Insurance & Financing

I know lapband surgerys vary in price but I'm not sure if my insurance will pay for mine and was wondering what everyone else has paid and what exactly that covers like fills, post op appoinments?

I've finally completed all of my requirements and waiting to be submitted to Cigna. I've read that they can take up to 30 business days but I'm really hoping it doesn't! It seems like my future weightloss is all I can think about. What had everyone else done to make it through this phase. My surgery cannot be scheduled before I am approved ;( I would feel better if I knee my date already!

I am currently doing the 6 month diet, does anyone know if it needs to be 30 days or each month? I went for a weigh in on may 1st, and have another today. But i keep thinking i should wait until at least tomorrow since it will be june??

Has anyone had their band covered by medicare and if so what was the process? Thanks for any help!

My insurance coordinator said that wellmark requires a 3 year weight history. I have been such a roller coaster with weight that I don't know if I have 3 years above a 40 BMI. I know I have been aroindd 37-39. Has anyone had this and still been approved? Thanks!

I want to have to sleeve done...but as of right now I do not have any insurance...is there anyone who has taken insurance out and gotten the sleeve done??If so what kind should i take out?

My insurance just changed its policy from 6months Dr prescribed diet to 3 months!!!

So... I called my insurer and they are still saying that the surgeon has not submitted the paperwork! My last visit was 2 weeks ago! I realize that I am not the only patient, but what in the world could the surgeon's office be doing to prepare the documents that could take 2 weeks? When I email the coordinator, she says that the paperwork has been forwarded to the patient advocate and that I should keep calling my insurance company every few days to check on the status! WTH? Of course, that's the polite way of saying don't call us! Annoying.... Does anybody know what the patient advocate might be doing with the documents other than sitting on them?

I have a $2,000 copay that needs to be payed to the surgeon. I can't seem to get a straight answer on this, but I was wondering if the entire amount has to be paid before surgery? I know every place is different but do they usually make you pay the whole thing or could I put say $500 down? My insurance is really good and will pay for the surgery 100%, but I don't have $2000....should I wait until I have $2000 saved up before I go any further with appointments, etc. ???

I qualified. Turns out my company (an airline) is pretty liberal when it comes to this surgery. My BMI was at 35.7. My insurance only requires one comorbid, and I have 2 diabetes and hypertension. I also have cholesterol at 249, and althoug that is not considered a comorbid, it was submitted just to solidify that this surgery will help me. any suggestions? I have been a lurker as I did not want to get my hopes up. My insurance did not even require psych, or nut visits. Again I was told that is is between my company and untied and what they deem required. Thoughts. Also, what is the minimal amount of time off that you would take in a highly physical job? I am a fli…

I have finally received all of my EOB's from the insurance company and here is the breakdown of expenses: Physician (Consult & Pre-op 2 appts) - Total billed $346 & insurance paid $81.25 and I have $70 in copays. Nutritional counseling (4 appts) - Total billed $405 and insurance allowed and paid $324. Psychiatry Eval (2 appts) - Total billed $200 and insurance allowed $103 & paid $78 and I have $50 in copays. Anesthesia - $2,875 billed and insurance allowed and paid $646.40. Surgeons fees - $2,211 billed and insurance allowed $1,189 and paid $1,039 & I have a $150 surgical copay. Hospital fees - $23,584.60 billed and insurance allowed $2,029 and pai…

But thanks to you guys, I expected it and didn't panic. They denied on the basis of needing a separate medical evaluation, which I have and was included in the information that was already sent. They are asking that we split it out and resend it. Once that is done, I should know in 5 days. It has been a long haul because the surgeon didn't originally want to do the surgery because of prior medical history-it has been over 2 years since my first visit there! Ready to get the show on the road already!

Well everything came to an abrupt halt today. When the surgeons office chked with Ins..they got the go ahead. So, I went through all the pre stuff, consult, nut, psych, having tubes shoved up my nose and misrouted...thousands in medical bills for my OOP only to be told my employer opted to cover everything UP TIL surgery. They opted out actual surgery coverage. Really?? How did that part get ommitted from the info provided?? Im so angry, frustrated, and now so in debt for nothing. Sorry, just had to vent.

