Insurance & Financing

All of the paperwork were given on Monday (hopefully) so I wanted to see if my surgery was approved. I called them up and they said only the doctor would know. Is yours the same? I find that so strange. When should I call them up?

Called Cigna today. Got the bad news. They say I was denied because my surgeon didn't send in a letter from an additional MD stating that I was evaluated and ok for surgery. I called and left my surgeon's office a voicemail. I just assume that if the insursance coordinator in the office does this on a regular basis that he/she knows what to send in. Guess I'll have to micromanage them now.

Hi! Anyone use Blue Cross Blue Shield of Texas, Health Select to cover the cost of their surgery? I am on my husband's insurance plan and need to know if it will cover the cost of me having this surgery. If it doesn't cover the cost, I will have to be a self-pay. I'm a newbie in North East Texas just starting the process. Any help is appreciated! Thanks!

Hello to all:-) I am new here. I've had the app for awhile now, but have been too shy to actually sign up until today. So I just found out my paperwork was submitted to ins today. I have Cigna & am wondering how long the approval process can take. My dr's offi e said 2-4wks.

Just had my lapband removed...this was the third surgery (not counting the first to have it inserted), first it slipped, then it twisted, then it collapsed...all in a period of almost 3 years....My insurance is not the same as when I first started....As a matter of fact, my insurance does not cover bariatric in any manner. I would like the gastric sleeve and am looking for suggestions that will not bankrupt me for the rest of my life....please email me directly at sonjamarder at gmail dot com with any info. I prefer not to go the out of country route unless there is someone in the new jersey area that i can go to for follow up..... I am desperate here....I have lost 1…

I go to my appt Monday and they will submitt everything that day! I'm having so much anxiety because I'm scared and I need this so bad. My bmi is 58 with several comorbidities and I pray this is enough to get an approval. I am 38 with small kids that need a healthier mom. My baby is 2 and my son is 7. I need this so bad and I pray that this get approved. If denied it could only be for pre existing I'm thinking...and then I would probably have to wait until January, I need this now! Say a prayer for Crystal!!!!!

they said I was denied due to the place of surgery, but I contacted my dr's office and they said it had already been corrected:-/ Oh well I guess I will be on the phone w/ Cigna here in a lil bit(keeping my fingers crossed).

Just called cigna and still pending; however the cust. Serv rept toldr that the doctor submitted for hernia repair?? I have a hernia but cigna didnt mentioned about vsg.

My wife and I had our group meeting with the Lap Band surgeon yesterday, basically so he could explain the mental part of making the Lap Band effective (changing your thinking about food, etc). After the meeting the we were told that our information should be filed with insurance today (UHC Options PPO plan through UMR)!! I know all insurance companies are different, but if anyone has experience with UHC or UMR, what is about the average wait time to see if your approved?? The woman who collected our information at the surgeons office told us that insurance companies are slow for some reason recently, so she predicts we will be waiting 30 days

Well I'm sure you all know I am still waiting on a surgery date! I received a phone call today from my weight loss center telling me that they talked with my insurance company and my insurance company has denied my approval for surgery because...get this.......IT IS NOT COVERED UNDER MY PLAN!!!! What????? When did this change I asked? She said she did not know but there was nothing more she could do. I told her that I would call my insurance company and call her back. I called my insurance company. I was on the phone with them for 30 minutes. The lady I talked to said that it IS a covered procedure, if it is medically necessary and said that I was denied because my BMI wa…

The plan says a3-mo supervised diet is required. Has anyone been approved after only 3 months or did you have to do six? Sent from my iPhone using VST

So after all the hard work I had to do to get an approval, my lovely husband gets fired from Fedex yesterday. Therefore, we also lost our health insurance as of today. :( :( He was told he could get COBRA and pay the full premium....which is fine, the problem is....I will have to resubmit my claim and get an approval. I don't think im that lucky. Soo sad...I jus want to cry and never get out my bed.

