Insurance & Financing

I’m not sure if I’m the only one but I just do not get how insurance works. I know that I have to pay my deductible first before they start to cover anything. So here is my insurance stuff and hopefully you all can explain. I have spoken with atena but I’m still not positive about it. So my doctor is in network. My deductible is 1500. In network annual co insurance is 3100 including deductible, out of network deductible 2675. Out of network co insurance 6250. So from what I understand. Once I reach 3100 of paying my cost. They cover the rest, as long as in network? Thanks for reading guys!!

I am so confused about all the insurance stuff - and I know that this isn't the best place to get specific help, but I'm hoping that it can just be made clearer for me. I'm not American - I'm from the UK and we have universal healthcare, so the insurance thing has always confused the feck out of me! I live in upstate NY, my husband works for the State and therefore has very good insurance. It covered our IVF and my breast reduction surgery 100%, for example. It's United Healthcare - but is also apparently the NYS Empire Plan. But it is Blue Cross Blue Shield if there is a hospital stay involved?? Anyway - I went to my primary care doctor. She has the s…

I found out this morning my insurance approved my vsg surgery. I just got a call from the surgeon's office, I see the surgeon on July 10th then my surgery will be 2-3 weeks after that. I'm so excited!

I'm anxiously waiting for insurance approval. My primary insurance is Medicare, BCBS is my secondary (I think that's how it works). I did the 6 months of diet consults, my BMI is 42, and I have severe sleep apnea. I completed the checklist from my surgeon's office; did my psych eval, nutritionist visit, breathing test, and all. I have read about people getting denied by insurance and it has me very worried. I've started stress eating because of it. I don't know the exact insurance requirements because I think it gets approved by BCBS, but BCBS has different requirements for people with Medicare and I cannot find that information online. I have called my insurances many ti…

Hey everyone, I will be starting a new job the 1st week of June and at the beginning of July, I will be able to sign up with Aetna insurance through my new job. I was given information that Bariatric surgery is covered under the plan and that there are 3 consecutive months that I will have to be on a physician-supervised plan. This week I went to see my PCP so that she could start me on a plan, thinking that the insurance company will take the documentation when the surgical center submits the paperwork. Also, I made an appointment with the surgical center but they cant get me in until the end of next month. ***So,that's why I opted to start the plan with my pcp. Am…

I was just wondering hoops Tricare made you go through? I live in Oklahoma, if that means anything lol. Thank you (:

The last pending insurance claim for my surgery/hospital stay processed today, so I thought I'd give the cost breakdown for anyone who is interested. Context: I live in Illinois and had my surgery at Barnes-Jewish Hospital in St. Louis, Mo., through the Washington University WLS program. My primary surgeon was Dr. Arghavan Salles, though Dr. Christopher Eagon assisted. My surgery was on Feb. 15, and I went home on the afternoon of Feb. 17. My insurance is the Health Alliance POS 6300 Elite Silver CS plan, purchased through the Illinois Health Marketplace. I have a $1,000 deductible. Laparscopic gastric bypass w/ Roux-en-Y: Billed = $5,100, My cost = $145.97 (I …

Hi all - i have an insurance-covered VSG scheduled for 6/28 and was curious if anyone had been in the same boat as me. I switched jobs a few weeks ago and was approved under my former job insurance which is active until 6/30. I have new insurance that kicks in on July 1 (after my surgery date). I was curious if anyone had experienced this across two insurances. I’m more concerned how the post-op care is covered or if it would be specifically excluded on my newer policy - especially in any worst case scenario with any post surgical complications etc. Certainly expect to go home the next day, but of course you never know! My new insurance does cover Bariatric, but only when…

The first place I wanted to go through has you find out if WLS will be covered. They told me it was an exclusion. When I asked the surgeons office if they would try to get it approved they said it wouldn’t happen and they won’t even try. I keep reading about people whose surgeons offices have all appealed again and again and their insurance finally says yes if they go through 6 months of stuff. I’m trying to find out if PacificSource is a hard NO or has anyone had success in getting it covered? Thanks!

