Insurance & Financing

I have united health care and all my ins required was a 5 years of medical history of being.over weight and I'm having a hard time with that , has anyone had problems with this and how did it turn out I have mine.from this here to 2008 but cant.find anything from 2007

Well, I got denied by my insurance provider today. I need 6 months of physician supervised weight loss, nutritionist consultation, and psych eval. I feel like 6 months is an eternity. How do I get through it?

We have Humana Commonwealth Optimum PPO. my husband already has this insurance I will be put on his plan October, but I was wondering what they require, is there anything I can go ahead and do and or how long does it take, what do they require? My BMI is 44.4, I do not have any documented problems, because I have not have insurance in 3 years. I have always been overweight. I have migraines and the normal back and knee pain as I am a nurse and work 12 hr shifts. ANY ADVISE ??

It appears that it's quite difficult to get financing for lap band surgery in Mexico, so I was wondering if there were any good doctors in the U.S. that had decent prices. The best price I've found so far is $9950 with Dr Kirshenbaum in Denver. Thanks.

Good news is Aetna covers revisions but they have criteria to meet, which according to my doctor I have met. •2yr weight history • medical problems from band • blood pannel • 90 day weight management Catch, the doctor (not my original surgeon who did band) will only do revision after I meet with their nutritionist for 3 months (I've been going to different ones for 2yrs) with a $50 fee each time since she doesn't take insurance, see their psychologist (again doesn't take insurance $300) then go before their board for review then based on all this would be scheduled for surgery. I know their not asking anything insane, but with being so sick for so long it's made w…

I met with my surgeon on 8/23/12, then had my psych eval on 8/24/12. Anyone with Anthem bcbs in ky who can tell me when my misery of waiting might be over?

So, my friend said that even though her insurance said she had to be 40bmi or 35 with 2 problems. she wasn't. she said she convinced the insurance compny to approve her. i have united health care. does anyone think this is actually possible? My bmi is 37.2

I am under my dads insurance and he works at firestone/bridgestone and the insurance is unitedhealth care. does anyone know anything about the insurance policy regarding this surgery? btw i am only 37.2bmi and have no problems as far as i know.

Any self-payers purchase the BLISS insurance coverage? What can you tell me about it? Did you opt in for higher/more coverage?

Got a call today saying that my insurance would pay after a 3 month medically supervised diet. Has anyone had this happen and then still not get approved? II'm trying not to get my hopes up but I am so excited at the possibility of turning my life around with this surgery.

I am excited that I have my first appoinment on Sept 25th but I am very nervous, because I don't want my hopes broken again.... Because of the insurance... Does anyone know how good United health of new jersey is? Or would it be considered united health of new York, being that corporate is in ny??? So lost :/ please anyone shed some light.... Thanks

How long is this process with Cigna ? I have my psy evaluation tomorrow and I'm nervous and scared to what they will ask as well as my first nutritionist class .. What should I expect ?

I wanted to post about my insurance because I remember franticly trying to find information on if my insurance covered the sleeve and the requirements. I have Anthem Blue Cross Medi-Cal in San Joaquin County and It does cover the sleeve! The requirements are that your doctors says there is a need and says he believes your able to go through with the surgery, a TSH blood test, a meeting with the nutritionist, a psych evaluation and after your approved you are required to take a 4 hour pre op class. The nutritionist takes a long time to get approved through this insurance so you can greatly speed up the process by paying out of pocket. The registered dietician I saw charge…

Is there anyone in Birmingham, Al with Viva health??? The only thing I was told is that I had to do 6 months of weighing in with my PCP, do a sleep study and have a psych eval. I was not told if I needed to lose a certain amount like the lap band. Is there any other things I need to be mindful/aware of???

Jumped through my last hoop for my insurance today--pre-op nutrition class--and my doctor will be submitting it to BCBS tomorrow! I should know something next week. Fingers crossed...

