Insurance & Financing

I'm really frustrated. I received a letter today from my insurance company saying that I will have to do 6 months of psychotherapy before they will further consider my request for VGS. They only required one session with the nutritionalist and a 6 month supervised diet isn't required. My BMI is 68! My doctor wrote, in his letter to the insurance company, that he didn't find it necessary to have any kind of psychotherapy. I'm really annoyed at the thought of having to wait 6 more months or longer. The waiting time to see a therapist around here us sometimes 2 or 3 months. My knees are not going to tolerate this weight much longer. I have no cartilage left and every step is…

Any one have this insurance and have problems getting revision covered?

please let me know if you can recommend a good doctor in the northern nj area...thanks.. sonja

OMG I am SO SO SO annoyed with the insurance coordinator for my surgeon's office. 3 weeks ago, I thought that everything was at insurance for approval. Nope. She told me she had everything she needed, but neglected to tell me she wouldn't be submitting it for another nearly 2 weeks. So, at the end of last week, she said she had faxed everything over. I call BCBS to confirm and yep they got it. However, she didn't put a procedure code so they can't start reviewing. *sigh* Ok fine, call her, leave her a message, even the insurance company called and left her a message asking for the information. We are both still waiting for that phone call. (She has the nerve to have on h…

Okay I have been approved and surgery is for June 28 but what about coinsurance. I have up to 500. That is the most ill be responsible for but do I pay that before surgery or after. I have called the office but I get diff answers with people. What was your experience? Thanks in advance

Hi, I have Blue Shield of Califonia. My paperwork was submitted Monday. I just checked my insurance claims online. My Preops have been approved. Does this a good sign that my surgery will also be approved? thanks, Denise

I am just wondering if anyone has ever went through GHI and BCBS because I am almost through my appointments,I was wondering if anyone has been approved through GHI-ppo,and the time limit that they have waited on the approval,I am not in a hurry but I dont want to have to wait,I am ready to start my journey with my new friends so that we can share our stories....

I'm sooo Close! I have 5 of 6mths of my diet and I have almost all of my tests done. The only thing that I know bcbs asks for is 5yrs of proof that I've been overweight. I don't have documentation since I've only had insurance for 2 years. I'm a little worried. Has anyone else had this issue or have any suggestions

Has anyone filed an addendum to their denied pre approval request? Since I was denied for a 39.6 BMI I have since been diagnosed with sleep apnea and insulin resistance. My Doctor has filed an addendum instead of an appeal with Anthem and I am wondering if anyone else went this route to get approved?

Ok, so I've had my 1st consultation with my surgeon on May 15 (last Tuesday). He's wonderful, thinks I'll do great and I'm scheduled for all of my appointment except the physical therapist already! I have Aetna which will cover the surgery at 100% after my (very low) deductible of $250.00. Great, right?! Well, here's the frustrating part. There is not an approved in-network provider in my area to do my sleeve surgery. (My surgeon is in-network for general surgery, but he files bariatric surgery under a different tax id.) Aetna told me that all they need to cover his fees as in-network (100%) vs. 70% after a $1250.00 deductible is for the insurance contact to call and …

Just got the call saying i have been approved for surgery im soooo excited and ready to start my journey now just waiting for my surgery date!!!

Hello everyone! I recently finished up most my clearances for BCBS of DE...I just have one nutrition class left in May. Immediately following my 5th nutrition class I stopped to speak with the nurse to discuss a possible surgery date. At this time, I was informed that my insurance company still views the sleeve as a two part procedure; therefore, they require a BMI of 50 or higher. My BMI is 38. I'm not really sure why it took five months for someone to share this information with me, but I am absolutely livid! I have HBP, Type II diabetes and (discovered during one of my clearances) sleep apnea. In addition to these issues, yesterday, the cardiologist (another cleara…

Okay so my insurance denied me because they want a letter from another doctor with a medical clearance and a letter of recommendation for surgery, ok the recommendation letter was original sent...now my doctor has sent the medical clearance letter so i wait again...i have cigna...any one else denied for something and after sending that in still denied...im so worry i really dont want to have to go through an appeal...i think its all a game with insurance companies sometimes, any input???

