Insurance & Financing

BCBS has approved removal of may band due to medical problems! Yeh, I am halfway there. But...they denied the revision to a sleeve stating insurance covers on one weight loss procedure in a lifetime. I am in the process of composing a request asking review of predetermination to pay for the sleeve. I have composed a two page letter covering all the medical issues and leaking band, etc. and have closed with the following three paragraphs. I welcome your suggestions for improvement. I plan to mail Saturday. ________________________________ The band is leaking and defective. Would a product failure through no fault of my own not be reason enough to replace the band wit…

So I have a surgery date set for August 1st, 2012. I am worried about how difficult it will be to obtain insurance after my surgery. I will be getting my own insurance in about 3 years. Anyone experience a rough time?

Okay so if I understand what the woman told me is that my insurance, if they approve me for lap band surgery, will pay 80% of the surgery and then I'll be left having to pay $11,000. Now I'm waiting on a settlement from the lawyer so that should be about $12,000 but I really don't want to have to pay that much. What are other options? I'm also not sure if $11,000 is what I'd be left paying or if she meant that they will pay 80% of $11,000. I'm waiting for the woman to call me back to tell me exactly because if all I'm left owing is $2,200 then okay that's a little easier to deal with. What are other options for me though? I know a lot of people say Care Credit but I alrea…

FInally, 6 month documented diet for insurance is DONE! now I wait for my md's office to call me hopefully it's to schedule surgery. dionaw- Sent from my iPad using LBT

So I am almost finished with my third month of pre-op diet. I called BCBS today to find out about the nitty gritty of the coverage requirements so I am ready when my consultation comes around. The rep tells me that this year the requirements changed and you don't need the 6 month pre-op diet any more. Does anyone else know if this is true? I don't want to get too excited to find out later that she was wrong.

Hi, Anyone here have experience with Aetna federal *** insurance requirements? My physician has me on the three month multidisciplinary program which includes: psych eval three months of nutritional counseling one visit with an exercise physiologist I still have two more nutritional appointments to complete. If you used this method, did you need to supply documentation of your exercise? I forgot to ask my doctor that & just want to know if I should be neatly documenting it to show Aetna. I'll f/u with him next week to be on the safe side.

I finished my 7th visit in March due to the fact I am not eligible for the sleeve (BMI<50) my office is resubmitted for the band. Got a call and I have to meet with a dietician for my insurance to be submitted... never mentioned this before (guess it's my fault for not reading the requirements) but went through the visits, increased exercise and was on Weight Watchers (documented the last 16 months). I am worried that I will be denied and have to start the 6 month supervised all over again to work with a dietician... what do you think... any tips! I am practically in tears! I am scheduled to meet with the dietician on Monday. Here's the medical policy wording: T…

Hello everyone, I started my sleeve journey in August, when I was told my insurance company required 6 months of work with a dietician, as I'm sure a lot of people here have experienced or heard of. I did all that, jumped through all the hoops, and was sleeved March 7th. Fast forward almost two months, I just yesterday found out my insurance company does not cover the sleeve (??????) and I've now acquired $65K in surgery bills. I called the insurance company and the man I spoke to said they only cover diagnostic fees that come with it (whatever that means) and that was the end of that. I called the surgeons office in tears, and they said they'd never heard of anythi…

I'm new (obviously) I've already spoken with my insurance co. and they pay 90% after the deductible is met, yay! Now, just to get started. I have an appointment the beginning of June for the initial consultation? - And I go to the required seminar at the end of June. All I really know so far is the mostly common BMI of 35 + 1 or more co-morbidities or a BMI of 40. And I was told that there is something about losing 10% prior to the surgery but clearly not to start that until after the actual weigh in. Anyone have any advice or experience they could share with me? Thank you! J

Has anyone ever included their own letter to the appeals dept of thier insurace company? What information did you include? Did it help? I am going to my first seminar on 5/10. I haven't been denied yet but I am anticipating it due to my BMI being 39 with only 1 comorbidity. My particular insurance carrier (united healthcare) has recently changed thier policy to be "case by case' rather than having strict criteria. Just wanted to know what to prepare for.

