Insurance & Financing

I have met the requirements. 6 month failed nutrition, ect. Waiting on approval for nearly a month. Called in to insurance company and they said they do not do preapproval??? Called weight loss center yesterday morning and still haven't gotten it resolved??? Anyone else have this problem???

Today is definetely not a good day for me. I was supposed to be at the hospital having my surgery. Ugh. My husband lost his job on July 5th so we had to wait for COBRA to send us paperwork. I submitted the paperwork and payment yesterday, so hopefully I dont have to wait much longer. #depressed and frustrated.

Does anyone have any info on this insurance and if there are restrictions, limits, etc to getting the surgery? I have my appt on Thursday 7/19 to find out more, and I was told insurance will cover but just not sure what I have to do - if anything - to move forward and get a scheduled date.

I was banded on 6/19/12 in Idaho, have my first fill August 1st, how ever I'm going to be moving down to San Diego by the end of the year. I'm worried I wont be in the "green zone" and will be needing fills after I move.. Can anyone recommend a dr with reasonable full costs??

Hi I am new here! I am so frustrated with my insurance/dr's office I could cry. I have jumped through all the hoops(psych appt, egd,etc). About a month ago my case was submitted to the insurance or was it? My insurance is saying they have never received anything in relation to my surgery. My case manager at the Dr office says she has submitted it three times. My insurance company says that my case manager should have a pending authorization number but when I ask her for it she doesn't have it. Has this happened to anyone? What else can I do? Thanks and nice to meet you all Melissa

Its been almost 3 weeks since i completed my requirements for surgery. When i initially finished i was told they didnt recieve my psych eval. There goes one week. I called that friday and the lady said they were reviewing my case and would "be in touch". There goes week 13 days. I called today and the lady tells me "I'll pull your file out and review it today". I'm wondering if its not too late to switch doctors or does it usually take this long? I probably wouldnt worry except when i first contacted this doctors office for referrals the same lady says "this isnt an emergency, so theres no rush to get this done". I really liked the doctor but im concerned with the lack of…

I have anthem blue cross *** with sharp community medical group and I keep hearing my medical group would require a 6 month diet but my insurance doesn't. When I first asked for the referral for surgery it was denied then I filled out a form listing past diets I tried and I was approved for the consult with the surgeon. Does anyone know if that means the surgery will get approved?

When I had my very first appointment with the surgeon, I told him I was interested in the LAP Band. At that appointment, he told me a little bit about the Vertical Sleeve but it was the first time I ever heard about it. After going home and doing lots of research, I decided the sleeve would be way better for me. I told this to an office staff member at the surgeon's office. Then I got a call from the office saying insurance had approved me for the LAP Band. I told them AGAIN that I didn't want the band, I wanted the sleeve. The office girl said, "Oh that's not a big deal to switch from the band to the sleeve." But a couple weeks later, it turns out the insurance DEN…

Hi guys. I am in the beginning process of getting the bypass. I met with my surgeon and am just now making tons of appointments for the various doctors they need me to see. I have united healthcare community plan, which is an HMO of medicaid in NY. They cover gastric bypass, but I have called a good ten times askung for the requirements, and have gotten 3 or 4 different answers. My surgeon's office doesn't know what they require, since the patient advocate is out on vacation till the 20th. So far, I need a pre-authorization from the doctor, then my insurance will let him know of the requirements. So far I've heard yes, I need the 6 month diet, then I've heard I need a yea…

I'm almost 3 yrs out from my surgery (Medicare coverage) but I'm also a vet. When I ad my surgery in 2009, the VA only covered gastric bypass. I've heard that they now cover lapband as well. My uncle (who only has the VA insurance) is actively seeking information on this. If anyone is in the know, I'd appreciate it! Marci

My insurance claims my obesity is a pre existing condition and won't cover surgery until after 1 year

I was recently banded on May 30 and also had a hiatal hernia corrected. I was a self pay for my band but now am finding out my insurance won't even pay for the hernia. Anyone else experience this or know why this is? I understand not paying for the band but not the hernia.

