Insurance & Financing

I am scheduled for my last appointment May 25th before approval from insurance. I have BCBS of IL and was wondering if anyone has been approved by this company and what time frame was it until you heard back with your approval? Hoping for a June surgery day. Thanks in advance Kati

So I called my insurance (Kaiser ***) to find out what my copay will be when I have the surgery, if it can be done outpatient, it would be $200. Or it will be $400 each day I’m in the hospital. I have two questions: Has anyone had the sleeve done as outpatient surgery? Do you have to pay upfront or will hospitals bill you? I have never had any type of surgery, so I’m new at this.

Anyone know any doctors that take medi-cal? Sadly I lost my insurance back in Jan and like to find a doctor that takes medi-cal for fills and doctor visits.

Can anyone from NJ with Blue Cross Blue Shields insurance tell me how long did it take for the insurance to approve the surgery? I am getting bit nervous because I am schedule for surgery on July 3rd and I will finish with all the requirements test on June 13th and I dont know if it will be approved on time.. Any advice will be greatly appreciated..

Hi all!! I am new here and all I have left to do is 5 more sessions with the NUT and my sleep study.... What has been everyone's expiriance with Cigna ppo??? I'm losing sleep over that part!! Ugh so anxious about getting approved

So upset I just found out I was denied!!! Going to try to appeal but wondering if I'm wasting my time?!?

Hey, gang, I had my last visit with the NP and the dietician before submitting to the insurance today. I'm trying to be hopeful. The NP said that she has to tell me that approval can take up to 90 days (geez) but she has never seen it take that long. She didn't seem to think that I would have a problem being approved. Famous last words, right? Once approved, I would finally meet with the surgeon and set a date for surgery. I have my heart set on doing this in August. Wish me luck!

Question for all my fellow sleevers, is it too much to be calling the insurance company twice a day once in the morning and once in the late afternoon?

HI anyone had to use insurance Uhc choice plus , and got approval how long was it to wait fo rthem to call ya? Was it a long time frame or a quick response.? Thanks

Does anyone have this insurance? Was it hard to get approved?

How long did it take for approval?

Does kaiser fill out forms for aflac if its not medically necessary. I hope I only have to be off a week or two not months.

Hello everyone! I've seen a few threads about self-pay options but the costs reporeted seem a few years old in most of the posts. Anyone recently self-pay that can share the total cost with me?

Okay , I call my insurance company which is breech street and they informed me that my plan hasn't changed just my ppo provider to Aetna so I don't get she say my plan the same but I'm tryna figure out of this mean I do what Aetna requires or beech street but the rep said everything is stool the same ..I don't get it

HI anyone who is living in my state NJ and who has UHC of NJ. Please give me some info on how it works. First off, I was searching and searching for a drs. office that would help me out. No one went the exta mile.In this case it was different, and i picked at random, a place in New Jersey, i don't know if they work with the insurance company but... the place i picked was called Bariaactric Ecxcellence something to that effect. And well, i got an email i do have this in my insurance . It is a matter of a deductible i ahve to maintain of $750.00 and at admission $500. The procedure would be, 80% paid and the copay would be like i stated 500 bucks! What i would like to kn…

I posted this on another website but no one answered me :confused5: Anyone approved on the first time for a revision from Realize band (2/11/10) to Sleeve? I just recently had to change insurance from Anthem to Cigna PPO.I tried to get the revision with Anthem in Sept. and Oct. of 2011 but I was denied twice, even though I had pouch dilatation, a minor slip and very minimal weight loss (40 lbs), I was told I was denied because I haven't had my band for 2 years. It will be 2 years next month. The patient coordinator was fighting for me but I didn't get approved. In my mind I kind of gave up. I was unfilled from Sept to Dec. and I have gained closed to 20 pounds...that …

Hi, So today I called my docs office to see how the peer to peer went. They told me that the peer to peer was not approved on the spot because my insurance needed more paperwork. Now, my docs office is going through with an appeal. Can anyone please tell me your experience with the appeal? How long did it take? What was the outcome? How did you get notified? thanks, denise

This morning I went to surgent's office to take my 6 nonths papers they got me approved in 10 minutes! And got my pre op diet, and surgery date all that in about an hour. thank God! Feel so happy. Will get surgery on the 19th!

