Insurance & Financing

I am looking to hear from the senior sleevers to determine if it is possible to be approved for the sleeve with medicare coverage? and if so, What doctor they would recommend in the Dallas,TX area?

I swore I wasn't going to be this way, but I am officially stalking my health insurance company. :ph34r: The first time I called was Tuesday- just looking for confirmation that the papers were in (they were not). After talking with the office coordinator, I said I must wait. Well, two days later there I was on the phone again, just checking. The papers are in and the nice gentleman gave me the claim number and told me what date they had put on for surgery. He said call again on Monday/Tuesday to check because the nurse had not reviewed the fie yet. Oh boy, I know I will be itching to call again Monday.

I wasn't quite sure where to post this, but I wanted to let you all know that I called my insurance provider today...just out of curiosity (lol) and I was told I was approved and that a letter had been mailed out to my home. I could literally pass out right now. It's like the reality of me getting the surgery has now actually hit me. My docs were submitted September 17th or 18th and Horizon BCBS made a decision on September 20th, mailed out my authorization letter on the 21st. That was quicker than I had anticipated. My surgery date is scheduled for November 9th. I am nervous as H*ll!!!!!!

Im just throwing this out there, but is 4k a "normal" out of pocket estimate amount for this procedure? I spoke with the surgeons office today, and she explained to me that this is my amount that is due PRIOR to surgery.... After I fainted, she explained that the hospital will accept 1/2 payment...(2K)?? I really didnt expect to pay that much... Everyone has thrown in anywhere between $0 to $1500~I called the hospital business line, but no one has returned my Call. My daughter has had 2 knees surgeries, and I never had to pay any more than $250 out of pocket prior to surgery. Is it because the VSG is considered an "elective" surgery? Should I plead with the billing depart…

My Surgery has been approved! yay! Nov 14th is the big day I have pre op testing Oct 22 and thats when I need to pay for everything, Most its gonna be is $3000 because thats my outapocket deductable. Just curious if anyone knows of any banks that give out medical type loans or good places for financing. Not sure I can come up with a spare $3000 in a month.

Hello All, New here... thought about surgery off and on for a while now. I just assumed my insurance covered this. Well, I just got off the phone with United Health Care and they confirmed that I am not covered. I am a school psychologist with Atlanta Public Schools. I've seen numerous posts here from people who have been covered by UHC and am soooooo upset that mine doesn't cover it. Specifically, I have UHC Choice Plus and it's been great until now. The person I spoke with on the phone said they stopped covering it at the beginning of 2012. I pulled up my benefits page online to reconfirm. I guess the school system got tired of paying for these surgeries and that's wh…

I'm currently jumping through hoops, I have the final visit of my 3 month medically supervised diet this Thursday, then paperwork goes to my surgeon's office then on to Aetna for approval. I'm anxious that they won't approve the surgery.

And if so what insurance covers it? Does the VA do it?

So happy to share that I just got my approval. Of course it seemed like forever, but the reality was it went very quickly. I have Horizon Blue Cross Blue Shield NJ. When I first spoke to BCBSNJ in June, I was told I needed a 6 month doctor supervised diet, letter of necessity from my doctor, nutrition visit, psych eval. Come August when I went to meet with my surgeon for the first time I found out from the office coordinator that Horizon changed their requirements. No more 6 month diet. They required an over 40 BMI, a letter from me stating what diets I had been on over the course of the last year, a two year weight history from my PCP. (Just whenever they w…

Anyone approved for revision with Aenta? Did they require pre surgery nutrition or any evaluations? Even if you had it for Band? How long did approval take? Sharon

I'm just so nervous about checking all the right insurance boxes. My first appt was with the bariatric center coordinator type person. She set me up for the following week with nutrition and psych. I finish with that and they ask if I've had the exercise eval yet. Nooooo. So they set that up. I asked if there was anything else and they asked if I had my other 2 psych appts scheduled yet. Noooo! I'm just afraid I'm not asking about something I'm going to end up needing! The nutrition person (who my friend who had WLS 5 years ago says was crucial to her success) was very brief. Said it was no big deal and she'd have me out of the appt in 20 minutes and do the nex…

well im not covered by my insurance for vsg so will have to be paying for it myself and was wondering if anyone knew of a finance company with 0% interest? im already going to have to pay a arm and a leg so dont want to have to pay interest also.. thx

I'm an Louisiana state employee who seeks to have the lap band surgery my bluecross bluesheild *** plan does not cover the surgery do anyone know of a insurance or finace company in my area that will pay for my surgery??

I am so utterly rejected. I was mid-process a few years ago when I had to change employers due to family reasons. We had to change our insurance to my husband's provider that did not cover WLS. Imagine my excitement when we got notification that they were changing providers to BCBS (VA) - which I knew covered WLS. So, I started over again. Went to the information session. Made the appointment with my surgeon for next week. Got the insurance cards in the mail over the weekend. Called the provider, and confirmed that the employer does in fact carry the rider. An hour later, had to call back for another question. Spoke with a different person. They saw somethi…

Hey all, I am in month 4 of 6 for the pre-op supervised diet before I can apply for surgery approval. With the way things are lining up, I will be approved (hopefully) sometime in December. However, I want to push my surgery date back to January for 2 reasons. 1) I will be able to switch to the low deductible high premium plan my work offers to hopefully make my money stretch a little further and 2) I'd rather start fresh with the new year and after the holidays. Only problem is I know you have to get re-approved for the lap band during a new calendar year even if you were already approved, so I have some questions: 1) How likely is it that I could be denied reapprova…

Documents submitted Friday I'm a nervous reck. I hope I'm approve can't wait to start my new life. I'm 5'7 256 goal lifetime weight 160.

