Insurance & Financing

As anyone with bc/bs federal been approved for The sleeve yet? I feel like I've been waiting forever!!

I'm very new haven't even been to the doctor yet about the lapband . What I was wondering is do I need to have my doc refer me to a lapband specialist ? Do I call my insurance first before seeing a doc ? What do I ask the insurance company ?

hi, I saw a nutrionist at the hospital before surgery- it was just a 1 time thing but I think I might like to see one again. does ins. typically pay for a nutrionist? I have Cigna PPO. thanks!

WOO HOO! Approved, surgery is Monday! Sent from my iPad using VST

So, I'm going to use this forum a bit to vent about my anxiety regarding coverage. I have Cigna coverage, but the plan is managed by APS Health. It's one of those "partnership" plans where you get a discount on your coverage for participating in health coaching, getting regular health screenings, etc. I only started considering bariatric surgery when my APS health coach said I should. She told me to call Cigna and ask for their policy and information on bariatric surgery to learn about coverage. So I did. When I talked to Cigna, they had my account number and member number and said they were sending me all the relevant information on bariatric surgery under my coverage. …

Here goes! I am doing the 6 month diet with PCP and am set to finish in December with it. I really, really want the surgery during winter break right after finals and a few days before Christmas (I'm in college). Can I submit to insurance in mid November even though only 5 will be documented (of course I'd still be doing the last weigh-in)...? I just know it takes time for insurance to make a decision and I'd need a two week liquid diet before surgery. Another reason why I ask is because I don't think I even need the 6 month weigh-ins! I've spoken to a million reps from my insurance and they say they require a 5 year weight history (which I have) and a prior authorizat…

I'm just starting this whole process and have so many questions about being approved. I have Cigna with a BMI of 36 and have "pre"diabetes, arthitis in my knees and degenerative disks in my back. I do not have high blood pressure or sleep apnea. My PCP says I have metabolic syndrome and he thinks I may get approved with that diagnosis? I don't know what I should try to stress with the insurance company for approval. My PCP says he will send the letter for medical necessity and I would like to have him address what Cigna is really looking for instead of just a generic letter. I see him next week for my first appt for the 3 month medically supervised diet. Any suggestions? …

I had my VSG on May 29, 2012 in Mexico, and now no one will touch me at all. I called all the bariatric clinics near me and they said they will not see because they did not perform the surgery. My doctor said if I have any problems I will have to go to the ER. My insurance company said if they determine that any of my problems have to do with my surgery, they will not cover it. So even if I have to have my gall-bladder taken out, it will be because of my weigh loss (my surgery) guess who will have to pay for it (all of it) me. So far I am doing great and I pray it keeps going this way. I feel that I finally started doing something to help me and I'm being punished.

So my surgeon's office just sent my information out today for tricare to approve (Even though I have had everything turned in for over a week.) After reading all these denials given for not having a six month diet, I am sort of concerned. My office told me tricare north literally just changed the requirements last month saying you just need to have documentation of a diet in a doctor's note and there is no time limit. Sooo i got that information for the doctor, printed out my nutrisystem and weight watchers receipts from the past 2 years but all I had were my personal weigh in logs, and i had an actual 8 month nutritionist diet and weigh in (from like 6 years ago) printed…

I have Cigna and will be starting the medically supervised diet next week. My BMI is just above 36. Does the insurance company look at your BMI before or after the diet? If is drops below 35 with the diet will that affect my chances for approval?

hello everyone, I just found out that Medicaid may cover my surgery. I plan to have it done in Atlanta at peachtree bariactri. oops spelled that wrong . anyway , just wanted to know if there is anyone out there who lives in Georgia and had it done with Medicaid ? how was your experience ? did it take long to get approved ? any advice you could give me? I live in Savannah ga. any info would be awesome . thank you!

The financial coordinator from my surgeons office called me today to notify me that they will be submitting my papers to medicare this friday : ) I was wondering if anybody else getting there papers submitted this week

My ins... Optima health says the will pay for surgery as long as preauthoizations are made? Anyone have optima? If so what was the requirments?

I am so frustrated. I called my surgeon Monday and they said they submitted everything to Horizon BC/BS for approval. I called Horizon today and they said they didnt get the paperwork from the surgeon! My surgery is just a week away and now I dont know if i will get approval in time. I called thw surgeons office back and they assured me that it was submitted. Has anyone faced this?

Hi I am getting ready to start in this new journy in my life . I had the lap band put on in may 2006 maybe lost 50lbs at most and now I am really thinking about the sleeve. I go for my first appointment on 8/10/12 (cant wait)! I guess I am asking anyone who has united (i have the most exsenise one the epo) . I guess I am wondering how other peoples made out with united health . I did not have united with my lapband ,so this is a new ball game for me ! Please feel free to leave any messages to help me out !

Hi!! This site is great! I've completed all my pre ops cardio test next Tue then last dietitan appt is September 5th. Anyone else in CT with Medicare?? They require 6 months consecutive dietician appointments but never specified how much or if we have to lose before surgery. Down 13 pounds so far. Anyone else have insight on this?? I doubt getting denied I feel like God has gotten me this far and its a sign to make it to the end thx for any input"!