Hi, I had to have revisoion surgery in Oct 2011. I am on Medicare so most of the bill was covered, but I kept getting notices from the hospital for $1132 unpaid. I have supplemetnal insurance, Aetna, which should have covered it. So, I call Aetna, and the hospital never put in the correct codes. After several months and phone calls, I just received notice that the whole bill is paid! Hurray for Aetna and persistance! Karen

I am terribly concerned about the documentation required by BCBC Federal regarding 2 years of documented morbid obesity. I do not have the documentation for the 2 years as I have just recently met the BMI required for the surgery. Does anybody have experience in the past with BCBC Federal in regards to this requirement? Are they strict with meeting all the requirements?

Does anyone have blue care isanetwork and if so how long did it take to get appove? and how much did you have to pay? thanks L

Hey All~ I am waiting on my Aetna approval. Does anyone know how long it takes?? My last appt with the Dr. was April 26th. I thought they had submitted everything that day but apparently it took the office a week to get all the paperwork together and Aetna said they recieved it on May 7th. Still haven't heard anything. Is this good or bad??? LOL. Just wondering how long other Aetna members had to wait. Stephanie

My head is spinning. I haven't much of a clue what my ins company wants from me. They sent me a list of the criteria I need to meet. Most of it is simple stuff that is self explanatory. This part I still don't get: 6 consecutive months of a supervised diet with your physician. Now. Does this mean we want you to get weighed every 6 months, period? Does it mean we want you to eat a diet you have been prescribed by your dr? Or do they simply want me to lose weight? Do they want me to prove that I can't lose weight? What percentage of my body weight do they want me to lose!? If I lose a bunch and am under a bmi of 35, are they going to say " hey, this lady can lo…

I found out on Monday I was team approved at my Bariatric program to have surgery so I picked my surgery date as June 11, 2012. They sent all my paperwork into my insurance co on Fri, 4/13/12. I talked to the bariatric program yesterday and she said Health Alliance usually decides within 1-1 1/2 weeks. I am hoping to hear something by April 27. I hope they approve me cause I am unable to pay for this surgery unless my insurance covers most of it less my deductable and some other fees. Anyone have any experience with this insurance co? Thanks in advance!

Just got my bill from Dr from when he started doing the fills, 3 months ago. He is charging me $500 to put in the saline without any xray or anything and the Ins is not paying ziltch but they lower it to $111.... so I called FEPBLUE and starting a conversation about whose is responsible for what,,, as I am already trying to get the Hospital to take lower payments, for my $1100 I owed them after the surgery. I am more than dead broke and have cancelled cable etc etc. to pay for this unexpected fees and co- pays. Wondering how your insurance co's are handling this aspect of it. I told her you take my blood and make tests that run $1000 and pay for it but not pay for a sho…

I was very pleased with my insurance approval and co-pay. The out of pocket co-pay was under $2,000.00 It was a blessing. Sent from Barbiedoll77 using RNYTalk

After finally submitting all of the required paperwork, completing nutritional and psyche consultation and finally building up enough courage to go through with the lap band procedure I am told that I now have to have 6 consecutive months of medically supervised weight loss program documentation- which I did not do :( . Now back to square one. So discouraged and depressed. Now I have to wait six more months before submitting documentation for insurance approval again. Just wondering when did the Oxford change their policy?

i have tricare prime in the north region. how does the fills work with our insurance? do i get the referral from my pcd to submit to tricare and then they approve it? do i end up only paying my co pay?

Hi! I am a newbie and have some questions regarding Blue Cross Blue Shield Federal. I have gone to my first consultation, had my psych eval, and EGD. I have a 35 BMI but several comorbitities. I am waiting on my PCP to send my records to my surgeon but I am wondering if it will work because for 2 years I have bounced all over the place as far as weight goes. Does it have to be a BMI of 35 the whole 2 years?