Hello friends, Can anyone tells me the difference ($) between the basic and standard versions of federal bcbs when it comes to getting this surgery?? I'm thinking of switching to Basic for next year. thanks, Melissa

Hi, does anyone know about how long it took their doctors office/coordinator to submit all paperwork to your insurance company? I just finished all my requirements. thanks, Denise

Hi everybody! I'm a journalist at a marketing company based in Los Angeles which specializes in medical and law fields. I'm writing an article about whether insurance companies cover the vertical gastric sleeve. If someone would be willing to speak with me about their experience in whether your insurance covered the procedure or if you had to convince them to, I'd like to hear your story. You could even tell me your experiences anonymously, if you don't want your name to appear. If you'd like to talk to me, either respond to this post or email me at meg@trafficbyte.com. Thanks!

I am wondering if anyone knows where I can go to see about getting a loan for my surgery that I need to have. I have tried a couple of places but they want your credit score to be like 750 and I am not at that. Any suggestion for fair credit loans?

Hello! This will be my first post. Forgive me if my questions are novice and/or ridiculous. I've read some old posts here (Back in 2006-2007) where PacifiCare would require a 6 month monitored weight loss program before approving the Lap Band surgery. Does anyone know if this is still the case? My consultation isn't for a month but I wanted to get a hop on information gathering so I can be prepared with the right questions. Thanks in advance!

Ok, i am overly anxious! And I am just curious if any of you sleevers sent in your information and thought you needed the 6 month diet, but were approved without? My insurance is NOT clear with it and surgeons office "thinks" i may need it but submitting all past diets etc to see what insurance says. I started the 6 month diet in april with my primary physician but I would love to get started sooner if i could!

I went for my initial consult. The one where they just decide if you're a candidate, discuss surgical types, health/weight loss history and rcvd a script for reflux tests. Does this consult normally cost $481??? This has got to be a mistake in billing. Anyone have any thoughts on this? I obviously can't call the docs office til Monday.

I was considering getting an AFLAC policy in anticipation of my surgery. I know they have one for hospitalization and didn't know if anyone here had used them or if they covered the procedure. I'm also concerned in case I have complications that require an extended stay. Any info you can give me would be appreciated.

I'm in the 6 month process for my insurance to approve (BCBS) I'm just wondering can my insurance deny my procedure if I gain weight during the 6 month period??? just curious did anyone go through this??

I have beechstreet health ins in Louisiana and I was wonder if any one been approved by the company since I've never heard of this insurance company .. I have it through my job .. I'm going through the process and I know they cover the sleeve .. So any of you out there let me know

After the nervous waiting and the pushing back of my surgery date.. I GOT APPROVED!!!! Surg set for June 28th! WISH ME LUCK!!!!!

I'm in the very early stages of considering lap band and I'm doing my research to prepare myself for what's to come. During my most recent visit with my PCP, I asker her if she thought I'd be a good candidate for it. She said that I'm a good fit given my well documented battle with my weight (she's been my PCP for close to 10 years). With that, I went ahead and attended an information session at Beth Israel Deaconess in Boston just this past Thursday. I was advised by one of the coordinators to give the hospital's Weight Loss Surgery Center a call to schedule an initial assessment and education with the center's nurse. Excited, I gave them a ring first thing the next…

My BMI is 36, I have GERD and High Cholesterol. What do you think my chances are of getting approved with BCBS NJ? Thanks.

So United Healthcare isn't going to cover my anesthesia because they say it was out of network provider. I DID NOT GET TO CHOOSE MY ANESTHESIOLOGIST. I owe over $2000. Perhaps I should have just downed a bottle of whiskey and chomped down on a wooden bit.