Today while recovering from my upper GI I received a call from the insurance coordinator at my surgeon's office. She informed me that I had been denied for my surgery next Tuesday due to the fact that the surgery was taking place at a hospital that is not a bariatric center of excellence. From the beginning of this insurance process in January I have communicated with CIGNA several times regarding my surgery and the steps I had to take for approval and NEVER has this been mentioned as a requirement. The coordinator has spoken to CIGNA several times regarding the criteria and CIGNA did not inform them that I had to have the surgery at a BCE. Aside from the problem that…

Oxford approved me at 12:00 noon today...surgery is Monday. Have all the crazy thoughts in my head that you all did, but KNOW this is the best thing for me. Keep me in your thoughts and prayers.

Has anyone use kasier?

Hi! My name is Amanda, I have decide I need weight loss surgey. I am 24 years old, and I am on a fixed income. My insurance will not cover surgery. I have no credit, so I do not qualify for a loan. Does anyone know where I can get a loan, that will not disqualify me for having no credit? Any ideas on how I could go about raising money for this operation would be much appreciated. This surgery is something I need, not just want. Six years ago I was in an automobile accident. I am currently paralyzed from the waist down. I have been heavy my whole life, but since the accident my weight continues to grow. I have already met with a surgeon and I meet all the criteria. I have…

Does anyone have United Healthcare and have any information on what they had to do to get the procedure approved? I am just at the beginning and have only attended the info session. The surgeon's office has all my insurance info and said they would be contacting them to see, but I am impatient and want to know what to expect, lol! Any advice, info would be appreciated!

Called insurance to check on my status and it haven't been submitted! Called the coordinator she just told me the surgeon QUIT!! I blame myself because he quit when he was in Virginia but I was giving him the benefit of the doubt! Then I tell my sister who says well u can lose weight on your own!! I'm so angry!

So I just called the UHC member number and asked if they could give me any information regarding the progress of pre-approval for the sleeve procedure. I was told what information they request from the dr's office, etc. (which I already knew....that wasn't the question!) and then was told I would have to talk to someone in the Care Coordination department. Prior to transferring me, she looked up in the system to see if there was any additional information. In there she found an in-patient pre approval for a surgery 8/31 - 9/1. I'm guessing this might be my date! Except....... Then when she transferred me to Care Coordination, I got NOTHING in the way of information…

My brother an I are doing this together. We both submitted on july 19th. I called cigna everyday as did my brother to uhc. Today we both learned we were approved! Should have some dates tomorrow. We still like a pre surgical class that our hospital requires and that's it. Should have a date for late august I hope

I want the surgery asap . I Will be self pay . I'm lookin for a Dr. that is affordable . I live in Savannah ga. any info would help me greatly

In theory, could it be possible to just switch over to an insurance that will pay for the sleeve, get the surgery, then switch back to your normal insurance? Would there be consequences for this?Like I said i'm not too insurance savvy.

finally after 6 months.....there could be one hiccup - h-pylori test done today. they said they are sending in the all the paperwork for insurance approval today, and that it's not pending the results of the h-pylori - however - if positive, surgery would be probably pushed from end of August to end of Sept....I am hoping i DO NOT get a phone call tomorrow when the lab work is back...... otherwise she said UHC was one of the better insurances to work with and we'd get something back within 7 days.... SO i won't call and bother the UHC people till next Wednesday! I can finally see the light at the end of the tunnel......

This sounds like good news for some people. http://asmbs.org/2012/06/access-to-care-alert-the-cms-final-decision/ Dear Colleagues, On June 27, 2012, The Centers for Medicare and Medicaid Services (CMS) released their decision on coverage for the laparoscopic sleeve gastrectomy (LSG). The final decision will allow laparoscopic sleeve gastrectomy to be covered by intermediary Medicare administrators as a stand-alone procedure at their discretion. The text of the decision is below. On behalf of our patients, ASMBS is very pleased and gratified that CMS has recognized the true value and compelling need for coverage of this procedure. ASMBS will immediately initiate the f…

Hi everyone... My name is Alisha and I'm a 25 yrs old from NY who just made my consult appt with my surgen today! "very excited" lol I have Health Plus and I'm wondering if anyone on here can give me a little insight on what my year to come will be like? Does anyone on here have health plus aswell?