After all the hoop jumping with the insurance and waiting for the decision from the insurance company, I finally heard from the dr's office saying that they got the approval. It has taken so long to get to this point that I am so FREAKIN EXCITED! Sounds really strange even to me to be excited about having 80% of my stomach removed but I am so looking forward to doing all the things I haven't been able to do for so many years!

I will be starting a new work at home job on the 25th. Benefits start day 1. YESSS!! I got the email about the benefits today and called the provider. The benefits are UHC choice plus. I called them to find out if they cover the sleeve and they do. The only requirements are a 5 year weight history and my out of pocket maximum is $3333( I know, right?). They also offer a FSA for up to 5000 bucks. So, I have two questions: If I get the FSA, can I use that to pay my deductible and expenses up to my out of pocket max/ 2.) Can I get weights from emergency rooms or does it have to be more substantial? Thanks everyone in advance!!!

Does Tricare Prime cover lap band and how do you get the process started?

Hi, all I am new to this site and I have read a few post. I do have a question about the requirements. I spoke with the young lady that was handeling my case from bcbs, and she informed me that I needed documentation showing that I have attempted to loose weight for 2011. I do not have that kind of documentation for this previous year, what am I to do.

I want the lapband and my policy reads " excludes surgical and non surgical treatment of obesity" but I am morbidly obese.. do I have a chance of beating this exclusion?

I am needing to show that i was on weight watchers. I no longer have my book that they give you to track your weight. I called Weight Watchers and they faxed me a receipt of what months i paid to be on the program. Do you know if that will work as proof.

I am done a lot of research on the gastric sleeve I've gone to the weight loss center. Unfortunetly we do not have health insurance and I'm trying to figure out a way to afford the surgery without taking a high loan. I absolutely frustrated because I have two young kids and trying to do the right thing by getting my health in order. my doctor is the one that told me I should get this surgery. Considering I've been trying since last november to lose weight. I've only lost 10 pounds and that's it and I haven't had any fast food I try to control my portions. I really do need the surgery.

.......are nerve-racking! My insurance had an appeal process where they waited the full 30 days to deny me, then another 2 weeks to deny the 2nd appeal. Now its with the external review. June 30th will be exactly one year that I started this journey. Starting to loose my cool!

So, I have a deductible of $350.00. I have met that. Insurance pays 80% and I am to cover the remaining 20%. Well I have a co-insurance of $2000 but due to doctor visits and other things I have it down to about $1200. Well I called to get an estimate on how much I'd owe and they told me $2200, which I don't think is right. I have Aetna. I'm wondering if they're just assuming that without looking in to MY particular insurance? There is financing available through the hospital but before I can get information from them I have to find out how much I'll be responsible for. I personally do not have $1200 lying around and with surgery approaching, not having things figured out …

OK - just checked my online account with UHC and I have already hit my deductive and already met my out of pocket maximum of $2500 - so my question is - when i get the lapband is all i'm required to pay for is the 20% (ins. 80%)? or nothing since I've hit my maximum out of pocket already?? not clear on how that all works.....

My paper work was submitted to Cigna on May 9th im so nervous because i dont want to be denied..i had a dream last night i was approved and my surgery date was June 15...this is one dream i hope comes true..anyone have problems with getting approved by cigna first time around?

I am getting close tothe time for my final medical clearance and I have a huge issue. I have actually gained weight. I started this process at around 241 and I now sit at around 245. I have heard from many different people that insurance companies will deny you if they see that you have gained weight whilt going through the process and so now I am freaking out. I am so afraid that I have put all this work and time into this the be denied because I have gained 4 lbs. anyone have any experience with this?

I have these labs scheduled: ferritin H pylori hgc a1c iron iron biding capacity lipid panel metabolic panel parathormone I am self pay, and I've paid for my surgery, but now I'm concerned over what the cost of these labs will be. My pcp had a few iron test completed a year ago. I wish he would write the lab order so my insurance would cover at least some of the labs. :/ My insurance doesn't cover any part of WLS, no exceptions. Am I looking at 500? 5000???