It's called UMR and they are a part of UHC!

Okay so I'm a little frustrated right now. Friday I had scheduled my surgery date for July 18th but then the woman called me back and told me that the woman in charge of getting approval from insurances emailed her to tell her that they need to cancel my surgery date because I have VT Medicaid and it could take 1 week to 1 1/2 months to get approval and they don't want to have to reschedule my surgery at the last minute if they still hadn't gotten approval. Once she gets the approval from my insurance company I have to schedule my surgery date again. Anyone with state insurance, how long did it take before you were approved?

Anyone here have any experience with Blue Cross Blue Shield of Massachusetts (Blue Care Elect PPO)? If so, how long did you have to wait for the lap band surgery approval after your surgeon submitted your paperwork?

Any insurance companies quick to approve procedure?

I got a surgery date and now the insurance company said no. What.!? Not medically necessary? I don't understand this at all diabetes, weight related early onset arthritis high cholesterol the list goes on . I had tohave a hysterectomy in 2004 because pcos was so severe so no kids for me and lord knows i desired them then had to have gallbladder removed in 2007. i have spent thousands on diets and exercise programs and doctors all i want is help a tool (surgery) so i can maintain a normal healthy weight for me so i can live a better life.. I know skinny people get some of these same health problems but as we all know being obese is a death sentence in and of it self tac…

Hi guys. Does anyone have united healthcare community plan? Every time I call them up and ask about requirements, there's never a clear answer! Any help would be much appreciated =)

Spoke with my insurance company today (BCBS of Georgia) to see the surgery was approved,they told me that they've only had the papers one week and it takes 4-6 weeks for approval or denial REALLY! Is this time frame normal,should I not call back,and if so when?

Hello Friends! I am a 40 yr. old female, 275 and 5' 3". I have been seeing my doc for 3-4 and for the past 2 or 3 yrs he has me on lortabs to control my back pain and I have been on Blood Pressure Meds for 15 yrs. I have severe leg, knee and back pain. He has been documenting this all due to morbid Obesity and has on my file that it is my Main medical Prob. he and I have been talking about weight loss and I have been doing Medifast, Slimfast, High Protien low carb type diets, WW, Chitosan...you get the picture, Ive tried lots since I have been obese which has been at least 18 yrs. When I went in to see him on his request last Mon. we sat and talked about all my efforts a…

So I got a call form the doctor's office saying my insurance company has authorizes my surgery (yay)...but the catch, I cant have it until October 28th because I have a pre-existing condition. When I asked what it was, they said my obesity. WTF? lol duh, I didnt get thin, then big again. So i have been calling and calling to try and figure this out.I have good insurance, its a PPO even have a coworker that got the band done 2 years ago. Same insurance, didnt have this problem. I know 2 years is a long time, but how is this a new thing? I have never been seen for obesity before, so how is it pre-existing? Anyone having this problem or know how to solve it???

Has anyone heard of UHC *** requiring a BMI of 35 or over with one comorbidity for surgery? I was denied for the surgery stating that I need to have one comorbidity to qualify. However, when they first denied me for my consultation they indicated that I had to have a BMI of 40 OR a BMI of 35-39 with a qualifying comorbidity. That was the letter from the medical group. When I appealed the consultation denial to the insurance company I received a letter from UCH stating the same thing BMI of 40 OR a BMI of 35-39 with a qualifying comorbidity. Now all of a sudden the game has changed? They clearly left out the part of the BMI being 40 or over on my most recent deni…

Hello, I have anthem ins. and bmi of 38 with sleep apnea. I am on my 8th day of waiting for approval. I can hardly stand it! Does anyone know if anthem is the same as bcbs? When I call anthem they are in Georgia does that mean I have anthem of Georgia even though I live in another state? Just wanted to see if anyone has a similiar situation. Thanks!