I want to call cigna and check on my application for surgery. What department do i call? Is it claims, benefits or something else. I hope they let me check even though im not the primary. And info would help. Thanks

I just found out that my employer excluded WLS on my insurance policy; and open enrollment is in October with coverage being effecting November 2012-and I can change to a plan that has coverage for WLS -but my question is I have already had some tests done and I have an appointment with the surgeon August 9th 2012 - Would I be able to switch to new insurance in November and use my tests and interviews from now or would I have to start all over again with my new insurance in November ?? Has anyone have any info on this ?? thanks for your help !

Approved!! Waiting for the doc to call with the date!! I cannot wait this was so fast. I teach and am on a time line so I think it might all just work out!! Yay! Medica!

After going through all of the stuff I needed to go through to get my surgery, my insurance company won't cover my surgery even though I qualify in a hundred ways. Either way, I have to start over in another city. I was wondering if anyone knew if the financing was based on credit, or do they finance to anyone? My credit score isn't good at all, so I know I won't be approved if its based on that. The only thing i know about the financing through the new place is that you can choose between 2 banks. I have to wait till the 30th, to go to their seminar before they will give me any more information about anything. Thanks in advance!

Hello - i'm one visit away (Aug. 1) from having my docs sent for insurance approval and obtaining my surgery date. I am really concerned with True Results as their facility (surgery center, not general offices) is NOT a part of my UHC Bariatric approved surgery centers - nor can my insurance advocate with UHC find them anywhere on her database. True Results keeps telling me that they will bill In Network and all will be fine....but that doesn't sound legal to me. Can anyone shed some light on this for me? i've emailed the 'insurance expert' at TR and placed a read receipt on the email -so I know that she opened it up and read it, but has yet to reply to me. I've …

I am in the process of getting approval with Aetna. My doctor told me stay confident that I will get approval but I was curious about one thing. I currently have a 40.5 BMI and meet all the requirements for my doctor. My one concern is that they require a 2-year of BMI history of being over weight. Do you have to have a 2 year weight history of a BMI over 40 or just an overweight BMI?? Over the past two years I have gained about 40 lbs due to a thyroid problem, which in turn makes it much harder to loose weight. Some of my weights from 2010 and 2011 only show a 33-34 BMI. Do you think this will keep me back from getting approval? Any feedback from others who have been app…

I am trying REALLY hard not to get discouraged on this journey... It's not easy, but I am pretty determined. Wondering if anyone had any success tapping into retirement savings to pay for surgery. I am a self pay and it's all gotta be done up front. I'm a little wary of medical credit cards because I've heard the interest is CRAZY. Thanks in advance for your input.

Need some clarification, please! So I called my insurance company (united healthcare community plan) and they said they only cover gastric bypass. I wanted the sleeve. I heard that some surgeons are able to actually get the sleeve covered, but it is a little bit of extra work. Is this just wishful thinking? Also, I had my first consultation with my surgeon. So far, no one knows if I need a 6 month supervised diet since the patient advocate was out on vacation. I called my insurance 900 times and they said they don't see anything about a 6 month diet and that the only requirement is pre-auth. Should I go ahead and assume I don't need it or just go ahead and do the 6 mont…

Not sure what to do still pre op don't have a date my psycologist office said there is something going on with my insurance and I don't know what to do I've been dealing with all this sence oct ive come to far to give up now any suggestions? I only have one psyc test and bam surgery scheduled !!!!!