So i called the hospital I want my surgery at, John T. Mather, and they said they didn't accept my medicaid/fidelis insurance, but they wouldn't take me anyway because i'm 16 T_____T. Saddest day ever, but I'm going to call another hospital in riverhead they referred me to, and if not that one, a special adolescent bariatric surgery center in the city. (I really don't want to go too far away :<) Whats the difference between now and two years when i'm 18? Nothing! thats what. Maybe i'll be sicker then -sigh- im in a depressed mood

Hi everyone, Does anyone have BCBS HMO (Blue Advantage)? I am in the process of completing my pro-op testing and have to get referalls from my primary care physician for all the testing that my surgeon wants. It is very frustrating! I was scheduled for my cardiac clearance tomorrow. After wating almost a month for the appointment they called me today to reschedule. GRRRR. SO frustrating. I am rescheduled for nest week and I hope ther aren't any more delays. My question is if anyone else has this HMO how long was your insurance approval process? I have done the 8 months of required weight loss classes and it will be over a year since I began this journey before I even get…

Is this something required by the insurance or surgeons office? My insurance company says that all I need is a 6 month supervised diet? Bcbs of Wny

After completing requirements and all the drama my paperwork was finally submitted Monday. The surgeons office lmost my paperwork several times, and waited a month after i completed everything to tell me they couldn't use the medical records i provided. After that month had passed i changed my gameplan. I have been calling the surgeons office almost every day about records. Even had to threaten to change surgeons. I personally went and obtained all medical records from any doctors i had visited in the past 2yrs and marked my weight with sticky notes. Then made the "patient coordinator" review all the sticky notes with me. Then I made sure they would submit it Monday and …

And of course I've been calling everyday since. Today they said ill get an answer by friday! I'm so nervous I have a bmi of 47 pcos and insulin resistant but no other health issues so I'm so scared of being denied. I do have family history of high bp..bs...cho...and heart disease. Ahh this wait seems longer and more stressful then the work up appointments! Lol

Anyone use Dr. Nick I went to seminar tues waiting on them to verify my bcbs of OK. Anyone know the steps after that? My BMI is right at 40 I'm nervous on my day to weigh that my weight will fluctuate and put me under do we weigh with our clothes on or a gown? any suggestion?

Problem - my surgery advocate finds that there is an exclusion for the surgery I want (VSG) in my health insurance policy. They say I should - 1) get a copy of the stated exclusion for bariatric surgery from the insurance company (which I should get in the mail this week), 2) contact my employer's HR department to find out if they'd be willing to make a one-time exception for me to have this medically necessary surgery, 3) ask my HR department if they have alternative health plans with coverage for bariatric surgery that I can switch to at my next benefit enrollment, and 4) use the self-pay option (NOT an option!). My PCP said he'd write a letter and/or contact the HR dep…

I am just gathering info & getting details about Lapband, so any info that can be shared would be great!

HI there, I am trying to find a way to pay for my sleeve as my insurance will absolutely not cover any of it. Bariatric surgery is an exclusion on my plan. Do any of you know any details about using the "credit" companies? Such as Care Credit? How hard is it to get approved? Will they loan you enough for full cost of everything? Any info on this kind of financing would be great!! Thanks so much!

Called Cigna today and bad news! Im denied. They are requesting a peer review with my doctor. Has anyone with the same issue and was approved after the medical peer review?

Hi everyone... I have my first consultation tomorrow with the surgeon. I have health first with Medicaid. One requirement so far that I needed was a referral from my pcp, which I obtained. I have a BMI of 38 and I have high blood pressure, just wondering if anyone out there in lap band world can give some advice. Thanks

My surgeons office submitted all the paperwork Thursday afternoon for approval. How long should I wait before I start calling the insurance company?

My weight at my annual PCP appointment last week put me at 40 BMI, but it normally hovers closer to 38-39.5. I am making the appointment to see the surgeon but didn't know if that weight would be the determining weight or one at the PCP?

Does anyone know what being in nurse review really means? I'm w/ Cigna & was denied due to my dr putting the wrong place of surgery & then she sent in the correction for the place of surgery & ins is saying I'm now in nurse review, so is this a good thing? Is my claim heading towards an approval. Oh the waiting is driving me nutso!!! Lol

Does anyone have experience with WHA and getting approval?

Has anyone use kasier for there procedure?

Was anyone able to use Kasier Permanente?

So I've been denied 2x now, once because they said I was suddenly an inch taller than I ever have been. This time I made it in to see the surgeon. I called the surgeon's office to see if they had submitted to my insurance & they said they do not submit until after the Nut(ritionist) sees me. Earliest date to see her is Oct 29th! She only works one day a week! I feel this is so unfair& they are denying me access to healthcare. There's no one else i can see. I was going to stay at my job if I knew I'd be approved, but it will be another 4 to 6 months before I even know. Planning self pay options.

Hello I am 25 with a bmi of 41 with no real health problems, yet!! Do you think I will have a problem getting UHC to approve my sleeve??

Has anyone been approve with using Kasier Permanente insurance ?

So my long awaited surgeon's appointment was today. I have the Medicare; so I have all 6 months worth of progress notes completed, met with the nutritionist for the first time today, all documentation is ready to go (except for a letter I still need) I'm almost there and I was excited because I thought I would actually get a surgery day today. I've read the posts here about how Medicare coverage has been approved nationally on a case by case basis. I was told by my doctor's surgical/insurance coordinator that NY is still awaiting a decision. They had submitted paperwork for another patient and that's when they were told this news. So I am waiting another month un…