Hi! I've just started my process. My insurance covers wls if you have a bmi above 40 or 35-39 with 1 co-morbidity. My bmi is 52-53. My primary care physician supports/ and thinks I should and would benefit wls surgery. I am starting all my testing. I do not think I have any co morbidities. I am thankful to not have any complications because of my weight. I see that a lot of people get denied with this co morbidity deal. Do many people get denied with an above 40 bmi and no co-morbidities? I have Premera bluecross Blueshield. I would love to hear your experience without co-morbidities. Evening!

I didnt expect this "insurance game" to play out like this. Bear with me --this may be a little lengthy... My first letter from Cigna (OA) was last week.. I posted my frustration, but felt as though things would get approved. This past monday I received an official denial. The letter stated that they needed the letter from another physician other than the surgeon. The problem is that my primary physician wrote a letter that included my weight, BMI, co-morbitities, and that I would be a good candidate for the surgery. this was included in my file. I spoke to my Pre-determination cordinator, and he didnt know why it was denied..... I called Cigna and asked them what were…

Hi, I have a bmi of 38 with sleep apnea. My policy states that I only have to have 1 co-morbidity. I'm on my 8th day waiting for a response. Anyone else have any experience with this? thanks

Wasn't sure where to post this so I'm going to post it here. I am having surgery in three weeks in Mexico and I almost have the amount I need, $500 dollars away. I know I'll get there but at the same time, I've been touching my savings to catch up when my checks are short. I feel like I'm never gonna get there with all these stupid bills. I can't take out any loans because that's more debt and I get paid hourly and tips. Lately my checks aren't enough and I use my tips and savings to pay things. I need some advice on what to do. Certain bills are due every two weeks and there's no way I can get around that. So stressed and tired of worrying about money.... ;(

hello everyone at this point im a bit nervous i have united healthcare & i dont think my "co morbitaties" are serious enough to get approved i have been obese most of my childhood & adulthood & im really counting on this to make a very serious commitment to lead a healthier life style i could never drop below 20lbs & i wanted to know what other financing options there are in case of a non approval my bmi is 37.9 and i have ild sleep apnea and high colest.

$10,000.00 max lifetime, $2,000.00 ded., $300.00 hospital, $35.00 co pay per visit specialist, and 90/10, also in network only....so how does one end up with hospital bill of $22,000.00 (remember they're in network also) for vsg after already paying surgeons $2,000.00 out of pocket, and being approved by Bcbs ga a friend had this surgery and this is the bill from hospital...I too share same ins. And this makes me uneasy....

This has to be some kind of world record, but the surgeon submitted my paperwork to insurance on Thursday of last week and it was approved on Monday. Excited! I go back on the 19th to schedule my surgery. BCBS-Illinois PPO. They are awesome.

From reading everyone's posts I have to say I really lucked out. I looked over my paperwork yesterday and my first appointment was on March 27th. I had my surgery April 30th. My bmi was 40.1 with no co-morbidities. I had insurance approval and a surgery date in less than two weeks. I have to admit it all happened so fast it was a little head spinning. There were days that I crammed in 3 appointments and the stress was unbelievable but I managed. I am honestly not bragging, I just feel truly blessed.

Does any one have this insurance? Just curious how long the approval process was? Thanks!

My doctor's office submitted my paperwork to Cigna on Friday morning. I called and they confirmed that they have received the paperwork. Anyone with Cigna OAP can give me some info on how long it took for approval. Im just nervous and ready to get rolling with my surgery.

hi, I was denied during my first attempt to get approved for the sleeve. My bmi was just below 40. I have been over weight most of my life and of course I lose weight (not much) & gain it right back. So, my question is.. can my surgeon update my bmi to 40 since I've gained weight before my coordinator files my appeal? If possible, will it help? thanks much, denise

For all, please remember that it is your sole responsibility to follow up with your insurance company to ensure that all requirements are being met in order for the surgery to be covered. I had my 4th appointment on May 30 (dietician) and May 31 (psych eval which was pretty fun). True Results receptionist made my next appointment (5th appt.) for July 2, I informed her that I needed to be seen each month and not to skip a month - she said my insurance required that i wait 30 days inbetween appointments. So i called my insurance company, and this is horse crap - If i didn't call the insurance company - I would of had to start all over with the 6 months again, and then I…

Hi I'm new here and I have Blue Shield Ca *** and having a hard time Getting a referral from my physician. Does anyone in the kern County area know any physician that will refer or start the lap band process. I'm 5'8 270 pounds. Thank you very much any help will be appreciated.