Hi Everyone, I'm scheduled for surgery on the 17th and noone has called me to tell me the exact figures that I have to come out of pocket the day of. I just got off the phone with the hosipital and they claim that someone will call me 1 day prior to my surgery date to give me an exact total. Really!!!? How the hell is that enough time!? I'm so concerned because I don't want to get to the hospital and they tell me my co-pay is like $1500 or something. I don't have any kind of money laying around. I called BCBS and they told me it depends on how the doctor/hospital codes the procedure. I know I have a $150 co-pay per performing surgeon plus $75/day if it's coded as outpat…

I have UMR/AURORA and i been doing the requirements for insurance but I'm nervous about is my BMI. My BMI was 40.4 when I started I'm wandering if I will be denied because I have no cor morbidity. I call my insurance and they say that I need to get approval from the surgeon and nutrionist. Than I talk to the people at the clinic and they give me mixed emotions. So I was wandering can anybody tell me if my BMI is high enough to even get approved

Does anyone have medicaid fidelis in new york and if so what did u have to go tbrough

Hi, Has anyone heard if Medicare is approving VSG in NY? I heard the final decision would be made today. It didn't look good last time I called from what they said about the previous review. It's so frustrating that they accept it in other states but not here. You'd think NY would be one of the first places to have it approved. I am afraid to call...but I will sum up the courage to do so... I hope it's approved! I'll be done with my 6 month paperwork next month so I'm ready!

How long did it take to approve once your papers were given/sent out? I have asked before, but most answers were people who had private insurance.

I am filling out paperwork for my Surgeon's office and I have almost completed the Weight Management History portion that has to be submitted to my Insurance company. They stress filling it out in detail, which I understand. I have come to the essay portion that asks me to " describe the limitations ( physical, emotional, employment) morbid obesity imposes on you in your daily activity." I am at a loss as to where to start. I am afraid they will not see my limitations as reasons for surgery. It feels like a test... LOL. I hate tests. I am afraid of writing the "wrong" thing. has anyone else had to do this, and if so could you give me a little advice? Thanks!

And if so when? I was just submitted yesterday and I am still waiting for the results of my H Pylori second test...not quite sure why antibiotics aren't started right away...blood test was positive then a stool submit...gross!

I have called my insurance (Healthnet h,m,o) and they cover WLS but have several conditions that worry me. first they require all procedures to go through their Bariatric Centers. Has anyone heard of these, dealt with them. Second, they only cover the lap-band or gastric bypass UNLESS some how the doctor proves that the sleeve is medically necessary. Does anyone know how to prove the sleeve is necessary and conversley that these other forms are WLS would be contra-indicated? I really only want the sleeve after doing my research. Lastly, does anyone with Healthnet *** know what the steps are to their approval process. I couldn't figure out if they require dieting, n…

hello! im looking into getting my lap band done...first time about two years ago while living in ny I completed the sixth month diet,psych eval,nutrition everything! then two weeks before my surgery the surgeon that took my insurance left for personal reasons so..no surgery. NOW living in AZ I really want to the ball moving. I have called emblem so many times but cant get a straight answer. My question for anyone that could possibly have an answer is in NY my insurance is EMBLEM HEALTH and on the back it says " outside of ny national network is MULTIPLAN" im not sure what to do....hopefully someone is in the same boat as me or knows what insurance I should tell my surge…

I was officially approved!!!! After 19 days of waiting and the I got a yes!!! So my out of pocket portion is $3800. Hospital says I must pay atleast $1900 upfront. Care credit denied me. Booooo My credit isnt horrible, just not long standing and also my stupid cc balances are still showing even though i paid both cards off in full last month. grrrr Alll in all we can come up with the 1900 but I wish I had gotten the carecredit so I could have surgery right away instead of scrambling for a month or so

Hello all, As stated this is the first time I am having to deal with insurance companies, as I am 25 years old and have never needed to prior. Im severely freaking out because my surgery coordinator told me I had to do a sleep study and she reassured me after looking at my explanation of benefits that it would be covered under insurance. Well today I got the claim alert from Aetna saying for the two nights it cost $14,000 and the portion I owe is $11,000. I have a $500 deductible and $2000 out of pocket max. For $14,000 I would have gone to Mexico! Because I am young and naive I was hoping anybody with education or experience in the area could help me proceed to fi…

Hey all, I am a self pay patient (surgery date aug 2). I am having my surgery in the US. My concern is coverage for complications. My clinic offers BLIS insurance but I am not really happy with thier coverage. Does anyone know of it is possible to purchase supplimental insurance for complications related to surgery?