I've been lurking on here a few days since I downloaded the app and I want this surgery soooo bad!!! Anyway, Dr. Ramos Kelly's site is showing a price decrease right now for vsg for $4500. I just applied for financing online. Prayers please I don't get denied. And if I do get the financing, that my husband won't blow a gasket that I 'made a bill'. He's a freak with finances. But I feel I am slowly dying. I need something to hope for!!! I'm ready for this!!!

I got my EOB, my costs are only $2800 of the total $24000 bill! Phew seems like a drop in the bucket to save my life!

I have BCBS of Florida, The sleeve is covered if you have had a 50 BMI for at least 5 years. I have not I am only at a 40. Has anyone had this trouble but fought against to have the sleeve and won? I am covered for gastric bypass but I choose not to have my intestines moved around. Any of you out there have had this problem?

Hi all, I am wondering what the process was like for any of you that had Anthem Blue Cross as an insurance company for your banding. How long did it take for approval? Any special hoops to go through? I just had my first consultation Saturday and they are submitting everything to my insurance. I am at a BMI of 39.4, overweight 7 plus years, pre diabetic and I don't have a thyroid anymore. I am beginning my sleep studies and endoscopy tests this weekend. Any comments are appreaciated!!!

Have a PPO Plus with UHC and it involves a $300 annual deductible. My dr's office says I owe them $545 and now I'm worried that I'll have to pay the hospital some $$ the day of surgery. I was told I would only have to pay $300 out of pocket (not including co-pays for doctor visits.). My plan states that they pay 100% after the deductible and my deductible is $300. IDK why all of the sudden I'm paying an extra $245 to the surgeon, and possibly a second fee to the hospital. Anyone else going through anything like this?

Please keep your fingers crossed guys, my approval is pending and I'm really anxious. I can't wait to hear back so I can get a definitive date. I'm so excited.

Hi, I am new to this site. I was just wondering if any one can share their journey with BCBS of California in getting the approval for the sleeve? What requirements? How long for approval? I would greatly appreciate any info. Thank you, Denise

Hey, gang, I had a question! I was diagnosed with sleep apnea after using the home sleep delivery machine? Does that improve my chances of getting approved with a BMI of 40 plus and hypertension?

I just found this website and thought I would share it with you all..... $8k ALL INCLUSIVE for a gastric sleeve in the US isnt bad! http://coastalbariat...16/Default.aspx http://coastalbariat...69/Default.aspx "The self pay option of $8,000* for Gastric Banding and Sleeve Gastrectomy in the Myrtle Beach area results in significant savings and can be advantageous to those looking for affordable weight loss surgery and not wishing to travel outside of the United States. *This price covers any complications that might arise within 90 days of either the gastric banding or sleeve gastrectomy surgery and one year of fills for the gastric band. Hospital, surgeon, anesthesia…

After 9 long months of having insurance change, and fussing with insurance yadda yadda, I got the call this morning that I was finally approved!!! Surgery for May 11 is a go! I can honestly say, Ive never been so excited in my life, for anything!

Let me preface this: I stayed in the hospital a total of 6 days/ 5 nights. I had complications from sleeve swelling and nausea. Surgeon: $5000 PCP (He checked on me 3 days) $600 Hospital: $54,392 Holy cow!!! So far the PCP claim has been paid. Other two denied - they need my medical records or something like that. I can check the claim status online. I have $0 copay for the surgery. I should be billed $200 a night for the hospital day for a max of 3 day. ($600 total) I'm going to call my insurance on Monday to get more info on why the surgeon and hospital claim have been denied. I'm a little nervous.....that is a crazy amount of money!!!!!!!!

HI, We all talk about ins. covering/ not covering. I thought it would be interesting to know exactly how much your ins. does cover. If I'm approved my ins. BCBS anthem of Ohio (even though I live in NC) will cover 85%. Anyone else?