Anyone know of an inexpensive RNY surgeon for self pay in Florida. I'm willing to travel Sent from my SM-N920T using BariatricPal mobile app

I just had a couple questions because I recently was sleeved and two of my coworkers that had bariatric surgery at the same facility as me with the same insurance both got these outrageous bills for $35,000 like six months to a year after surgery. It's unclear what they were getting billed for but I just don't want 2 get one of these bills because my insurance says they cover bariatric surgery a hundred percent I have Blue Cross Blue Shield of Arizona it's a federal plan Sent from my SM-G920T1 using BariatricPal mobile app

I’m going through the process of getting gastric sleeve through my IEHP insurance. Just started this month, looking to see if anyone else has gone through IEHP and what their experience was like. The only person I found was posted in 2016.

A bit of background first. I went in for my 2nd pre-op visit with the nurse pract. yesterday. My 1st visit was with a pa who put me on phentermine and topamax. She asked that I get an upper gi endoscopy because of my severe gerd and esophageal spasms. This is scheduled for June 19. I already had the therapist appt. After I get the endoscopy I will start the 6 week required classes. Then I see the therapist again and the nurse one more time. I believe at that point I will finally meet the surgeon. On to my question. my bmi on the 1st appt was 37.2. Since they put me on the diet pills it went down to 36.7 trying hard not to lose any. I am afraid to lose too much and…

Anyone here have MDIPA insurance? If so, how hard was it to get your WLS approved? TIA.

I am hoping to be able to get Gastric Sleeve and have Tricare East. It is a new region so I don't know if anyone has had weight loss surgery since Tricare's transition. Also I have prime and the doctor I have been assigned to as my PCM is more concerned about sending me for a sleep study, which he seems to think will solve my weight problems. My previous physician was ready to send me to a weight loss surgery center when I had to change doctors due to getting married, moving 3 hours north of her and now having Tricare only. Any help?? By the way, my BMI is 40.

Anyone who works for AIG with United Healthcare had the surgery or going through process? I have my 6th visit with PCP next month as well as psych appt. wondering how long for approval and of process is easy.

I was given prior authorization to have my gastric sleeve on January 24th and everything has been going well until today. I got a bill for $1800 and am very upset/confused. I was under the impression that the approval meant full coverage of the procedure. The financing person at my surgeon's office did not mention anything about a copay that substantial. Does anyone have any experience with Tricare standard or tricare select (as it is now called) and getting a giant bill 3 months later with no warning? Any information is appreciated.

I’m having a horrible time with the business office of my doctors office. I live in NC but my insurance is through MA. They keep telling me I have a 6 month wait/supervised weight loss program but no one I’ve contacted at BCBS MA sees that requirement. Just wondering if anyone else has run into this issue and if so what did you do? Thanks!

Im curious, has anyone on here had their surgery yet with Paramount Advantage? What did it take to get approved and what kind of problems did you run across? I'm at the final steps and just so nervous for approval to go through

I’m beyond frustrated with my PCP right now. Last month my Bariatric coordinator told me that his documentation on my monthly visits were lacking a lot of details the insurance company wants. So she contacted him, I mentioned it at my last visit and he said “oh yeah yeah she talked to me about it”. I checked on that visit visit today on my patient portal and it was STILL lacking details. Has anyone else had this happen and still get approved? I don’t know if he can go back and amend his previous notes but I SWEAR ON ALL THAT IS HOLY IF I DONT GET APPROVED BECAUSE HE IS A LAZY SCHMUCK THAT CANT DOCUMENT MORE THAN HALF A SENTENCE OF THESE G***DAMN VISITS IM PAYING FOR…

So I contacted my insurance (excellus BCBS) and asked them about coverage. The rep emailed me a copy of my policy and told me to go over it with my PCP. I have an appt with her on Thursday. My question is, once I go through the document with my doctor, To see if I meet the criteria (which I’m assuming I will) what next? Submit the request to insurance? Will my doctor know? Age 37, Mom of 2 awesome boys HW-288 lbs Started journey 4/19/18

I was wondering...will my insurance (UHC) inform my work of my upcoming surgery? Are they entitled to do so? I really didn't want them knowing and was going to use my vacation days instead of telling them. Thanks and happy losing!!!

Who has BCBS of Alabama that pays 80% for Bariatric? Wondering how much you paid out of pocket?

I am trying to figure out how long I have to do the medically supervised diet. I have had one program tell me 6 months and I have had another program tell me 3 months. Has any gone through the surgery with this insrance have any idea what it is. I am really just tried of waiting for the surgery and want to do it the quickest way possible.

