Insurance & Financing

Was feeling so excited and happy about the chance to take control of my weight.. requested an appointment for an initial consult.. then in today's mail I received a Summary of Benefits for 2013 from my insurance provider... United Healthcare... and it specifically said Bariatric Surgery was not covered. I was broken-hearted! I can't do this out of pocket! My question is: Even though they say its not covered, should I go ahead and try to get approval? Is it worth the trouble and more heartache? If they say its not covered, is that the bottom line - its just not covered? Has anyone gained approval despite the insurance company initially stating they didn't c…

Hi there so i guess this would be my official first post so i just started a new job with a small company and was pretty stoked to know they offered bcbstx since i have seen so many approvals on here lately. HOWEVER looks like my deductible is $7500!!! So I am looking into possibly getting an individual policy but i want to know which ones specifically cover this surgery. Can anyone help me out? Thank you in advance!!

HI, I am hopefully having my surgery in Dec. Had to move if from October. Anyway, I have a 50/50 coverage for WLS. I know that if I wanted to pay cash it would be around 19k here. My question is - What was the allowed (contracted) amount that your insurance company covered?? And, if you had a co-pay, did you have to pay that up front???

For those of you with BCBS. Did your handbook spell out NO coverage for any weight loss surgery even if medically necessary. Mine does but I was wondering if I should try anyway

Has anyone out there had any problems with BCBS MI and coverage for RNY?? I go to my nutrition eval and first meeting with surgeon on Nov. 13th. Just wondering about other peoples experience.

Just found out I was approved!! "I'm Walking On Sunshine" seems to be a pretty appropriate song right now! And don't it feel GOOD!?!?!

Just curious if anyone has gotten this type of denial overturned. What did you do? My ins states I need 35 bmi + 2 comorbities for last 5 yrs. 3 or 4 out of the five I'm over 35 and more like 38-41 (current 40.6). My ins. States the next step is having my dr. Do a peer review by having a call w/the medical director that denied it.....any ideas?

Do i need separate approval for the dr to fix my hernia during surgery??? I dont want it to not be covered !!!!

I currently have the United Healthcare choice plus plan which should cover 80 percent of wls. However, I do not plan to have surgery until next year when I have pto available to cover my time off. I plan to change my insurance coverage for next year to a plan that will cover 100 percent after copay and deductible. Does anyone know if I get approved this year for wls this year but don't have the procedure until next will I have coverage based on the new plan? I know it may seem like a dumb question but I am clueless for the most part when it comes to insurance. Thanks everyone for your help.

For those of you who already had the surgery or were approved for the surgery, would you mind sharing your story of the approval process? I haven't even attended my first seminar yet (it's on Nov. 15) but I'd just like to get a better feel for the process. thanks so much! -Jennifer

Has anyone had experience with BCBS of TN ? I'm waiting for approval but I'd love to hear from someone who has dealt with them and how long approval took ....

I am self pay, and I have heard that there is such as a thing as medical complication insurance if anything should happen after surgery. Does anyone carry this or know who provides this? Thanks!!

I am fairly new to the lapband journey. I have me with my surgeron and he agrees that I am a good canidate I just need to wait for approval from insurance. This is where things get fuzzy. I am covered under my husband's insurance, which is blue cross blue shield. We live in Georgia, but his company is based out of Jacksonville, Florida, so our insurance card states BCBS of Florida. When I was doing all of my preliminary reserach I did all of it based on BCBS Fl which has just dropped their 6 month wait. This would mean that since I meet all other requirements I would be ready to submit my claim to insurance, but when the financial dept. at my surgeon's office spoke to my …

Good afternoon all! Has anyone had to go the route of sending in a letter from your primary care dr with pictures for the last three years versus the records for the last three years to show that you have indeed had the require BMI for that long?? I'm kind of in a pickle and am starting to panic. I am a little over one month away from being finished with my 6 month dr. supervised fitness/diet. My insurance also required documentation for the last 3 years. However, the last 3 years i've only been to the urgent care (who moved locations), another dr (office is closed now), and the orthopedic who didn't weigh me. The first two are really giving me a HARD time about sending…

Hi everyone, I am a virgin to this WLS journey and I want to thank you all for your posts as they are truly inspiring. I just met with a WLS surgeon yesterday and I have Aetna insurance and a BMI of 43 so I am prayerfully expecting a smooth experience during this new journey in my life. My question ..it is open enrollment through my job and I am trying to guesstimate how much I would need to allot for, for my HFS benefits. I had to pay a copay of $20 and when my surgery is approved Aetna covers it 100% Praise God! Are there nutrients, Vitamins etc..that I should allot for? I appreciate your opinions. Thank you, Monique

Just got my hospital bill today. OMG! so glad insurance is paying for most of it. I got billed for a warm blanket and for every 15 minutes I was in recovery and in the o.r. WOW! The lap band alone was not cheap.

