Insurance & Financing

I am soooo very excited...just called my insurance company...i have been approved!!!!!!!!

Good morning: June 2012 the doctor suggested that due to a Slipped band and my diabetes and unsuccessful weight loss, I remove the band and get a Gastric Sleeve. June 2012 - CIGNA approved removal of the Lap Band, but denies the Gastric Sleeve. Reason: There is no documentation I followed Diet/Exercise Program. July 2012 - My doctor submitted paperwork again and got denied. September 2012 - Doctor gathered the 6 month Diet/Exercise documentation showing I followed the protocols, but due to my Diabetes and Slipped Band my weight loss have been unsucessful. The doctor said he would appeal the decision and resubmitted the paperwork to obtain authorization, they wou…

I am currently on my husbands insurance which does NOT cover WLS for any reason. His open enrollment is January 1st so hes dropping me from his insurance which will give me a "changing event" to be able to enroll thru my employer which DOES cover WLS. Im going to be getting Wellmark Alliance Select. Anybody have any experience with them? I know that I wont have a pre-existing condition clause because I wont have a gap in coverage. The Bariatric surgeon has instructed me that I will at a minimum need a 6 month supervised diet and 10% weight loss. Im currently seeing a nurse practitioner and have four months out of the way and have lost 21 pounds. My starting BMI wa…

http://asmbs.org/2012/08/bariatric-surgery-prevents-diabetes/ BARIATRIC SURGERY REDUCES RISK OF TYPE 2 DIABETES Article and supporting article link that you can use in your insurance letter, if you need to - also just good to understand and pass it on!!!!

Has anyone been sleeved through tricare? What were your thoughts on the process?

Anyone have the sleeve covered with Fidelis managed Medicaid. Doc thinks it may be a problem, but will push for it due to severe ulcerative colitis. I did not get surgery two years ago, because sleeve was not offered in my area, and I will not have band or bypass.

Hi everyone, I'm new around here, nice to "meet" you! I am just starting my journey. I've been doing a lot of research past few weeks and about to make my first appointment and take it form there! From what I've read, my insurance, Highmark BCBS (NY) does require the 6 month diet. Has anyone had this expierence with this insurance company? good/bad? As of right now my BMI is about 55 and I know at my weight i'll more than likely need to lose at least 10% before any surgery. Thanks for any info you can supply!

I got denied today! I am so down! I called the insurance company due to a letter I got in the mail saying the approval was pending. They denied me stating " lack of medical nessecity " and said I need to provide more documentation regarding support groups and exercise.plans tried. I had included info about gym memberships and weight watchers among info on many other diets and weight loss attempts. I have 45 days to appeal but I tell ya, the insurance company has just about stole my thunder by denying me.

Should I go onto my husbands insurance kaiser or stay with United Healthcare? Which is less strict? What is kaisers guidelines?

New here! Seminar, initial consultation, and psychological evaluation done! Yay! Does anyone know how long Health Alliance takes to grant approval? I want to finish by hoop jumping and have my surgery early December.

My surgeons office sent the request for my records...my question is generally how long does it take for the records to get to them? Thanks

My insurance company paid for my band. I have been working a job I hate for the last year because I knew my insurance company would cover my band. Now that I am banded I'm ready to get the heck out. If my new insurance doesn't cover wls how much will my fills be?

All done all my requirements and the doctors office submitted my package to BC BS of North Carolina last week. Heard today that they need a single doctors visit from 2011 to verify my weight and a thyroid test. I'm READY! Tired of this waiting game and all the hoops! Just wondering if they will keep coming back with additional requirements after I get them the records and have my thyroid test???

Ok, so far, the first claim filed was from the hospital, 2 night stay and Davinci robotic surgery, 2 procedures.. Plano Presbyterian Hospital.... $67,386.81 I will update the amounts and discounts on this thread as they come through. It better go right! I should owe ZERO!!!!!!!!!!

Hello, im needing all the advice I cant get my insurance is bcbs of ok they do not cover obesity!, so im self pay any pointers or advice ive chosen to go ahead and do rny, anybody have info on any ok bariayric surgeons thanks

Hi everyone, i will be enrolled in nj bcbs epo plus program after 10-15 for $280 a month. 1) has anyone else used this insurance to cover vst? 2) did they approve? 3) where there any co payments? So far when you call horizon the reps just ask that you meet the requirements. Ty

My insurance was approved but I'm wondering do I have to pay the rest right away or is there a payment plan. I have blue cross of California.