I have BCBS of Louisiana which doesn't cover the sleeve and in six months our company is switching to BCBS of WNY which covers the sleeve!!! My question is..Should I wait til the six months are up to see the nutritionist and psych or do it now under the old insurance. Did you have a deductible to meet before getting your surgery?

My paperwork was sent by my surgeon last Tuesday, and was accepted by Cigna on Thursday. I called on Friday just to make sure, and was told a decision would be made no later than today...and yep, I got the call saying I was approved. Not sure how I feel, overwhelmed that this for real now. The surgery scheduler is supposed to call with a surgery date. Good Luck to everyone with Cigna, sometimes they can surprise you.

Hello all!! I am new to this so bare with me. I have bcbs Fed and wanted to know if anyone has had a hard time getting approved? I know their requirements and my BMI is right at 40/41 with no comorbidities. I also noticed that they require proof of morbid obesity for at least 2 years. Being that my BMI is at 40/41 and my weight fluctuates, my recorded weight is lower and at a lower BMI. Will this effect my approval? I am scared that I will go through the process and get denied at the end. Just ready to be at a healthy weight

I have my consult June 8th we have Tricare, any specific things they require before surgery will be approved?

I had an email today from UHC inviting me to view my statements online. So I logged in to my insurance account and was SHOCKED. A bill for over $80,000 from the hospital was submitted. This does not include the surgeon's bill, radiology, pathology or anesthesia. The hospital has been paid per plan contract slightly over $28,000. Other bills are still pending. Either hospitals are taking a beating on self-pays, or subsidizing them with what insured patients are paying. All totalled, this process has been billed to my insurance at somewhere close to $130,000.

I brought my medical records from over the past 23 months to my surgeon's office yesterday and the bariatric coordinator said she'd send out the request for approval...They have "up to 30 days" to make a decision but usually don't take longer than 2 weeks or so. I'm super excited! Super nervous at the same time..Ahhhhh! Must..fight..urge....to...call...Aetna...everyday...

I think I just found a comorbidity for me. I have been taking diuretics almost daily for 6 years since a complete hysterectomy w/o ovaries. My feet and ankles will swell abnormally several times a year even with the diuretics. I always felt there was a weight connection with this. I'm in month 2 of a 3 month supervised diet for insurance and haven't had my first appt. with my surgeon yet. I am just over the 40 bmi and am concerned if I lose too much, I will be below the 40 mark. I am going to ask the surgeon office about this. Any advice???

Well...I finally joined the forum instead of "lurking". I guess the fact that I've officially submitted to insurance is making this all real to me now...I'm ready to join the losers bench! Cigna OA Plus says they have the info...let's hope for a speedy approval!

I actually had an insurance agent write a policy to cover RNY bypass. My insurance company at the time (United Healthcare) excluded all weight loss surgeries, so I was told BCBSNC (Blue Cross Blue Shield of NC) would be the best bet. Problem is, it's not effective yet and I REALLY REALLY want to know what they require. I have no preexisting conditions (although I've been heavy since I can remember!), so idk if I'm going to be asked to jump through any hoops? Help!! I was ready for surgery yesterday!

Im so excited..i called ins company this morning and they gave me the wonderful news. I was so nervousr because my bmi is only 36. Surgery is July 30th...cant wait!

If so, just wondering how your approval process went and how long it took for a reply. just had my paperwork submitted on Friday! Thanks

Has anyone with Tricare Prime North gotten approved this year? I am working with Duke and they called this morning and advised that Tricare required 6 months documentation. However I called Tricare yesterday and they said they did not. I also looked at the website and could not find it in the requirements.

I have been considering wls for while. My husband is self employed and we have not had insurance for a while. We have finally caught up on everything and so I went through the very long process to apply for insurance through BCBS of TX for us and our 4 kids. I knew they would not cover the wls and planned to self pay but wanted to have the insurance in case of complications. Once everything was submitted to underwriting I started the process for gastric sleeve, met with the Dr and set a date for July 31st. Then the next week was notified by insurance that I was denied coverage because of the meds I take for water retention. It does not make sense to me why they denied me …

I am wondering if anyone has this insurance company? What kind of luck did you have when applying for the surgery?

