me to get surgery as I'm a student, but it would also be a really long time to wait. I started on this in March, but skipped the last two appointments because I was having doubts about surgery the longer I had to wait. My parents have offered to pay for the surgery out of pocket, and I would be able to get it done in a couple of months after I have been able to learn more about the process (nutrition pre and post surgery, what I need …

Not sure if anyone can give me advice on this one. I am just starting the process. I have been working with my dr on a dietary plan since September of last year. Here is my problem, I have dr visits in Sept, Oct, Nov, Jan, Feb and April but since I did not go in December and March the office I contacted believes I will have to start the process all over again for my 6 month weight loss. I find that ridiculous. Can anyone help me with this or give me some advice? Thank you all!

Hi everyone, This is my first post on the site. I’ve read and learned a lot so far. I have Anthem BCBS which requires 6 months of visits with a nutritionist. My doctors office submitted everything to Anthem on 4/19 but I still am waiting to hear back. It’s just so hard to be so close to the end of the process but yet so far away! Any words of advice during this time? Thanks!

Good morning friends. I'm writing to you from my desk at work. I get paid to do a lot of things at work, and this is one of them. Thankful for that. Anyhow... I'm on here because I have a lot of anxiety related to approval for surgery. I just kind of started this journey beginning of June. Monday is my 2nd month appointment of 7 required months of supervised diet and weight loss management. I am doing most of the pre work at my primary provider as I cannot afford the time and money to drive over an hour away each way to Indianapolis. I called my insurance company more than once to try to get some guidance and advice on approval for this process. All anyone can tell m…

I'm curious, did anyone have to self pay for their band removal to have insurance cover bypass? My insurance denied me based on the fact my band had no technical failure. The surgeon I was seeing did a peer to peer, which was denied as well. I reached out to a new surgeon! His insurance coordinator suggested I go self pay for the band removal, then ask the insurance to cover bypass. My surgical policy states, repeat surgery will not be covered if patient was non compliant with first surgery. I have over 100 pages of fill documents that span over 6 years. I'm just curious if anyone else has had to go this route?

If you get denied how long do you have to wait to appeal or apply again?