Hi guys there's something that has been bugging me. INSURANSE after the surgery. I know I got approved and all that and that we all have a copy for the hospital some higher some lower mine was $300. I know they told me I have to cover 10% of that but if the hospital itself was 54K or so do the math it's crazy. Can I ask you after you got approve and sleeved how much did you ended up paying? I really need to be able to sleep hehe thanks in advance

Yesterday I found out I was approved by my insurance for VSG. I submitted on April 2 and had been calling just about every other day to see if it had been reviewed. When I called yesterday the women for BCBSTX told me, it looks like according our records blue cross will NOT cover the surgery! I was like what really? Then she retorts, oh I apologize I read that wrong, according to our records blue cross has approved medical necessity for the surgery, you have been approved! For a second there I was devastated but when she clarified I kind of freaked out! I had been preparing and jumping through all of the insurance hoops for 6 months and I can't believe that it is really h…

Does anyone else have BCBSTX? If so, how long did it take to get your approval. My surgeon submitted my paperwork today.

they approved me to have surgery. the clinic just told me today. ((thank you to everyone who offered me support))

Hi, I'm new to this. I was wondering if any one knows of BSBC of California requirements for the sleeve? thank you

I received a notice from a third party entity informing me of the "Initial Denial Notice." The letter stated I was denied because "No Severity of Illness." Since my BMI is slightly under 40 I must have A co-morbity, which I do, I have high blood pressure. My main annoyance is from the lack of communication. The surgeon's office NEVER communicated the denial. I received a letter in the mail. When I called the surgeon's office, the insurance coordinator seemed put-out with my questions. This is suppose to be a top-noch/top-rated program. I have been very impressed up till this point. She made it quite clear that it is MY problem to do all the appeal work, she did her part…

Hi I am new to this forum and i am thinking of getting the VSG. I wanted to know anyone living in New Jersey, who has this insurance and what were the outcomes ectra.Thanks.

Hello, I became curious about the lapband lastnite so found this forum and was wondering about my insurance, i live in TN and i have what is called TNcare ...americhoice, so i called them this morning and ask if lapband is covered and he said yes with authorization..so what is my next step? Ive never talked to my doctor about this because didnt figure insurance would cover it, but i do have an appointment early may for a meds check up so should i ask about it then? And how willing is a dr to say yea you need it? Thanks..Trish

I'm approved thru BCBSIL. Their approval was easy. The problem was I had to get approved thru an outside agency because my insurance is thru the city of chicago and they have their on guidelines. It took a week for an approval that should have only taken 2 days. I called every day for 4 days and finally on Friday I talked to the the nurse. It took her all of 1.5 min to look over my paperwork and say she would send it on to the doctors. My approval came thru on Tuesday!!!

Does anyone know if Coventry Healthcare/Medicare covers the sleeve surgery and how do I go about finding out?

Submitting to my insurance this week. I've jumped through the hoops of the psych eval and such. My BMI is 36 with 2-3 co-moribities. I have documented that I did weight watchers for 5 months in 2010, but I have not had a BMI over 35 for the past 5 years. Should I even bother getting my hopes up? My GI, OBGYN, Chiropractor, and Pulmonologist all wrote letters of recommendation. Need some advice...

i have a bmi of 37.2 and my only major co morbid is asthma the surgeon said i would be a good canidate, i can approve my asthma 70*80% which would be great considering the fact i was in a medically induced coma last year for my asthma do u think i could get approved or appeal it to show med necc? i have bcbs of Indiana...i am submitting to my insurance this week

Okay so my husband is an over the road truck driver and I'm covered under his insurance now. I had state of Vermont health insurance but now I have WellMark Blue Cross Blue Shield of Iowa I'm guessing because that's where it says that they are out of. Does anyone live in a different state then where their insurance is out of and did it cover the lap band surgery? I started this whole process while I had state health insurance. When I called they said that they do cover bariatric surgery but I'm guessing that they don't understand that I live in Vermont and I'm having it done in New Hampshire. Now on my insurance card it doesn't say a state or anything all it says is Blue …

Do anyone have bcbs of Pennsylvania. Are they strictly by the book.