I'm getting so frustrated waiting for Insurance Approval! I feel like it has been forever since everything was submitted, which was on the 29th of May. I was told about a week for BCBS. I have my whole summer planning waiting on the date of my surgery and since I'm not telling others I can't set dates to go visit family until I know where I will be in my recovery! UGGGG! Just feeling frustrated with this today and want to set a date already so I can start this journey! I'm ready... beyond ready... but want to start NOW! Fingers crossed I hear from them tomorrow!

What was the experience trying to get approved for lap band?

I have been denied coverage of my revision of lab band to sleeve. I have been researching Mexico options for self-pay. My husband prefer that I stay in the US, because of after care. Has anyone used a US doctor for a revision that gave a good price for self-pay patients. I will travel anywhere in the US. Thanks for any information! Heather

Hi Everyone I am new here and have trolled the site and I am so glad there is a place for my questions. I had a gastric bypass 10 years ago and I am now back up to 280 pounds. I was denied a lap band by Kaiser or any other secondary surgery for that matter. My questions is, I am actually starting work at Healthnet tomorrow and my primary goal has been to have band over bypass. I will have all these choices of their insurance to go with and not really no which one is best from this stand point, weight loss surgery I mean!! If anyone has any insight I would appreciate it. Thannks Mandy

I have health first and My np told me i didn't needed but another nurse said i did! Has anyone ever avoided the letter?

Why are all BCBS state plans different? My doctors office has never had any problems with getting approvals with other BCBS but mine. It doesn't make any sense to me. I am hoping they will eventuallt approve it.

I have good insurance now, and barring complications I shoud be getting my surgery next month. I was wondernig though if people have had issues in the past getting their fills, etc covered if they switch insurance after lapband? Are there ways to know what insurance is good to switch to, and what insurance is bad to switch to? I ask because I have a government job with an expiration date in my contract and want to know how I should go about finding someone to allow my fills (I live in MD if that helps).

I haven't started the six month diet cus I don't no if I'm suppose to join a weight program or do it w my pcp ... I want it to count and be able to use it for the insurance company plz help me and tell me how am I suppose to be supervised on this six month diet

I was banded in 08, I should of done the gastric bypass now I'm going in to get revised but, I have to wait to see if my insurance will accept it! If they don't I still want the band out!! It's useless and I don't recommend it for anyone. Hoping 2013 will be the year for me at my goal weight!

The title says it all I assumed I weighed more than I do. Sounds like a good thing unless you are trying to get approved for the lap band. I am about 12 lbs. less than what would make me have a bmi of 40. Right this second I am about 38 bmi. I know my triglycerides are through the roof, I have shown in the past to have prediabetes, I have a fatty liver and I've shown high cholesterol in the past, too. I get officially weighed in on June 6th. Without getting jumped on here - I am just hoping I can gain the necessary weight to be approved by insurance. Anyone else felt the need to do this? I just don't think my version of comorbidities matches with bcbs of california.…

I have health first w/ Medicaid and was wondering if anyone else has it. If they need the 6-months letter and how long did it take for the insurance to approve the surgery. Thanks!

Would anyone know if a bmi of 38.74, 240lbs, high cholesterol, asthma, GERD's, sleep apnea, 48"waist, and late 40's female would be enough to qualify for wls (sleeve) through bcbs of ga? I do know my insurance covers wls but I am not 40 plus bmi nor do I have diabetes, hbp, although my mother and both of her parents have both. Just not sure my issues are qualifying comorbidities?! Thanks

Hello, My case manager has just sent my stuff to my ins. for approval this week. I am so nervous about it. I was just wondering how does the ins. notify me? I was told that a letter would be sent to my doctor and myself. Surely they have a quicker way than that. I have read where people have been approved in 24 hrs. How is that possible? Does the case manager just scan the forms in and email it to the ins.? I know the ins. recieved it in one day. I have anthem BCBS. Don't really know what state, it's not the state I live in. Thanks