Hey everyone, I've been lurking on the site for some time now and decided to join for support. I'm currently finishing my last 2 months on a 6 month supervised weight loss plan. And the journey so far has been pretty smooth but now I am running into bumps. Up until this point I have been told my insurance covered the VSG. But I did not know how much? Yesterday I found out 50% this was a huge blow. I have money saved but not enough to cover the other half. My question is can I ask my insurance to make an exception and cover more than half? What should I do I'm 20 yrs old and have no credit..so loans might be difficult and only been working at my job for about 6months. …

Does anyone have this insurance? Or even got approved thru them. Feel free to comment if so, would like to hear about it. This is my insurance thru Medicaid

Just found out my new companys insureance doesn't cover athing to do with gastric bandings! one of the owners had a bad experience so they excluded it from the policy! So bummed! I did call my dr office and the cost is only 92 a fill.

I am not rich, I don't have the money to drive out to cooperstown all the time. That's 126 miles EACH DIRECTION! I don't even know if my car will make it that far. That is my ONLY option though because I can't afford to pay out of pocket. I really just want to give up and go crawl in a hole. This is bs.

Hi. Nurse coordinator called today, doing a final review and submitting first thing in the morning! Let's do this!!

Anyone have any tips on ensuring insurance approval? I meet all the criteria but have oftened wondered if during the monthly check ups with your doctor you are brutally honest and say "no, I haven't worked out like I should?" if that will affect approval. Does the insurance company say..."this person hasn't done what they have been asked to do." Or should I just go and tell my doctor exactly what they want to hear..."oh yeah, doing exactly what is asked of me....all day,....everyday." Which we all know is not true but I have tried to lose weight for YEARS and now I am just going through the motions to get approved. Thoughts, suggestions?

Hi bandies!! Does anyone know if I can get my insurance to pay for a thight lift because the sagging skin rubbin together leaves me with dry Patches and it burns and scabs up very bad at times and the eczema doesn't help Sent from my iPhone using LapBandTalk

Has anyone changed surgeons? Did it prolong your getting approved. Nothing has been submitted to insurance so I figure now is the best time. I just don't feel comfortable with my choice:(

i am about to start my fills next month. i have tricare prime. how does tricare work/handle with fills? is it still the reg copay? if you get a fill under fluorsopy, do you need prior approval?

Just received a call from my surgeons office, she called to tell me that medicare and medicaid has approved the sleeve gastrectomy but has to wait for a submission date so she can submit my paper work.. But yes it is approved!! I'm so excited!! I'm in Philadelphia for those who are in near by states.. Sent from my SPH-D710 using VST

Any FEP Blue members out there? How was your approval process. i only have 4 things to submit: A letter of necessity from my primary doctor An upper GI endoscopy A nutrition visit A Psych eval. All of which I will have by next week. Hoping approval is swift

I spoke to the Bariatric team yesterday with Humana Gold. Humana Gold is a MEDICARE PLAN. As of July 2nd 2012 they are now paying for the Sleeve. It is not on a case by case like Medicare announce on June 28th. I thought this was great news for ppl on Humana

So I found out today that my insurance does not cover WLS, but I was told my doctor could submit a preauthorization letter which would be reviewed. Has anyone had any experience with this? Specifically trying to get Lap Band covered by an insurance company that is expressly saying they don't cover it?

Hi, I have a bmi 37 and my doctor just diagnosed me with mild sleep apnea. Does this help my chances of getting approved? I also have one kidney (donor) & had gestational diabetes with my last baby.

Anyone here self-pay (because insurance doesn't cover WLS) and have difficulty having insurance pay for pre-op testing? I'm worried i'm going to get some crazy bill...

Anyone have positive or negative issues with getting approval from Aetna? I am starting my journey tomorrow with an appointment to my primary care physician!

For those of you in California and who were self-pay, how much did you have to pay for your surgery and after surgery fills? I dont think my insurance or doctor is going to help me out.