Does anyone know or remember the cost of their EDG?

Does anyone have this coverage and can tell me if they were able to -get vitamins and supplements covered - get approved in a reasonable amount of time

Hi everyone, I just wanted to know if your insurance is covering 100% (Aetna) or any others. Was it really or did you have to come out of pocket? I’ve only had to pay pre op copays. Tia

Hey all!! I am just starting out on my weight loss journey and wanted to see if anyone had any good tips or suggestions to make this an easy process. I have anthem BCBS and every time I’ve called about approval they haven’t mentioned about weigh ins or wait times just have your doctor send the request for approval. My first appointment with the surgeon, case manager, and nutritionist is May 14 and I know a lot of my questions will be answered then but I like to be prepared! Thanks in advance!

Anyone have 1199 ? Just wondering how they are with approvals Sent from my iPhone using the BariatricPal App

I am at my wits ends. My pre determination of benefits were denied. My doctor did a peer to peer review this morning and it was denied. I filed an appeal as soon as I got the denial call. The reason I was denied was because my current EGD shows no sign of erosion, slippage, or reflux. I wrote a pretty lengthy letter and faxed to the insurance company. The letter detailed all the issues I have had with my band over the last two years. I have had horrible reflux and port pain. I faxed over 132 pages. Yes I know that’s a lot. Has anyone had to appeal?

I just jumped through my last hoop with the Bariatric Program. The next step is to contact the Highmark BCBS for approval. Is there anything I should or could do to monitor / move that process along from my end?

I'm currently going through my 4th monthly weight loss visits. I have a question & hope someone has any insight. My Weight loss appts should be once a month every 30 days. My last month visit was on March 30th. 30 days from that date will be on April 30th which is a Monday..My PCP is off on Monday so she schedule me for Tuesday May 1st. I want to know will this cause a issue in the approval stage due to: I didn't see my PCP in the month of April & second I didn't see my PCP until the 31st day. I wouldn't hope seeing my doctor a day or two after 30 days will be a issue. Plus missing the month of April was out of my control. My advocate at the hospital that…

Does anyone have any experience at all with Aetna better health. I can't seem to get straight answers on requirements. Also curious on experiences as far as approval/ denial and timeframes. Any help at all would be great.

I have UHC and like most have to have 6 visits with my Dr, a nutritionist, etc. UHC stated i was allowed to go back 2 yrs prior as long as the visits were consecutive. I went to a weight loss clinic last year and my personal Dr will sign off on the months of Dec, Jan and April cause that is when I have seen her. My question is has anyone else done it this way or do you start your 6 months at the beginning of your plans to have surgery? I just want to make sure I do it right. Sent from my SAMSUNG-SM-G930A using BariatricPal mobile app

Hello, I have Aenta, any suggestions on what I should be doing or making sure my doctor does so my claim is approved for surgery? My 3rd appointment with my surgeon is Friday.

i am trying to find a dr in vegas that will take medicaid can someone help me please Sent from my SM-G950U using BariatricPal mobile app

My surgeon's office said I need at least one comorbidity for Medicare to cover my bariatric surgery. My PCP has put in a referral for me to have a sleep study done to see if I have sleep apnea. I do snore loudly every night (my boyfriend has to leave and sleep in another room), feel tired during the day, have trouble falling asleep, and am a light sleeper. It can take me up to 12 hours of being in bed to feel rested. I'm definitely not a morning person LOL. According to my Fitbit, when I sleep I spend 17% awake, 20% REM, 50% Light, and 13% Deep during my average of 7 hours of sleep. My PCP said it would be an at-home sleep study, and depending on the results I would go to…

Cigna denied me for the sleeve surgery on the basis of records not including a "nutritional evaluation" by a physician or RD AND because one of my diet visits did not include any exercise information. The doctors office keeps telling me the doctor will do a peer to peer to try to get it approved on the basis that they must not understand that the diet visits I did were with a RD. My question is - did anyone have a specific nutrition evaluation in addition to the diet visits- similar to the psych eval? It has been two weeks and they have no update for me on when they will do the peer to peer and I do not want to sit around wasting time dragging this out because th…

Just waiting for a date for surgery. I’m looking forward to this journey and hoping this tool helps me get myself together! I’m so thankful!