I'm scheduled for surgery on August 14th and wanted to know if anyone has good through the insurance approval process and the surgery and afterwards had a problem with the insurance backing out and being stuck with a huge bill? I have United Healthcare and I'm terrified they will do that when it's too late to go back. Any insight would be appreciated!

I'm so thankful that my insurance is through my husband's work, because I'm laid off from my job today..and btw I work in healthcare! I'm so worried about approval and now this! I'm worried about my out of pocket expenses! Because I was depending on a mileage reimbursment drom work to pay them...don't know what I'm gonna do...say a prayer for me.

Well, I called Cigna today, and found out that my bariatric's office actually submitted my info on Tuesday and it was accepted yesterday. The rep said my 5 days for review started yesterday, so I should know if I was approved or not by Wednesday of next week. Excited, but skeptical.

My doctor submitted everything today and I checked with the insurance company and they received it. It's pending. How long did it take for approval with others that have the same insurance. I already have a surgery date and I can't wait to find out if I'm approved!

If you have UHC they may waive the 6 month waiting period. I saw my Dr last August 10 or there about, had my surgery Sept 20. The total bill was $63,000. My part, $0 Wonder why self pay is generally under $20,000 and insured is $50,000+???

Hello all you wonderful people. I am a senior 66 yrs young, with a laundry list of medical problems and a BMI of 46. I know I read somewhere that as of June 27, 2012 that the sleeve surgery was going to be covered by medicare. I have told that to the surgery's nurse that checks eligibility and they keep telling me that I am not covered under medicare for that surgery. I know I read the guidelines wherever I have seen that article and I would be covered. The nurse wants me to finance the surgery and I don't want to do that. Can someone please clarify if it is covered or not. I live in Las Vegas, NV. Thank you all for your time, and any help you can give me. Respectfull…

I'm so happy! Today I got the approval for my surgury..! Can't wait to begin this new lifestyle!! :-).

Well was scheduled for surgery on Monday but got denied now my doctor has to fight for me! Goes to the review board Monday! Ugh!

After seeing my surgeon for over a year and paying out of pocket, now that I have insurance, his office is telling me that they will not take my insurance. That once I am self-pay and I will remain self-pay. This is absolutely ridiculous! I feel like thru out the time that I was a self-pay and forking over $150 a pop, I wasn't getting much of a fill. I haven't felt any restriction for the longest time. And, at $150 a visit, I cannot go as often as they recommend I do. Now, I'm stuck. I'm gonna have to find a new surgeon that will take me even if they didn't perform my surgery. This is very frustrating. I chose the higher insurance so that it would cover the fills. Now, th…

I have Cigna and having hiatal hernia repair along with my lapband surgery. Cigna is coving the repair part but I'm paying the rest. I can't seem to find the surgery center listed on my insurance. I have met my in network deductible but not the out of network one. And it's 10K. Anyone else come across the same problem and have to have it done at a hospital instead? Did it change your out of pocket cost?

I was considering self pay and my husband and I were wondering if the insurance would ever cover the fills or if there is problems with the band down the road. I didn't know if it was something they would consider pre exsisting and not cover it for a period of time or if they would never cover it. I have BCBS of IL if anyone knows. Thanks.