May 7......Houston, TX. Thanks to all of you for your best wishes and support for this Chapter in my Journey. Wishing others the best in dealing with insurance! Ii'm looking forward to the next Chapter and the next and the next. I'll post my progress on this board. Xoxo

Does anyone on here have BSBCTX

Does anyone happen to know how to go about finding the closest MTF that performs bariatric surgery?

I went for my first appointment today and the insurance coordinator told me all the necessary things I need for my insurance to cover surgery. I have a bmi of 41 at the moment, but no other issues. Problem is my isurance (Cigna PPO) requires my BMI to be 40 or over for the last two years. Well it hasn't been. I got married last year and the 2 years prior I was dieting hard core so my weight up and down and my BMI was probably only 37-39 at any of my Dr's visits.When I got engaged a couple years ago I was around 230lbs, then off and on over our engagment I bounced around from 200-230lbs. On my wedding day I weighed 216. Now I am up to 250lbs a year later. I am so disaHe su…

If you financed who did you use? I'm shopping around and don't want high interest I'm self paying in Mexico with dr Aceves. Or is it better to Use equity from your home?

I have spent the last 7 mths jumping thru the insurance hoops making sure every little detail was taken care of and not leaving anything to chance when it comes to 6 mth diet, test, psych eval, 5 years of medical history not just 2 and every other detail the insurance requires. I fit the requirements of my insurance requirements for my bmi having type II diabetes, gerd, high cholesterol, having issues with my joints due to my weight to the point I have had to have foot surgery, etc....My surgeons office submitted the paperwork and Cigna sent a denial as they sd it was missing 2 pieces of information, which by the way was submitted. My surgeons office immediately followin…

Well, I learned today that my insurance, CareFirst BCBS, has an exclusion for bariatric surgery. I am totally frustrated. In 2009, I was in a different job with different insurance that had no coverage, so I paid cash for a band. It worked well for a year, at which time I moved to another city. I got off track and never recovered. I have now regained 40 of the 60 pounds I had lost -- and I already was not at goal. The band is simply not working for me and my doc recommended a revision to the sleeve. Now I find out the insurance won't pay. I paid $11K for the band (which feels like a waste of money) and i just can't pay that kind of money again. So I guess I will look at…

Does anyone know of any employers in Omaha, NE that cover weight loss surgeries??

Nine days until surgery and I get a phone call that my surgery was denied. So now I am scrambling around trying to get medical records from my Dr. I hope this is a quick fix.

I got the call this morning that my insurance has been approved and she has let the dr.'s office know!!! I'm just waiting on them to call me back to officially set my date. I'm hoping for May 16. This is so exciting and scary all at the same time. As soon as I seen her number come up on my phone my heart dropped! New me here I come!

I just got approved today! Yay! I talked about this in another thread - I received a denial letter last week, primarily because the insurance coordinator for my surgeon's office hadn't submitted sufficient information (no information from my PCP except a letter, no information from my pulmonologist (and sleep apnea is my most advanced comorbidity), not enough info in the surgeon's attestation, etc.). I ended up talking to my PCP to get additional case information, sent medical records from my old doctor from 2001-2005 showing the comorbidities from back then, got my pulmonologist to supply a letter and my records, all to the surgeon's office. They faxed over ALL the rec…

Anyone ever heard of this? Lapband procedures are usually done as a same day surgery. But my insurance wants me to stay overnight.

So i mentioned before that I had ppwk submited on 4/30 and I was approved on 5/7..yay me! buuuuuuut...yes, here comes the BUT.... i was reading online on an obesity website bout the insurance approval letters and to make sure they dont expire...well i havent gotten mine in the mail so I called Cigna to see if there was some type of 'expiration' and I was told YES...it expires on 5/23 which means and i quote "you have to have surgery on 5/22" UMMMMM. I had told my doctor i couldn't have it until 6/22 and then cigna said i need to have my doctor call them right away to change the date but it may not be able to be changed because i have to have surgery within 6 months of m…