Have weights for the past year and then there is a 2 1/2 year gap and then off an on for past 5 years prior to that. Do u think I will be okay? Also, my surgeons office says that they only require 3 consecutive months of doctors diet not a full 90 days. Has anyone heard of this? Do u think I will have problems with approval? Any comments would be appreciated.

Hello all! I am new here. I was wondering if anyone else here has used this group from http://www.gastricbandinstitute.com/ it is based in Chattanooga area of TN. I will be moving to TN soon and shortly after will be looking into this. I am very interested in the sleeve surgery and have been gathering my info and research to better prepare myself. My questions are about financing. I do not have insurance to cover the surgery so we (fiance and I) are considering to finance it. I have actually been in contact with the group themselves via email and they gave me some information on the financing servicers they coordinate with and which ones they recommend the most, etc. I …

Are there any sleevers that have used BCBS FEP for the procedure? If so how was the process?

Hi I am new here, but I have been on the journey since March 2012. Everything is moving so slow. My insurance tells me they will cover the vertical sleeve if it is a medical necessary. The Insurance Lady at my Doctor's office is being to by the insurance that they go by Medicare guidelines and the VSG is not covered. Is anyone else going thru this? I am also frustrated with the Psychologist I saw. She feels I need follow ups with another Physchologist because of my medication and because of anixiety. Now that will take more time. I thought this process would take 3 months..... I would really appreciate input on this, thank you so much!

Hello everybody, Cigna changed their criteria effective 5/15/12 from a 6 month medically supervised weight management program to a minimum of 3 months. If you have Cigna, and you're in the first phase of the weight management program, this applies to you. Please call your surgeon's office to see if they gotten the good news. BTW, this is courtesy of Crichard1107. She was nice enough to pass it along even though she's nearly finished with the 6 month program. Thanks!

I am new to the forum and just beginning my journey towards WLS. I just found out my husband's insurance (Aetna Choice Pos II) covers the procedure and will switch to his provider at the end of the year. I have already selected my doctor and they have begun the process of meeting all the requirments for the Aetna insurance plan. Once I switch providers they will submit the paperwork for approval. I sent an email to Aetna asking them about the coverage. Below is the response from the insurance company. I have two questions if anyone is familiar and can offer answers: 1. Does this mean I will only pay a maximum of $5,750.00 before the deductable? 2. Is the maximum incl…

Hi, Im new here and have a quesiton for you all. Back in late Feb/ early March when i started this journey i had Amerihealth. Insurance was willing to cover the sleeve 100% after my $300 Deductable. I had to do 6 visits with the Nutritionist before approval. On March 26 i found out that the company my husband works for was changing insurance carriers effective April 1. We went from having Amerihealth to now having Meritain Health/ Aetna. Just called the new insurance company because i want to know what my coverage is and wanted to clarify if i still had to do 6 months with the nutritionist or if the nutritionist is right and its now 4 months. They don't h…

Has anyone used medical financial.com for there financing??

I may have to self pay and I am hearing prices of $60,000 for Englewood Hosiptal in NJ.

I am new at all this and recently found out that although my insurance is with anthem blue cross of califrnia PPO that blue cross bears no liability in that they simply administer the plan. My insurance is self funded by my husbands larger employer who at the beginningof march 1, 2012 was still working out the specifics of the SPD and thus could not provide me the detailed description of what specifically they covered in regards to bariatric surgeries...it just says that bariatric services are not covered if it is not medically necessary. I called 1800 thin here in California. I have been seen at Dr Johnson's office where I have had a sleep study done, upper GI, ultra …

I have blue cross and let me tell u its a nightmare. I started this chapter of my life Dec 2011. I just finished up my 6 months of seeing a Dr a month and a dietary Dr. I did everything they needed except that i don't have my weight for 2007. And they denied me. So i just went to my primary Dr and asked him to write a letter to see if they will change there mind. I feel like im on a roller coaster. Im frustrated and upset.. Id anyone having the same problem