I have been on Medicaid for 5 years as a single mom in college and then 2 years as an AmeriCorps VISTA. was referred for the sleeve in December by my family dr. Medicaid approved. Started a new job in February, insurance starts 4/27. Medicaid ends 4/30. Obesity surgery is excluded with my new coverage and I was so close! I can’t stop crying. A friend suggested I contact HR. Does anyone have any suggestions what I should say?

If you have Fed Blue, if you login to your account and send an email via the website, they will email you the approval letter!! If you're impatient like me, I know this is a big deal! Good luck, everyone!

I’m just wondering why insurance companies would deny you?

Hi! I was originally denied through my insurance for a revision. However I think I have found the best way to do RNY. I will have to be self pay to remove my band, then start the consultation for RNY! My policy states that a repeat surgery will be paid for if patient was compliant with first surgery! Has anyone had a similar situation to this?

After bugging BCBS of IL and TeamCare, I was approved. My dr's office submitted everything last week on 4/3/18 and I was approved today! I am so overjoyed. Cannot wait to talk to my Dr's office and get this surgery scheduled. My son graduates from college on 5/12 so I'm going to wait until after his graduation to have it done. I cannot wait. I'm so thrilled! Literally feels like there is light at the end of the tunnel.

Hello everyone, I'm scheduled to have the gastric sleeve surgery May 1st. It's been a very long process. I started with my primary care physician in October. So it's been roughly 6 months, and I also saw a nutritionist the last three. I've completed every single step in the guidelines. EKG, X-RAY, LABS, Endoscopy, supervised diet 3+ months, psych eval, and weigh ins with PCP for 7 months total. I also have history of obesity since 2015. Starting weight was 256 and current weight is 248. My liquid diet starts 4/17. With that being said, I've spoken to my insurance numerous times over the last week just to get a general idea and they're pretty vague. …

I had rny in 2004 in MN and lost 167 pounds. In 2009 I started having pain and went back to my bariatric dr who did no tests but said I probably had ulcers and put me on meds. Several months passed with no relief but dr said keep taking meds, no tests. I went to my primary dr who sent me for an upper endoscopy. They found no ulcers and said I was fine but I was still in pain. He gave me pain meds but no followup tests or suggestions for correcting the issue. Long story short 3 years go by in constant pain and 3 doctors later I decided if I didn't leave MN I would die. I moved it CA and started the whole process again only to be told nothing showed on any tests so they sen…

Hey all! I'm still in the process of making my first appointment with the weight loss surgery office. I just called my insurance provider for information on surgery and she told me that I only need a doctor's authorization for reason of medical necessity and that I need to stay in network. When I asked her if there were any specific requirements for surgery, she said that that was all I needed. This seems unusual to me since I have often seen that insurance requires 6 month doctor-supervised nutrition/diet visits. Anyone have anything happen to them similar to this? Is this unusual? Are the pre-surgery programs actually an individual doctor related requirement rather…

So, I know that I keep posting about this but I'm desperate to find someone who has used Lindstrom. I was denied by insurance company with a peer to peer. My doctor only does peer to peers, and not appeals. So now I am stuck doing it. I contacted Kelley Friday and spoke with her. She made me incredibly hopeful. The basis for my denial was there was no mechanical failure of the band. Kelley suggested I see a Gastroenterologist. I made the appointment as soon as she suggested it. Went today for a consultation and barium swallow. My barium swallow showed reflux, which I knew I had. However it showed that the bad was positioned correctly. Has anyone else been in this situatio…

I had surgery 12 years ago and have kept off 160lbs. For a myriad of reasons, not to do with me, I've cancelled reconstructive surgery about 4 times..... NOW I'm in Denver and have better insurance UNITED HEALTH CARE..... surgeons in Denver or CO? Best? Most comforting? I need a lower body/tummy lift and the top thighs and my neck [emoji170]? Please feel feee to pm me too. Sent from my SM-G935V using BariatricPal mobile app

I have had a lapband for 10 years and want to have it removed and a gastric bypass done. I’m told that my insurance has a “failure” clause but I’m not sure what qualifies as a failure. Has anyone had a second surgery paid for by insurance?