I just got all my paper work into United Healthcare Choice Plus. My requirements were 5 year weight history and letter of failed attempts. For my five yeat weight history I was 235, 215, 215, 235, 250 from 2008-2012. I also am pre-diabetic, have asthma, polycystic ovary syndrome and social anxiety because of my weight. I provided the insuracnce with a letter from my pcp and my therapist. My doctor wrote down several diets I tried and also gym attempts. My BMI has always been above 35, but not 40. This year it really shot up. My insurance coordiantor said that she thinks it will more likely be approvaed with my 2 comorbidites, then without but I am scared they are not goi…

I'm so happy! I'm in tears! I have a better chance to see my kids grow up! I called BCBS AL today to see if they received the missing paperwork and the rep said "it was approved yesterday as soon as your doctor sent it" I screamed with joy!!!!!! My coordinator is out of the office until Tuesday! Will keep u guys updated and thank u all for every post, reply,prayer thanks!!

I recently enrolled with medical mutual has anyone had to work withthem for the surgery?

Hi, my name is Amanda, and I have decided on getting the lap-band surgey. I am so frustrated because I am paying for it myself (my husband and I are). I have considered Mexico, and really dont think thats an option for me. It seems like it is taking forever to save the money up, we have saved almost half but, I am ready to get this done so I can begin a healthier life. Neither myself or my husband qualify for loans, because we don't have enough credit. Does anyone else have any suggestions? All comments are appreciated. Thanks!

So I've lamented on this board before about how my MD office doesn't have a scale that goes high enough to weigh me. That could very well be A BLESSING for me, it turns out. I went to the MD today and told him that I went to the NUT, started the carb counting diet, and that I have a psych eval tomorrow. I asked him what would happen next and was a little sad when he told me that the insurance will want 3 months of supervised diet. Well, I can wait if needed, but the doctor then said he would talk to the medical group and see if there's a way to skip that part... since his scale only goes as high as 350 and I'm in the 440ish range, there's no way I'm going to lose enoug…

Hello, I was so encouraged and excited by the fact our insurance BCBS/tennessee was so open & easy to work with WLS patients. I had all m y 'clearance' work done, paper work sent in, and 5 years past BMI being over 40 THEN BAM! The year I had a band, I'd lost over 40 pounds, during THAT year my BMI dropped to be under 40. The insurance requires that I ahve 5 consecutive years of a BMI over 40! I am heart broken, yet, have peace, the Lord will work this out. I do have high choloestral and have had since 06' BUT no one has ever put me on medicatin for it, they all wanted me to 'try weight loss' first. Please pray with me & for me as I am SO VERY DICSOURAG…

Hi! I'm waiting for my approval, been a week, I'm a little impatient! How long does this process take? I'm also afraid they will deny me.

So I was speaking with the coordinator at the surgeon's office and I was told that I need to pay my deductible, out of pocket amount, then 20% of the procedure (insurance would pay 80%) along with a $675 program fee. All of this is due at my pre-op appointment on Aug.30th and once this is paid, she will then submit to BCBS to see if it is approved. I forgot to say that all of this is non-refundable and they can't guarantee an approval from the insurance company. I'm trying to figure out if this is a common practice among surgeons everywhere. I really can't afford to give up all that money for it to be denied. Then what?? I'm also trying to figure out how in the wor…

I finished the 3 weight loss management classes in 3 months, the Nutrition class, the cardiac clearance, the psych evalution, all the bloodwork and got a recommendation and clearance letter from my PCP. Now I just have to do the Endoscopy and the Colonoscopy. I am doing that tomorrow and the paperwork on my procedure says that it takes 10 business days to get the results from them. Question - is the endoscopy and colonoscopy required by the insurance usually or is it a requirement of the surgeon so he knows what's going on there before the surgery? In other words, am I ready for them to submit to insurance for my approval or will I have to wait for the Endoscopy/Col…

Hi everyone, Had my paperwork submitted to Tricare South (Humana Military) on Monday. They came back today requesting additional documentation of failed weight loss attempts. The surgeons office said she has never seen this before from Tricare. Tricare is requesting 2-3 consecutive months of doctor supervised weigh-ins. Luckily I went to the doctor on July 11th, so I can count that as my first month and I made an appointment for August 10th, so I can use that as my second month. In both visits we will have discussed my weight loss attempts and that we are proceeding towards weight loss surgery. I will take the doctor's notes from both office visits and have them r…

They say they only have the last 2 months of my 6 month diet but hell if they just look through the paperwork they will see the whole damn 6 months was completed!! Wow they make things so difficult!! My coordinator is resubmitting it to them, but she has comfirmation that she did send it! Be so glad when this is over!!!