I called and received my approval code today. This is only 4 business days after successful submission. My surgeon's billing coordinator did have to submit an extra form and have some of the wording changed in the psych eval letter of recommendation. They required: - 6 month supervised diet - Psych eval - Pre-op nutritionist The preauth helpline has been very helpful and I only had to call twice. They actually said it was due tomorrow but I called before closing today and am good to go! A great experience with BSofCA!

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Hi all, I was denied by Aetna in August and am in the appeal process with Lindstrom Advocacy. If that doesn't gain me approval I am thinking of doing self-pay. I was curious what happens if you self pay and have complications down the road. Do you have to pay to get the band removes/fixed? I'm only 20 and know that complications can occur with pregnancy, time, etc and I wouldn't want to pay the money for the surgery to have to pay again to fix it in a few years. Do any insurances that don't cover the initial surgery but do cover complications?? Please let me know, any feedback would be great!! Thanks Mandy

Hey everyone, I've had my band for 3 yrs now and happy with the results (lost 104 lbs). However, my band slipped about 6 mths ago and I still haven't gotten it fully fixed. My Dr says he "treats the symptoms, not the xray" meaning that when he unfilled me partially, my reflux stopped. So he left it alone. Unfortunately, at this current fill level, I no longer have that same restriction. Not to say I have none, I can tell it's there till about 7 pm -then I can graze like a cow. Used to throw up quite often cuz I ate way too fast. Haven't thrown up in 6 mths since my partial unfill. Still have occasional reflux (about 2x a week). I was banded for a reason: Diet don't wo…

I go for my meet with my new doctor in the morning. I am very excited I cant spell. So i am taking with me a complete blood work up, my EKG reports, a letter from my obgyn stating how she had me on a diet with weekly way in's and not but least a letter from the head doctor stating I good for surgery. So with that what am missing so we can get this show on the road? They did say being what I have and this is it told me if all goes well insurance of course i could have done for sure Nov. Is humana gold choice hard to get approval?

I was planning on having my Psychologist, Surgeon, and Dietician visit all on the same day. I got a call from the Psychologist's office today telling me that my insurance wouldn't cover my visit. Not so much that Cigna wouldn't cover it, but that Magellan which is over psychological treatment wouldn't approve it. Has anyone else experienced this problem that has Cigna and maybe Magellan for psych services?

My husband recently changed jobs and isn't eligible for insurance until 90 days. We were able to get United Health from my employer for now. Although United Health said my plan does not cover lap band. I could switch to Kaiser in May but I'm not sure if it will cover lap band (I will ask before switching). My husband will be able to get BCBS of NJ (odd since we're in SW WA/Portland OR) in December through his contract company, but we're hoping for direct hire shortly after that in which case we'd change again to Aetna. I don't know if BCBS or Aetna will cover lap band or not. My question is.... should I try to get started with the process now or do I wait until we have th…

Does anyone have champva insurance? I was wondering how long they take to approve or deny ? They are like tricare and I've heard some people say tricare only took a couple of days. What is the average waiting period to get your answer from the insurance companies??

Okay, I am getting a lap band in Detroit at Harper hospital on the 24th of this month thanks to medicare. They provide the surgery, a private nurse and a hotel suite for 2 days. A plane ticket comes with them as well, but since we do not have the funds for my hubby to fly does anyone knows if there is any chance that medicare would pay me the $700.00 for ground travel? I know that that sounds dumb and stupid but I am a disabled veteran and the Fayetteville, Arkansas va hospital gives me $24.00 for "travel pay" to compensate me for gasoline from my Missouri home. Thanx:clap2:

Anyone has aetna? There are two different criteria for surgery requirements, either 6 months of a medically supervised diet or 3 months of preoperative teaching for RNY. Anyone has any experience with this? Please share.

I am on BCBS Nebraska. I need to provide the following: Medical documentation of the patients BMI from the past five years. Any additional information supporting the medical necessity for the above procedure (lapband) How do i support or prove medical necessity? I have a BMI of 42, have had a BMI of 39+ for 5 years. I was diagnosed with HBP 3-4 years ago and was diagnosed with sleep apnea 3 months ago.I also have yearly physicals from my emloyeer and doctor supporting my BMI. Is that enough? I have tried almost every diet i can think of BUT i don't have any receipts for any diet. What should i do? I have to have my info in by 9-30-12. Thanks!!!