I'm getting all my paperwork ready to submit to the insurance but I'm scare that I will not qualify. I'm 5' 7" and weight 245. I have lost 30 pounds in the last year but I gain all of it back plus more after I stopped taking diet pills. I having high blood pressure, and high cholesterol. My insurance requires bmi of > 35 with relative illness or > 40 with documentation of weight loss attempts. I have tries many diets but how do I show proof?

Heard back yesterday that my employer (I am a public school teacher) does not cover wls of any kind. So I was wondering if anyone else has paid for a second insurance coverage specifically for your surgery. Self pay of course doesn't cover any complications from surgery. What company do you suggest? My hospital is a health first hospital. I am really disappointed ...will be writing a letter to my employer to complain for sure!

Anyone go through the external appeal process? Just wondering what this may be like. They say no because 5 years of BMI over 40 isn't recorded. We are trying to appeal under medical necessity because of apnea, fibro, and ms. Just wondering if the external board looks at more then just the policy....

Just starting my journey and wondering how many of you got approved for surgery just based solely on BMI without any other comorbidity issues? Thanks!

Just got my approval!!!! surgery is Dec. 13 so excited and nervous:)

I'm so excited and have to share this! I just called my I durance company (magnacare) for a second time to find out if Lapband is covered. The first time I was told there was nothing showing about coverage so I'd have to send in a predetermination letter and they'd go from there. So I called again today and if I go to an in-network surgeon I'm 100100% covered!!!!!!

Just too short months ago I begin this journey to have paperwork submitted to insurance and now the time is come it has been submitted it is pending approval and I wait praying to God that he will grant this for my life. I'm so excited to think that it's even a possibility the only way I can make it through this. Is to just ask God for help. I know that there are others at the beginning of the journey and some just waiting for their surgery God bless us all!

Hi! So I was denied for the sleeve by my insurance MVP because they do not view it as medically necessary but they will cover the band or bypass... I have mailed in my appeal letter and any prayers and good thoughts you guys can send my way would be much appreciated!!! Keeping my fingers and toes crossed!!!

My Dr. just referred me for the surgery, but I don't know what will be covered by my insurance and what won't. Anyone else have both medicare & medicaid? I'd like to know if the pre-surgery, surgery, &/or fill-ins are covered? Thanks

Hi all, Well I won't know until end of Oct/beginning Nov if my UHC HRA Plus insurance will approve my sleeve w/only showing my past failed diets and 5 yr history. To be prepared just in case they say I need 6monyh diet... Has anyone been approved with using 2 --3 month diets at least 2 yrs within current date? Did u have to go to NIT/Dr for notes? Or could you use online diet logs/weight?

How long is the approval processes?

I called my insurance company (MagnaCare) and since they were unable to find out if bariatric surgery was covered, she told me to send in the predetermination and they'd go from there. Has anyone who's had the LapBand dealt with this? Would you assume this is a good thing? Maybe meaning if I qualify for the LapBand I will be covered? Fingers crossed!

So I see my PCP in the morning for my last appt of my 3 month supervised diet. I have done horrible and haven't lost any weight, i have gained! If I could lose weight in the first place, I wouldn't be where I am now, right? My surgeon requires the 2 months of not smoking so I quit. Hardest thing I've ever done but how was I supposed to lose weight and quit smoking at the same time? Now I'm worried I'll be denied because of the weight gain. Anyone know how this will affect my chances? I hate to have come this far in the process and not get approved!! Does anyone know if I need to send my food journal in to the insurance company or if my doctor's progress notes are all that…

I have Tricare. Going to doctor tomorrow to get a referral . Hope I am successful

mine was turned in to medicare on the 2nd now its a waiting game.has anyone else went thru medicare and how long did it take?

Has anyone out there had any problems with BCBS MI and coverage for RNY?? I go to my nutrition eval and first meeting with surgeon on Nov. 13th. Just wondering about other peoples experience.

Can anyone who has cigna tell me if they required a weight history and if so for how long? My BMI is right on the line of 35 with diabetes. My weight has been creeping over the past year. Someone told me 2 years showing your are at the BMI that is high enough for the surgery, does anyone know if that's corrrect?