So I saw my surgeon for the first time today and wow what a great monday I got a date sept 18 so excited I still have to do all my pre op testing so if that goes as planned ill be getting surgery then and if everything goes smooth with insurance

***This post was originally under Pre-Op, but I moved it here.*** Hi everyone! I'm on the fence about submitting everything to my insurance carrier. I have UMR (UHC) but and the requirements are physician visits 6 months or more within 3 years *the requirements do not state consecutive*, a bmi of 40 or higher or at least 35/38 with a comorbity. My bmi is 43.4 with high blood pressure, pre-diabetic. I also have joint pain with all the extra weight. I have more than 6 months (not all consecutive). I don't know if I want to go ahead and apply now or just wait until I have all consecutive months to ensure all my bases are covered. I would have been done in July but I …

I am sure everybody lives this life when seeking WLS approval through insurance: Spend 3-12 months of your life meeting monthly with your PCP Dietician appointments Initial consultation with surgeon Labs, EKG, Chest x-ray (and any other applicable testing) Psych Evaluation Etc Etc Etc Submit to insurance AND, now we wait for insurance to approve. And what is really frustrating is waiting around for something that might not happen. I mean really, I just spent 9 months of my life jumping through hoops and paying ridiculous copays, deductibles, etc for no good guarantee that insurance will cover the surgery. So, I wait and hope for good news! Sincerely, H…

I saw numerous posts about using Weight Watchers history. Cam anyone tell me how do go about getting this documentation? Its been about 2 years, but I was an online member.

In my other post I was dreading talking to my PCP about weight loss surgery and actually worked myself up for nothing! He referred me to my supervised diet which is an 18 week program then I have 2 phsyc eval then I get the final referral to the surgeon. All I am hoping now is that I dont have to do a 6 month diet for my insurance company. The 18 week program is just for my medical group. hmm hope not!! Excited to start this journey and hoping next year will be a great new chapter (if everything goes well)

Hello! I have Aetna insurance and I am just about to start my 3 month pre-surgical program. According to the guidelines, BMI over 40 is enough to get approved. BMI over 35 but not 40 requires 2 documented comorbidities. I have them, just haven't gone for the sleep test to officially prove the sleep apnea, haven't been to an ortho to prove the knee problems, etc. I'd rather avoid it if I possibly can. My BMI is about 40.6, so I should be ok. My question is this, on what day do they consider my BMI to be the ONE they will use? When I start the 3 month program, I would hope I'd lose at least 5 or 10 pounds, if not more. If I do, it will put my BMI at less than 40. …

Has anyone had surgery at true results in Richardson I have heard they are good with insurance company to help getting you approved

My doctors office just called saying that they received all my test results back ( EKG, endoscopy, labs and chest X-ray) and are submitting everything to my ins./medical group today! I'm so nervous.. I hope I'm approved and sleeved my the end of the year! Ins: Blue Shield of CA Physician: John Morton M.D.

First, I would like to thank all of you guys post. Without ya'll I wouldn't have madis discovery today. Ok.....ok... I'm getting there make sure you guys are standing so you can jump for joy. Effective Jan 1, 2011 partial gastrectomy (sleeve resection of the stomach. ICD-9-CM procedure code 43.89 procedures when accompanied by a primary diagnosis. Unspecified (278.00), morbid obesity (278.01) or overweight (278.02) will be included as part of APR-DRG 403 "Procedure for obesity" . Version 28.0 of the APR-DRG classification system now include this procedure as a procedure for obesity and this classification system Will be used for payment beginning Jan 1, 2011. …

Are there any fellow maniacs here who have had the sleeve? What was the total cost of your surgery and how much did your co pay end up being? Did you have to pay up front? Or did your hospital have payment plans? Not mainer? Answer anyway! Haha thanks

I am hoping to have VSG approval from UHC - Options PPO later in March or early April. Wondering if anyone else has had this coverage with the Bariatric option and how your approval process went?? They are not covering anything pre-op or post-op; only the surgery and facility. I will be sleeved @ Vanderbilt in Nashville, TN. Congrats to all that have made it through this process and can now see the light at the end of the tunnel! Hope to join you soon

Has anyone experienced WLS denial even when you meet the insurance requirements i.e. bmi, supervised diet, test?