I was scheduled for July 9th and I just received a call from my surgeons office that Cigna denied me due to a clause the company I work for has on their policy , Cigna was just recently changed to 3 months from 6 months well according to them my workplace has a cause of 6 months ... so even tho Cigna changed the clause on the company policy is 6 months ..... I am so frustrated that I feel like just giving up ...I know its only another 3 months however its always something ..... feeling depressed

we submitted to Cigna 11 days ago. I called a couple days after and was informed that they had received my paperwork, should know in 5 days. Called on day 5, they dont have my paperwork? When I informed them a few days prior they did have it they put me on hold forever.they found it in the wrong department and so they faxed to the correct department. They said 2-3days i should know unless they required more information. Called again 2 days later. Again, they couldnt find it in the system so I explained the previous situations. After they called the precertification department, they said it was opened that day and they had everything they needed. They said it would be…

It is confirmed. Since we are stationed abroad, no preapproval needed. I just have to follow the BCBS/Federal guidelines to a T. I am doing a happy dance!

I Am going In two weeks for a consultation. I have been to one before when I was 16 and I was too young for insurance to even consider. So I was wandering about the process after the consultation. Many have said things about insurance approval and pre-op diets. I really would just like to know kind of what to expect between my first visit and my actual surgery date.

For those of you who had to pay out pocket for the nutritionist (if it wasn't covered by insurance) about how much was the consult?

Just some clarification needed...and it might be a silly question! For the 6 month consecutive weigh-ins, are we allowed to make appointments with our PCP monthly in ANY date within the month? For example, my first weigh-in was July 10, my next is August 13, but what if I ever have trouble getting an appt and it ends up being like September 28 or something. Just wanna make sure, because I know insurance companies are a pain in the ass with this!

So as most of you know, cigna has required a 6 month supervised diet for awhile now. I consisently hear how much trouble people have with insurance companies approving lapband. Why in the world would cigna go and make it easier?! beats me but i LOVE it!!! I went for my 3rd visit today and the woman at the desk informed me i had a change in insurance and wondered if i was aware. well no i definately was not aware. She had me thinking it was something bad and finally she said.. "today is your last visit! Cigna now only requires a 3 month supervised diet". holy crap that excites the poo outta me! now it looks as if ill be getting banded in june rather than september/novem…

I had my upper endoscopy a week ago today. I was told that it was the last step before submitting everything to my insurance for final approval. I have called several times this week and left messages for the weight loss center to call me with any updates. I called again today and was told that my chart was still on the nurses desk and hasn't went to the insurance company yet. The receptionists transferred me to the nurse, but of course she didn't answer and she didn't return my call today!! UGH!!! I would really like for my chart to go to my insurance so I can hurry up and get a surgery date!!!!!

at first I had no issues with Cigna! Everything was going to smoothly and I really didn't think I was going to have any issues. I finished all my pre op visits, nutrition, I had a letter of referral from my primary doctor and a letter necessity from my surgeon, 6 months nutrition, and the only thing else I needed was a psychological evaluation, which I had done early in the game. I had my meeting with my surgeon on June 18th and they submitted everything to insurance June 20th or 21st. My surgery was scheduled for July 10th, but it wasn’t until July 6th did I hear anything for Cigna or my Doctors office in regards to approval. We received a letter saying that I still was…

I'm from Wisconsin- anyone ever work with UMR? (I don't know what it stands for off the top of my head)

I just got the mail & I seen a letter from the external appeals place & was instantly sick to my stomach. I was convinced this was my final denial for the sleeve. So I went ahead & opened it & it has been APPROVED!!!!!! OMG! I am beyond excited right now!! If anyone is going through this or wondering if it is even worth it, the answer is Yes! Fight for it! I'm so glad I did!! I was denied by Highmark because my bmi is not 50. But with much perserverance, research, proof, & appeal writing I GOT APPROVED!! WooHoo! Can you tell I'm excited?!?

Does anyone happen to know how much "weight" history that cigna requires? And also when the insurance company does require a weight history, are they looking for you to be the same exact weight for the entire history time? I mean many of us flucuate from time to time. Thanks!

I am about to start getting my fills. My surgeon only does fluro fills (which is fine with me). Do we need to have any other approval for this type of fill? Tricare has already approved me 6 more visits until September. Please advise if you think that I need to get another type of approval from my Tricare. (we are tricare prime north as my hub is retired)