Hi Everyone I've been snooping around on this site for almost two months now and this is my very first post. Just wanted to let you all know that I met with my surgeon (Dr. Silva in Paramus, NJ) on Friday 7/1/11. I was pro-active and found out all of the tests I would need in order to have the procedure, and had everything done just in time to meet my surgeon. The same day I met with him, I submitted all my results (psych eval, ekg,upper endoscopy and letter from my pcp). The young lady in the insurance department was not in in Friday 7/1/11 and Monday was Independance day so she couldnt submit for approval until today Tuesday. I thought it would take about a week or …

Well I had my evaluation with the counselor as required by BCBS of Texas...now I'm just waiting to find out if I'm approved or not! Keeping my fingers crossed!

Im just waiting on approval from insurance. Does anyone have healthfirst? If so what are excuses they can use to deny the surgery?? Please help i really need this surgery.

I have not had insurance in 3 years, I will get insurance w Humana KY state employee in Jan will I be able to start my 6 month diet plan or will I have to wait ??

unbelievable....... Surgeon $29,279.00 Asst Surgeon - which is NOT covered - $16,061.22 - which I will fight against since I was NOT told there was an assistant surgeon Hospital (1 night) - $42,227.20 Anes - $2,562.00 Pic line - $551.00 Lab work - $185.00 thank goodness for insurance.....just to think that we charge here in the US over 80K for a surgery and you can go to Mexico and pay under 10K....something is really wrong with this picture and Obama Care is NOT the solution, trust me.

Called my insurance this morning, they cover 80% of surgery.i would need to pay $3,000 and my deductable is $1,500

Hi there! I am throughly lost and no matter who I "officially" speak to, I get mixed answers. I was hoping to find some help here. 1. I am enrolled with US Family Health Plan-a Tricare Prime beneficiary plan, I'm in Marland, Ft. Meade 2. I make the 200%/over 40% BMI requirements of Tricare, 5 foot even and 243 pounds, small frame 3. I have some other issues such as severe GERD all my life (been overweight whole life too), asthma, osteoarthritis of spine, and family history of diabetes and stroke before age 50 (something my PCM says is a big red flag) Here's the problem: They are wanting me to do this 6 month supervised "diet" which is basically anything I choose, b…

Have Empire BCBS, approved less than a day. Now things are getting real. Getting nervous. Trying to remember that my health and new clothes are better than food! I almost cannot believe im doing this. Ahhhh!!!

I have a pre-screening on November 5th,worried i will be denied

I have been to 2 civilian surgeons, neither of whom told me that TriCare would not cover VSG outside a mtf. After finding this out for myself, I called the nearest Naval Hospital that does them and am awaiting a call for my first appointment with the surgeon there. I have already had a sleep study ( have sleep apnea and am now on a cpap), have had a psych eval done, seen a nutritionist and have another appointment for one, done 4 out of the 6 months of weight monitoring with my PCM that TriCare asked for. I have lost 14 lbs, my BMI is 51, I have hypertension and sleep apnea (2 co-morbidities), limited range of movement in my joints and I have been on this journey since …

The more I read, the more I experience personally, the more I am certain that obesity is a disease much like diabetes, heart disease or cancer. If society and insurance companies viewed obesity as a disease, the approval process would be easier and the emphasis on prevention would be greater!

I'm so anxious....I can't even stand it.....I had the lapband in August 2010 and had to have emergency surgery to have it removed in July of this year....I've sent ALL information to my insurance and they told me that they have everything needed...still have High Blood Pressure and Type 2 Diabetes....My BMI is now at 36....I'm really hoping that I get approved...they are handling this as a brand new claim - thought they would be approving me sooner since I had to have the band removed...... Anybody else have the same situation and if so...how long is it going to take for an answer??? I'm not being very patient right now...

I have my surgical consultation on 8/2 and I'm a ball of nerves over getting it approved by my insurance! I tried doing a search in the forum for answers buit wasn't able to find much, so I apologize if this has been asked before (which I'm sure it has). I have Anthem BCBS. I've already verified that Lap Band is covered by my plan as long as I meet the requirements, which I do. Requirements are here: http://www.anthem.com/medicalpolicies/policies/mp_pw_a053317.htm I have no co-morbid conditions. My BMI is 46. Everything else is in the works - I've attended the mandatory seminar that the surgeon's practice requires. I also have appointments to meet with the d…

I have Tricare Prime Remote North. Anyone know if you NEED the 6month diet before approval? Has it changed?

I have a. Question about the surgery ,,, how much it costs usually in Oregon ???

I am wanting to get banded but wanted to have a general idea of what to withhold for my fda account just in case after surgery. How much did you withhold if you don't mind me asking.

Any one have bcbs peehip alabama? Just wondering how easy/ difficult they are to work with and get approved?