Has anyone used there flexible account to pay for a portion of there surgery? If so was there a process you had to go through??

Has anyone used there flexible account to pay for a portion of there surgery? If so was there a process you had to go through??

Does any one know if true results will finance all the lap band surgery ?

So excited and scared but so ready"!!! Left work early today. Allergies got the best of me!! But I got the call for my approval today pre op appointment scheduled for Oct 15th 10:30am. Then I will get my surgery date Sent from my SCH-R720 using VST

I have BCBS-IL, they said my co-pay for gastric bypass is $250. That's good to know!

An someone please give me an idea of what to expect. About how long it's going to take

I was wondering if anyone knew if Dr. Moazzez took tricare?? I am researching a dr in the Northern Virginia area.... Thanks Monica

Bcbs Pennsylvania, for a revision, RNY to DS

Do anyone have blue cross independence of Pennsylvania if so how was the approval process

I'm jst starting the process of getting the band. No cormorbities but bmi is over 45. Any advice on if this insurance will cover the band? I'm nervous and hoping it gets approved! Going to my first seminar tonight.

Hello everyone, I have an insurance plan that has a specific exclusion for weight loss procedures and I'm a graduate student who is unable to pay 20k and up. I'm wondering a few things... Are there any self-pay, private insurance companies that allow for lap-band procedures? Has anyone been successful with clinical trials? I can't find any in my area (North Carolina) Are there any unique/creative ways that people have found to help with the funding process? I don't qualify for private loans so that's not an option. I know this is a LONG shot. But...you never know Thanks

Does anyone have Propel Insurance through Senior Services of America, LLC?? Thanks in advance!

I've just started the approval process for tricare so I have a few questions. As far as the 6 month diet goes does anybody know if they will accept a letter from my primary doctor that says I've been on weight watchers for 6 months or do they want to actually see the 6 months of weigh ins with the doctor. Also I'm Tricare prime remote and I got denied to get my travel paid for because it's elective. Has anyone else had their med travel paid for? I know tricare can be inconsistant sometimes so I was just curious. Thank You

I am self-pay and I just set my surgery date for October 15th and I have to have my money turned in for the surgery next Monday, Oct 1st. I was planning to charge the surgery to two different credit cards that have enough limit for the surgery and then pay them off as soon as I could so that I could also get the benefits such as miles on my cards. Has anyone tried this? Does the credit card companies consider this a cash advancement? Or would it be like any other purchase you would make with your card. Please help me?! =)

The other day I posted a question regarding insurance. Today I received my approval I have bcbs my request was submitted on 25th and it was approved on Sept. 27th. I found out by calling bcbs my doctors office does not know yet, but I called them. Hoping to get a October surgery date.

Does anyone have HIP?

I received a call from my surgeons office on Friday saying I needed to draft a letter of motivation for insurance. I have no idea where to start or what to include. If you've been through this, please guide me as to what should be included. I've tried to do a letter, all 10 pages of it, but don't know if I'm providing too much information, or even if what I've included is relevant. I've basically documented my life and what has lead to my addiction to food.

Anyone have any experience with BCBS Federal Basic plan and what you ended up covering out-of-pocket?

I am super excited, after following the 6 month nutrition visits, and all the other necessary requirements...the request was submitted 8/6, and I was approved today! Thank you God. I was thinking I would have to wait weeks

To say I'm frustrated is an understatement! I've spent the last 7 months doing EVERYTHING that was asked of me by the medical center/Aetna and I found out today that I was denied because I haven't been morbidly obese for at least 2 years (I've been 100 lbs or more overweight for MANY years) and I have no comorbidities. I am 5'5'" 232 lbs. I have GERD, a hiatal hernia, high cholesterol and rediculous hypothyroidism since my thyroidectomy 10 years ago. My previous case manager at the bariatric surgery clinic led me to believe these would be sufficient for Aetna, hence why I went through the long, tedious process to be approved. The case manager in charge of my case now ap…

I have Tricare south and am doing a 60 day medically supervised diet. Today was my last day, and I have dipped below a BMI of 40. Does anyone know if tricare goes by beginning weight or not? I am 5 lbs below the weight now.

Hi I'm looking to change my doctor, he does not recommend Lap-Band and my Insurance (MediCal) says they will cover whatever is recommended by my primary doctor. So you can imagine I'm kinda pissed my doc doesn't want to help me out. Was wondering if anyone from Southern California area who's doctor has recommended them for surgery, doctors name and how it went? Thanks