Hey all, I am in month 4 of 6 for the pre-op supervised diet before I can apply for surgery approval. With the way things are lining up, I will be approved (hopefully) sometime in December. However, I want to push my surgery date back to January for 2 reasons. 1) I will be able to switch to the low deductible high premium plan my work offers to hopefully make my money stretch a little further and 2) I'd rather start fresh with the new year and after the holidays. Only problem is I know you have to get re-approved for the lap band during a new calendar year even if you were already approved, so I have some questions: 1) How likely is it that I could be denied reapprova…

My surgery scheduler has told me on two separate occasions that lap band is covered on my policy, once before my initial consult and then when we scheduled all the classes and psych and diet eval. However, today I got the eob back from the insurance concerning the first class I attended six weeks ago. Payment was denied. When I called anthem they said that nutrition classes for the treatment of obesity were not covered. It's through my husbands insurance at rolls Royce. How the heck are they going to pay for a 15 thousand dollar surgery if they won't pay for a 75 dollar nutrition class. I haven't called the doctors office because I do not want to draw attention to myself…

Approved!!!

I went to see my PCM today to get my referral sent to tricare for the surgeon..she said she'd make sure to word it so it's approved the 1st time...I'm hoping that im approved! Any thoughts or encouragement is welcomed

Hello all! I have a question. Hopefully I can make it understandable.I've tried talking to Aetna but they dont understand what I'm trying to say...aaaahhhhH!!! LOL! First, I am doing the 3 month plan with Aetna. Aetna Choice POS II. I have a BMI of 40 plus 2 comorbities. I have to do the doctor visits with the 3 months of diets and exercise plan. I started going to my PCP doctor in June will his approval of the Lapband. So, I had my initial doctors appointment June 6. I didn't see my trainer for the exercise piece till the end of June. So my exercise plan is a whole month behind my PCP visits! This is the complication part for me to figure out. Sooo....this is the …

In the preliminary process of being submitted for approval...totally nervous! Anyone have previous experience with BCBS of Texas??

i posted this in my blog but doubt ill get feedback if anyone has an opinion please share with me!! http://www.verticalsleevetalk.com/blog/1918/entry-4635-a-little-bit-obsessive-but-def-no-behavioral-issues-wtf/

I have been moving stuff from my old house to my new one for the last two days and finally checked the mail.....found a letter saying I was approved! I am so happy I can't stand it. I even cried tears of joy...lol I am such a big baby.

Currently I have bcbsil ppo but I'm nervous about being approved... I'm so excited yet feeling discouraged at the same time

I am 30 years old, and will be eligible for medicare/humana on May 1st. I am really hoping for the sleeve. But I can't find the info on medicare/humana approval

Hi I am hoping someone can me with direction how to go around the insurance requirement of having a BMI greater than 50 to qualify for VSG. My insurance will cover Gastric bypass for those with BMI 40. I initially called the 800 number for my insurance 4 months ago and was told that they cover VSG hurrahhhh! But after going over the policy myself I found the true BMI requirements for VSG. I did research and thought the VSG would be the best choice for me. The full gastric bypass scares me and I don't think I can handle the added complications that come with RNY. The thought of "dumping" syndrome gives me hives. Can anyone give me any advice? I am 5'5 and current…

I'm just wondering what these coordinators do all day at the doctors office. I know they have to meet with prospective patients and call insurance. But why does it seem to take them a week to get back to you every time you call? I just want a time frame for when she plans to submit for approval. It has been a week and nothing. Inma bout ready to be a pain in her bum that even preperation-h cant cure.

My surgeon office didn't fax all paperwork needed within 2week time frame and I got denied on Sept 4. I didn't cry...I wanted to because I have been seeing doctor since Nov! I even had to switch surgeons! So I am exhausted and want surgery by now. I just joined and started to write on forum about my frustration being denied and while I was typing my surgeons office called and said I was approved!! I'm ecstatic! But my appointment to get my date is not until October 4th! I'm going to start my liquid diet Monday and hopefully he will give me a sooner date!! I pray!!

Have anyone purchased insurance just to get the band? If so, what policy did go with and how long do u have to wait before having a lapband surgery? My BMI is 40 so I don't think I'm required to do the 6 month diet.

It's official- I have finished all my requirements for Aetna. Papers should be submitted next week. Hoping for a quick approval.

If you had to do the 6 month requirement did you just had weigh in with your PCM? I did 7 month with a nutritionist and they denied me so I have to go back and do 6 month with a physician. Please tell me who you saw for the 6 month process. Sent from my iPad using RNYTalk

Has anyone used this insurance for the operation? What was the process?