I was told by my insurance that they would only cover 50% of the surgery. I can not get a straight answer as to how much the procedure costs, and if I need my half all up front before the surgery. I am so frustrated!!!!! I have all my requirements met, with the exception of my stress/echo and sleep test. I do not want to go any further with this if I can not afford it!

After many stalls my paperwork was finally submitted yesterday! I was reviewing my claims online and I saw the approval for my surgery already! Tentative date of October 15!! Unfortunately that isn't a good time for me at all... so I'll talk with my surgeon and see if we can bump it up. If not I'll take what I can get!

Check your insurance policy. It will say whether weight loss/bariatric surgery is covered or not, and if it is what it will cost you out of pocket. For example, in my policy is it listed under Surgical Procedures in Section 5b. You can also call customer service at the number on the back of your card and ask them what your policy says about weight loss surgery. Schedule an appointment with your Primary Care Physician (PCP). Ask them to please refer you to Nutrition Services to be considered for for weight loss surgery. They will probably mail you some forms to fill out and return. Then they will send you a letter. If you qualify you will be on the program waitlis…

Insurance have had my documents 5 days and I'm super nervous, scared you name it. I've been calling and sent an email yesterday and its still incomplete. I know having a bmi of 59 has to be medically necessary! I'm praying for a positive answer!

Hello, So I have stated this before but my insurance under my dad's policy is running out. I am trying to find an insurance plan to get so I can get the surgery done. Anyone in California that has worked with an insurance company that was easy and didnt require much for the pre-op phase? I would love opinions. I have Pacificare right now.

The individual must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery; Ok this is exactly what is in my plans guidelines. Does this mean I need 6 months of diet or should the diets I've used in the past be sufficient as long as my pcp describes them in the referral? I have got the referral, going in for the psych eval tomarrow, and really don't want to miss a step! I am so nervous that I've missed something.....please help.

Its seems that my coordinator "jumped the gun" and submitted my paperwork without the required letter of medical necessity from my primary care physician. Which got my claim denied. One measly piece of paper. Now its in national appeal which may take 30 days to get a response back. I wouldn't be as bummed about this if she at least took some responsiblity for it. I mean, doesn't she do this EVERY DAY AT HER JOB? My insurance is Cigna, Also I am due to start school on November 19th and I am freaking out about the surgery date coming too close to my first day of school. This could have been sooooo easy. Anybody have any ideas on how to push my claim or how to hand…

I am hoping to get banded next month in Wilmington, NC but will be moving in January to Beaufort, SC. I am having a hard time trying to find a Dr that will do the fills. I have called Tri-Care and know that i need to switch from North to South and get a referral from my PCM.. which i have no problem with.. I'm just worried there won't be anyone to do my fills since I didn't get the surgery with the Dr. that will be doing the new fills. Anyone move or have any issues with a different Dr./location doing your follow ups and fills that wasn't your initial surgeon? Thanks for your help

Hubbys work is dragging about giving insurance info we are suppose to have insurance as of 08/29/12 .. office lady keeps having excuses on why she don't have the info. Idk if its upsetting me so much because I so desperately want this to be the next chapter In my life ? Or if I'm just use to having control of our insurance and its been far to long sense we have had insurance.

I jumped through all the hoops that my insurance (Affinity) required, the same day that the coordinator sent in my documents I was denied. Denied because after all that I did they do not cover gastric sleeve. So now I have a choice says my surgeon either do the band or roux en y which my insurance do cover. I don’t know what to do.

What a bunch of lazy people. We submitted ALL of my paperwork and whoever reviewed my claim just looked at the first page and denied it. They said I needed to give them the H&P and 6 months of supervised nutrition classes and I told them it is all there in the paperwork. So I called my case manager and told her what they said. She called them and went page by page. Writing down what page number all the info they wanted was on. Now it has all been RE-submitted and now I am waiting AGAIN!!! You would think they were capable of turning a few pages! Geez! Ok Rant over.

I'm sitting here waiting for one of my friends. She's taking me to the hospital for surgery. My surgery was rescheduled from Thursday to today. I'm not really nervous. I'm just ready to get this part over with so that I can begin adjusting to the many changes. I will talk to you guys on Wednesday. Pray for me and I will pray for you.