Anyone have Cigna and had them pay for the lap and surgery? My policy says weight loss is not covered for gastric bypass surgery. But I had my insurance verified by the patient coordinator and she was told its covered if I meet their criteria. I was also told since I have a high deductible (which has been net) that I might have to pay fit the lap and device itself. She said that runs about $5000.00. But since my deductible is met shouldnt insurance cover the device? I really can't afford the 5000.00 since I paid for shoulder surgery 4 months ago in full. Anyone had anything like this with insurance. I go for my seminar next Saturday then I get my free consultation. Just h…

did anyone else go through this? I called the insurance company. the first time they said "sure, lose as much weight as you can, tha'ts what the 6 months are for." I was leary so i called again. second person said "no- do not lose weight, that would put you under bmi 40 and with no co morbidities, you wouldn't qualify for surgery at the end of the 6 mos." today I called AGAIN to get an answer and they said they couldn't find the answer to my question and they needed to ask someone higher up and she'd call me back. "it might be a day, or even a week or 2 before we can get you an answer." OH PLEASE! I know this will all pass, and I'll look b ack and giggle at my imp…

Hi, I'm 20 and I called my insurance company (UHC Choice Plan A) back when I was 19 and they said I couldn't get any type of WLS until I was 21.. I just got off the phone with them and they told me I can do the 6 months of supervised dieting. But they didn't really answer any of my other questions like nutrition classes and psych evals. I turn 21 in Oct and really want to get sleeved in Dec due to school. Am I being unrealistic about being sleeved in Dec? Do nutrition classes span over 4-6 months?

Has anyone gone through HealthFirst Insurance what do they require to approve the surgery can anyone give me some input. thanks!!

Wondering if anyone has this insurance in Southern California, and has had the Lap-Band? who is your Primary doctor and how was your experience? * my doctor said my insurance won't pay for the process, and wants to get me in touch with a dietician. i called my insurance and they said they will pay for whatever is deemed medically necessary!! my BMI is 60+ so looking to change doctors to one that has recommended the band on this insurance. thanks!

Hello, i live in southern california, i have Medi-Cal insurance (HealthNet, Mainstream Molina) i called my insurance and asked about bariatric/lap-band surgery coverage and was told they will pay for anything that is deemed medically necessary and referred by my doctor. So i have my doctor's appointment next week and i am going to go over all my symptoms with him and hoping he will refer me to get the surgery. - Does anyone have experience with similar situation? - Do you have all the symptoms, but your doctor won't refer you to get the surgery? - Is it easy for doctor to refer insurance to cover and get surgery done? - In your experience, given my info below …

Hi! Do you have Premera BCBS? What was your experience with them like? I would love to hear from you!! 6 month diet? Anything? I have talked to them but I am getting conflicting info.

Hello all! I am new to this sight, but have found some awesome topics on here!! I have met with the surgeon finally, and the nurse "thought" that my insurance would require a 6 month diet. I have read where Wellmark has changed in some states and they do not require the 6 month supervised physician diet. I have a supervised diet but it was in 2009 so I think it is too old? I also have all of my weight watchers recpts etc, and gym membership with the wellness key (which is like a physical trainer that we met and changed my programs etc). I have tried every diet.. Body by Vii, HCG, etc. and have all of those as well.. Long story short. Wellmark of Iowa/SD has changed their …

I've read a lot of Northern California experiences with Kaiser Permanente. I was just wondering if there are any Southern Cali experiences. I'm in the city of Downey and I really want to get the lap band.

So, I originally thought my insurance would pay 100% of my WLS since my sinus surgery on April 11th will cover my deductible and, I expect, all of my out of pocket for the year. Then, I was told it will only cover 50% after I meet my deductible and that there is no out of pocket maximum. I'm still waiting on final confirmation of this but I suspect this is the case. Oh, and if I go with insurance, I have to have it at a Center of Excellence. Only hospitals qualify as a Center of Excellence. My doctor does the majority of his surgeries at at "outpatient" surgery center where you can stay confined for up to two days to help cut costs. If I have to have it at a hospita…

Well, after starting this journey almost a year ago, doing the whole 6 months, getting denied 3 days before surgery, and then being denied TWICE by the insurance appeal.....................My external review found surgery medically necessary!!!!!!!!!!!! So, does this mean my insurance has to approve the surgery?? Or can I still get stuck paying the bill??

can anyone guide me as to which was the best anthem plan for lapband? i would like to find someone to talk to at anthem but can't seem to find a phone number...so if you could share which plan you are on or an approximate cost per month, this would be helpful....thanks, sonja

I had my last visit,but doctor was out of town . I have to wait til the 4th. I am worried about getting approvef since im not diabetic or have high blood pressure. pretty much I'm healthy except I am about 120 pounds overweight. Do you think I will get approved. I am so nervous. please pray for me.