Hello, Right now I am in progress of taking my 18 weeks worth of nutriton classes for my health insurance. The only problem is, my health insurance runs out on October 31st and my classes end in Janurary. I have no other option then to get on Medi-cal to have health insurance. I am from southern California and wanted to know if anyone has had the surgery done with Medi-cal, which option and how did you go about the whole process. Please Please help.

Anyone who has BCBS have to pay an extra *3000* or any different amount to have * gastric * surgery? That is an additional to what your deductible, co insurance is. I mean surgery is surgery regardless of what kind they all are done do due to some sort of health related issue? Why I ask is I'm thinking of getting in contact with HR seeing if they will still have that when it comes time to renew OR see if they can drop this part. Sounds silly I know but I have seen other BCBS that don't have this *extra*

Has anyone had any experience with insurance approval or denial with Caremark UMWA?

Has anyone bought insurance to cover Sleeve? I work for a small company and my boss is willing to switch insurances to make us happy and cover WLS. Any suggestions as far as what insurance company to go with? Which plan?

Tried google and searching here but without luck. I already had the surgery in may in mexico and i will deffinately need skin removal surgery (i was 550lbs) i wanted to know if id be excluded because i had a surgery out of country,or would i even need to tell them. Thanks in advance.

Hi, I have united health care choice plus... Has anyone used this insurance? Please advise how good this insurance is if any one knows...thank you kindly

Hi all, I was recently denied by Aetna for lapband due to not having a high enough weight for 2 years. My problem was that I lost some weight on a supervised diet (Jenny Craig) and then gained it all right back, so the insurance company denied me for having once lost weight. I have now developed a thyroid problem which makes it that much harder to loose weight. In saying all this, I am working with lindstrom advocacy to hopefully get it over turned. Has anyone worked with them having Aetna and had success. I'm very discouraged and want this really bad! Any information would be greatly appreciated -Mandy

Has anyone gotten their job to add weigh loss to the health insurance policy? I have an exclusion on my current plan but the company is shopping for new insurance for Dec 1st. If you have what did you do or say? I'd love to convince my job to add it instead of excluding it. Please help?

I thought the emotional part was making the decision to have surgery. But the roller coaster ride with insurance is making me crazy! Denied but not really, now pending is wearing me out!! I am sure this is normal but it's to much!!!

Has any one had it where the insurance company says that any bariatric surgery has been excluded from plan? If so, has the doctors office fought it and ended up getting approval or that was it, No more trying. please advise...

Today I submitted all of my documents were submitted to my insurance. The funny moment of it all was the pre cert coordinator must have showed my letter documenting my weight loss attempts in the past 12 months...all i heard was "OMG! Why do these people write books!" I looked at her dead in her face as she said it and then she walked away as if she had been caught robbing a bank. It was kind of hilarious, but unbeknownst to the mortified nurse I would have been negligent had I not given them a sneak peak in the 20+ years of weight loss attempts. 12 months to me just barely hit the surface. Needless to say my paperwork has been submitted to Horizon BCBS. Right now I have…

So my surgeon requires me to see their dietician atleast 3 times , this is the thing i was going to another dietican and i feel like they should have scheduled me after i saw my dieticain 3 times so i can do the last 3 with their dietician. I say this because the insurance comapny wont pay for two. I am sure someone knew that when they made my appointments. I am sooooo frustrated with these people. And i didn't mention they made all of these appointments with out approval from my insurance. I feel like they dropped the ball on me and now i have to pay for 2 visits with the dr and 3 vistits with the bariatric dietician. I don't know what to do. I think i need to cancel my …

Sounds like approval, right! [ATTACH]4994[/ATTACH]

I have a question, I have not had insurance in about 2 1/2 years, I will be getting insurance in Jan 2013, I was wondering if surgery was covered right away after all the requirements are meet for if you have to wait a certain amount of time, before they will cover it? Thanks

My final weigh in was sept 6th with my primary dr. The Surgeon office faxed paperwork sept 10th, I received an email sept 11th and final approval letter in mailbox Friday! Was a very quick approval process! For everyone doing the 6 month diet, I was disappointed having to wait the 6 months because I felt like I was ready in April! But.. These months went very quick and I've done a lot if research, I feel like I'm more prepared. I have quit drinking any drink with carbonation or caffeine. I was a heavy coffee and diet coke drinker and knew I'd go through withdrawal. I didn't want to go through caffeine withdrawal after surgery. I do still drink decaf hot tea, and lots of w…

Just like most of you. I am doing the 6 months of supervised dieting Will appts every 4 weeks be okay? Will the counts as 6 months? August 18 September 15 October 13 November 10 December 8 January 5 Any tips on what to ask the dr? The surgeons office gave me paperwork to give to the dr. Any tips on what not to do? What happens if I gain or lose 2 much? Lastly what can I do to pass time?. Lol

So my surgeon sent in all of my paper work to insurance on Monday. I just checked with my insurance company and it was approved the same day and they already sent the letter to my home and my doctors office on Monday! I am so excited I am almost giddy. I can't believe approval happened so fast.