I am expecting to be able to have my surgery in August or September upon approval of insurance. The reason I am unsure of the exact date is the facility i will be having the surgery requires me to pay my part of the facility (hospital) charge upfront. And on top of that the finacial representative at the hospital is unable to give me the amount i will be due as it is subject to possibley change. While I completely understand change, I would just like to at least get a grasp on the range of dollars i should expect to pay. I work for the insurance company that I am covered through and know i am not able to get a quote from them as they can not quote on facility charges beca…

I recieved a bill in the mail and an EOB from my insurance stating I owe $53,000 for my VSG!!!!!! I called the hospital where I had the surgery , also where I worked until May 8th, and they said that called the insurance and they stated they paid their maximum amount. They also said that some of what I had done was denied. My surgeon's office assured me that they will look into this and resolve then call me back. This is so nerve racking because I wouldn't have had VSG at the time I did because I don't want to have to pay this much for it. If anybody has anybody has any pointers to how to fight this, I will welcome your advice. Between this and student loans, I could hav…

Hi everyone, So I got a bill in the mail today from my surgeons office with two bills to the amount of $75,000, and I nearly passed out. My surgeon does bot participate in my insurance plan, but he accepts it. I was told that after I was approved (GHI/BCBS/Emblem Health) I would get checks in the mail from the insurance company and have to endorse them, and then send then to the surgeon. I received two checks, one for $303 and one for around $2,500. The surgeons office included a copy of my claim to the insurance company, which basically showed that's all that was covered. I don't know what to do and I'm panicking. Can someone please help me understand if this is co…

I have always hated that insurance requirements are so rigid. I have Aetna and they will approve the procedure but the copayment is nearly as much as the price in Mexico. Am I being crazy and inpatient to consider just going to Mexico and being done with it? I have done the sleep study (used a cpap now or twelve years but they did say that I need to increase the pressure considerably). Doctor is requiring a new endoscopy and I had one eighteen months ago. Still need the psych exam and three visits with the NUT. Anyone else considered this?

Good Morning, I will try not to go on and on. I went to my seminar last week. I had called my insurance company (they do cover wls). We have had this insurance for over 7 years. They don't really seem to have much of a criteria other than having a bmi of 40 or higher, and proof of failed weight loss. Of which, I have a bmi just at 40. And I have tried everything. My pcp has suggested surgery as an option as well. My insurance company covers my many meds, 4 knee surgeries, and a few other things. It just seems a little too easy. They do have an outside pre-cert company that will go through the info submitted. I am wondering if I will initially be approved and…

Hi my name is Kim I now have beech street insurance my insurance is changing Aetna ... My insurance before covered wls I want to kno is there anyone with this insurance and what was the process like I'm in the middle of my process with just sleep study , phys eval and six month diet .. The enrollment for this new insurance is in June and it will take effect in August .... So I just want alittle in site on it I kno insurance varies depending what your employers pick ...

had the surgery; now the dr. no longer takes my insurance (and frankly, i'm not thrilled with him); so, i'm looking for private insurance to cover the issues i'm having with my lapband (it has already once slipped and it twisted as well) and now, basically i need to find out if there is a leak in it or it slipped again as i am putting weight back on... the prices i am being quoted are like $600 per month....i can't do it...any other suggestions, options, advice? thanks, s

I am currently working on the financing for my surgery..my insurance is bcbc of tx. I do not qualify for coverage because with my bmi (35) I have to have two co-morbid conditions and I have none! I tried care credit was denied and I also tried to get a loan through my credit union and was denied. I was looking up other loan options and came across my medical loan.com ...anyone ever heard of them or tried them? Im open to any suggestions for financing.. Thanks guys!